Clinical trial NCT02258737: Efficacy of Transitional Case Management Following Psychiatric Hospital Discharge
Official title: Efficacy of Transitional Case Management Following Psychiatric Hospital Discharge: a Randomized Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Mental Disorders
Keywords: Case management
psychiatric hospitalization
discharge
Lead sponsor: University of Lausanne Hospitals
Sponsor class: OTHER
Collaborators: name: Swiss National Science Foundation
First posted: 2014-10-07
Enrollment: 110
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Efficacy of transitional case management following psychiatric hospital discharge: a randomized trial

Background The movement of deinstitutionalisation in Western societies has modified the role of psychiatric hospital, which has lost its asylum function to become a place for acute care.

Psychiatric stays are now shorter and close interactions with the outpatient care network is therefore more critical than before. The first weeks following discharge from psychiatric hospital represent a period of high risk for relapse, readmission or even suicide. Case management has a proven efficacy in facilitating patients' deinstitutionalisation after very long hospitalisations and in stabilizing high users of psychiatric care. In contrast, studies exploring the impact of time limited case management following discharge from short stays (transitional case management) in earlier phases of psychiatric disorders in connection with primary care are lacking.

Working Hypotheses The investigators hypothesize that transitional case management following hospital discharge decreases risk of readmission, improves adherence to outpatient care, facilitates recovery and improves patients' satisfaction with treatment as compared to routine care.

Specific Aims In this study, the investigators will compare the impact of both intervention on number of contact and level of adherence to outpatient care. The investigators will also compare both groups on number of readmission, risk of early aggravation of the disorders, level of functioning and satisfaction with care.

Methods This is a randomized single-blind study comparing transitional case management after discharge with routine post-hospitalization care for subjects living independently without institutional psychiatric follow-up. Demographic and clinical data will be gathered during hospitalization, and 1, 3, 6 and 12 months after discharge. Quantitative assessment of outcomes using validated instruments will be: contact and level of adherence to outpatient care (primary outcomes), as well as number of hospitalization days, number of readmissions, severity of illness and satisfaction with care (secondary outcomes).

Expected Value of the Proposed Project This study should improve psychiatric patients follow-up in collaboration with the different levels of care in the global context of deinstitutionalization.


Eligibility criteria: Inclusion Criteria:

* Patients are 18-65 years of age
* No immediate institutional follow up after discharge
* Independent living condition

Exclusion Criteria:

* Organic brain disease
* Clinically significant concurrent illnesses
* Poor understanding of French

Primary outcomes:
measure: Adherence to outpatient care
timeFrame: one year
measure: Working alliance
timeFrame: one year
measure: Number of readmissions
timeFrame: one year
measure: Degree of psychiatric symptoms
timeFrame: one year
measure: Hopelessness
timeFrame: one year
measure: Substance use
timeFrame: one year
measure: Perceived Improvement
timeFrame: one year
measure: Severity of mental health problems
timeFrame: one year
measure: Global Assessment of Functioning
timeFrame: one year
measure: Social and Occupational Functioning
timeFrame: one year
measure: Social support
timeFrame: one year
measure: Empowerment
timeFrame: one year
measure: Satisfaction
timeFrame: one year
Secondary outcomes:
Other outcomes:
Locations:
city: Prilly
country: Switzerland
facility: Social Psychiatry Section, Lausanne University Hospital
state: VD
Study officials:
affiliation: University of Lausanne Hospitals
name: Charles Bonsack, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Bonsack C, Golay P, Gibellini Manetti S, Gebel S, Ferrari P, Besse C, Favrod J, Morandi S. Linking Primary and Secondary Care after Psychiatric Hospitalization: Comparison between Transitional Case Management Setting and Routine Care for Common Mental Disorders. Front Psychiatry. 2016 Jun 2;7:96. doi: 10.3389/fpsyt.2016.00096. eCollection 2016.