[The efficacy of day care in preventing the readmission of chronic schizophrenic patients].
Prolongation of outpatient treatment period assessed on the basis of outpatient survival rate (SR), etc., was used to evaluate the efficacy of day care (DC) in preventing the readmission of 95 chronic schizophrenic patients with a history of multiple admissions. Before using DC, SR gradually decreased as time since discharge passed, and after 300 weeks had fallen to 26%. After the introduction of DC, on the other hand, although SR decreased up to 230 weeks, from 230 weeks SR is found to plateau so that by 300 weeks it was 51%. In other words, not only was a lower readmission rate observed at the end of 300 weeks after the introduction of DC than before, but it became clear that about 230 weeks (approximately 4.5 years) had become a turning point with respect to prognosis. In addition, the mean duration of outpatient treatment was significantly longer beginning 175 weeks after discharge, after the introduction of DC than before (at 175 weeks, p less than 0.05; at 200 weeks, p less than 0.01, Wilcoxon test). The above demonstrate a readmission preventing effect and an outpatient treatment period prolonging effect of DC. Next, whole 95 patients were divided into a response group and a no-response group depending on whether their outpatient treatment period had been prolonged by DC. The prescribed doses of psychotropic drugs, which were represented by equivalent doses of chlorpromazine and haloperidol, were compared during the outpatient treatment period before and after the introduction of DC in the subjects in the response group, however, at least the possibility that increasing doses of psychotropic drugs as maintenance therapy agents was involved in prolonging the outpatient treatment period was ruled out. Moreover, the 47 patients who were readmitted within 300 weeks after the introduction of DC were divided into a response group and a no-response group, and when the proportions of patients who had to be readmitted during DC were compared, there were more in the no-response group (p less than 0.05, chi 2 test). Many of the cases requiring readmission during DC were intractable, and since there were many such patients in the no-response group, it appeared that the likelihood of belonging to the no-response group meant the simultaneous likelihood of being intractable during DC. Furthermore, when we checked the percentage of the number of DC users among patients who came to the outpatient clinic without being admitted, it was found to plateau at 30% around 170 weeks after discharge.(ABSTRACT TRUNCATED AT 400 WORDS)
Takeda
T
T
Jikei Hospital.
Omori
B
B
D000328:Adult; D002908:Chronic Disease; D003631:Day Care, Medical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011379:Prognosis; D011788:Quality of Life; D012559:Schizophrenia / Q000628:therapy*; D013997:Time Factors