Continuity of care for patients with schizophrenia and related disorders: a comparative South-Verona and Groningen case-register study
S. SYTEMA a1 , R. MICCIOLO a2 and M. TANSELLA a3
a1 Afdeling Sociale Psychiatrie, Rijksuniversiteit Groningen, Groningen, The Netherlands
a2 Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona, Italy
a3 Istituto di Statistica e Ricerca Operativa, Università di Trento, Trento, Italy
Background. It is widely believed that for the severely mentally ill continuity of care is essential to ensure a better outcome and prevent long-term hospitalization. However, not much progress has been made in the operationalization and measurement of this concept. We used two indicators to compare continuity of care of schizophrenic patients in two kinds of mental health systems. One is a community mental health system without the back-up of a mental hospital (South-Verona, Italy). The other is an institution-based system in which mental hospitals are still predominant (Groningen, The Netherlands).
Methods. The first indicator of continuity of care, readiness of aftercare, is the time from discharge from hospital to the first day- or out-patient contact. Survival analysis was applied to correct for censored observations. The second indicator, flexibility of care, is the use of combinations of in-, day- and out-patient care during 2-year follow-up.
Results. More patients in South-Verona received community care within 2 weeks after discharge (71·5%), than in the Groningen register area (54·6%). The survival functions differed significantly. Cox regression analysis revealed that in both systems a contact before admission, the time between this contact and admission and the duration of the admission are predictors for aftercare. A higher percentage of patients made multiple service use (combinations of in-, day- and out-patient care) in South-Verona than in Groningen (62 v. 45%).
Conclusions. Both indicators showed a higher continuity of care in the South-Verona system.
Address for correspondence: Dr S. Sytema, Academisch Ziekenhuis Groningen, Psychiatrische Universiteitskliniek, Afdeling Sociale Psychiatrie, Postbus 30001, 9700 RB Groningen, The Netherlands.