Arikawa Masatoshi, Ota Kazumi, Azekawa Takaharu, Ohashi Shizuko, Funaoka Yoichi, Yoshiie Hiroshi, Koshi Haruka, Takaishi Yohei, Nakao Saeka
Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan.
Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan.
Patient Prefer Adherence. 2021 Feb 2;15:169-175. doi: 10.2147/PPA.S282958. eCollection 2021.
One of the challenges of treating schizophrenia is how to improve persistence with outpatient treatments. Lengthening community life by improving persistence and preventing relapse and rehospitalization can have positive influence on the patients' personal recovery and well-being. In Japan, there is "Medical Expenses for Services and Supports for Persons with Disabilities" ("Jiritsu-shien-iryo-hi" in Japanese) which is the public financial support system for psychiatric outpatient treatments. However, it is not clear how this financial support affects persistence with outpatient treatments for patients with schizophrenia. The purpose of the study is to investigate how the financial support affects persistence with outpatient treatments for schizophrenia.
Data of outpatients who visited the clinic between October 1, 2006 and September 30, 2016 was collected. The variables for the analysis were continuation and discontinuation of treatment of those who used the financial support (user) and those who did not (nonuser). The covariates were sex, age, time from onset of the disease to first visit to the clinic, number of hospitalizations in the past, use of psychiatric day care, and use of psychiatric home nursing care. Kaplan-Meier analysis was performed using propensity score matching. The observation period was five years from the first visit to the clinic.
Among 1155 patients who were diagnosed with schizophrenia, 718 were excluded, based on the exclusion criteria. The propensity score matching was performed for 437 patients, and the subjects for the final analysis were 278. Average survival period was 1.09 (SD ±1.66) years for nonuser, 3.02 (SD ±1.77) years for users, and users exhibited a significantly longer number of years of outpatient treatments (<0.001).
The results indicated that use of the financial support can contribute to persistence with outpatient treatments.
治疗精神分裂症的挑战之一是如何提高门诊治疗的持续性。通过提高持续性、预防复发和再住院来延长社区生活，可对患者的个人康复和幸福感产生积极影响。在日本，有“残疾人服务与支持医疗费用”（日语为“自立支援医疗费”），这是精神科门诊治疗的公共财政支持系统。然而，尚不清楚这种财政支持如何影响精神分裂症患者门诊治疗的持续性。本研究的目的是调查财政支持如何影响精神分裂症患者门诊治疗的持续性。
收集了2006年10月1日至2016年9月30日期间到诊所就诊的门诊患者的数据。分析变量为使用财政支持的患者（使用者）和未使用财政支持的患者（非使用者）的治疗持续和中断情况。协变量包括性别、年龄、从发病到首次就诊的时间、过去的住院次数、使用精神科日间护理情况以及使用精神科家庭护理情况。采用倾向得分匹配法进行Kaplan-Meier分析。观察期为从首次就诊到诊所起的五年。
在1155例被诊断为精神分裂症的患者中，根据排除标准排除了718例。对437例患者进行了倾向得分匹配，最终分析的对象为278例。非使用者的平均生存期为1.09（标准差±1.66）年，使用者为3.02（标准差±1.77）年，使用者的门诊治疗年数显著更长（<0.001）。
结果表明，使用财政支持有助于门诊治疗的持续性。
