Does high and intensive care reduce coercion? Association of HIC model fidelity to seclusion use in the Netherlands
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RESEARCH ARTICLE
Open Access
Does high and intensive care reduce coercion? Association of HIC model fidelity to seclusion use in the Netherlands A. L. Van Melle1,2*, E. O. Noorthoorn3, G. A. M. Widdershoven1, C. L. Mulder4,5 and Y. Voskes1,6,7
Abstract Background: A new inpatient care model has been developed in the Netherlands: High and Intensive Care (HIC). The purpose of HIC is to improve quality of inpatient mental healthcare and to reduce coercion. Methods: In 2014, audits were held at 32 closed acute admission wards for adult patients throughout the Netherlands. The audits were done by trained auditors, who were professionals of the participating institutes, using the HIC monitor, a model fidelity scale to assess implementation of the HIC model. The HIC model fidelity scale (67 items) encompasses 11 domains including for example team structure, team processes, diagnostics and treatment, and building environment. Data on seclusion and forced medication was collected using the Argus rating scale. The association between HIC monitor scores and the use of seclusion and forced medication was analyzed, corrected for patient characteristics. Results: Results showed that wards having a relatively high HIC monitor total score, indicating a high level of implementation of the model as compared to wards scoring lower on the monitor, had lower seclusion hours per admission hours (2.58 versus 4.20) and less forced medication events per admission days (0.0162 versus 0.0207). The HIC model fidelity scores explained 27% of the variance in seclusion rates (p < 0.001). Adding patient characteristics to HIC items in the regression model showed an increase of the explained variance to 40%. Conclusions: This study showed that higher HIC model fidelity was associated with less seclusion and less forced medication at acute closed psychiatric wards in the Netherlands. Keywords: Seclusion, Coercion, Model fidelity, Psychiatry, High and intensive care (HIC)
Background The use of seclusion in psychiatry is highly problematic. Effects on reducing stimuli and creating a context for calming the patient, which are often mentioned as a reason for secluding an agitated patient, have not been demonstrated [1–4]. On the other hand, negative * Correspondence: [email protected] 1 Department of Medical Humanities, Medical Faculty, Amsterdam University Medical Centers, location VUmc, F-wing, De Boelelaan 1089a, 1081, HV, Amsterdam, The Netherlands 2 Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany Full list of author information is available at the end of the article
experiences and traumatizing effects have been shown [5, 6]. In acute adult psychiatry in the Netherlands, seclusion use has been an issue of debate over the past twenty years. The Dutch Government invested heavily in seclusion reduction between 2006 and 2012 [7–9]. A national program was started, aiming at reduction of seclusion by 10% a year, without substitution by other coercive measures, including forced medication. This
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