Department Psychiatry Amsterdam University Medical Centre - location VUmc, Oldenaller 1, 1081 HJ, Amsterdam, The Netherlands.
Department Psychiatry Amsterdam University Medical Centre - location AMC, Amsterdam, The Netherlands.
BMC Psychiatry. 2021 Jun 29;21(1):319. doi: 10.1186/s12888-021-03319-7.
Patients with schizophrenia need continuous integrated healthcare, but many discontinue their treatment, often experiencing adverse outcomes. The first objective of this study is to assess whether patient characteristics or treatment history are associated with discontinuity of psychiatric elective care. The second objective is to assess whether practice variation between providers of psychiatric care contributes to discontinuity of elective care.
A large registry-based retrospective cohort of 9194 schizophrenia patients, who were included if they received elective psychiatric care in December 2014-January 2015. Logistic regression models were used to identify predictive factors of discontinuity of care. The dependent variable was the binary variable discontinuity of care in 2016. Potential independent predictive variables were: age, sex, urbanization, and treatment history in 2013-2014. Practice variation between providers was assessed, adjusting for the case mix of patients regarding their demographic and care utilization characteristics.
12.9% of the patients showed discontinuity of elective psychiatric care in the follow-up year 2016. The risk of discontinuity of care in 2016 was higher in younger patients (between age 18 and 26), patients with a history of receiving less elective psychiatric care, more acute psychiatric care, more quarters with elective psychiatric care without antipsychotic medication, or receiving no elective treatment at all. No evidence for practice variation between providers was found.
Our findings show that the pattern of previous care consumption is an important prognostic factor of future discontinuity of elective care. We propose that previous care consumption can be used to design strategies to improve treatment retention and focus resources on those most at risk of dropping out.
精神分裂症患者需要持续的综合医疗保健，但许多人中断治疗，经常出现不良后果。本研究的首要目标是评估患者特征或治疗史是否与精神科择期治疗的中断有关。第二个目标是评估精神科治疗提供者之间的实践差异是否导致择期治疗的中断。
这是一项基于大型登记的回顾性队列研究，纳入了 9194 名精神分裂症患者，如果他们在 2014 年 12 月至 2015 年 1 月期间接受了择期精神科治疗。使用逻辑回归模型来确定治疗中断的预测因素。因变量是 2016 年治疗中断的二项变量。潜在的独立预测变量包括：年龄、性别、城市化程度和 2013-2014 年的治疗史。评估了提供者之间的实践差异，并根据患者的人口统计学和护理利用特征对病例组合进行了调整。
在随访的 2016 年，有 12.9%的患者出现择期精神科治疗中断。在 2016 年，治疗中断的风险在较年轻的患者（18-26 岁之间）、接受较少择期精神科治疗、更多急性精神科治疗、更多个季度接受无抗精神病药物的择期精神科治疗或根本没有接受择期治疗的患者中更高。未发现提供者之间的实践差异的证据。
我们的研究结果表明，以前的护理消费模式是未来择期护理中断的一个重要预后因素。我们建议可以使用以前的护理消费来设计策略，以提高治疗保留率，并将资源集中在那些最有可能退出的患者身上。
