Free Nursing Dissertations - (o'driscoll C Et Al 1993). the Paper Is Well Structured And Well Written. It
(O'Driscoll C et al 1993).
The paper is well structured and well written. It takes an entry cohort of nearly 700 patients and follows them over a 7 year period. In terms of statistical validity, to the study’s credit, it managed to follow up over 500 of the patients who survived to the end of the 7 years. (Leff J et al 1996)
The study itself was complex with many different outcome measures. Of specific importance to us in this dissertation, was the fact that nearly 90% were still living in the community at the end of the follow up. 60% were still in their original placement (which effectively means the same hospital catchment area) and 33% had been readmitted at least once. It is possibly of significance that over 80% of the study cohort were known to be suffering from schizophrenia.
If we consider the portion of the paper that deals with the readmission aspect of the problem, we can deduce that over one third of all of the patients followed up were readmitted at some stage during the study period, and that this can be broken down further with 60% of this group needing readmission more than once. The 201 patients who were readmitted required a total of 538 readmissions between them and 160 of these readmissions turned out to be long term admissions ( longer than 6 months). (Fennell P 1997)
Epidemiological breakdown of those patients readmitted showed that the largest group were young men. They were primarily those with previous readmissions and those with the most severe forms of the illness. (Timms PW et al 1999). The authors make a number of predictions and recommendations based on their evidence. Of particular interest to us is the fact that they believe that the provision of between 9-10 acute beds are required for every 100 long term patients cared for in the community. In the words of the authors:
Although most patients, including dependent ones, could be managed successfully in the community, a considerable proportion of our sample required transient readmissions, thus creating a steady demand on local services for acute admissions.(Gooch C et al 1996).
Risk factors affecting readmission to hospital were inherent that is, depended on age, sex, diagnosis, and previous admissions rather than variables related to care. This implies that even with the best treatment and adequate support, patients with schizophrenia or other chronic illnesses are prone to exacerbation of symptoms that necessitate periodic admissions.
The authors significantly also conclude that this level of need for beds:
Has not been accounted for in planning psychiatric services and is one factor contributing to the crisis affecting admission wards. (KFR 1997)
It is fair to comment that there were a spate of papers which looked at the whole issue of the aftermath of the decommissioning of the long stay mental hospitals in the UK.(Milne.
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