Patient Guided Psychiatric Admissions

Study Overview
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Brief Summary
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To meet the requirement for increased patient involvement, several Community Mental Health Centres (CMHC) have initiated a service called patient-guided admissions. The investigators will compare a group with patient guided admission/self-referral to inpatient beds with a group having treatment as usual. It is expected that patients in the intervention group will experience more increased feeling of coping (patient activation) after 4 months and 12 months as a result of participating in patient-guided admissions than patients getting treatment as usual. In addition the total number of inpatient days either in the CMHC, psychiatric hospital or community rehabilitation centre is expected to be clearly lower in the intervention group than in the 'treatment-as-usual' group during one year after intake. Also the number of involuntary admissions either as inpatient or outpatient will be significant lower in the intervention group than the 'treatment-as-usual' group.The number of admissions in CMHC and psychiatric hospital, as well as the number of outpatient consultations in primary care, CMHC and psychiatric hospitals, will be lower in the intervention group than in the 'treatment-as-usual' group. Patients in the intervention group will experience improved mental health, increased feeling of coping (patient activation) and increased experience of recovery after 4 months and 12 months as a result of participating in patient-guided admissions.

Detailed Description
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Participants will be patients with psychosis or bipolar disorders. Patients in the intervention group will have a contract on self-referral to inpatient beds for one year. They can call the CMHC directly and ask for a bed for until 5 nights. The patients in the 'treatment-as-usual' group will follow common procedures by either contacting their general practitioner, emergency department or duty doctor, and they will be offered a self-referral to inpatient bed contract after a year if they satisfy the inclusion criteria. Regardless of the participation in the intervention group, the patients can also be ordinary admitted during the project period by a doctor via regular procedures in both hospital and CMHC if there is a need for this. All admissions will appear in the register data.

Official Title
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Patient Guided Psychiatric Admissions (Self-referral to Inpatient Beds)

Conditions
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Schizophrenia, Bipolar Disorder

Intervention / Treatment
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* Other: wait list control
* Behavioral: admissions contract


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: schizophrenia or bipolar disorder long term care established relationship with the ward Exclusion Criteria: extensive substance use problems self-destructive behavior not able to consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: admissions contract<br>contract regarding patient-guided admissions | Behavioral: admissions contract<br>* contract regarding patient-guided admissions starting immediately<br>|
| Active Comparator: wait list control<br>1 year on waiting list | Other: wait list control<br>* Patient-guided admissions contract regarding patient-guided admissions starting a year after.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient activation/coping | Patient Activation Measure (PAM 13) | 4 months | 
| Patient activation/coping | Patient Activation Measure (PAM 13) | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of admissions | Number of admissions in CMHC, psychiatric hospital of community rehabilitation centre | 12 months | 
| Total number of inpatient days | Total number of inpatient days in CMHC, psychiatric hospital or community rehabilitation centre | 12 months | 
| Number of outpatient consultations | Number of outpatient consultations in primary care, in CMHC and psychiatric hospital | 12 months | 
| Number of involuntary admissions | Number of involuntary admissions either as inpatient or outpatient | 12 months | 
| Symptoms/functioning and recovery | Behavior and symptom identification scale (BASIS 32) and Recovery Assessment Scale (RAS 24) | 4 months | 
| Symptoms/functioning and recovery | Behavior and symptom identification scale (BASIS 32) and Recovery Assessment Scale (RAS 24) | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Schizophrenia, bipolar disorder, Long term care, patient admission