Comparison between the day-care ward and the inpatient ward in terms of treatment effectiveness based on the analysis of psychopathologic symptoms, subjective quality of life and number of rehospitalisations after discharge
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Psychiatr Pol 2008;42(4):571–581
Aim. To assess effectiveness of treatment in the day-care and inpatient wards within the Wroclaw branch of the international multicenter EU-fundcd EDEN study. The authors analysed the number of rehospitalisations after discharge from the index hospitalisation as well as psychopathologic symptoms and subjective quality of life. Methods. Out of 1089 patients admitted to the mental hospital in Wroclaw, 238 were randomly assigned to either the day-care ward (n=115) or the inpatient ward (n=123). There were three interviews with patients: upon discharge, three and twelve months later. Scores of the extended version of Ventura's BPRS were used for representing the psychopathology level and for calculation of between-setting differences. Subjective quality of life was measured using the MANSA questionnaire. Statistical parameters of effectiveness (scores at given time-point, models adjusted for the scores at admission and for the duration of hospitalisation) were analysed. The frequency of rehospitalisations was also investigated. Statistical analyses after discharge were performed using the random multiple imputations method in consecutive time-points. Results. There were no statistical differences between settings in the effectiveness of treatment three months after discharge. Interviews performed one year after discharged revealed a higher level of psychopathology in patients treated in an inpatient setting (p=0.03) and it was confirmed by the model adjusted for the duration of hospitalisation (p=0.04). Yet day-care ward patients had a higher number of rehospitalisations within one year after discharge. Conclusions. The absolute superiority of treatment in an inpatient ward over day-care setting in terms of its effectiveness was not confirmed using BPRS, MANSA scores and index of rehospitalisation.