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Services to schizophrenic patients: epidemiological and cost-effectiveness issues

Published online by Cambridge University Press:  13 June 2014

Richard Williams ,
Dermot Walsh  and
J Thomas Dalby
Richard Williams
Affiliation:
University of Calgary and Psychiatrist, Calgary General Hospital, 841 Centre Avenue E, Calgary, Alberta, Canada T2E 0A1
Dermot Walsh
Affiliation:
St. Loman's Hospital, Palmerstown, Dublin 20, Ireland
J Thomas Dalby
Affiliation:
Calgary General Hospital and Adjunct Associate Professor (Psychology and Psychiatry), University of Calgary
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Abstract

Objective: This study is designed to evaluate a hospital based integrated service for the comprehensive delivery of care and treatment to patients with schizophrenia, on epidemeological, cost effectiveness, and quality of life parameters. Methods: All patients with an ICD9 diagnosis of schizophrenia who received services from the St. Lomans Catchment area during a 2 year period were evaluated for service utilization during a subsequent 2 year period. Data was collected on basic demographics for the epidemiological aspects of the study, and for all aspects of services utilized, eg. day hospital attendance, inpatient bed useage, time spent with psychiatrist, community nurse visit or clinic visit. Costs for all services were calculated using disaggregate cost data. Quality of life of the patients was assessed through the Lehman quality of life questionnaire administered to every third identified patient. Results: 572 schizophrenic patients were identified from the case register and case records search. An analysis of the data indicated no difference in age of first contact with services on rural/urban or male/female comparisons contrasting with previously reported findings. Males tend to utilize proportionately more services in both rural and urban settings. Inpatient hospitalizations contributed the most to per patient costs and a small group of patients, comprising less than 5% of the total population, consumed 10% of the total costs consumed by all diagnostic groups and 30% of the costs of all schizophrenics. Non-hospitalized patients experienced the highest quality of life ratings. Conclusions: Hospital based community services to schizophrenics can be run cost-effectively. There remains a small subgroup of schizophrenic patients who are hard to place or treat in the community and they consume a disporportionate amount of the hospital's costs. Services that attempt to establish patients in the community can do so cost effectively provided there are hospital inpatient beds available as a back up. The benefits of this type of comprehensive service delivery to the schizophrenic population served are demonstrated.

Keywords

Cost effectivenessEconomic evaluationSchizophreniaService deliveryCommunity careEpidemiologyQuality of life
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 9 , Issue 2 , November 1992 , pp. 83 - 89
Copyright
Copyright © Cambridge University Press 1992

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References

1.Lehman, AF. Ward, NC, Linn, LS. Chronic mental patients: the quality of life issue. Am J Psychiatry 1982; 139: 1271–1276.Google ScholarPubMed
2.Lehman, AF, Possidente, S, Hawker, F. Quality of life of chronic patients in a state hospital and in community residences. Hosp Community Psychiatry 1986: 37: 901–907.Google Scholar
3.Loranger, AW. Sex differences in age of onset of schizophrenia. Arch Gen Psychiatry 1984; 41: 157–161.CrossRefGoogle Scholar
4.Hafner, H, Riecher, A, Maurer, K, Loffler, W, Munk-Jorgensen, P, Stromgren, E. How does gender influence age at first hospitalization for schizophrenia? Psychol Med 1989; 19: 903–918.CrossRefGoogle ScholarPubMed
5.Seeman, MV, Lang, M. The role of estrogens in schizophrenia gender differences. Schizophr Bull 1990; 16: 185–194.CrossRefGoogle ScholarPubMed
6.Williams, R, Dalby, JT. Drug and subject influences on measure of depression and negative symptoms in schizophrenic patients. In: Williams, R, Dalby, JT, editors. Depression in schizophrenics. New York: Plenum Press, 1989.CrossRefGoogle Scholar
7.Hafner, H, Heiden, W. Effectiveness and cost of community care for schizophrenic patients. Hosp Community Psychiatry 1989; 40: 59–63.Google ScholarPubMed
8.Drummond, M, Stoddart, G, Torrence, GW. Methods for the economic evaluation of health care programs. London: Oxford University Press, 1988.Google Scholar
9.Weisbrod, BA. A guide to benefit-cost as seen through a controlled experiment in treating the mentally ill. J Health Polit Policy Law 1983; 7: 808–845.CrossRefGoogle ScholarPubMed
10.Dickey, B, McGuire, TG, Cannon, NL, Gudeman, JE. Mental health cost models. Medical Care 1986; 24: 857–867.CrossRefGoogle ScholarPubMed
11.Schwefel, D, Zollner, H, Potthoff, P, editors. Costs and effects of managing chronic psychotic patients. Berlin: Springer-Verlag, 1988.CrossRefGoogle Scholar
12.Webb, M. What's Irish about psychiatry? Ir J Psychol Med 1990; 7: 7–16.CrossRefGoogle Scholar