Self-admission in the treatment of eating disorders: an analysis of healthcare resource reallocation

BMC Health Services Research

Elisabeth Welch¹  Mattias Strand²  Cynthia M. Bulik³  Sanna A. Gustafsson⁴ 

[1] Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, 171 77, Stockholm, Sweden;Stockholm Centre for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden;Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, 171 77, Stockholm, Sweden;Transkulturellt Centrum, Solnavägen 4, 113 65, Stockholm, Sweden;Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden;

关键词: Economics;    Delivery of health care;    Health care rationing;    Health resources;    Voluntary admission;    Anorexia nervosa;   

DOI  :  10.1186/s12913-021-06478-1

来源: Springer

【 摘 要 】

BackgroundSelf-admission to psychiatric inpatient treatment is an innovative approach to healthcare rationing, based on reallocation of existing resources rather than on increased funding. In self-admission, patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. Previous findings on patients with severe eating disorders indicate that self-admission reduces participants’ need for inpatient treatment, but that it does not alone lead to symptom remission.MethodsThe aim of this study was to evaluate if, from a service provider perspective, the resource reallocation associated with self-admission is justified. The analysis makes use of data from a cohort study evaluating the one-year outcomes of self-admission at the Stockholm Centre for Eating Disorders.ResultsParticipants in the program reduced their need for regular specialist inpatient treatment by 67%. Thereby, hospital beds were made available for non-participants due to the removal of a yearly average of 13.2 high-utilizers from the regular waiting list. A sensitivity analysis showed that this “win-win situation” occurred within the entire 95% confidence interval of the inpatient treatment utilization reduction.ConclusionsFor healthcare systems relying on rationing by waiting list, self-admission has the potential to reduce the need for hospitalization for patients with longstanding eating disorders, while also offering benefits in the form of increased available resources for other patients requiring hospitalization.Trial RegistrationClinicalTrials.gov ID: NCT02937259 (retrospectively registered 10/15/2016).

【 授权许可】

CC BY