Does deinstitutionalisation work? Relationships between psychiatric outpatient and inpatient care provision in a rural German catchment area

Objective: We intended to find out whether an intensification of outpatient care could have an influence on hospitalisations, readmissions, length of stay, coercive measures and involuntary admissions. Method: We investigated the development of some care variables within a district psychiatric hospital responsible for a rural catchment area of 320,000 inhabitants. Associations between inpatient care variables and outpatient activity were assessed by means of multivariate Prais-Winsten regression models for time series. Results: There was a dramatic reduction of mean LOS figures, associated with the activity level of the outpatient clinic. After the conclusion of the deinstitutionalisation process, total number of admissions, cumulative LOS, quotas of involuntary admissions and number of coercive measures did not increase when the number of beds and mean length of stay decreased. Readmissions decreased significantly when outpatient activity increased. Conclusions: Community-oriented ambulatory care on the basis of multi-disciplinary outreach teams seems to be able to reduce high-frequent readmissions and control mean LOS while at the same time a number of coercive measures keep the number of admissions stable. Economic and clinical effects on real inpatient care, however, cannot be definitively evaluated as long as bed provision does not decrease proportionally with the increase of ambulatory activity.