Psychiatr Prax 2011; 38 - OP28_TP
DOI: 10.1055/s-0031-1277832

The role of psychiatrists and nurses present a strong association with the number of outpatient visits among patients with schizophrenia

B Moreno-Küstner 1, J Bellón 2, F Mayoral 3, P Angona 4, J García-Herrera 4, D Navas 1, P Moreno 1, F Rivas 3
  • 1Department of Personality, Evaluation and Psychological Treatment, University of Málaga, Spain
  • 2El Palo Health Centre, Department of Preventive Medicine, University of Málaga, Spain
  • 3Psychiatric Service, University Hospital Carlos Haya, Málaga, Spain
  • 4Community Mental Health Centre „Guadalmedina“, University Hospital Carlos Haya, Málaga, Spain

Background/Objectives: To identify factors associated with visits by patients with schizophrenia and related disorders to community mental health services at the Mental Health Department of Carlos Haya Hospital in Malaga, Spain.

Methods: This study was carried out in the Mental Health Department of Carlos Haya Hospital. The hospital covers a geographically defined area in Malaga (southern Spain) with a population in 2006 of 346,504 inhabitants, attending one of 13 primary health care centres. We undertook a cross-sectional study. Data on demographic and clinical factors and service use were obtained from the public mental health services database and centralised in the „Malaga Schizophrenia Case Register“ (RESMA). The outcome measure, defined as the total number of outpatient consultations during one year, was analysed by multilevel multivariate linear regression.

Results: The analysis included 1097 patients with diagnoses of schizophrenia and related disorders (F20-F29, ICD-10). The adjusted model explained 46.35% of the variance. Patients who contacted both types of professional (nurses and psychiatrists) had a higher number of visits compared to patients who only contacted a psychiatrist (p<0.001), and the individual psychiatrist attending the patients was also associated with the number of visits (p<0.001). Clinical variables, such as a higher global level of severity (p<0.001), a diagnosis of a persistent delusion disorder (p=0.04) and having an inpatient episode (p<0.001), were also associated with a higher number of visits. Patients who were receiving welfare benefits (p=0.02) or who had no formal education or were illiterate (p=0.02) had a higher number of visits. Furthermore, fewer ambulatory contacts were associated with patients living alone (p=0.05), living outside the study area (p=0.07) and living in more rural municipalities (p=0.07).

Discussion/Conclusions: Although the investigation was carried out in a particular area of Malaga, Spain, the results can be applied to patients with schizophrenia in other community-based, public mental health care systems in Spain. Among all variables, the role of psychiatrists and nurses in organized outpatient settings present the strongest association with the number of visits by similar patients.

Funding: Andalusian Health Department (grant numbers 05/353, PI-0338/08; PI-0332/08), the Andalusian Research Plan (grant no. PAI: CTS-587) and the Spanish Ministry of Health (grant no. RedIAPP: RD06/0018/0039).

Keywords: Public and private services, schizophrenia, service use.