Effectiveness and cost-effectiveness of psychiatric mother and baby units: quasi-experimental study.

Autor:	Howard LM; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK., Trevillion K; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK., Potts L; Biostatistics and Health Informatics, King's College London, UK., Heslin M; King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK., Pickles A; Biostatistics and Health Informatics, King's College London, UK., Byford S; King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK., Carson LE; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK., Dolman C; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK., Jennings S; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK., Johnson S; Division of Psychiatry, UCL, London, UK., Jones I; National Centre for Mental Health, Division of Psychiatry and Clinical Neuroscience, Cardiff University, UK., McDonald R; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK., Pawlby S; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK., Powell C; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK., Seneviratne G; South London and Maudsley NHS Foundation Trust, Beckenham, UK., Shallcross R; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK., Stanley N; School of Social Work, Care and Community, University of Central Lancashire, Preston, UK., Wieck A; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK., Abel KM; Centre for Women's Mental Health, University of Manchester, UK.
Jazyk:	angličtina
Zdroj:	The British journal of psychiatry : the journal of mental science [Br J Psychiatry] 2022 Oct; Vol. 221 (4), pp. 628-636.
DOI:	10.1192/bjp.2022.48
Abstrakt:	Background: Psychiatric mother and baby units (MBUs) are recommended for severe perinatal mental illness, but effectiveness compared with other forms of acute care remains unknown. Aims: We hypothesised that women admitted to MBUs would be less likely to be readmitted to acute care in the 12 months following discharge, compared with women admitted to non-MBU acute care (generic psychiatric wards or crisis resolution teams (CRTs)). Method: Quasi-experimental cohort study of women accessing acute psychiatric care up to 1 year postpartum in 42 healthcare organisations across England and Wales. Primary outcome was readmission within 12 months post-discharge. Propensity scores were used to account for systematic differences between MBU and non-MBU participants. Secondary outcomes included assessment of cost-effectiveness, experience of services, unmet needs, perceived bonding, observed mother-infant interaction quality and safeguarding outcome. Results: Of 279 women, 108 (39%) received MBU care, 62 (22%) generic ward care and 109 (39%) CRT care only. The MBU group ( n = 105) had similar readmission rates to the non-MBU group ( n = 158) (aOR = 0.95, 95% CI 0.86-1.04, P = 0.29; an absolute difference of -5%, 95% CI -14 to 4%). Service satisfaction was significantly higher among women accessing MBUs compared with non-MBUs; no significant differences were observed for any other secondary outcomes. Conclusions: We found no significant differences in rates of readmission, but MBU advantage might have been masked by residual confounders; readmission will also depend on quality of care after discharge and type of illness. Future studies should attempt to identify the effective ingredients of specialist perinatal in-patient and community care to improve outcomes.
Databáze:	MEDLINE
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