Évaluation quantitative de l’effet sur le passage aux urgences et les hospitalisations d’un dispositif départemental innovant de prise en charge des situations de crise durant l’adolescence en Haute-Garonne, France

IF 0.5 4区 医学 Q4 PSYCHIATRY Annales medico-psychologiques Pub Date : 2024-05-01 DOI:10.1016/j.amp.2023.04.013
Raphaël Der Kasbarian , Alexis Revet , Marie Frere , Ivan Gicquel , Olivier Azema , Isabelle Claudet , Nadège Costa , Laurent Molinier , Vanessa Houze-Cerfon , Michel Vignes , Jean-Philippe Raynaud , Valeriane Leroy
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The Departmental Reactive System for Adolescents was implemented in 2017 in the French department of Haute-Garonne to provide adolescents in crisis an immediate specialized psychiatric consultation including on-going support for three months. Our objective was to measure the effect of the implementation of this health system organization (HSO) on the evolution of the annual incidence of emergency room visits and hospitalizations of adolescents for psychiatric reasons at the Toulouse University Hospital, the sole facility for such care in Haute-Garonne.</p></div><div><h3>Methods</h3><p>We conducted a quasi-experimental study comparing the evolution, before and after the implementation of the DDRA31, the annual incidence rates of emergency room visits (pediatric and adult) and hospitalizations related to mental health at the Toulouse University Hospital for adolescents aged 12 to 17 years of age, residing in Haute-Garonne, from 2014 to 2019. Factors associated with the risk of hospitalization were analyzed using mixed-effects logistic regression to measure the effect of the system, over time, with the specific year as the primary explanatory variable, adjusted for sex and age.</p></div><div><h3>Results</h3><p>From 2014 to 2019, 6 686 emergency room visits by 4 245 adolescents took placefor psychiatric motives or diagnostics. The annual incidence rate of emergency department visits related to mental health was stable from 14.0 (95 % CI: 13.2–14.9), per 100 adolescents in 2014 to 13.9 (95 % CI: 13.2–14.7) in 2019, with a higher incidence rate for girls and adolescents aged from 15 to 17 years old. The main reasons for emergency room visits were behavioral problems or agitation, drug intoxications or suicide attempts, and drug or alcohol use or abuse. The annual incidence of hospitalizations decreased significantly since 2017, from 38.3 (95 % CI: 34.1–42.8) per 100 adolescents in 2014 to 24.2 (95 % CI: 21.2–27.4) per 100 adolescents in 2019. This decrease was shown for both males and females but only for adolescents aged from 15 to 17 years old, from 21.8 (CI 95 %: 17.9–26.1) in 2014 to 2.6 (CI 95 %: 1.5–4.1) in 2019. Modeling of the hospitalization risk showed a significant reduction from 2017 onward inclusive with an odds ratio ranging from 0.63 (95 % CI: 0.49–0.80) in 2017 to 0.52 (95 % CI: 0.41–0.67) in 2019.</p></div><div><h3>Discussion</h3><p>The fact that an impact of the HSO was found only for adolescents aged 15 to 17 years of age could indicate a selective effectiveness depending on age possibly caused by differences in physician attitudes depending on the age of the patient. The chronology of changes in hospitalization rates after a visit to the emergency room corresponded to the period when the HSO was implemented, whereas hospitalization rates were stable over the three years prior to its implementation. The main limitations of our study were the absence of data regarding emergency department diagnoses and discharge modes for the year 2019 and the lack of a temporal perspective.</p></div><div><h3>Conclusion</h3><p>Our study did not show any significant effect of the HSO on the annual incidence of emergency room visits related to mental health, but there was a possible effect on reducing the yearly incidence rate and the risk of hospitalization of adolescents in psychiatric services following an emergency room visit. 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引用次数: 0

Abstract

Objectives

Crisis situations are common during adolescence. Current data show that adolescents in crisis are either directly referred to hospital psychiatric emergency rooms, or they make an appointment for a specialized consultation, in a medical-psychological center (CMP), in a medical-psychological-pedagogical center (CMPP), or with a private practitioner. The Departmental Reactive System for Adolescents was implemented in 2017 in the French department of Haute-Garonne to provide adolescents in crisis an immediate specialized psychiatric consultation including on-going support for three months. Our objective was to measure the effect of the implementation of this health system organization (HSO) on the evolution of the annual incidence of emergency room visits and hospitalizations of adolescents for psychiatric reasons at the Toulouse University Hospital, the sole facility for such care in Haute-Garonne.

Methods

We conducted a quasi-experimental study comparing the evolution, before and after the implementation of the DDRA31, the annual incidence rates of emergency room visits (pediatric and adult) and hospitalizations related to mental health at the Toulouse University Hospital for adolescents aged 12 to 17 years of age, residing in Haute-Garonne, from 2014 to 2019. Factors associated with the risk of hospitalization were analyzed using mixed-effects logistic regression to measure the effect of the system, over time, with the specific year as the primary explanatory variable, adjusted for sex and age.

Results

From 2014 to 2019, 6 686 emergency room visits by 4 245 adolescents took placefor psychiatric motives or diagnostics. The annual incidence rate of emergency department visits related to mental health was stable from 14.0 (95 % CI: 13.2–14.9), per 100 adolescents in 2014 to 13.9 (95 % CI: 13.2–14.7) in 2019, with a higher incidence rate for girls and adolescents aged from 15 to 17 years old. The main reasons for emergency room visits were behavioral problems or agitation, drug intoxications or suicide attempts, and drug or alcohol use or abuse. The annual incidence of hospitalizations decreased significantly since 2017, from 38.3 (95 % CI: 34.1–42.8) per 100 adolescents in 2014 to 24.2 (95 % CI: 21.2–27.4) per 100 adolescents in 2019. This decrease was shown for both males and females but only for adolescents aged from 15 to 17 years old, from 21.8 (CI 95 %: 17.9–26.1) in 2014 to 2.6 (CI 95 %: 1.5–4.1) in 2019. Modeling of the hospitalization risk showed a significant reduction from 2017 onward inclusive with an odds ratio ranging from 0.63 (95 % CI: 0.49–0.80) in 2017 to 0.52 (95 % CI: 0.41–0.67) in 2019.

Discussion

The fact that an impact of the HSO was found only for adolescents aged 15 to 17 years of age could indicate a selective effectiveness depending on age possibly caused by differences in physician attitudes depending on the age of the patient. The chronology of changes in hospitalization rates after a visit to the emergency room corresponded to the period when the HSO was implemented, whereas hospitalization rates were stable over the three years prior to its implementation. The main limitations of our study were the absence of data regarding emergency department diagnoses and discharge modes for the year 2019 and the lack of a temporal perspective.

Conclusion

Our study did not show any significant effect of the HSO on the annual incidence of emergency room visits related to mental health, but there was a possible effect on reducing the yearly incidence rate and the risk of hospitalization of adolescents in psychiatric services following an emergency room visit. The implementation of reactive ambulatory structures could therefore reduce the demand on hospitalization services that are under pressure.

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定量评估法国上加龙省处理青少年危机情况的创新部门系统对急诊就诊和住院治疗的影响
目标危机是青少年时期的常见问题。目前的数据显示,处于危机中的青少年要么被直接转诊到医院的精神科急诊室,要么预约专门的咨询,如医疗心理中心(CMP)、医疗心理教育中心(CMPP)或私人医生。2017年,法国上加龙省实施了 "青少年部门反应系统",为处于危机中的青少年提供即时的专业心理咨询,包括为期三个月的持续支持。我们的目标是测量这一医疗系统组织(HSO)的实施对图卢兹大学医院(上加龙省唯一一家提供此类医疗服务的医院)每年青少年因精神疾病而到急诊室就诊和住院的发生率变化的影响。方法我们进行了一项准实验性研究,比较了上加龙省 12 至 17 岁青少年在 2014 年至 2019 年期间,在图卢兹大学医院因精神健康原因急诊就诊(儿童和成人)和住院的年发生率,以及 DDRA31 实施前后的变化情况。采用混合效应逻辑回归法分析了与住院风险相关的因素,以衡量该系统随时间推移产生的影响,并将具体年份作为主要解释变量,同时对性别和年龄进行了调整。结果从2014年到2019年,共有4 245名青少年因精神疾病动机或诊断前往急诊室就诊,共6 686人次。与精神健康相关的急诊室就诊年发生率从2014年的每100名青少年14.0人次(95 % CI:13.2-14.9)稳定降至2019年的13.9人次(95 % CI:13.2-14.7),女孩和15至17岁青少年的发生率更高。急诊室就诊的主要原因是行为问题或躁动、药物中毒或自杀未遂,以及使用或滥用药物或酒精。自 2017 年以来,住院治疗的年发生率明显下降,从 2014 年的每 100 名青少年 38.3 例(95 % CI:34.1-42.8 例)下降到 2019 年的每 100 名青少年 24.2 例(95 % CI:21.2-27.4 例)。男性和女性的发病率都有所下降,但只有 15 至 17 岁的青少年发病率有所下降,从 2014 年的 21.8(95 % CI:17.9-26.1)下降到 2019 年的 2.6(95 % CI:1.5-4.1)。对住院风险的建模显示,从 2017 年起,住院风险显著降低,几率比从 2017 年的 0.63(95 % CI:0.49-0.80)降至 2019 年的 0.52(95 % CI:0.41-0.67)。讨论HSO仅对15至17岁的青少年产生影响,这一事实可能表明,由于患者年龄不同,医生的态度也可能不同,因此HSO的有效性取决于年龄。急诊室就诊后住院率变化的时间顺序与《健康保险计划》实施期间一致,而《健康保险计划》实施前三年的住院率保持稳定。我们研究的主要局限性在于缺乏有关 2019 年急诊科诊断和出院模式的数据,以及缺乏时间视角。结论:我们的研究并未显示出《健康分类》对与精神健康相关的急诊室就诊年发生率有任何显著影响,但对降低青少年急诊室就诊后精神科服务的年发生率和住院风险有可能产生影响。因此,实施反应性非住院机构可以减少对住院服务的需求,因为住院服务的压力很大。
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来源期刊
Annales medico-psychologiques
Annales medico-psychologiques 医学-精神病学
CiteScore
1.30
自引率
33.30%
发文量
196
审稿时长
4-8 weeks
期刊介绍: The Annales Médico-Psychologiques is a peer-reviewed medical journal covering the field of psychiatry. Articles are published in French or in English. The journal was established in 1843 and is published by Elsevier on behalf of the Société Médico-Psychologique. The journal publishes 10 times a year original articles covering biological, genetic, psychological, forensic and cultural issues relevant to the diagnosis and treatment of mental illness, as well as peer reviewed articles that have been presented and discussed during meetings of the Société Médico-Psychologique.To report on the major currents of thought of contemporary psychiatry, and to publish clinical and biological research of international standard, these are the aims of the Annales Médico-Psychologiques.
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