Heavy use of acute in-patient psychiatric services: the challenge to translate a utilization pattern into service provision.
OBJECTIVE
There is an inequality in resource utilization among acute psychiatric in-patients. About 20-30% of them absorb 60-80% of the total resources allocated to this form of treatment. This study intends to summarize findings related to heavy in-patient service use and to illustrate them by means of utilization data for acute psychiatric wards.


METHODS
Longitudinal assessment of consecutive acute in-patients hospitalized for the first time. Analysis of individual utilization patterns by using latent class cluster analysis.


RESULTS
Four groups with different utilization patterns were found all including heavy service users. In most cases heavy service use was temporary and could only be poorly predicted.


CONCLUSIONS
Specific preventive interventions to contain heavy service use seem to be out of reach for the majority of high utilizing patients. However, services that have proven effective in reducing admissions to in-patient treatment and length of stay may nevertheless help to reduce heavy service use.
Junghan
U M
UM
University Hospital for Social and Community Psychiatry, Bern, Switzerland. junghan@spk.unibe.ch
Brenner
H D
HD
D000208:Acute Disease; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013557:Switzerland; D016896:Treatment Outcome; D014600:Utilization Review / Q000706:statistics & numerical data