A comparison of psychiatric day hospitals in five European countries: implications of their diversity for day hospital research.
OBJECTIVE
As the use of "day hospitals" increases, conceptual models of these services are changing dramatically across Europe. Therefore, the need arises for mental health services research to assess this process cross-nationally in a standardised and systematic way. Such research approaches should seek to maximise the generalisability of results from high-quality (e.g. randomised controlled) single- or multi-site trials assessing specific models of day hospital care.


METHODS
Using a self-developed structured questionnaire, the European Day Hospital Evaluation (EDEN) study group carried out national surveys of the characteristics of day hospitals for general psychiatric patients in Germany, England, Poland, the Slovak Republic and the Czech Republic, during the period 2001--2002.


RESULTS
Response rates varied from 52 to 91 %. Findings show that day hospitals have no consistent profile of structural and procedural features. Similarities across countries focus on three main issues: on average, consideration of concepts oriented toward providing acute treatment are equivalent; disorders associated with disabled functioning in everyday life, high risk of somatic complications, and need for behaviour control are excluded to a comparable degree; and some core therapeutic activities are consistent with the main approaches of social psychiatry. Identified according to self-rated conceptions and extended with data from individual hospital's statistics on the clientele in 2000, three clusters of limited selectivity subdivide the services. One category focuses mainly on rehabilitative tasks; two categories are oriented toward providing acute treatment as an alternative to inpatient care, but combine this either with rehabilitative tasks or with equal additional functions of shortening inpatient treatment and providing psychotherapy. The distribution of services across these three clusters varies significantly in the five European countries.


CONCLUSIONS
Future day hospital studies should always clarify the type of services being assessed. To fully consider the impact of their results, the current national and international health policy environment of these services should be taken into account. Such surveys require enhanced methodology, however, in order to identify clear, distinct categories of services characterised by overlapping programme functions, and to increase the generalisability of valid results from single- or multi-site trials.
Kallert
Thomas W
TW
Dresden University of Technology, Faculty of Medicine, Dept of Psychiatry & Psychotherapy, 01307 Dresden, Germany. thomas.kallert@mailbox.tu-dresden.de
Glöckner
Matthias
M
Priebe
Stefan
S
Briscoe
Jane
J
Rymaszewska
Joanna
J
Adamowski
Tomasz
T
Nawka
Petr
P
Reguliova
Helena
H
Raboch
Jirí
J
Howardova
Andrea
A
Schützwohl
Matthias
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016000:Cluster Analysis; D003631:Day Care, Medical / Q000458:organization & administration* / Q000706:statistics & numerical data; D005060:Europe; D019538:Health Care Surveys; D006778:Hospitals, Psychiatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D016134:Organizational Policy; D010561:Personnel Staffing and Scheduling; D011795:Surveys and Questionnaires; D014600:Utilization Review