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Abu-Dhabi Psychiatric Day HospitalEfficacy and acceptability A survey of treating team, patients and families E.mail : |
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q Aims and Methods |
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Team workers psychiatrists ,
nurses , psychologists, social workers , as well as patients and their
families were surveyed on their experience and attitude to wards day hospital
services. Three self - rating instruments were designed for the purpose of
the study to evaluate the service quality , satisfaction and attitude of
medical team , patients and their families respectively. The results greatly favours day hospital as a
substitute for in-patients and proper facility for treatment as shown by
result of attitude measure of team workers, patients and families. |
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q Clinical Implication |
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Day hospital is a debatable issue both to health service planners and
professionals in under developed countries. Our study in Abu - Dhabi new
psychiatric hospital reveals a remarkable benefit of day hospital service in
terms of both psychosocial and economic gain and a suitable place for
training and rehabilitation and a step to normal integration in community. The aim of establishing
day hospital is to promote and deliver health service to psychiatric patients
out side the traditional hospitals (Lois, E. Passi, Li 1998). Some consider day center
or hospital as partial hospitalisation with limited residency, and as
substitute to in patients wards (casino , etal , 1982), and it's multi-
facets of therapy is targeted to patients already remitted or partially
improved form acute state and so lessen pressures on hospitals services
(Frank , J.Ayd , 1995).This will mitigate the impact of social stigma of
mental illness and facilitate the transfer of acquired skills to community
after discharge ( Bierer, 1951) Several of psychiatric patients in hospital
can be managed easily in day hospitals instead of being in - patients, and
some studies clearly showed that 40% of in- patients can be cared in day
centers , (Herz, etal 1971) . Not all patients in day hospital are chronic
psychotics and socially disabled , but other diagnostic categories are
included such as depression . anxiety disorders , mental retardation and
personality disorders (Bender & Pilling 1985), even young people with
phobic disorder and lack of social skills can be contained in day
hospital to get their chance of improving psycho social abilities , (Gath,
etal 1973). The roles of
general hospitals and geriatric departments are still vital and will remain,
and there are a lot of patients who are unsuitable for day hospital like
acute cases , suicidal behaviour , aggressive and violent patients and
organic cases. All these patients need close supervision and intensive care
(Bowrnan , etal 1983). In Arab Countries, lack
of resources and trained specialized personnel’s , made health authorities
reluctant to think of establishing day hospital units. In Abu Dhabi New
Psychiatric hospital , we pioneered in establishing a day hospital in 1996.
It is run by trained team of clinical psychologist, social workers,
occupational therapist physical therapist and psychiatrists. The unit is
headed by consultant psychiatrist who organizes the available facilities and
methods of treatment according to patients individual need . The treatment
modalities include drug therapy, behavioral therapy, individual and group
therapy, counseling & depot clinic. This study is aimed to look on our
short experience and evaluate the opinions of staff, patients and families to
the day hospital service and activities . |
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q The Study |
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All patients who
attend day center in Abu - Dhabi New Psychiatric hospital (No.66) are the
sample of the study (table -1). Most of the patients have been admitted as in
-patients several times. Diagnosis, social and psychological assessments were
evaluated thoroughly before referral to day hospital and again assessed by
day center team. Treatment already advised by consultant was maintained,
unless there is clinical change or impending relapse. Diagnostic categories
of the sample are depicted below (table - 2). Table 1 : Distribution
of the sample by gender & nationality
Table 2 :
Diagnostic Categories of patients attending day hospital
Three self - rating instruments were
designed for the purpose ot the study to evaluate the service quality,
satisfaction and attitude of medical team, patients and their families
respectively (copes of these scales can be obtained from authors ).There was
agreement by specialist and experts that these self - rating scales can
measure the real objective aim of the study with high significant test
- retest reliability , correlation coefficient (0-88). The scale were also
provided by instruction and general information with open questions to elicit
more information not mentioned in the questionnaire. Percentile
results and frequencies were used, with application of correlation
coefficient ratio between various variables and X2 to reveal the significance
of differences (AI Zarrad, 1988). Findings The questionnaire (team scale) was given to the medical team of the
day unit and also to specialists who have been in day hospital and
transferred to other units of the hospital. This will give us a global
picture of the quality of service and plan deemed necessary. Content analysis
of response is shown below (table- 3). Table – 3 : Percentage of team attitude
The main key points mentioned
by positive attitude (98.97%) group are: 1- Programs and activities given to day
patients with the available resources are considered good. 2- The day hospital has achieved part of
it's goal in medical care and rehabilitation. 3- Being in a day hospital reduce the relapse rate and improve the
quality of life and suitable for psychosocial skill training necessary for
daily activities . The pessimistic group (negative
attitude 21.03%) gave their views on ideal expectation and aims. They
mentioned patients heterogeneity and absences of objective methods for
assessments. They also mentioned the shortage of training period of staff and
the repetitive boring activities and lack of evaluation after discharge. The
difference between negative and positive attitude group was significant 2
8.52, P 0.01 in favour of positive group. Family attitude toward day hospital care and utility to
their sick member is of paramount importance. This will reflect his
improvement in social and occupational domain as well as psychological
stability. Families response to the specially designed scale referred to a
bore was , + attitude 80%Vs - attitude 20% . Those who prefer day hospital
were impressed by improvement of self - care , participation in horne chores
and better communication with their sick member. The negative attitude
families (20%) gave no clear reason of their opinion and this probably sterm
from family dynamic with conflict, rejection and misunderstanding with wishes
to keep patient in long stay wards. There was a high percentage of patients
(90.35%) who feel happy, satisfied and much better in day hospital.
They gain a lot of skills , training and can interact with people in
acceptable way. The negative attitude group (9.65%) feels unsatisfied due to
frequent change of treating team members, lack of spacy areas, noises of music
and lack of privacy to discuss their personal problems. Results of groups
attitude were analyzed using the significance of percentile differences there
was no significant difference between the groups (table -4) Table – 4
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q Discussion |
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The
published studies about day centers agree about utility of the service in
these hospitals and it's suitability for treatment and rehabilitations and
helps family to support their sick members to integrate in community. Vaughan
, (1985) appeals for more implementation of day hospitals in health services.
Our study clearly showed that the day hospital is a best place for training
those patients who have pronounced defective psychosocial skills. The drop
rate in our sample was low (10%) Compared with (50%) reported by baek and
lundwall (1975) which they attribute to lack of transport personality
disorders and depressive illness . This observation is also found in our
study with additional factor of poor employment history. Although attitude of
our sample was significantly positive , we feel that there is a scope for
improvement in programs , training and objective evaluation of function out
side hospital. In spite of our limited experience with day hospital , the
achievement gained was rewarding and hospital administration is keen
to enlarge and maintain a modern standard of health care to patients through
training and teaching facilities. |
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q Conclusion |
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This study of patients (no.66)
attending day hospital in Abu Dhabi psychiatric hospital to find out their
satisfaction and attitude to the service and also their families (no.30) and
team work (no.29) The attitudes of the groups concerned were measured by
specially designed scales. Results greatly favours day hospital as a
substitute for in- patients and a place for proper training, treatment and
rehabilitation. We are looking for ward to improve our service and enlighten
our experience in day hospital utility and efficacy in UAE. |
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q Limitations of the study |
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This study in a small under developed country
with high percent of non- locals and small sample size may not represent the
views of people at large. Recent introduction of health service insurance
system will put great limitation on non-locals to attend day hospital. This
bias of interest rnight be reduced in the future with more homogenous large
sample. |
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q Acknowledgements |
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We wish to thank all the psychiatrist , nurses, social workers
psychologists, occupational therapists, patients and
families for their participation. |
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q References |
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1- BaekLand , F. Lundwall , L. (1 975)
Dropping out of treatment, A critical Psychological Bulletin. No. 82,P.738 2- Bender, M.P., Pilling, S. (1985) A study of variables associated
with under attendance at psychiatric day center Psychological Medicine, No
15,P. 395 3- Bierer,J.(1951) The day hospital
-Lewis Co. London, P.69 4- Bowman, E.P.etal (1983) Day hospital patients Vs, in -patients ,
factors determining selection of acutely ill patients for hospital treatment.
British J.Psych. No. 42,P .584 5- Casino, J.P., Wilner , M., Maxey, J.T. (1 982). American
Association for partial hospitalisation. International journal of partial
hospitalization. No. 1, (5-21) 6- Faisal Al Zarrad (1988) Edit Advanced
Educational & Psychological Statistics . Dar - Al Gallam -Dubai 7- Frank , J.,AYD, JR (1995) Lexicon of
psychiatry , neurology and neurosciences William and Wakins , USA.P.
185,494 8- Gath, D. , Hassal , C., Cross, K.W. (1973) Psychiatric day
hospital care. A study of day patients in Birmingham. British M.,
journal No. 1 , P-94 9- Herz, M.I. etal (1971) Day Vs in
-patients hospitalization controlled study American J. Psychiatry, No.
127,P.1371 10- Lois, E.
Passi, L (1 998) A guide to creative group programming in the
psychiatric day hospital The Haworth press, Inc Binghamton, NY 11- Vaugham, Pj. (1985) Development in psychiatric day care
British. Journal of Psychiatry . No 147.(1-41). |
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Document Code
OP.0062 |
ترميز المستند OP.0062 |
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