Survey of compulsory hospital admissions

Survey of compulsory hospital admissions in four french regions: Nord Pas-de-Calais, Aquitaine, Ile-de-France, Provence-Alpes-Côte d'Azur

Three structures WHOCC, ANCRE PSY and ACFCP a decided to set up 5 years a study (with a 1 year descriptive phase)  to analyze the conditions of Compulsory Hospital Admissions (CHA) in psychiatry districts and departments of four French regions, and study the situation of these  patients afterwards. Based on the collected data, this study will promote a CHA prevention policy and develop a list of best practices regarding monitoring and prevention of CHA.
Furthermore, the data issued by the Departmental Committees of Psychiatry Hospitalization (CDHP) show a great variability of CHA rates depending on the departments (factor ranging from 1 to 9.8 in 2007).
Data found in several database (ATIH, SAE, CDHP) show that this variability can also be found on a smaller scale, among various districts, and also  sometimes within the same department.
The assumption underlying this survey is that variability in the use of CHA is not related to the severity of the patients disorders but have to do with local practices.

Methodology

A two phases study is being considered:

1. Descriptive phase: a one year analysis of the population and of the decision making process in the context of CHA in four different French regions. Objectives:

- A description of psychiatric and socio-demographic profiles of people who enter in the context of CHA
- Getting to know the views of all stakeholders involved in CHA (patients, psychiatrists who decided CHA, personal caregivers and/or relatives, physicians or private practice psychiatrists and local officials).

2. Longitudinal follow-up phase of the cohort: study of the situations of these patients after CHA and over a five year period.

- Collect of epidemiological data routinely (RIM-Psy) to follow the path of those who went through CHA, according to the profiles identified in the first phase of investigation.
- Study of results in connection with the typologies of practices regarding hospitalizations without consent which have been highlighted by studies conducted by the DREES.

The main objective is to show that the variability of CHA rates according to psychiatric sectors bears no relation to the severity of the disorders. The primary endpoint was the score on the Global Assessment of Functioning (GAF).

24H Certificates routinely delivered by psychiatrists when the patient enters hospital carry a clinical description of symptoms that could justify or not the continuing the measure of CHA. Information provided by the certificate allow a GAF rating.

A study was conducted by WHOCC to assess the inter-rater reliability between 12 raters (8 psychiatrists and psychologists 4). It turned out excellent, so a psychologist, after thza gathering of all certificates (agreements, refusal and impossible investigations) conducted the coding of the GAF of 1138 records based on anonymous 24 hours certificates data.

Statistically

Constitution of 3 groups of sectors (low rate <10 - average rate: from 10 to 20 - high rate of HO> 20) for comparison of GAF scores, for comparisons of all the variables of each questionnaire, and of the variables of care availability (or counfounding factors).

Inclusions

The survey was implemented on November 1st 2009. Trainings for the disctricts took place until July, 31th 2011.
Therefore, the last patient for the descriptive phase was included on July 31th, 2012. And the cohort follow-up phase will end on July 31, 2016 for the last persons included in the study in the course of the first phase.

Agreements reached

The study obtained the necessary agreements for its implementation:
The Persons Protection Committee (PSC North West) gave a favorable opinion on December 18, 2008. And following the new law No. 2011-803 of 5 July 2011, PSC agreement May 31, 2012.
The Advisory Committee on Treatment of Information regarding Research on Health gave a favorable opinion on May 7 2009.
The national Committee on Computer Data and the Preservation of Freedom later agreed after having requested a questionnaires alteration. The favorable opinion was obtained on  October 20th, 2009.
And following the new Law No. 2011-803 of 5 July 2011, CNIL agreement June 11, 2012.