Effectiveness of a Telephone Support Line to Reduce Hospital Use by Older Patients with Psychiatric Disorders

Background: Hospital-based services, such as emergency departments and in-patient wards, are fundamental resources for provision of acute care but are associated with significant risks and may not fully address the needs of older patients with psychiatric disorders. In order to provide a more flexible approach for continuous management of these complex conditions a telephone support line operated by a nurse was implemented in our psychogeriatric unit. Aims: To evaluate whether this intervention was associated with a reduction in hospital admissions and emergency department visits. Methods: Pre-post test study, involving 903 patients who attended the Old Age Psychiatric Unit (OAPU) three years before and three years after the implementation of the intervention (1.09.2008 to 1.10.2014). A patient*time of follow-up index was calculated to weight the periods under OAPU care in both time lapses. Data were also obtained from medical files regarding demographic variables, number and type of hospital admissions and emergency department visits. Results and Conclusions: In the three-year period prior to the intervention 671.2 patients*years were included (76 +/- 7.1 years of age) while after the intervention this reached 2010.1 patients*years (77.8 +/- 7 years of age). The intervention was independently found to be associated with a decrease of 43% in psychiatric emergency visits, 54% of non-psychiatric emergency visits, and 61% of non-psychiatric ward admissions. The implementation of this telephone-based program showed to be associated with a significant reduction of hospital-based acute care utilization. Future research should determine if this was coupled with improved health outcomes.