Hospitalizations of patients with severe schizophrenia treated in a community based, case managed program vs. standard care. A ten-year follow-up.

șIntroduction: Case management has been shown to be successful in reduction of hospitalizations and people leaving treatment. Objectives: To know the treatment adherence and the psychiatric hospitalizations of patients with severe schizophrenia (GCI-S ≥5) before (standard treatment) and during treatment in a community based, case managed program. And also the role of oral or longacting injectable antipsychotic medication. Methods: Observational study, mirror image, of ten years of followup and ten retrospectives, of patients with severe schizophrenia in a community based program, with integrated pharmacological and psychosocial treatment and intensive case management (N=344). Reasons for the Program discharge and psychiatric hospital admissions were recorded ten years before and during treatment. And also the antipsychotic medication prescribed. Results: After 10 years 12.2% of the patients were voluntary discharges (In previous standard treatment: 84.3%). CGI-S at baseline was 5.9(0.7). After ten years 51.7% of patients continued under treatment (CGI-S= 3.9(0.9); p<0.01); 19.3% were medical discharged (CGI-S=3.4(1.5); p<0.001); and 12.2 were voluntary discharges. Forty patients died during follow-up, five of them by suicide. The percentage of patients with hospital admissions and the number of admissions due to relapses decreased after beggining in the Program (p <0.0001), and as well the involuntary ones (p <0.001). To be on long-acting injectable antipsychotic treatment was related to these results (p <0.0001). Conclusions: Treatment of patients with severe schizophrenia in a integrated, case-managed community-based program achieved higher retention, and was effective in reducing psychiatric hospitalizations, compared to the previous standard treatment. To be treated with long-acting injectable antipsychotics was clearly linked to these outcomes. [ABSTRACT FROM AUTHOR]