Quality of public sector care for schizophrenia in Arkansas.
OBJECTIVE
Using process-of-care indicators, we examined the quality of care provided to 139 individuals receiving treatment for schizophrenia in public sector systems.


METHODS
Longitudinal data on services use and medication management were abstracted from medical records. Medication adherence data were obtained by self- and informant reports.


RESULTS
Overall, 39% of participants had less than monthly contact with community-based service (CBS) providers. When participants in day treatment or partial hospitalization programs were excluded, less than monthly CBS contact increased to 70%. Of participants, 40%-60% were prescribed medications outside guideline-recommended dose ranges. Up to half of participants reported taking half or less of prescribed antipsychotics. The adverse impact on patient outcomes of these practice patterns is well established.


CONCLUSIONS
Public sector organizations face powerful challenges to the behavioral changes needed to sustain best practice care. Overcoming these challenges to assure high-quality care for schizophrenia will require tremendous creativity and commitment.
Centers for Mental Healthcare Research, Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, USA. fischerellenp@exchange.uams.edu
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Fischer
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Owen
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001131:Arkansas; D003156:Community Mental Health Services / Q000592:standards*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006760:Hospitalization / Q000706:statistics & numerical data; D006783:Hospitals, State / Q000592:standards*; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012559:Schizophrenia / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy*; D016896:Treatment Outcome
D014150:Antipsychotic Agents