Physician follow-up reduces hospital readmission in schizophrenia

SAN DIEGO — Timely follow-up with a physician reduced risk for early readmission among individuals with schizophrenia, particularly those with high-risk for readmission at discharge, according to data presented at the American Psychiatric Association Annual Meeting.

“Discharge is a very, very common event,” Paul Kurdyak, MD, PhD, of the Centre for Addiction and Mental Health, Toronto, said in a presentation here. “When we looked at a 2012 population-based sample, there were 48,000 patients who had a discharge from a psychiatric hospitalization in Ontario. I can tell you that in Ontario, discharge as a process of care is the furthest thing from standardized. If you focus on schizophrenia, there are very high rates of hospitalization. People with schizophrenia count for 1 in 5 psychiatric hospitalizations in Canada.”

To assess associations between physician follow-up care with 30 days of discharge and readmission within the following 180 days, researchers analyzed data for 19,132 individuals with schizophrenia discharged between 2007 and 2012 in Ontario.

Overall, approximately 35% of participants had no follow-up care 30 days after discharge.

Readmission rates were lower and similar among participants with some type of physician follow-up, including primary care physician only (22.2%; aRR = 0.88; 95% CI, 0.81-0.96), psychiatrist only (21.6%; aRR = 0.84; 95% CI, 0.77-0.9), or both (21.3%; aRR = 0.82; 95% CI, 0.75-0.9), compared with those with no follow-up (25.5%).

The READMIT scale indicated 66.1% of participants had high risk for readmission; 26.1% had medium risk; and 7.8% had low risk.

Physician follow-up significantly affected readmission risk among participants with high risk for readmission only; with associated adjusted relative risk of 0.85 (95% CI; 0.77-0.94) for those with a primary care follow-up only; 0.84 (95% CI, 0.77-0.92) for a psychiatrist follow-up only; and 0.81 (95% CI, 0.73-0.9) for both.

“Rate of no follow-up is very high for this population. Seeing a physician after discharge matters a little bit overall, but it’s really the interesting use of the READMIT scale that introduces the concept of data-driven alignment of service intensity with need,” Kurdyak said. “So, you could imagine those individuals who were at very low risk, if you applied the READMIT score at admission it might be an argument for avoiding the $1,000 or more day admission and see if you could do a more cost-effective non-hospitalization intervention. With medium risk, you might even argue to reduce the length of stay. With high risk, you really want to think carefully about whether the patient is ready for discharge or make very sure that services are in place and that there are services to make sure that that individual actually follows up with services.” – by Amanda Oldt

Reference:

Kurdyak P. Impact of follow-up care on readmission rates in a population-based sample of patients with schizophrenia. Presented at: American Psychiatric Association Annual Meeting; May 20-24, 2017; San Diego.

Disclosure: The researchers report no relevant financial disclosures.