The revolving door phenomenon in psychiatry: comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country.
BACKGROUND
Deinstitutionalization has led to a dramatic reduction of inpatient beds and subsequent increase in pressure on available beds. Another consequence of deinstitutionalization has been the phenomenon of the revolving door patient; high-frequency users (HFUs) admitted to hospital repeatedly, remaining well for only short periods of time. The purpose of the study was to determine factors that contribute to HFU of inpatient psychiatric services by schizophrenia and schizo-affective disorder subjects in a developing country with a view to understanding this phenomenon better.


METHODS
Subjects were divided into HFU and low-frequency user (LFUs) groups for comparison with regard to selected variables.


RESULTS
HFUs had higher PANSS scores (p < 0.01), were more likely to admit to lifetime substance use (p = 0.01), be on mood stabilizers (p < 0.01) and also to have been crisis (premature) discharges (p < 0.01). LFUs were more likely to have been treated with depot medication (p < 0.01). Multivariate analysis showed crisis discharge (p = 0.03) and depot use (p = 0.03) to be the only remaining significant predictors of HFU versus LFU status.


CONCLUSIONS
Our findings suggest HFUs' characteristics to be similar across different settings, with under-utilization of depot antipsychotics and early discharge from hospital as particular contributors to high-frequency use of services in our sample.


CONCLUSIONS
Results seem to indicate that HFU-specific interventions are vital to addressing these issues.
Botha
Ulla A
UA
Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa.
Koen
Liezl
L
Joska
John A
JA
Parker
John S
JS
Horn
Neil
N
Hering
Linda M
LM
Oosthuizen
Piet P
PP
D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003688:Deinstitutionalization; D003692:Delayed-Action Preparations; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology
D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations