title: Predictors of psychiatric aftercare among formerly hospitalized adolescents.
abstract: OBJECTIVE
  Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, we investigated time to aftercare for adolescents following psychiatric hospitalization.
  
  
  METHODS
  We conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge.
  
  
  RESULTS
  Among the 7111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1.21 to 1.43, P < 0.001) and psychotic disorders (AHR 1.24; 95% CI 1.12 to 1.36, P < 0.001) were associated with greater likelihood of aftercare. Youth in the northern part of the province (AHR 0.48; 95% CI 0.32 to 0.71, P < 0.001), rural areas (AHR 0.82; 95% CI 0.76 to 0.89, P < 0.001), and with self-harm or suicide attempts (AHR 0.58; 95% CI 0.53 to 0.64, P < 0.001) and substance use disorders (AHR 0.50; 95% CI 0.44 to 0.56, P < 0.001) were less likely to receive aftercare.
  
  
  CONCLUSIONS
  Hospitalization is our most intensive, intrusive, and expensive psychiatric treatment setting, yet in our cohort of formerly hospitalized adolescents fewer than 50% received psychiatry-related aftercare in the month postdischarge. Innovations are necessary to address geographic inequities and improve timely access to mental health aftercare for all youth.
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. corine.carlisle@camh.ca
authors.forename: Corine E
authors.initials: CE
authors.lastname: Carlisle
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.forename: Russell
authors.initials: R
authors.lastname: Schachar
authors.forename: Teresa
authors.initials: T
authors.lastname: To
mesh_terms: D000293:Adolescent; D000359:Aftercare / Q000523:psychology* / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D009864:Ontario; D011320:Primary Health Care / Q000706:statistics & numerical data; D011570:Psychiatry / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data