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Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care

Randomised controlled trial

Unit for Social and Community Psychiatry, Bart’s and the London School of Medicine, Queen Mary, University of London

MICHELLE SLEED, BSc

Personal Social Services Research Unit, University of Kent, Canterbury

JENNIFER BEECHAM, PhD

Personal Social Services Research Unit, University of Kent, Canterbury and Centre for Economics of Mental Health, Institute of Psychiatry, London, UK

Correspondence: Professor Stefan Priebe, Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK. E-mail: s.priebe{at}qmul.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Data on effectiveness of acute day hospital treatment for psychiatric illness are inconsistent.

Aims To establishthe effectiveness and costs of care in a day hospital providing acute treatment exclusively.

Method In a randomised controlled trial, 206 voluntarily admitted patients were allocated to either day hospital treatment or conventional wards. Psychopathology, treatment satisfaction and subjective quality of life atdischarge, 3 months and 12 months after discharge, readmissions to acute psychiatric treatment within 3 and 12 months, and costs in the index treatment period were taken as outcome criteria.

Results Day hospital patients showed significantly more favourable changes in psychopathology at discharge but not at follow-up.They also reported higher treatment satisfaction atdischarge and after 3 months, but not after12 months. There were no significant differences in subjective quality of life or in readmissions during follow-up.Meantotal supportcosts were higher for the day hospital group.

Conclusions Day hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the shortterm and generates greater patient satisfaction than conventional in-patient care, but may be more costly.

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