[Smoking Behaviour Among Patients and Staff of a Psychiatric Hospital: Two Independent Surveys in 2007 and 2015]. / Rauchverhalten bei Patienten und Beschäftigten einer psychiatrischen Klinik: zwei unabhängige Stichtagserhebungen im Abstand von 8 Jahren.

OBJECTIVE: In order to evaluate the prevalence and smoking behaviour in a psychiatric hospital two independent surveys in 2007 (t1) and 2015 (t2) were carried out before and after implementing strategies to protect non-smokers and to offer assistance to stop smoking. METHODS: In two cross-sectional surveys all in-patients and staff of the Centre for Psychiatry Ravensburg-Bodensee were interviewed by questionnaire. RESULTS: The prevalence of smoking among patients was very high at both time points with 59 % (t1) and 57 % (t2), respectively. Among staff, the prevalence of smoking was 35 % (t1) and 33 % (t2). In both surveys, patients were more severely nicotine-dependent than staff. 57 % of all smokers wanted to stop smoking. CONCLUSIONS: High prevalence and strong nicotine dependence of patients and staff were observed in both surveys in 2007 and 2015, respectively. More rigorous interventions in psychiatric hospitals and the society as a whole seem to be required to decrease the prevalence of smoking among psychiatric patients and staff.

[High utilisers with affective and schizophrenic disorders in the psychiatric health care system: a comparison between Eastern and Western Germany]. / High Utiliser in der psychiatrischen Versorgung: ein Ost-West-Vergleich bei affektiven und schizophrenen Störungen.

OBJECTIVE: High utilisers of psychiatric services are defined as a group of patients showing a great amount of service use, especially inpatient care, consequently causing immense costs. There is a lack of studies investigating differences between East and West Germany. METHODS: Service use and psychopathology were examined in 350 high utilisers receiving inpatient treatment in one East German and three West German psychiatric hospitals. RESULTS: Whereas current length of stay was higher in participants from West Germany, readmissions were more frequent in the East German participants who also exhibited higher psychopathology. CONCLUSION: Presumably, the deficient situation of outpatient health care in East Germany is compensated by increased stationary admission, consequently leading to a structural promotion of high utilisation.

[A needs-oriented discharge planning intervention for high utilisers of psychiatric services: quality of the implementation and opportunities for improvement]. / Eine bedarfsorientierte Entlassplanungsintervention bei Patienten mit hoher Inanspruchnahme des psychiatrischen Versorgungssystems: Qualität der Umsetzung und Verbesserungsmöglichkeiten.

OBJECTIVE: Process evaluation of a needs-oriented discharge planning and monitoring (NODPAM) intervention for patients with severe mental illness with high utilisation of inpatient psychiatric care (within a RCT showing lack of evidence of superiority over treatment as usual). METHODS: Analysis of intervention drop-outs vs. intervention group patients participating in the intervention; analysis of the impact of intervention characteristics on unmet needs over time. RESULTS: Patients with more severe forms of illness were more likely to be among intervention drop-outs, a relatively high proportion of unmet needs persisted in patients participating in the intervention. Good intervention implementation and high patient satisfaction with the intervention were associated with a reduction of unmet needs. CONCLUSIONS: The NODPAM intervention failed to reach patients with high service use and more severe forms of illness; quality of intervention implementation might have contributed to the lack of superiority over treatment as usual. The intervention might not have been well integrated in routine treatment and was therefore experienced as extraneous to routine care.

[Cost-effectiveness of needs-oriented discharge planning in high utilizers of mental health care]. / Kosteneffektivität bedarfsorientierter Entlassungsplanung bei Menschen mit hoher Inanspruchnahme psychiatrischer Versorgung.

OBJECTIVE: To establish the cost-effectiveness of needs-oriented discharge planning in high utilizers of mental health services. METHODS: As part of a multicenter RCT (n = 458), costs were measured via the German version of the "Client Sociodemographic and Service Receipt Inventory" (CSSRI-EU), and the EQ-5 D was used to ascertain QALYs. Cost-effectiveness analysis included deriving incremental cost-effectiveness ratios (ICERs) and plotting them onto the cost-effectiveness plane as well as examining cost-effectiveness acceptability taking into account willingness-to-pay. RESULTS: During an 18-month period after discharge from inpatient psychiatric treatment, neither total direct and indirect costs (44,278 € vs. 43,302 €) nor quality-adjusted life years (0.960 vs. 0.958 QALYs) significantly differed by participant allocation to intervention or control groups. Also inspection of ICERs showed that the intervention had no economic advantage over standard care. CONCLUSIONS: The intervention is no cost-effective alternative to standard care. Future studies aiming to improve organization of mental care should be considerate of institutional context.

[Wish to change smoking behaviour among staff and patients of a psychiatric hospital]. / Wunsch nach Änderung des Rauchverhaltens bei Patienten und Mitarbeitern eines psychiatrischen Krankenhauses.

Objective To examine smoking behaviour and motivation to reach abstinence among staff and patients of a psychiatric hospital.Methods In two due day surveys all in-patients and staff of the Centre for Psychiatry Weissenau were interviewed by a questionnaire.Results The response rate was 78.5 %. 442 (48 %) out of 933 subjects (523 patients, 410 staff) were smokers. Patients were smoking more frequently than staff (58 % vs. 34 %) and were more severely nicotine-dependent. Significant gender differences were observed with regard to prevalence and nicotin dependence. 57 % said they wanted to stop smoking and 34 % would appreciate therapeutic offers. There were no significant differences between patients and staff.Conclusions Psychiatric patients are as motivated as staff for offers about smoking cessation. There is a need for therapeutic offers.

[RCT on discharge planning for high utilisers of mental health care: conduct and quality of the intervention]. / Entlassungsplanung bei Menschen mit hoher Inanspruchnahme psychiatrischer Versorgung in einer randomisierten kontrollierten Multicenterstudie: Durchführung und Qualität der Intervention.

OBJECTIVE: To evaluate feasibility of a structured discharge planning intervention for high utilisers of mental health care developed in a multicentre RCT. METHODS: Data of N = 241 participants (discharge and 3-month follow-up) allocated to the intervention group are analysed with regard to the intervention's quality of implementation, acceptance, and changes in needs. RESULTS: The intervention was well accepted among patients and staff. However, a subgroup of participants showed manual violations. Total and unmet needs could be reduced between baseline and follow-up. Amount and change of needs substantially varied by centre and there was a trend towards variation by dose. CONCLUSIONS: The intervention was feasible. Further analyses are needed to explore differential efficacy.

Smoking cessation and relapse prevention for postpartum women: results from a randomized controlled trial at 6, 12, 18 and 24 months.

AIM: To test the efficacy of an aid to cessation/relapse prevention intervention for women postpartum. METHOD: Two-armed randomized controlled trial. Follow-ups at 6, 12, 18, and 24 months, screenings on maternity wards. Intervention group received face-to-face counseling 40 days postpartum plus telephone counseling calls 4 and 12 weeks later. Control group received usual care plus self-help material for each parent. RESULTS: With regard to smoking cessation, 4 week point prevalence abstinent rates were higher in the treatment group at 6, 12, and 18 months (7% vs. 1%, 7% vs. 2%, and 9% vs. 1%, respectively). Sustained abstinence was higher in the treatment group at 6 months follow-up (3% vs. 0%). No difference was observed with regard to relapse prevention. DISCUSSION: Regarding aid to cessation we observed small effects, regarding relapse prevention no effect. In order to capitalize on the opportunity childbirth poses with regard to smoking, theories on relapse prevention in smoking cessation that guide in designing interventions are needed.

Smoking during pregnancy and postpartum: smoking rates and intention to quit smoking or resume after pregnancy.

BACKGROUND: A substantial number of women smoke while pregnant. The majority of those who quit return to smoking within 12 months. The aim of this study is to estimate smoking rates and to measure the urge to smoke and the motivation to change smoking behavior among women who recently delivered. METHODS: Data presented stem from two studies. Study 1 is an epidemiological survey investigating the health of neonates. Study 2 presents screening data of an efficacy trial for a smoking cessation and relapse prevention intervention. Participants were recruited on maternity wards within 7 days after delivery. RESULTS: Five hundred fifty-three (29.1%) women were never smokers, 145 (7.6%) were former smokers, 492 (25.9%) abstained during pregnancy, and 712 (37.4%) smoked throughout pregnancy. Of the smokers, 69% did not intend to quit smoking within the next 6 months. Of the women who quit during pregnancy, 80% did not want to resume smoking within the next 6 months or after weaning. CONCLUSIONS: Smoking and relapse rates indicate a need for increased efforts to reduce smoking during pregnancy and postpartum. Reported intention to quit or resume does not reflect the high number of relapses. Indicators for relapse need to be found.

An intervention to support postpartum women to quit smoking or remain smoke-free.

Effectiveness studies among pregnant and postpartum women indicate that pregnancy and the postpartum period provide a window of opportunity to promote smoking cessation and smoke-free families. Yet, there is a lack of information about interventions that are portable to routine care. The goal of this article is to describe the structure, basic strategies, and the application of a smoking cessation and relapse prevention intervention for postpartum women in the general population. By using the stages of change concept and motivational interviewing, a classification of current and former smokers is given, and basic strategies and techniques are described to counsel women postpartum with regard to smoking.