Timely outpatient treatment for schizophrenia ‘lacking’
MedWire News: Results from a US study show that more than 40% of schizophrenia patients receiving Medicaid do not receive timely outpatient treatment after discharge from hospital.
The transition from inpatient to outpatient psychiatric care poses substantial risks for premature treatment disengagement and increases the risk for relapse and poor mental health outcomes among patients with schizophrenia, explain Mark Olfson (Columbia University, New York, USA) and team.
Linking inpatient to outpatient care following hospital discharge is therefore a recognized indicator of quality of care.
To investigate factors associated with timely schizophrenia-related outpatient treatment following hospital discharge, the team studied Medicaid claims data for 2003 supplemented with data from the American Hospital Association facility survey, the Area Resource File, and a Substance Abuse and Mental Health Services Administration Medicaid policy report.
Factors associated with receipt of outpatient visits within 30 days after hospital discharge were assessed in 49,239 schizophrenia patients (59,567 treatment episodes) who were aged 20-63 years.
Overall, just 59.3% of patients received outpatient follow-up visits in the first 30 days after discharge, the team reports in the Journal of Clinical Psychiatry.
The researchers found that factors associated with an increased likelihood of receiving outpatient follow-up visits within 30 days of discharge included receipt of preadmission outpatient mental health visits (odds ratio [OR]=3.72), depot (OR=2.83) and oral (OR=1.73) antipsychotic treatment, compared with no antipsychotic treatment, and the absence of a substance use disorder (OR=1.35).
They also found that treatment in a general versus a psychiatric hospital and patient residence in a county with a large versus a small number of psychiatrists per capita were associated with an increased likelihood of receiving an outpatient visit within 30 days of discharge, at ORs of 1.32 and 1.27, respectively.
Factors associated with a reduced likelihood of receiving outpatients visits within 30 days of discharge included residence in a county with a high poverty rate (OR=0.60) and receipt of treatment in a state with authorization requirements for fewer than 12 annual outpatient visits (OR=0.69).
Olfson and team conclude: "Approximately four in 10 adults diagnosed with schizophrenia in this national sample of Medicaid patient did not receive outpatient treatment for their disorder within 1 month of hospital discharge."
They add: "A greater focus is needed on treatments services and policies that promote the timely transition to outpatient care in the community treatment of schizophrenia."
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By Mark Cowen