Admitting or Discharging Patients with Opiate or Alcohol Related Problems? Psychiatrist Uncertainty and Welfare Losses.

BACKGROUND Much attention has focused on variations in therapeutic strategies across catchment areas and the related question of whether the differences in attitudes are due to socio-economic variables in the studied population or to physician uncertainty about making a specific therapeutic recommendation. SUBJECTS AND METHOD We monitored the emergency admission rate for patients with alcohol or opiate related problems of 9 resident psychiatrists for a year. To rule out differences in population characteristics, the study took place in only one hospital: Brugmann University Hospital, whose catchment area is the north of Brussels. RESULTS Our results show 3 distinctive practice styles. We suggest that variation in urgent admission rates for patients with alcohol and opiate related problems can be due not only to the socio-economic variables of the population, but also to medical uncertainty about the effectiveness of admission for the treatment of these disorders. CONCLUSION The extent of uncertainty about appropriate standards of care and the plausible related inappropriate care and welfare losses are discussed.