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Do Home-Based Psychiatric Services for Patients in Medico-Social Institutions Reduce Hospitalizations? Pre-Post Evaluation of a French Psychiatric Mobile Team

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Abstract

World Health Organization recommends the implementation of alternatives to full-time hospitalizations. Psychiatric home-care has known a worldwide development in the last 20 years. The psychiatric mobile team for social and medico-social institutions in Saint-Etienne, France, (Equipe mobile d’intervention en établissements Sociaux et Médico-sociaux, ESMS) aims to support professionals from medico-social housing institutions (MSHI) in order to maintain people in housing. The objective of the study was to evaluate the efficiency of home-based interventions to reduce hospitalizations and improve collaboration between psychiatric hospital facilities and MSHI. We used a pre-post study design. A same cohort of patients living in a MSHI one year before intervention and one year after implementation of the ESMS was studied. Hospitalizations were compared between the two periods. A survey was conducted for qualitative evaluation among professionals in MHSI. Sixty-three patients were included. Most patients suffered from psychotic disorders (71%). We found a significant decrease in the mean number of admissions per year from 2,06 to 1,48 (Wilcoxon signed rank test; df64; p = 0,01). Mobile-team interventions included answering phone calls, home visits, coordination meetings, or clinical interviews with patients in inpatient and outpatient services, with an average of 9,3 interventions per patient (SD = 11,4). ESMS was evaluated as “essential” for 73% of 11 professionals from MSHI who answered the questionnaire in May 2017. Assertive Community Treatment and Crisis Resolution Teams are the most studied home-care models in psychiatry. Our results tend to show the efficiency of mobile-team interventions in MSHI, to enhance partnerships.

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Acknowledgements

We would like to thank ESMS staff and all professionals that were involved in its development.

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Authors and Affiliations

  1. Psychiatry Department, University Hospital of Saint Etienne, Saint Etienne, France

    Sophie Cervello, Mael Pulcini, Catherine Massoubre & Eric Fakra

  2. Rehabilitation Department (CRR and CL3R), Le Vinatier Hospital, 4 rue Jean Sarrazin, 69008, Lyon, France

    Sophie Cervello

  3. Public Health and Medical Information Department, University Hospital, Saint-Etienne, France

    Béatrice Trombert-Paviot

  4. TAPE, EA7423, Jean Monnet University of Saint-Etienne, Saint Etienne, France

    Catherine Massoubre & Eric Fakra

Authors
  1. Sophie Cervello
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  2. Mael Pulcini
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  5. Eric Fakra
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Contributions

Author 1 analysed the data and wrote the first draft of the manuscript. Author 4 and 5 designed the study and helped analysed the data. Author 5 edited the manuscript, coordinate the study and supervised the ESMS team. Author 2 and 3 commented on the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sophie Cervello.

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Competing Interests

The authors declare that they have no competing interests related to this work.

Ethics Approval

The ethics committee of the university hospital of Saint-Etienne approved the study (N°IRBN462016/CHUSTE). The authors assert that this work complies with the ethical standards of the relevant national and institutional guides on human research and with the Helsinki Declaration of 1975, as revised in 2008.

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Cervello, S., Pulcini, M., Massoubre, C. et al. Do Home-Based Psychiatric Services for Patients in Medico-Social Institutions Reduce Hospitalizations? Pre-Post Evaluation of a French Psychiatric Mobile Team. Psychiatr Q 90, 89–100 (2019). https://doi.org/10.1007/s11126-018-9603-6

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  • DOI: https://doi.org/10.1007/s11126-018-9603-6

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