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VCR 99-012 – HSR&D Study

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VCR 99-012
Improving Health Services for Veterans with Schizophrenia
Alan S Bellack PhD
Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD
Baltimore, MD
Funding Period: April 2000 - March 2003

BACKGROUND/RATIONALE:
Schizophrenia exacts a high toll on the lives of patients and their families and constitutes a major health care cost. VISN 5 has placed special emphasis on improving care for veterans with severe mental disorders, an effort recently recognized by the VA as a Program of Excellence in the Care of Seriously Mentally Ill Veterans.

OBJECTIVE(S):
This study is implementing a set of promising QOC methods for assessing QOC for schizophrenia in routine settings, using the evidence-based treatment recommendations developed under the AHCPR/NIMH-sponsored Schizophrenia Patient Outcomes Research Team (PORT).

METHODS:
A random sample of 350 persons with a schizophrenia spectrum disorder is being drawn from the VISN 5 sites. Patients must have more than one outpatient contact during the preceding six months. Each subject will participate in two one-hour interviews, one at baseline and another six months later. An informant, psychiatrist, therapist, etc. will also be interviewed to help validate participant response.

FINDINGS/RESULTS:
To date, we have analyzed results from the initial 134 patients enrolled at the Baltimore and Perry Point VAMC sites who have completed baseline and follow-up assessments. The sample characteristics include: average age 49.2, 92.5 percent men, 35.1 percent Caucasian, 88.8 percent at least high school graduate, and 50 percent ever married. The rates of adherence of treatment plans to the PORT treatment recommendations are as follows: 58.8 percent antipsychotic doses within recommended range, 55 percent receiving adjunction anti-Parkinson agents, 67.4 percent receiving adjunctive antidepressant therapy for comorbid depression, 91.5 percent receiving psychological counseling, 30.1 percent receiving family services, and 24.6 percent in vocational rehabilitation. Compared to a non-VA sample in Baltimore, recruited under an NIMH grant, the rates of adherence within VA are higher for the recommendations on maintenance antipsychotic dose, use of antidepressants, and access to vocational rehabilitation.

IMPACT:
Our study will provide important insight into effectively treating persons with schizophrenia and schizophrenia spectrum disorders.

PUBLICATIONS:
None at this time.


DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Epidemiology
Keywords: Quality assessment, Schizophrenia
MeSH Terms: none

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