Scheduling mental health outpatient appointment beneficial following psychiatric discharge
Scheduling a mental health outpatient appointment following psychiatric discharge increased the odds of successful transition from hospital to community-based care, according to study results published in Journal of Clinical Psychiatry.
“People who receive inpatient care for a mental illness have much lower rates of following up with treaters in the community after discharge, which is alarming,” Thomas E. Smith, MD, of New York State Psychiatric Institute, told Healio Psychiatry. “We wanted to understand more about what types of routine discharge planning practices are offered by inpatient providers, as well as their impact.”
Although scheduling timely appointments for outpatient mental health follow-up care is considered a standard of care for inpatient psychiatric treatment, data are sparse regarding how many hospitalized individuals receive this form of care and its effectiveness.
Smith and colleagues analyzed data of 15,520 inpatient psychiatric discharges included in the 2012 to 2013 New York State Medicaid and other administrative databases to assess the link between scheduling an outpatient mental health appointment as part of a discharge plan and attending outpatient care following discharge after controlling for system, hospital and patient characteristics.
Participants were aged less than 65 years, admitted to an inpatient psychiatric unit and discharged to the community. The investigators used participants attending an outpatient mental health service within 7 and 30 days of inpatient discharge as an outcome, with scheduling a mental health outpatient appointment as part of discharge planning serving as the primary predictor variable. They adjusted for propensity scores estimating the likelihood of having an outpatient appointment scheduled to address potentially confounding covariates.
Results showed an outpatient appointment scheduled with a mental health provider as part of discharge planning among 77% of discharged patients. These patients were significantly more likely to visit an outpatient mental health service within 7 (OR = 1.69; 95% CI, 1.48-1.94) and 30 days (OR = 1.65; 95% CI, 1.42-1.93) vs. those who did not have an appointment scheduled, after adjustment for propensity scores. Moreover, patients with a low propensity to have an appointment scheduled were still more likely to attend outpatient services.
“For some patients, routine discharge planning practices such as scheduling outpatient mental health appointments will be insufficient to ensure a successful care transition,” Smith and colleagues wrote. “Research is needed to identify these individuals and determine what levels of increasingly intensive care transition interventions are necessary to meet their needs. In the meantime, findings underscore the importance of scheduling outpatient appointments as part of routine discharge planning for patients being treated in psychiatric inpatient units.”