Bed utilization in two differently organized community mental health services in Northern Norway: the VELO-project.
BACKGROUND
The literature on the dynamics between community- and hospital services concerning utilization of psychiatric beds is inconclusive. The Norwegian VELO-project provides an opportunity to study this in a natural experiment. Two service-systems are compared. The "central-bed system" have mainly outpatient- and day-hospital services locally, with psychiatric beds at a central mental hospital. The "local-bed system" have only one outpatient clinic, with beds at three local inpatient units. Also utilization of sheltered homes was studied. Hypotheses were predicted from Goldberg and Huxley's' stage theory and the Thornicroft and Tansella's' hydraulic model.


METHODS
The case-registries of 2005 were linked across service levels by patients' 11-digit Social Security Number. From 1,865 single treatment episodes, 1,348 continuous courses by 1,253 individual patients were extracted.


RESULTS
For overall utilization of psychiatric beds there was only a small difference, were the central-bed system utilized 10% less than the other. For utilization of emergency inpatient admissions and acute hospital beds, the rate was more than twice in the central-bed system compared to the other. For utilization of municipalities sheltered homes, the rate was three times higher in the local-bed system.


CONCLUSIONS
There may be bedrock of need for psychiatric beds regardless of system-organization. Distance may in general be a minor issue for utilization of psychiatric beds, and may primarily interact with patient- or contextual characteristics associated with acute situations. Activity of day-hospital services rather than outpatient consultations may affect utilization of sheltered homes. The main theoretical models are conceptually useful, although more research is needed to specify mechanisms.
Myklebust
Lars Henrik
LH
Psychiatric Research Centre of Northern Norway, UNN-Asgård, 9291, Tromsø, Norway. lars.henrik.myklebust@unn.no
Sørgaard
Knut
K
Bjorbekkmo
Svein
S
Nymann
Asle
A
Molvik
Stian
S
Olstad
Reidun
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D001509:Bed Occupancy / Q000706:statistics & numerical data; D001513:Beds / Q000706:statistics & numerical data*; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D003156:Community Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D003631:Day Care, Medical / Q000706:statistics & numerical data; D003688:Deinstitutionalization / Q000639:trends; D005260:Female; D006291:Health Policy; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D009664:Norway; D017063:Outcome Assessment, Health Care; D012112:Residential Facilities / Q000706:statistics & numerical data