Length of stay and associated factors in patients with schizophrenia and schizoaffective disorder in a specialised psychiatric hospital
Date
2021
Authors
Goga, Ladawa Yasese
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: Patients with schizophrenia and schizoaffective disorder often require
long admissions. There exists a progressive shortage of beds in South African
psychiatric hospitals and investigating current length of stay (LOS) trends is
necessary to better inform future health system planning.
Aim: To explore LOS and associated factors of patients with schizophrenia and
schizoaffective disorder, at a public sector specialised psychiatric hospital, over a 4-
year period.
Setting: The study was conducted at Tara Hospital, in Johannesburg, South Africa.
Methods: A retrospective record review of 367 adult schizophrenia and
schizoaffective disorder patients was conducted. Average LOS was calculated and
the proportion of short-stay (<30 days), medium-stay (31-90 days) and long-stay
(>90 days) admissions determined. Further data was collected, from a randomly
selected subset of patients in each LOS category, regarding sociodemographic,
clinical and admission outcome factors.
Results: Mean LOS was 128 days (median 87, IQR 49-164, range 0-755 days). A
significantly greater proportion of patients had long-stay admissions (p<0.001). Male
gender (p=0.018), being unmarried (p=0.006), treatment resistant (p<0.001) and on
clozapine (p=0.009) were factors found to have a significant association with long-stay
admissions. Overall, rates of unemployment (>80%), comorbid substance use
disorders (>40%), medical illnesses (>40%), antipsychotic polypharmacy (>40%) and
readmissions (>80%) were high. Of those with treatment resistance, approximately
half were discharged on clozapine. Most (>80%) were discharged home, despite
psychiatric residential placement being recommended.
Conclusion: Long-stay admissions were frequently required for patients with
schizophrenia and schizoaffective disorder admitted to Tara Hospital. More research
is needed into whether increased and improved community-based services such as
residential and day-care facilities could translate into shorter admissions, less
frequent relapses and improved outcomes in this population
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for
the degree of Master of Medicine in Psychiatry, 2021