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Readmission of psychiatric patients
Readmissions of Psychiatric patients in Sri lanka
Psychiatric illnesses is a group of disease which manifest with disordered psychological (mental) functioning in the areas of thinking, emotion, perception, purposeful behavior and memory with or without an established biological basis or a functional or anatomical abnormality of the brain resulting in distress or disability. Psychiatric illnesses have been shown to be common, occurring in all societies and in all sections of any society. These can be broadly divided into neuroses (e.g.: anxiety disorders, dissociative disorders, obsessive compulsive disorders, and psychoses (e.g. mood disorders such as bipolar affective disorder, depression, and schizophrenia).
Most of the time psychiatric illnesses are recurrent conditions which lead to frequent hospitalizations (e.g. bipolar affective disorder, severe depressive disorder, and schizophrenia).If a patient diagnosed as having a psychiatric illness in a prior admission is admitted to the ward again, irrespective of the reason for that admission the second and the subsequent admissions are considered as re admissions.
Majority of the population in the psychiatric inpatient units consists of readmitted patients who were started on treatment in a prior admission and ideally should be managed as out patients.Reasons for re admissions can be broadly divided into few categories as related to medications and drug compliance, related to precipitating factors, related to investigations and treatment, respite admissions of patients and other reasons.
Whatever the reason is readmission of a patient is a problem both to the patient and to the ward staff.Frequent re admissions lead to reduction of the productivity and working capacity of both the patient and his family and also increase the expenditure for treatments. It would also disturb their day to day life, mental and social well-being. These factors ultimately contribute to reduce the productivity of the whole country.
Increased number of re admissions leads to overcrowding which makes the ward noisy and busy and also an unpleasant place to stay. Due to overcrowding the patients tend to get discharged from the wards early, before optimal recovery, which may in turn increases the relapse rate and definitely the need to get readmitted. Extra workload on the ward staff may make them feel exhausted and the quality of the service provided will deteriorate invariably. This process will go on as a vicious cycle.
Frequent re admissions increase the cost of health care. Sri Lanka being a country where 95% of inpatient care is provided by the public sector, major proportion of this expenditure is done by the Government.Rising cost of health care and reducing productivity affects the economy of the country in a negative manner. This is a very serious issue for a developing country like Sri Lanka.
Thus it is very important to prevent or if not reduce re admissions. To do that the reasons for re admissions should be known to all medical professionals including the workers in the primary health care system. Reducing the number of re admissions may reduce the cost of health care, increase the productivity of the country, and improve the quality of health care services. Ultimately reducing the number of re admissions will reduce the disease burden due to psychiatric illnesses improving the economical state of the country.
In spite of the importance and high relevance only a few researches were done on this topic worldwide with almost no studies published on this topic in Sri Lanka yet
By Gayani Chamika
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