Use of patient-controlled psychiatric hospital admissions: patients’ perspective

<b>Background:</b> By patient-controlled admission (PCA), psychiatric patients with a PCA contract can initiate a brief admission without a health professional gatekeeper. However, research regarding use of PCA is scarce. <b>Aims:</b> In this Danish multi-centre study, motives for and satisfaction with PCA were explored. <b>Methods:</b> During a 1-year period, patients from 11 Danish mental health units evaluated PCA using a questionnaire developed for the purpose. <b>Results:</b> In total, 190 patients evaluated 462 admissions. The majority had concluded a PCA contract to receive early help. PCA was mostly initiated because of mental health conditions, but also because of social and everyday problems. The purpose was mainly to be at peace and prevent symptom increase. Patients from units with a quarantine period felt more ready for discharge than the others. Patients were in general satisfied with PCA (61.7%), but patients who hoped for improved medication or wished to obtain more care were less satisfied. <b>Conclusions:</b> Patients can use PCA as a means to receive timely help. Motives for patients seeking help are not limited to mental conditions. Expectations that cannot be met within the organizational structure of the PCA programme are associated with less satisfaction. However, regional differences in structures were associated with satisfaction. Patients who had access to shorter PCAs were more satisfied, and a quarantine period may even help patients become more ready for discharge. A brief admission period does not cause dissatisfaction at discharge and can be used in the clinical setting.

**背景：** 签署患者自控入院（patient-controlled admission, PCA）协议的精神科患者，可无需经过医疗专业人员守门人环节，自行发起短期入院申请。但目前针对PCA使用情况的相关研究仍较为匮乏。
**研究目的：** 本项丹麦多中心研究旨在探讨PCA的使用动机及患者满意度。
**研究方法：** 本次研究为期1年，来自11家丹麦精神卫生医疗机构的患者使用专为本次研究设计的调查问卷对PCA服务进行了评估。
**研究结果：** 总计190名患者对462次入院情况完成了评估。多数患者签署PCA协议的初衷是获得早期干预帮助。PCA的发起原因主要为精神健康状况相关问题，同时也包括社交及日常事务难题，其核心目的多为平复情绪、防止症状加重。设有留观隔离期的科室患者，其出院准备度显著高于其他科室患者。总体而言，61.7%的患者对PCA服务表示满意，但那些希望调整用药方案或寻求更多照护的患者，满意度相对更低。
**结论：** 患者可通过PCA途径获得及时的医疗帮助。患者寻求帮助的动机并非仅局限于精神健康问题。无法在PCA项目的组织架构内达成的预期，会导致患者满意度下降。不同地区的机构设置差异同样会对患者满意度产生影响。可接受较短时长PCA服务的患者满意度更高，设置留观隔离期甚至有助于提升患者的出院准备度。短期入院并不会导致患者出院时产生不满情绪，因此该服务模式可在临床场景中推广应用。