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Treatment adherence of a case managed program for patients with severe schizophrenia compared to standard care in mental health units.

Published online by Cambridge University Press:  19 July 2023

S. Díaz-Fernández ,
J. J. Fernández-Miranda  and
F. López-Muñoz
S. Díaz-Fernández*
Affiliation:
AGC Salud Mental V- HUCAB, Servicio de Salud del Principado de Asturias-SESPA, Gijón
J. J. Fernández-Miranda
Affiliation:
AGC Salud Mental V- HUCAB, Servicio de Salud del Principado de Asturias-SESPA, Gijón
F. López-Muñoz
Affiliation:
Health Sciencies, Universidad Camilo J. Cela, Madrid, Spain
*
*Corresponding author.

Abstract

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Introduction

Although some studies have reported that case management (CM), when is compared with standard care, reduces the loss of contact with health services, the debate continues about its superiority over other treatment models.

Objectives

To assess treatment adherence and reasons for treatment discontinuation, and the impact of the type of APs administration on it, for a group of patients with schizophrenia treated in a CMP or receiving standard treatment in mental health units (MHUs).

Methods

An observational, longitudinal study (ten-year follow-up) was conducted on 688 patients with severe schizophrenia (CGI-S ≥ 5). All the causes of the end of treatment were recorded, together with the AP medication prescribed and kind of regimes.

Results

43.6% of the patients had discontinued treatment in MHUs and only 12.1% on the CMP (p < 0.0001). 27.6% of patients in MHUs were on long-acting injectables (LAIs), and 57.6 on the CMP (p < 0.001). Treatment discontinuation was closely linked to be on OAPs medication in both cases (p < 0.001).Table 1.Treatment discontinuation, hospital admissions and suicide attempts [N(%)]

N= 688MHU (N=344)CMP (N= 344)P value
Treatment discontinuation290 (84.3)42 (12.2)<0.00001
OAPLAIOAPLAI
Treatment discontinuation180(52.3)90(26.2)a34(9.9)8(2.3)b
Hospital admissions260 (75.6)80 (23.5)<0.001
OAPLAIOAPLAI
Hospital admissions180 (52.3)80 (23.5)a65 (18.9)15 (4.4)b
Suicide attempts134 (38.9)26 (7.7)<0.0001
OAPLAIOAPLAI
Suicide attempts160(46.5)74(21.5)a18(5.2)8(2.3)b

a: p<0.01 b: p<0.001 N: number of patients %: percentage of patients

MHU: mental health unit CMP: case managed programme

AP: antipsychotic FGA, SGA: first, second generation antipsychotic

OAP: oral antipsychotic LAI: long-acting injectable antipsychotic

Conclusions

Our findings show how specific strategies as programs with an integrated treatment and case-managed approach, increase adherence. Moreover, treating with LAI APs clearly contributes to the achievement of these results. The widespread implementation of comprehensive community programs with case management, and the use of LAI-APs, should be an effective choice for people with schizophrenia and clinical severity and impairment, and at high risk of treatment discontinuation.

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 66 , Special Issue S1: Abstracts of the 31st European Congress of Psychiatry , March 2023 , pp. S1088 - S1089
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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