Farr Amanda M, Smith David M, Pesa Jacqueline A, Cao Zhun
Truven Health Analytics, Cambridge, MA, USA.
Janssen Scientific Affairs, Titusville, NJ, USA.
J Health Econ Outcomes Res. 2014 Oct 2;2(1):29-40. doi: 10.36469/9882. eCollection 2014.
For patients with schizophrenia, the transition from inpatient hospitalization to outpatient care presents a challenge to providing continuous care. Lapses in care during this time period can result in poor clinical outcomes. To date, there is little information regarding the association between inpatient antipsychotic treatment and outpatient care. The objectives of this study were to describe trends in and identify factors associated with post-discharge follow-up outpatient care among Medicaid enrollees with schizophrenia treated with antipsychotics. Adults administered oral or long-acting injectable antipsychotic medication during a hospitalization for schizophrenia were identified in the linked MarketScan® Hospital Drug and Multi-State Medicaid Databases. Psychiatric-related follow-up outpatient visits within 30 days of discharge were identified from Medicaid claims based on Healthcare Effectiveness Data and Information Set specifications. Kaplan-Meier curves and Cox proportional hazards models were used to describe and analyze time to follow-up visit and to identify patient and hospitalization characteristics associated with follow-up visit. The study sample (N=1,312) had a mean age of 40.5 years and was 57% male. A follow-up outpatient visit was identified among 47% of patients. The proportion of patients with a follow-up visit ranged from 25% in 2005 to 48% in 2010/2011. The Cox proportional hazard model suggests that capitated health plan, attending physician specialty of psychiatry/psychology, and later year of index hospitalization significantly increase the probability of a follow-up visit, while substance-related disorders significantly decrease the probability. Type of antipsychotic received during index hospitalization was not significantly associated with probability of a follow-up visit. While follow-up visit rates have increased over time, this study highlights the ongoing need for improvements in effective linkage to outpatient care for patients hospitalized and treated for schizophrenia, particularly among patients with comorbid substance abuse disorder.
对于精神分裂症患者而言，从住院治疗过渡到门诊护理对提供持续护理构成了挑战。在此期间护理的中断可能导致不良的临床结果。迄今为止，关于住院抗精神病药物治疗与门诊护理之间的关联信息甚少。本研究的目的是描述接受抗精神病药物治疗的医疗补助计划（Medicaid）参保精神分裂症患者出院后门诊随访护理的趋势，并确定与之相关的因素。在链接的MarketScan®医院药物和多州医疗补助数据库中，识别出在精神分裂症住院期间接受口服或长效注射抗精神病药物治疗的成年人。根据医疗保健有效性数据和信息集规范，从医疗补助理赔记录中识别出出院后30天内与精神科相关的门诊随访就诊情况。采用Kaplan-Meier曲线和Cox比例风险模型来描述和分析随访就诊时间，并确定与随访就诊相关的患者及住院特征。研究样本（N = 1312）的平均年龄为40.5岁，男性占57%。47%的患者有门诊随访就诊记录。有随访就诊记录的患者比例从2005年的25%到2010/2011年的48%不等。Cox比例风险模型表明，按人头付费的健康计划、主治医生为精神病学/心理学专业以及较晚年份的首次住院显著增加了随访就诊的可能性，而物质相关障碍则显著降低了这种可能性。首次住院期间接受的抗精神病药物类型与随访就诊的可能性无显著关联。虽然随访就诊率随时间有所增加，但本研究强调，对于住院并接受精神分裂症治疗的患者，尤其是合并物质滥用障碍的患者，仍需不断改进与门诊护理的有效衔接。
