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APHA Scientific Session and Event Listing

Jonathan D. Prince, PhD, School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, 732-932-7411, jdprince@rci.rutgers.edu

Title: Intervention Adherence among Recently Discharged Inpatients with Schizophrenia.

Objective: Delineate factors associated with dropout from community mental health care in order to promote ongoing enrollment and prevent re-hospitalization.

Methods: Data for this longitudinal analysis were taken from the Rutgers Hospital and Community Survey (1994-1996). Upon psychiatric hospital discharge, 315 inpatients with schizophrenia completed a structured assessment that covered several domains. After three months, 264 persons were available to report extent of outpatient program adherence. Chi-square analyses and t-tests for categorical and continuous variables, respectively, identified non-adherence risk factors. Logistic regression equations then determined which factors could predict dropout after accounting for age, gender, and race influences.

Results: After at least one appointment, forty-nine of the 264 individuals discontinued one or more outpatient programs during the three months (19%). Individuals who discontinued outpatient care were significantly more likely to be admitted to an inpatient unit of a hospital for psychiatric or substance abuse reasons. As in prior studies, medication noncompliance, substance abuse, and service dissatisfaction predicted non-adherence. Moreover, arrest history more than doubled dropout odds after accounting for influence of demographic characteristics. Inpatient use of substance abuse services decreased dropout odds by a factor of almost six.

Conclusion: Perhaps non-adherence risk can be assessed in the hospital using chart information and clinical interview, and once identified the more vulnerable individuals can be offered services that have been shown to enhance outpatient care participation in order to prevent costly inpatient stay.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• List five factors that promote outpatient program withdrawal among recently discharged inpatients with schizophrenia
• Articulate several services that can facilitate ongoing enrollment in community mental health care in order to prevent re-hospitalization.
• Evaluate dropout risk in outpatient care and develop an intervention strategy for vulnerable persons.

Keywords: Mental Illness, Outcomes Research

Presenting author's disclosure statement:

Not Answered