Linking inpatients with schizophrenia to outpatient care.
OBJECTIVE
This study focused on inpatients with schizophrenia or schizoaffective disorder who were scheduled to begin outpatient care with clinicians who had not previously treated them. The authors evaluated the effects of communication between the patients and their outpatient clinicians before discharge on patients' referral compliance, psychiatric symptoms, and community function at follow-up three months after discharge.


METHODS
A total of 104 adult inpatients with schizophrenia or schizoaffective disorder who were scheduled to receive outpatient care from clinicians who had not previously treated them were evaluated at hospital discharge and again three months later. Comparisons were made between patients who had telephone or face-to-face contact with an outpatient clinician before hospital discharge and patients who did not have such contact.


RESULTS
About half (51 percent) of the inpatient sample communicated with an outpatient clinician before leaving the hospital. Compared with patients who had no communication, those who spoke with an outpatient clinician were significantly more likely to complete the outpatient referral. After baseline scores and other covariates were controlled for, predischarge contact with an outpatient clinician was associated with a significantly lower total Brief Psychiatric Rating Scale score at follow-up and less self-assessed difficulty controlling symptoms. Nonsignificant trends toward improved medication compliance and a lower rate of homelessness were also found. The two patients groups did not significantly differ in the proportion who were readmitted to the hospital or who made a psychiatric emergency room visit during the follow-up period.


CONCLUSIONS
Direct communication between inpatients and new outpatient clinicians may help smooth the transition to outpatient care and thereby contribute to improved control of clinical symptoms.
Olfson
M
M
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute 10032, USA. olfsonm@child.cpmc.columbia.edu
Mechanic
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D
Boyer
C A
CA
Hansell
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D000328:Adult; D000359:Aftercare / Q000458:organization & administration* / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000458:organization & administration / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D003156:Community Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009519:New York City; D010349:Patient Compliance; D010351:Patient Discharge; D010352:Patient Dropouts / Q000706:statistics & numerical data; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000628:therapy*; D016896:Treatment Outcome