Psychiatric day hospital treatment concepts have to deal with a wide spectrum of mental disorders. We raised the question, if day hospitals can be differentiated concerning their treatment concepts and if so how much this is reflected in their structural and procedural features. In 1999 a survey was initiated concerning structure, concept and method of treatment in psychiatric day hospitals for adults in Germany. Furthermore data concerning rate of utilization, patients' characteristics and aspects of referral and further treatment were ascertained. One hundred and seventy-three (63.4%) of 273-day hospitals contacted took part in the inquiry. The data were interpreted using multivariate as well as non-parametric procedures. The results show that treatment concepts of day hospitals can be specified as three main areas of function (psychotherapy, crisis intervention orientated treatment alternative, rehabilitation) and four therapeutic orientations (psychodynamic social psychiatric, behavioral social psychiatric, psychodynamic, sociotherapeutic). Structural features are predominantly comparable and the differences found concerning the treatment concepts are especially related to patients' characteristics and some procedural features. The conclusion is that the differentiation of day hospital treatment concepts should be taken into consideration in planning psychosocial treatment services as well as in day hospital evaluation research.

A survey of the first two years of a psychiatric clinic within a geriatric medical day hospital was undertaken to determine the role of such a clinic. Forty per cent of all day hospital attenders were referred for psychiatric evaluation: at least 80 per cent of these had major psychiatric diagnoses and 20 per cent had other conditions needing psychosocial intervention. Depression and dementia accounted for 62 per cent of all psychiatric referrals. Those who were referred to the psychiatric clinic were quite comparable to the unreferred group in age, sex, marital status, pre-retirement employment and source of referral to the day hospital. The outcomes of intervention at three, six and 12 months were similar in both groups but referred patients stayed longer in the program. It is concluded that such a clinic provides a necessary mental health service where it is needed.

The objective of this study was to compare enhanced access to geriatric assessment and case management to usual home care service provision for the frail elderly. This was a demonstration project, with randomized allocation to control or intervention groups of frail elderly persons who had been referred to the Home Care service in Winnipeg. Of the 164 persons who were randomized, 78 intervention and 74 control patients were evaluated. Intervention subjects received a multidimensional assessment as soon as possible by a specially trained coordinator, who had enhanced access to geriatric medical and day-hospital services; intervention patients were case managed for a 3-month period. Control cases received usual care from home care coordinators. The intervention group received significantly faster assessment and deployment of home services, as well as greater utilization of the geriatric day-hospital services. Utilization of emergency room and hospital services was similar for both groups. Control subjects experienced more prolonged hospital stays and a significantly higher proportion (23%) were designated for long-term care than of intervention clients (9%). We conclude that the SWING program, which facilitated access to geriatric services and case management, reduced or delayed the need for long-term care.

Evidence suggests that frailer older patients benefit from a continuum of care rather than the admit/discharge model of our health system. This study examined patient outcomes after discharge from a geriatric day hospital (GDH) to determine what proportion continues to do well, what proportion declines, how the two groups differ, and if factors predictive of deterioration can be identified. Using telephone survey and Goal Attainment Scaling methodologies, the goals of 151 patients discharged from a GDH between 6 and 18 months previously were examined to determine whether GDH achievements were maintained or lost. All but 5 patients improved between GDH admission and discharge; after discharge, 39 per cent deteriorated. The need for more support in the community was predictive of deterioration, probably reflecting patient frailty. Number of medical diagnoses or medications were not predictive. Frailer older patients tend not to maintain goals achieved in a GDH after discharge and may benefit from ongoing maintenance.

Objective: To conduct an audit of the patients treated at a day hospital or in an inpatient unit of a district general hospital from the South Kildare sector of the Kildare Mental Health Service, a new community based psychiatric service.

Method: Retrospective case note review of all admissions over a six month period. ICD-9 diagnosis used.

Results: There were 39 and 29 admissions to the inpatient unit and day hospital respectively. The average duration of stay in the inpatient unit was 14 days, 66% were discharged home and 33% discharged to the day hospital. The average duration of stay was 30 days in the day hospital, 62% were discharged home and 17% discharged to the inpatient unit.

Conclusions: The trend was to treat more neurotic patients in the day hospital; psychotic patients were treated in both settings; the proportion of patients discharged home was similar. The duration of stay was longer in the day hospital.