Local availability of outpatient psychiatric specialists and inpatient length of stay

Background

Mental disorders involve long hospital stays that place strain on patients as well as healthcare resources. International evidence suggests that a portion of these stays may be longer than clinically necessary due to insufficient community care. If outpatient psychiatric specialists in particular are lacking it may be necessary to retain patients in a setting where contact is assured. Geographic variation in the provision of specialists may leave some regions more reliant on this fall back than others. This study investigates whether the density of outpatient specialists in patients’ district of residency is associated with the average length of hospital stay (ALoHS) for mental disorders in Austria.

Methods

We linked the number of outpatient psychiatric specialists per 100 000 population with administrative data on ALoHS for working-age adult patients with a mental disorder (ICD-10 F00 – F99) at the district level in Austria for the years 2018 – 2023. We used a spatial regression framework with a selection of socio-demographic controls to estimate the effect of specialist density on ALoHS.

Results

We assessed 519 149 inpatient stays across all 116 Austrian districts. Our model revealed a negative association between the density of outpatient psychiatric specialists and ALoHS (-0.8, 95%-CI: -1.6 to -0.2). In practical terms, each additional specialist per 100 000 population was associated with a 0.8-day reduction in ALoHS. We found substantial geographic variation among specialists with densities ranging from 0.4 to 6.3.

Conclusions

Our findings suggest that increasing the density of outpatient specialists may help to reduce ALoHS. They also suggest that an unequal distribution of specialists may leave some regions at higher risk of unnecessarily long stays. Further research is needed to identify causal mechanisms, but this study provides early evidence for a potential pathway through which the strain of long hospital stays might be alleviated.

Key messages

• Regions with a higher density of outpatient psychiatric specialists tend to have shorter inpatient stays for mental disorders.

• Increasing the density of outpatient psychiatric specialists may be a viable pathway through which the strain of long hospital stays on patients and healthcare resources can be alleviated.