Reducing mental health emergency department visits through community-based assessment services. A controlled time-series analysis in the city of Lyon, France

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy Pub Date : 2025-08-14 DOI:10.1016/j.healthpol.2025.105419

Guillaume Barbalat, Romane De Rozario, Nicolas Franck

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引用次数: 0

Abstract

Background

The mental health burden on Emergency Departments (EDs) is significant. Community-based mental health services are key to lowering ED visits by addressing mental health needs proactively.

Objective

To examine the impact of CAdEO, a community-based patient assessment and triage service launched in 2020 in Lyon, France, on psychiatric ED visits among new patients at a local psychiatric hospital.

Methods

We first used a quasi-experimental interrupted time series design to compare populations exposed (new patients) vs. non-exposed (patients currently under care) to CAdEO from 2015 to 2023. Second, we investigated how the quality of service functioning, measured by delays between referrals and consultations, affected ED visits.

Results

Exposure to the CadEO service was associated with a 0.5% daily decrease in mental health-related ED visits (Risk ratio (RR): 0.995; 95% Confidence Interval (CI): 0.991, 0.999). Reducing the waiting times for triage from 12 days to 4.7 days over a six-week period was associated with a 26.5% decrease in ED presentations (RR: 0.735; 95% CI=0.548, 0.986). Our sex-stratified analysis revealed that the ongoing effects of CAdEO resulted in males having lower ED visit rates than females. However, reducing waiting times for triage was associated with a lower rate of female ED visits. Finally, shorter CAdEO waits were linked to lower ED visits for mood and personality disorder patients.

Conclusions

This study suggests that a community-based patient assessment and triage service may help reduce the overall demand for mental health care in ED. Our findings also highlight the necessity for tailored approaches that consider gender and specific mental health conditions.

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通过社区评估服务减少精神卫生急诊就诊。在法国里昂市进行的受控时间序列分析

急诊科（EDs）的心理健康负担是显著的。以社区为基础的心理健康服务是通过主动解决心理健康需求来降低急诊室就诊的关键。目的研究CAdEO（一项于2020年在法国里昂推出的基于社区的患者评估和分诊服务）对当地精神病院新患者精神科急诊科就诊的影响。方法：我们首先采用准实验中断时间序列设计，比较2015年至2023年CAdEO暴露人群（新患者）和未暴露人群（目前正在接受治疗的患者）。其次，我们调查了服务功能的质量（通过转诊和会诊之间的延迟来衡量）如何影响急诊科的访问。结果暴露于CadEO服务与心理健康ED就诊减少0.5%相关(风险比（RR）： 0.995；95%置信区间（CI）： 0.991, 0.999)。在6周的时间内，将分诊等待时间从12天减少到4.7天，与ED发生率降低26.5%相关（RR: 0.735; 95% CI=0.548, 0.986）。我们的性别分层分析显示，CAdEO的持续影响导致男性急诊科就诊率低于女性。然而，减少等待分诊的时间与女性急诊科就诊率降低有关。最后，较短的CAdEO等待时间与情绪和人格障碍患者较少的急诊科就诊有关。本研究表明，以社区为基础的患者评估和分诊服务可能有助于减少急诊科对精神卫生保健的总体需求。我们的研究结果还强调了考虑性别和特定精神健康状况的量身定制方法的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.