Лечение психических расстройств на дому снижает частоту повторных госпитализаций

Intensive home treatment (IHT) is an approach to acute psychiatric care that avoids the stressful psychiatric ward admission procedures and allows the patient or service user to remain in a familiar environment. A new study published in BMC Psychiatry finds that IHT for people in need of acute psychiatric care was linked to lower readmission rates, fewer readmissions, fewer days spent in inpatient care, and longer average time to readmission after treatment compared to inpatient admission. This research, led by Konstantinos Nikolaidis from the Charité Universitätsmedizin Berlin in Germany, also reports people that had received IHT were more likely to opt for IHT over inpatient treatment for subsequent acute psychiatric care needs. The authors write: “IHT was associated with significantly fewer inpatient readmissions, fewer inpatient days, and a reduced number of total inpatient episodes over a 36-month follow-up period. The significantly longer readmission-free survival in the IHT group, with the median time to readmission not being reached within the observation period, suggests a robust and lasting effect of IHT on prevention of inpatient readmission. In contrast, the IT group reached the median time to readmission at 610 days, highlighting a substantially higher risk of rehospitalization over time. ” Clinical and Practical Benefits of IHT IHT is most typically delivered for short term care (one to six weeks) and involves home visits from a multidisciplinary treatment team several times per day with 24/7 availability where the patient and their family can reach the crisis team anytime. Past research has found that patients and service users receiving IHT were less likely to be admitted to inpatient treatment at an eight week post IHT follow-up. A 2017 study out of Trieste, Italy linked IHT to an 80% reduction in involuntary psychiatric detention while a 2016 study out of England found that IHT was associated with a 27% reduction in suicides. Research has found that patients and service users receiving IHT report higher rates of satisfaction and quality of life. One study also reported that acute psychiatric care delivered through home treatment was cheaper than inpatient care. England’s National Institute for Health and Care Excellence clinical guidelines lists IHT as the first line choice of treatment for people experiencing acute psychosis and severe depression. While IHT is not common in the US, eight countries (UK, Ireland, Australia, New Zealand, Netherlands, Germany, Norway, and Belgium) have adopted IHT as a viable approach to acute psychiatric treatment. Study Details While past research has found that IHT was linked to fewer readmissions in the short-term, the current study examined the long-term effects of IHT on inpatient readmission rates, total treatment days, and the utilization of outpatient psychiatric services. To achieve this goal, the authors used data from the 2020 clinical records of three psychiatric hospitals in Berlin, Germany. The researchers compared 263 patients that received IHT to 263 patients that received inpatient treatment. For the purposes of analysis, patients and service users receiving IHT were paired with a counterpart that received inpatient treatment. Each pair shared similar age, gender, psychiatric diagnosis, and history of psychiatric service use. These groups were tracked for 36 months after discharge to evaluate how often they required additional psychiatric care, and how that care was delivered. Overall, IHT was linked to lower inpatient readmission rates, with 41.1% of IHT patients requiring inpatient readmission in the subsequent 36 months compared to 55.5% of those initially receiving inpatient treatment. IHT patients that required inpatient readmission spent an average of 48.7 days in inpatient care compared to 51.66 days for those that received inpatient treatment initially. Due to less than half of IHT patients and service users requiring inpatient readmission, the median time to readmission was not reached for this group during the 36 month follow-up. The median time to readmission for the group that initially received inpatient treatment was 610 days (20 months). IHT patients and service users were more likely to connect with sustainable, continuous psychiatric services through outpatient treatment. More than one-third (33.5%) of IHT patients initiated outpatient care for the first time compared to 24.7% of those receiving inpatient treatment. People from the IHT group were also more likely to prefer IHT when facing subsequent psychiatric crises. The IHT group averaged 0.85 subsequent home treatments with an average of 21.55 days of home care over the 36 month follow-up compared to 0.35 subsequent home treatments averaging 7.41 days of home care for the inpatient group. The authors note that when considering all types of crisis care, including inpatient stays, home treatment, and day clinics, both the IHT and inpatient groups spent a similar number of days in acute psychiatric care. These findings indicate that home treatment likely does not eliminate the need for crisis care, but offers a path to acute psychiatric treatment that avoids many of the problems associated with inpatient care. This study had several limitations. The design of the study means the findings can only speak to associations, not causes. This means this research cannot definitively say that IHT causes less inpatient readmissions, only that it is linked to fewer readmissions. IHT requires a specific patient profile, including a stable home environment, consent of the household members, and a safe, cooperative risk profile. These findings are not generalizable to patients and service users that are homeless, do not have a stable home environment, or do not have the support of household members in their recovery. Data was collected from clinical records at three Berlin psychiatric hospitals. These findings may not be generalizable to rural populations or populations outside Germany. The authors did not have data on some factors that may have affected inpatient readmission such as baseline symptom severity, personal support networks, exposure to coercive practices, and service user housing. Clinician judgment was used to determine which patients and service users received IHT. While patients and service users were paired based on diagnosis and past psychiatric treatment, its possible that the IHT group may have been more stable than the inpatient group. The authors conclude: “The present results are consistent with the notion that shifting psychiatric treatment into patients’ home environments—even for selected patients requiring acute psychiatric inpatient care—is feasible and associated with various benefits … These findings apply to a selected subgroup of voluntary patients with sufficient clinical stability and social resources to permit home-based acute care. They do not support generalized conclusions about all patients requiring acute psychiatric admission.” Barriers to IHT in the US The US has several structural and financial barriers to implementing IHT. Insurance billing in the US operates on a fee-for-service model. This means insurance and Medicaid typically will not pay for the travel time, multi-provider team supervision, and on-call capacity necessary for providing IHT. Insurance authorization also heavily favors facility-bound acute psychiatric care. Federal and state policies around community crisis systems favor the creation of mobile crisis teams that are designed for short-term de-escalation, emergency room diversion, and initial triage rather than 24/7 on-call home care. The US healthcare system also prioritizes facility-bound treatment and short-term stabilization over continuous community support. IHT requires stable housing and social support, resources that are historically under-funded in the US. **** Nikolaidis, K., Rout, S., Hardt, O., Richter, C., Janßen, B., Timm, J., & Bechdolf, A. (2026). Intensive home treatment compared to inpatient psychiatric treatment: A 36-month follow-up of a propensity-score matched retrospective multicenter cohort study. BMC Psychiatry, 26(1). (Link)