Article

Prediction of Homelessness Within Three Months of Discharge Among Inpatients With Schizophrenia

Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA.
Psychiatric Services (Impact Factor: 1.99). 06/1999; 50(5):667-73. DOI: 10.1176/ps.50.5.667
Source: PubMed

ABSTRACT The authors' goal was to identify factors that place inpatients with schizophrenia at risk of becoming homeless after hospital discharge.
Patients with schizophrenia or schizoaffective disorder (N=263) were assessed at discharge from general hospitals in New York City and reassessed three months later to evaluate whether they had become homeless. Sociodemographic and clinical characteristics associated with homelessness were identified using likelihood ratio chi square analysis and logistic regression.
Twenty patients (7.6 percent) reported an episode of homelessness during the follow-up period. Patients who had a drug use disorder at hospital discharge were significantly more likely to report becoming homeless than those without a drug use disorder. Patients with a total score above 40 on the Brief Psychiatric Rating Scale (BPRS) at hospital discharge were more likely to report becoming homeless than patients with lower scores, as were those with Global Assessment Scores less than 43. Twelve of 30 patients with a drug use disorder, a BPRS score above 40, and a GAS score less than 43 at hospital discharge reported becoming homeless.
The combination of a drug use disorder, persistent psychiatric symptoms, and impaired global functioning at the time of hospital discharge poses a substantial short-term risk of homelessness among patients with schizophrenia. Patients who fit this profile may be candidates for community-based programs that are specifically aimed at preventing homelessness among patients with severe mental illness.

0 Followers
 · 
88 Views
 · 
0 Downloads
  • Source
    • "Advantages • No need for daily administration • Guaranteed administration and transparency of adherence [Gerlach, 1995; Remington and Adams, 1995] • Allows healthcare professionals to be alerted and to intervene appropriately if patients fail to take their medication [NICE, 2009] • Less probability for rebound symptoms and rapidly occurring/abrupt relapses • Overcome partial adherence or overt nonadherence • If a relapse occurs, it is due to other reasons beyond noncompliance [Waddell and Taylor, 2009] • Reduced risk of unintentional or deliberate overdose [Gerlach, 1995; Remington and Adams, 1995] • Lower relapse rates [Walburn et al. 2001; De la Gándara et al. 2009; Gabel et al. 2010; Kane et al. 2010] • Minimal gastrointestinal absorption problems, circumventing first-pass metabolism [Dencker, 1984; Marder et al. 1989] • More consistent bioavailability [Waddell and Taylor, 2009] • More predictable correlation between dosage and plasma levels [Rocca et al. 2013] • Reduced peak-trough plasma levels [McEvoy, 2006] • Improved patient outcomes [Olfson et al, 1999] • Improved patients' and physicians' satisfaction [Peuskens et al. 2010] • Regular contact between the patient and mental healthcare team [Pandarakalam, 2003] Disadvantages • Slow dose titration [Heres et al. 2007] • Longer time to achieve steady state levels [Heres et al. 2007; Remington and Adams, 1995; Knox et al. 2004] • Less flexibility of dose adjustment [Gerlach, 1995] • Delayed disappearance of distressing and/or severe side effects • Pain at the injection site can occur, and leakage into the subcutaneous tissue and/or the skin may cause irritation and lesions (especially for oily long-acting injectable) • Burden of frequent travel to outpatient clinics or home visits by community nurses for their administration • Risperidone long-acting injectable needs refrigeration, which may be cumbersome in some latitudes • Perception of stigma "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite their widespread use, long acting injectable (LAI) antipsychotics (APs), are often regarded with some negativity because of the assumption of punishment, control and insufficient evolution towards psychosocial development of patients. However, LAI APs have proved effective in schizophrenia and other severe psychotic disorders because they assure stable blood levels, leading to a reduction of the risk of relapse. Therapeutic opportunities have also arisen after introduction of newer, second-generation LAI APs in recent years. Newer LAI APs are more readily dosed optimally, may be better tolerated and are better suited to integrated rehabilitation programmes. This review outlines the older and newer LAI APs available for the treatment of schizophrenia, with considerations of past and present pharmacological and therapeutic issues. Traditional, evidence-based approaches to systematic reviews and randomized clinical trials are of limited utility in this area so this paper’s blending of experimental trials with observational research is particularly appropriate and effective.
    Therapeutic Advances in Psychopharmacology 07/2014; DOI:10.1177/2045125314540297 · 1.53 Impact Factor
  • Source
    • "During the past years, many attempts have been made to propose models based on the potential risk factors to predict disease status as well as to determine the performance of such models in determining the matches between observed and expected outcomes. Some of the examples of prediction models include: homelessness within three months of discharge among inpatients with schizophrenia (Olfson et al., 1999), nerve function impairment in leprosy patients (Croft et al., 2003), pressure ulcer development (Schoonhoven et al., 2006), risk of depressive episode in adolescents (Van Voorbees et al., 2008), return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest (Gundersen et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper develops models for prediction of disease status from longitudinal data. The estimation of area under curve (AUC) is illustrated on the basis of estimates of sensitivity and specificity for repeated binary outcomes of disease status. There are several research papers in this field on cross-sectional data but only a few dealt with the repeated observations. This paper shows the procedures to deal with repeated observations employing Markov models. These procedures employ covariate dependent Markov models for estimating sensitivity and specificity, which in turn, produce the estimates for area under curve. The tests for equality of areas under curve for two models are also suggested. An application is illustrated for depression data from the Health and Retirement Survey, USA. The results indicate that the transition model approach can reveal the matching of disease status very efficiently; an estimate of more than 0.96 was obtained for the AUC for a transition model based prediction of disease from the depression data.
    Pakistan Journal of Statistics 03/2014; 30(2):181-196. · 0.34 Impact Factor
  • Source
    • "Most direct health care costs related to this mental illness are attributable to hospitalization for initial episodes and subsequent relapses.20 In addition to increasing inpatient care costs, repeated relapses may cause patients, family, and caregivers to become increasingly discouraged and pessimistic about the course of illness,9 which may produce secondary consequences of nonadherence: neurological deterioration,32 comorbid illness progression,33 substance use,34 criminal behavior,35 suicide attempts,36 re-hospitalization,23,37 or homelessness.38 "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is strong evidence supporting the link between nonadherence to antipsychotic medication and relapse of schizophrenia. However, less obvious are the economic consequences of nonadherence. The systematic review reported here evaluated the economic aspects of nonadherence to antipsychotic medication. A systematic review of scientific papers in the PubMed MEDLINE, Embase, PsychINFO, BIOSIS, and Evidence-Based Medicine Reviews databases was undertaken. Studies that measured adherence to antipsychotic medication and that provided comparative information on health care costs were included. Eight studies met the inclusion criteria. All were observational. Despite the differences between the studies in terms of design, adherence measures, and cost components analyzed, the results of this systematic review indicate that nonadherence to antipsychotic medication is associated with increased hospitalization rates and resource utilization, resulting in increased direct health care costs. Nonadherence to antipsychotic medication results in poor health and economic outcomes; therefore, the authors suggest endorsing interventions aimed at improving adherence because they can improve patient health without substantially increasing costs.
    Patient Preference and Adherence 04/2013; 7:275-84. DOI:10.2147/PPA.S41609 · 1.49 Impact Factor
Show more

Preview

Download
0 Downloads
Available from