ArticleEpidemiology and psychiatric sciences2018
The same or different psychiatrists for in- and out-patient treatment? A multi-country natural experiment.
Article in Epidemiology and psychiatric sciences, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- Continuity of Care and Patient Outcomes in Populations With Schizophrenia: A Systematic Review.Psychiatric services (Washington, D.C.) · 2026Pooled it
- Relational continuity may give better clinical outcomes in patients with serious mental illness - a systematic review.BMC psychiatry · 2023Pooled it
- Peer support for discharge from inpatient mental health care versus care as usual in England (ENRICH): a parallel, two-group, individually randomised controlled trial.The lancet. Psychiatry · 2022Trial
- Pursuit of Digital Innovation in Psychiatric Data Handling Practices in Ireland: Comprehensive Case Study.JMIR human factors · 2025Article
- Context, health and migration: a systematic review of natural experiments.EClinicalMedicine · 2023Article
- Association between continuity of care and treatment outcomes in psychiatric patients in Germany: a prospective cohort study.BMC psychiatry · 2023Article
- Do outcomes of psychiatric hospital treatment differ for migrants and non-migrants?Social psychiatry and psychiatric epidemiology · 2021Article
- Structure and Functioning of Acute Inpatient Psychiatric Units in Spain: Qualitative Study.JMIR research protocols · 2021Article
- Social contacts, friends and satisfaction with friendships in patients with psychotic, mood and neurotic disorders 1 year after hospitalisation: data from five European countries.Social psychiatry and psychiatric epidemiology · 2021Article
- Factorial structure of the Manchester Short Assessment of Quality of Life in patients with schizophrenia-spectrum disorders.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2020Article
- Personal continuity versus specialisation of care approaches in mental healthcare: experiences of patients and clinicians-results of the qualitative study in five European countries.Social psychiatry and psychiatric epidemiology · 2020Article
- Changes in German Mental Health Care by Implementing a Global Treatment Budget-A Mixed-Method Process Evaluation Study.Frontiers in psychiatry · 2020Article
- The same or different psychiatrists for in- and out-patient treatment? A multi-country natural experiment - ADDENDUM.Epidemiology and psychiatric sciences · 2019Article
Corrections and comments
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Authors and funding
12 authors at 6 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsA core question in the debate about how to organise mental healthcare is whether in- and out-patient treatment should be provided by the same (personal continuity) or different psychiatrists (specialisation). The controversial debate drives costly organisational changes in several European countries, which have gone in opposing directions. The existing evidence is based on small and low-quality studies which tend to favour whatever the new experimental organisation is.We compared 1-year clinical outcomes of personal continuity and specialisation in routine care in a large scale study across five European countries.
methodsThis is a 1-year prospective natural experiment conducted in Belgium, England, Germany, Italy and Poland. In all these countries, both personal continuity and specialisation exist in routine care. Eligible patients were admitted for psychiatric in-patient treatment (18 years of age), and clinically diagnosed with a psychotic, mood or anxiety/somatisation disorder.Outcomes were assessed 1 year after the index admission. The primary outcome was re-hospitalisation and analysed for the full sample and subgroups defined by country, and different socio-demographic and clinical criteria. Secondary outcomes were total number of inpatient days, involuntary re-admissions, adverse events and patients' social situation. Outcomes were compared through mixed regression models in intention-to-treat analyses. The study is registered (ISRCTN40256812).
resultsWe consecutively recruited 7302 patients; 6369 (87.2%) were followed-up. No statistically significant differences were found in re-hospitalisation, neither overall (adjusted percentages: 38.9% in personal continuity, 37.1% in specialisation; odds ratio = 1.08; confidence interval 0.94-1.25; p = 0.28) nor for any of the considered subgroups. There were no significant differences in any of the secondary outcomes.
conclusionsWhether the same or different psychiatrists provide in- and out-patient treatment appears to have no substantial impact on patient outcomes over a 1-year period. Initiatives to improve long-term outcomes of psychiatric patients may focus on aspects other than the organisation of personal continuity v. specialisation.
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