title: Local inpatient units may increase patients' utilization of outpatient services: a comparative cohort-study in Nordland County, Norway.
abstract: OBJECTIVE
  In the last few decades, there has been a restructuring of the psychiatric services in many countries. The complexity of these systems may represent a challenge to patients that suffer from serious psychiatric disorders. We examined whether local integration of inpatient and outpatient services in contrast to centralized institutions strengthened continuity of care.
  
  
  METHODS
  Two different service-systems were compared. Service-utilization over a 4-year period for 690 inpatients was extracted from the patient registries. The results were controlled for demographic variables, model of service-system, central inpatient admission or local inpatient admission, diagnoses, and duration of inpatient stays.
  
  
  RESULTS
  The majority of inpatients in the area with local integration of inpatient and outpatient services used both types of care. In the area that did not have beds locally, many patients that had been hospitalized did not receive outpatient follow-up. Predictors of inpatients' use of outpatient psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of affective disorder, central inpatient admission only, and duration of inpatient stays.
  
  
  CONCLUSIONS
  Psychiatric centers with local inpatient units may positively affect continuity of care for patients with severe psychiatric disorders, probably because of a high functional integration of inpatient and outpatient care.
authors.affiliation: Psychiatric Research Centre of North Norway, Nordland Hospital Trust, Bodø, Norway.
authors.forename: Lars Henrik
authors.initials: LH
authors.lastname: Myklebust
authors.affiliation: Psychiatric Research Centre of North Norway, Nordland Hospital Trust, Bodø, Norway ; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Knut
authors.initials: K
authors.lastname: Sørgaard
authors.affiliation: Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Rolf
authors.initials: R
authors.lastname: Wynn
keywords: affective; continuity of care; decentralization; health service research; hospitalization; outpatients; psychiatry