Patient, Provider, and Treatment Factors Associated with Poor-Quality Care for Schizophrenia
Tóm tắt
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.
Tài liệu tham khảo
Allebeck, P. (1989). Schizophrenia: A life-shortening disease. Schizophrenia Bulletin, 15, 81–89.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: Author.
American Psychiatric Association (1997). Practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry, 154, 1–63.
American Psychiatric Association Steering Committee (1996). The Expert Consensus Guideline Series. Treatment of schizophrenia. Journal of Clinical Psychiatry, 57, 3–58.
Baker, F. M., & Bell, C. C. (1999). Issues in the psychiatric treatment of African Americans. Psychiatric Services, 50, 362–368.
Barnes, T. R. (1989). A rating scale for drug-induced akathisia. British Journal of Psychiatry, 154, 672–676.
Belitsky, R., & McGlashan, T. H. (1993). The manifestations of schizophrenia in late life: A dearth of data. Schizophrenia Bulletin, 19, 683–685.
Bickman, L., & Salzer, M. S. (1997). Measuring quality in mental health services. Evaluation Review, 21, 285–291.
Brook, R. H., McGlynn, E. A., & Cleary, P. D. (1996). Quality of health care. Part 2: Measuring quality of care. New England Journal of Medicine, 335, 966–970.
Brook, R. H., Park, R. E., Chassin, M. R., Solomon, D. H., Keesey, J., & Kosecoff, J. (1990). Predicting the appropriate use of carotid endarterectomy, upper gastrointestinal endoscopy, and coronary angiography. New England Journal of Medicine, 323, 1173–1177.
Buchanan, R. W. (1995). Clozapine: Efficacy and safety. Schizophrenia Bulletin, 21, 579–591.
Caton, C. L., Shrout, P. E., Dominguez, B., Eagle, P. F., Opler, L. A., & Cournos, F. (1995). Risk factors for homelessness among women with schizophrenia. American Journal of Public Health, 85, 1153–1156.
Cuffel, B. J., Jeste, D. V., Halpain, M., Pratt, C., Tarke, H., & Patterson, T. L. (1996). Treatment costs and use of community mental health services for schizophrenia by age cohorts. American Journal of Psychiatry, 153, 870–876.
Day, J. C., Wood, G., Dewey, M., & Bentall, R. P. (1995). A self-rating scale for measuring neuroleptic side-effects. Validation in a group of schizophrenic patients. British Journal of Psychiatry, 166, 650–653.
Dixon, L., Weiden, P., Torres, M., & Lehman, A. (1997). Assertive community treatment and medication compliance in the homeless mentally ill. American Journal of Psychiatry, 154, 1302–1304.
Dixon, L. B., Lehman, A. F., & Levine, J. (1995). Conventional antipsychotic medications for schizophrenia. Schizophrenia Bulletin, 21, 567–577.
Donabedian, A. (1980). Explorations in quality assessment and monitoring. Volume 1: The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press.
Drake, R. E., Mercer-McFadden, C., Mueser, K. T., McHugo, G. J., & Bond, G. R. (1998). Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24, 589–608.
Essock, S. M., Frisman, L. K., & Kontos, N. J. (1998). Cost-effectiveness of assertive community treatment teams. American Journal of Orthopsychiatry, 68, 179–190.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for the Diagnostic and statistical manual of mental disorders, 4th ed., Patient Edition, Version 2.0. New York: New York State Psychiatric Institute.
Gittelsohn, A. M., Halpern, J., & Sanchez, R. L. (1991). Income, race, and surgery in Maryland. American Journal of Public Health, 81, 1435–1441.
Goldberg, H. I., Wagner, E. H., Fihn, S. D., Martin, D. P., Horowitz, C. R., Christensen, D. B., Cheadle, A. D., Diehr, P., & Simon, G. (1998). A randomized controlled trial of CQI teams and academic detailing: Can they alter compliance with guidelines? Joint Commission Journal on Quality Improvement, 24, 130–142.
Jeste, D. V., Eastham, J. H., Lacro, J. P., Gierz, M., Field, M. G., & Harris, M. J. (1996). Management of late-life psychosis. Journal of Clinical Psychiatry, 57, 39–45.
Jeste, D. V., Lacro, J. P., Gilbert, P. L., Kline, J., & Kline, N. (1993). Treatment of late-life schizophrenia with neuroleptics. Schizophrenia Bulletin, 19, 817–830.
Jeste, D. V., Rockwell, E., Harris, M. J., Lohr, J. B., & Lacro, J. (1999). Conventional vs. newer antipsychotics in elderly patients. American Journal of Geriatric Psychiatry, 7, 70–76.
Jones, S. H., Thornicroft, G., Coffey, M., & Dunn, G. (1995). A brief mental health outcome scale—Reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry, 166, 654–659.
Kahn, K. L., Pearson, M. L., Harrison, E. R., Desmond, K. A., Rogers, W. H., Rubenstein, L. V., Brook, R. H., & Keeler, E. B. (1994). Health care for Black and poor hospitalized Medicare patients. JAMA, 271, 1169–1174.
Kane, J. M. (1985). Compliance issues in outpatient treatment. Journal of Clinical Psychopharmacology, 5, 22S-27S.
Kane, J. M., & Marder, S. R. (1993). Psychopharmacologic treatment of schizophrenia. Schizophrenia Bulletin, 19, 287–302.
Khan, S. S., Nessim, S., Gray, R., Czer, L. S., Chaux, A., & Matloff, J. (1990). Increased mortality of women in coronary artery bypass surgery: Evidence for referral bias. Annals of Internal Medicine, 112, 561–567.
Kissling, W. (1994). Compliance, quality assurance and standards for relapse prevention in schizophrenia. Acta Psychiatrica Scandinavica Supplement, 382, 16–24.
Krakowski, M. I., Kunz, M., Czobor, P., & Volavka, J. (1993). Long-term high-dose neuroleptic treatment: Who gets it and why? Hospital and Community Psychiatry, 44, 640–644.
Lehman, A. F., & Steinwachs, D. M. (1998a). Patterns of usual care for schizophrenia: Initial results from the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey. Schizophrenia Bulletin, 24, 11–20.
Lehman, A. F., & Steinwachs, D. M. (1998b). Translating research into practice: The Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophrenia Bulletin, 24, 1–10.
Lurie, N., Ward, N. B., Shapiro, M. F., Gallego, C., Vaghaiwalla, R., & Brook, R. H. (1986). Termination of Medi-Cal benefits. A follow-up study one year later. New England Journal of Medicine, 314, 1266–1268.
Marder, S. R., & Meibach, R. C. (1994). Risperidone in the treatment of schizophrenia. American Journal of Psychiatry, 151, 825–835.
McGlynn, E. A., Norquist, G. S., Wells, K. B., Sullivan, G., & Liberman, R. P. (1988). Quality-of-care research in mental health: Responding to the challenge. Inquiry, 25, 157–170.
McGuire, T. G. (1991). Measuring the economic costs of schizophrenia. Schizophrenia Bulletin, 17, 375–388.
Miklowitz, D. J., Goldstein, M. J., Nuechterlein, K. H., Snyder, K. S., & Doane, J. A. (1986). Expressed emotion, affective style, lithium compliance, and relapse in recent onset mania. Psychopharmacology Bulletin, 22, 628–632.
Mittman, B. S., Tonesk, X., & Jacobson, P. D. (1992). Implementing clinical practice guidelines: Social influence strategies and practitioner behavior change. Quality Review Bulletin, 18, 413–422.
Mueser, K. T., Bellack, A. S., & Blanchard, J. J. (1992). Comorbidity of schizophrenia and substance abuse: Implications for treatment. Journal of Consulting and Clinical Psychology, 60, 845–856.
Munetz, M. R., & Benjamin, S. (1988). How to examine patients using the Abnormal Involuntary Movement Scale. Hospital and Community Psychiatry, 39, 1172–1177.
Oxman, A. D., Thomson, M. A., Davis, D. A., & Haynes, R. B. (1995). No magic bullets: A systematic review of 102 trials of interventions to improve professional practice. CMAJ, 153, 1423–1431.
Peralta, V., Cuesta, M. J., Caro, F., & Martinez-Larrea, A. (1994). Neuroleptic dose and schizophrenic symptoms. A survey of prescribing practices. Acta Psychiatrica Scandinavica, 90, 354–357.
Peterson, E. D., Shaw, L. K., DeLong, E. R., Pryor, D. B., Califf, R. M., & Mark, D. B. (1997). Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? New England Journal of Medicine, 336, 480–486.
Rosenheck, R., & Cicchetti, D. (1998). A mental health program report card: A multidimensional approach to performance monitoring in public sector programs. Community Mental Health Journal, 34, 85–106.
Rupp, A., & Keith, S. J. (1993). The costs of schizophrenia. Assessing the burden. Psychiatric Clinics of North America, 16, 413–423.
Salokangas, R. K. (1997). Living situation, social network and outcome in schizophrenia: A five-year prospective follow-up study. Acta Psychiatrica Scandinavica, 96, 459–468.
Salzer, M. S., Nixon, C. T., Schut, L. J. A., Karver, M. S., & Bickman, L. (1997). Validating quality indicators: Quality as relationship between structure, process, and outcome. Evaluation Review, 21, 292–309.
Segal, S. P., Bola, J. R., & Watson, M. A. (1996). Race, quality of care, and antipsychotic prescribing practices in psychiatric emergency services. Psychiatric Services, 47, 282–286.
Sullivan, G., Wells, K. B., Morgenstern, H., & Leake, B. (1995). Identifying modifiable risk factors for rehospitalization: A case-control study of seriously mentally ill persons in Mississippi. American Journal of Psychiatry, 152, 1749–1756.
Udvarhelyi, I. S., Gatsonis, C., Epstein, A. M., Pashos, C. L., Newhouse, J. P., & McNeil, B. J. (1992). Acute myocardial infarction in the Medicare population. Process of care and clinical outcomes. JAMA, 268, 2530–2536.
Ventura, J., Green, M. F., Shaner, A., & Liberman, R. P. (1993a). Training and quality assurance with the Brief Psychiatric Rating Scale: “The drift busters.” International Journal of Methods in Psychiatric Research, 3, 221–244.
Ventura, J., Lukoff, D., Nuechterlein, K. H., Liberman, R. P., Green, M. F., & Shaner, A. (1993b). Brief Psychiatric Rating Scale (BPRS) expanded version (4.0): Scales, anchor points and administration manual. International Journal of Methods in Psychiatric Research, 3, 227–243.
Veterans Health Administration (1997). Clinical guideline for management of persons with psychoses, version 1.0. Washington, DC: Author.
Wagner, E. H., Austin, B. T., & Von Korff, M. (1996). Organizing care for patients with chronic illness. Milbank Quarterly, 74, 511–44.
Wallace, C. J., Liberman, R. P., MacKain, S. J., Blackwell, G., & Eckman, T. A. (1992). Effectiveness and replicability of modules for teaching social instrumental skills to the severely mentally ill. American Journal of Psychiatry, 149, 654–658.
Wells, K. B., Katon, W., Rogers, B., & Camp, P. (1994). Use of minor tranquilizers and antidepressant medications by depressed outpatients: Results from the Medical Outcomes Study. American Journal of Psychiatry, 151, 694–700.
Young, A. S., Sullivan, G., Burnam, M. A., & Brook, R. H. (1998). Measuring the quality of outpatient treatment for schizophrenia. Archives of General Psychiatry, 55, 611–617.