An integrated medical and psychosocial treatment program for psychotic disorders: patient characteristics and outcome.
OBJECTIVE
To provide an overview of a comprehensive and integrated case-management program that incorporates principles of assertive community treatment and combines effective medical and psychosocial interventions and to present the results of a process and outcome evaluation of the program, with particular emphasis on its impact on service utilization and consumer satisfaction.


METHODS
Data on demographic, clinical, and several outcome measures were collected on all patients who received care in the program for a minimum of 6 months. For process evaluation we assessed the extent to which the program adhered to its goals and satisfied the patients, their families, and community-service agencies. Outcome-evaluation data on the number and length of hospital admissions were compared for each subject with individual historical data for a period equal to the time spent in the program. In addition, relapses of psychotic symptoms that did not result in hospital admissions were calculated for each patient while in the program.


RESULTS
Demographic, clinical, and treatment characteristics of clients show that the program has succeeded in maintaining its focus on providing services to relatively chronically ill patients with psychotic disorders over a mean period of 3 years. The process-evaluation data indicated a high level of satisfaction by patients, families, and other service agencies with the services received. Information on outcome variable showed that the program achieved significantly lower rates of hospital admissions and relapse of psychosis than expected. There was a highly significant reduction achieved in the utilization of inpatient hospital resources for patients receiving care in the program. Most of the inpatient service utilization was attributed to patients either who were resistant to treatment with antipsychotic agents or who refused to accept or comply with medication.


CONCLUSIONS
It is possible to provide effective continuity of care from inpatient treatment to community adjustment for most individuals with psychotic disorders across the spectrum by blending hospital and community resources within an integrated case-management model of care.
Department of Psychiatry, University of Western Ontario, London. akmalla@julian.uwo.ca
A K
AK
Malla
R M
RM
Norman
T S
TS
McLean
S
S
Cheng
A
A
Rickwood
E
E
McIntosh
L
L
Cortese
K
K
Diaz
L P
LP
Voruganti
D000328:Adult; D002170:Canada; D019090:Case Management / Q000592:standards*; D002908:Chronic Disease; D003266:Continuity of Patient Care / Q000592:standards*; D005260:Female; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D008960:Models, Psychological; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D015397:Program Evaluation; D011618:Psychotic Disorders / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012559:Schizophrenia / Q000628:therapy*