Self-admission in the treatment of eating disorders: an analysis of healthcare resource reallocation

Mattias Strand, Cynthia M Bulik, Sanna A Gustafsson, Elisabeth Welch, Mattias Strand, Cynthia M Bulik, Sanna A Gustafsson, Elisabeth Welch

Abstract

Background: Self-admission to psychiatric inpatient treatment is an innovative approach to healthcare rationing, based on reallocation of existing resources rather than on increased funding. In self-admission, patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. Previous findings on patients with severe eating disorders indicate that self-admission reduces participants' need for inpatient treatment, but that it does not alone lead to symptom remission.

Methods: The aim of this study was to evaluate if, from a service provider perspective, the resource reallocation associated with self-admission is justified. The analysis makes use of data from a cohort study evaluating the one-year outcomes of self-admission at the Stockholm Centre for Eating Disorders.

Results: Participants in the program reduced their need for regular specialist inpatient treatment by 67%. Thereby, hospital beds were made available for non-participants due to the removal of a yearly average of 13.2 high-utilizers from the regular waiting list. A sensitivity analysis showed that this "win-win situation" occurred within the entire 95% confidence interval of the inpatient treatment utilization reduction.

Conclusions: For healthcare systems relying on rationing by waiting list, self-admission has the potential to reduce the need for hospitalization for patients with longstanding eating disorders, while also offering benefits in the form of increased available resources for other patients requiring hospitalization.

Trial registration: ClinicalTrials.gov ID: NCT02937259 (retrospectively registered 10/15/2016).

Keywords: Anorexia nervosa; Delivery of health care; Economics; Health care rationing; Health resources; Voluntary admission.

Conflict of interest statement

Dr. Bulik reports: Shire (grant recipient, Scientific Advisory Board member); Idorsia (consultant); Pearson (author, royalty recipient). MS, SAG, and EW have no conflicts to report.

Figures

Fig. 1
Fig. 1
Resource reallocation in the self-admission program at the Stockholm Centre for Eating Disorders
Fig. 2
Fig. 2
Participants over time in the self-admission program at the Stockholm Centre for Eating Disorders
Fig. 3
Fig. 3
Change in the mean number of days spent in inpatient treatment at the Stockholm Centre for Eating Disorders
Fig. 4
Fig. 4
Net increase in available regular hospital days outnumbering the days “lost” to the program

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