title: Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis.
abstract: BACKGROUND
  Persons with schizophrenia and related disorders may be particularly sensitive to a number of determinants of service use, including those related with illness, socio-demographic characteristics and organizational factors. The objective of this study is to identify factors associated with outpatient contacts at community mental health services of patients with schizophrenia or related disorders.
  
  
  METHODS
  This cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and use of service factors. Data were collected from clinical records.
  
  
  RESULTS
  The multilevel linear regression model explained 46.35% of the variance. Patients with significantly more contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p < 0.001), with one or more inpatient admissions (p < 0.001), and in contact with both types of professional (nurses and psychiatrists) (p < 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p < 0.001).
  
  
  CONCLUSIONS
  As expected, the variables that explained the use of community service could be viewed as proxies for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More research is needed to carefully examine how professional support networks interact to affect use of mental health.
authors: Research Unit Distrito Sanitario Malaga, IMABIS Fundation, Department of Personality, Evaluation and Psychological Treatment, University of Malaga, Spain. bertamk@uma.es
authors: Berta
authors: B
authors: Moreno-Küstner
authors: Fermín
authors: F
authors: Mayoral
authors: Fabio
authors: F
authors: Rivas
authors: Pedro
authors: P
authors: Angona
authors: Javier
authors: J
authors: Requena
authors: José M
authors: JM
authors: García-Herrera
authors: Desiree
authors: D
authors: Navas
authors: Patricia
authors: P
authors: Moreno
authors: Antoni
authors: A
authors: Serrano-Blanco
authors: Juan A
authors: JA
authors: Bellón
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006302:Health Services Research; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012559:Schizophrenia / Q000628:therapy*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013030:Spain