Patterns of Usual Care for Schizophrenia: Initial Results From the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey

Johns Hopkins University, Baltimore, Maryland, United States
Schizophrenia Bulletin (Impact Factor: 8.45). 01/1998; 24(1):11-20; discussion 20-32. DOI: 10.1093/oxfordjournals.schbul.a033303
Source: OAI


To examine the conformance of current patterns of usual care for persons with schizophrenia to the Schizophrenia Patient Outcomes
Research Team (PORT) Treatment Recommendations, the PORT surveyed a stratified random sample of 719 persons diagnosed with
schizophrenia in two States. The types of treatment settings surveyed included acute inpatient programs and continuing outpatient
programs in urban and rural locales. Using data from medical record reviews and patient interviews, the PORT assessed the
conformance of current care with 12 of the Treatment Recommendations. The rates at which patients' treatment conformed to
the recommendations were modest at best, generally below 50 percent. Conformance rates were higher for pharmacological than
for psychosocial treatments and in rural areas than in urban ones. Rates of Treatment Recommendation conformance for minority
patients were lower than those for Caucasians, and patterns of care varied between the two States. The findings indicate that
current usual treatment practices likely fall substantially short of what would be recommended based on the best evidence
on treatment efficacy. This disparity underscores the need for greater efforts to ensure that treatment research results are
translated into practice.

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Available from: Donald Steinwachs, Jan 19, 2014
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    • "Thus, while vocational rehabilitation programs in general and supported employment in particular have been shown to be beneficial for people with severe mental illness, such services are underutilized (Drake, Skinner, Bond, & Goldman, 2009). For example, in a survey of individuals with SMI, only about a quarter were either participating in or had been referred to supported employment (Lehman et al, 1998). "
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    ABSTRACT: Background: Supported employment is an effective intervention for people with serious mental illnesses (SMI) but is underutilized. Clients’ desire to work might be heightened by programs that provide counseling about managing one’s funds, since money management helps people become more aware of the advantages of having money. Aim: To analyze the thoughts of recently homeless or hospitalized persons with SMI concerning their personal finances and employment. Methods: We interviewed 49 people with SMI about their finances, reviewed transcripts and analyzed their baseline characteristics. Results: Twenty of the 49 participants spontaneously expressed a desire to work in order to earn more money. Those who expressed a desire to work managed their money significantly better than those who did not. Conclusion: Discussion of finances, such as that fostered by money management programs, may promote engagement in vocational rehabilitation and working for pay.
    Full-text · Article · Jul 2014 · Journal of Mental Health
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    • "This can be started either during the acute phase or later, including inpatient stay. " However, despite the strong evidence-base and the availability of clear guidelines, CBTp remains poorly disseminated in the US where pharmacological interventions remain the nearly exclusive treatment option for psychosis for a preponderance of patients (Olfson et al., 2002; Lehman & Steinwachs, 1998). Yet, as 25–55% of individuals with schizophrenia do not experience full relief from psychotic symptoms in response to pharmacological interventions (Kane, 1999; Pantelis & Barnes, 1996), and 3 out of 4 discontinue their medication within 18 months (Lieberman et al., 2005), many patients in the US may be potentially receiving suboptimal treatment, resulting in increased suffering and dysfunction. "
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    ABSTRACT: Cognitive-Behavioral Therapy for psychosis (CBTp) is an evidence-based treatment for psychosis-related disorders. However, despite the strong evidence-base and inclusion in national treatment guidelines, CBTp remains poorly disseminated in the US. It is proposed that this state is a product of lack of CBTp knowledge among clinical training leaders along with limited availability of training opportunities. We surveyed training directors in US psychiatry residency and clinical psychology doctoral programs to characterize the penetration of CBTp training and to assess their familiarity with basic CBTp facts. Directors displayed limited knowledge of CBTp effectiveness, with only 50% of psychiatry and 40% of psychology directors believing that CBTp is efficacious. Only 10% of psychiatry and 30% of psychology directors were aware that the CBTp evidence-base is based on meta-analyses. While 45% of all directors reported that their program offer CBTp training, trainees received limited training - 4 hours of didactics, 21 hours of treatment, and 12 hours of supervision. CBTp dissemination in the US is characterized by training directors' minimal awareness of the CBTp evidence-base along with training opportunities that are so limited, as to be unlikely to be adequate to provide CBTp effectively, hence unlikely to improve patients' psychoses.
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    • "In our study, only 43% of patients received the recommended antipsychotic maintenance dose of 300–600 mg CPZ equivalents, while 26% received doses below the recommended doses and 32% received above the recommended doses. Similar results were reported in other studies [34,35]. Kreyenbuhl et al., (2007) observed that dosages prescribed for patients receiving polypharmacy were the same or modestly higher than those prescribed for patients receiving monotherapy [30]. "
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    ABSTRACT: Analysis of the prescribing patterns of antipsychotic drugs can improve therapeutic outcomes. The purpose of this study was to evaluate the prescribing pattern of antipsychotics and its conformance to international treatment guidelines. A cross sectional study at primary psychiatric centers was carried out. Patients' medical files were used to obtain demographic, medication and clinical information. International guidelines for schizophrenia were used to create conformance indicators. All statistical analyses were conducted using Statistical Package for Social Sciences. 250 patients were included in this study. A total of 406 antipsychotic agents were used; 348 (85.7%) were first generation antipsychotics (FGA). The prevalence of antipsychotic combination was 50.4% (n=126). There was no significant difference in positive (p=0.3), negative (p=0.06) and psychopathology (p=0.5) scores of schizophrenia symptoms among patients on monotherapy versus those on antipsychotic combination. Furthermore, no significant difference was observed in the annual cost of antipsychotic monotherapy versus combination therapy. One hundred and five patients (42%) were using optimum dose of (300 -- 600 mg CPZeq) while the remaining were using sub or supra therapeutic doses. Analysis showed that use of depot, use of anticholinergic agents and increasing amount of total CPZeq were significant factors associated with antipsychotic combination. This study indicated that antipsychotic prescribing was not in conformance with international guidelines with respect to maintenance dose and combination therapy. Type of antipsychotic treatment regimen, combination versus monotherapy, was not associated with better clinical or economic outcome.
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