Residential alternatives to acute in-patient care in England: satisfaction, ward atmosphere and service user experiences.

BACKGROUND Alternatives to traditional in-patient services may be associated with a better experience of admission. AIMS To compare patient satisfaction, ward atmosphere and perceived coercion in the two types of service, using validated measures. METHOD The experience of 314 patients in four residential alternatives and four standard services were compared using the Client Satisfaction Questionnaire (CSQ), the Service Satisfaction Scale - Residential form (SSS-Res), the Ward Atmosphere Scale (WAS) and the Admission Experience Scale (AES). RESULTS Compared with standard wards, service users from alternative services reported greater levels of satisfaction (mean difference CSQ 3.3, 95% CI 1.8 to 4.9; SSS-Res 11.4, 95% CI 5.0 to 17.7). On the AES, service users in alternatives perceived less coercion (mean difference -1.3, 95% CI -1.8 to -0.8) and having more ;voice' (mean difference 0.9, 95% CI 0.6 to 1.2). Greater autonomy, more support and less anger and aggression were revealed by WAS scores. Differences in CSQ and AES scores remained significant after multivariable adjustment, but SSS-Res results were attenuated, mainly by detention status. CONCLUSIONS Community alternatives were associated with greater service user satisfaction and less negative experiences. Some but not all of these differences were explained by differences in the two populations, particularly in involuntary admission.