Continuity of care: time to first outpatient appointment after child and adolescent psychiatric hospital stays in Germany

Optimizing treatment outcomes requires smooth sectoral transfer, which is especially true in child and adolescent psychiatry where timely outpatient follow-up is crucial. This study measured the time from hospital discharge to first outpatient contact (TDO) within the German healthcare system before and during the COVID-19 pandemic. Anonymized data of ~ 700,000 publicly insured children and adolescents (age: 0.0–17.9 years) were retrieved from the InGef database (2018–2021). An exploratory analysis examined TDO among patients with documented outpatient contact following discharge, and length of stay (LOS). Analyses were stratified by index diagnosis, sex, age, residency, socioeconomic status, and outpatient specialty. Results were compared pre-COVID-19 (01/2018–03/2020) vs. intra-COVID-19 (04/2020–12/2021). Between pre-COVID and intra-COVID, TDO decreased significantly for anorexia nervosa (pediatricians: -22.8 days, |d|=0.28; child and adolescent psychotherapists (CAPPs): -33.4 days, |d|=0.35), anxiety disorders (CAPPs: -27.1 days; |d|=0.22), and depressive disorders (child and adolescent psychiatrists: -25 days, |d|=0.22; CAPPs: -23.6 days, |d|=0.21). Reductions in LOS were significant for depressive disorders (-6.8 days, |d|=0.11). Considering the most rapid mean times to any outpatient provider within diagnoses in the pre-COVID period, depressive disorders (≈ 74 days) and anorexia nervosa (≈ 66 days) showed the longest TDO (anxiety disorders ≈ 47 days; obsessive-compulsive disorders ≈ 61 days; post-traumatic stress disorders ≈ 49 days). Regarding sex, residency and socioeconomic status, only minimal differences were observed. This study shows delays (> 2 months) between discharge from child and adolescent psychiatric inpatient care and first outpatient contact. Such intervals are noteworthy given the critical need for continuous care in potentially life-threatening conditions like anorexia nervosa, although these intervals shortened during the COVID-19 pandemic. While the underlying mechanisms remain unclear, further investigation is needed to evaluate whether these trends are associated with changes in inter-sectoral transfer.