Patient, provider, and treatment factors associated with poor-quality care for schizophrenia.
Interventions are needed to improve the quality of care for schizophrenia. However, in designing these interventions it would be helpful to understand better which patients are at highest risk for poor-quality care and why care for this disorder is often of poor quality. We study the extent to which patient and treatment factors are associated with poor-quality care in 224 patients randomly sampled from two mental health clinics. Quality of medication management is evaluated using an established method based on national treatment recommendations. Multivariate regression is used to study the effect of patient and treatment factors on treatment quality, controlling for provider. Risk for poor-quality care was greater for patients who were more severely ill, older, and less compliant with treatment recommendations. There were trends toward poor management of symptoms in men and substance abusers, and poor management of side effects in Black patients. Provision of poor-quality care was associated with failure to document symptoms and side effects in the medical record. Interventions to improve care for schizophrenia should attend to the need for accurate clinical assessment and strategies for managing challenging clinical situations.
Veterans Health Administration VISN 22 Mental Illness Research, Education and Clinical Center, Los Angeles, California 90073, USA. ayoung@ucla.edu
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Young
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Sullivan
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Duan
D000293:Adolescent; D000328:Adult; D000368:Aged; D003155:Community Mental Health Centers / Q000592:standards*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000592:standards; D011369:Professional-Patient Relations; D011567:Psychiatric Department, Hospital / Q000592:standards*; D011570:Psychiatry / Q000592:standards; D011787:Quality of Health Care; D012559:Schizophrenia / Q000175:diagnosis / Q000534:rehabilitation / Q000628:therapy*; D012720:Severity of Illness Index