Hospitalization in the First Year of Treatment for Schizophrenia

Article excerpt

Objective: To determine the rates of hospitalization during the first year of treatment for schizophrenia, using an epidemiologic sample.

Method: We examined inpatient and outpatient administrative databases in the province of Nova Scotia for cases of schizophrenia (ICD-9 code 295 or 298) newly diagnosed during the years 1995 to 1998. We noted the diagnosis site (that is, inpatient or outpatient) and hospitalizations in the year following diagnosis. We also established links to the clinical database maintained by the Nova Scotia Early Psychosis Program (NSEPP).

Results: Over the 4-year period, we identified 434 unique cases from an at-risk population of 320 000 (yielding a yearly average age-specific incidence rate of 3.3/10 000), of whom 119 had received care from the NSEPP. Of the cases, 54% were initially diagnosed while they were inpatients. In the year following diagnosis, the overall hospitalization rate, excluding initial hospitalizations, was 17%. Patients who were initially diagnosed while inpatients had a higher rate of hospitalization in the first year of treatment (25% vs 7%), compared with those initially diagnosed while outpatients. This relation was also present among patients who received care from the NSEPP.

Conclusions: Of newly diagnosed patients with schizophrenia, 46% were not hospitalized at the time of initial diagnosis. Of all patients, 17% required hospitalization during the first year of treatment, excluding an initial hospitalization, if present. Hospitalization rates in the first year were higher among patients initially hospitalized and among those with a rural residence. Patients requiring hospitalization during the first year form an important target group for improved interventions.

(Can J Psychiatry 2004;49:635-638)

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Clinical Implications

* Approximately one-half of newly diagnosed patients with schizophrenia do not require inpatient services.

* Patients who are first diagnosed while inpatients and those who reside in rural areas are more likely to require additional inpatient services in the first year of treatment.

* Patients who require hospitalization in the first year of treatment may require targeted interventions to improve outcomes.

Limitations

* Data were drawn from databases established for administrative rather than research purposes.

* Some patients who received previous treatment outside Nova Scotia may have been included.

* Several factors, including illness severity and availability of appropriate outpatient services, are likely to influence hospitalization rates.

Key Words: schizophrenia, early psychosis, hospitalization rates

Over the past decade, interest has increased in designing services to optimize care during the early stages of psychotic disorders (1,2). In designing these services, it will be important to study such service indicators as hospitalization rates and to investigate factors that may influence these indicators.

The province of Nova Scotia is an advantageous setting in which to carry out such studies. Available administrative databases contain all inpatient admissions and outpatient psychiatric contacts. As do all Canadian provinces and territories, Nova Scotia provides universal access to health care.

A prototype Early Psychosis Program, designed to enhance prompt assessment and optimize treatment, has been operating in the province since late 1995 (3). The program has focused on education about the signs and symptoms of early psychosis (4) while also providing expert clinical care for a self-selected convenience sample of first-episode patients (5).

This study measured hospitalization rates during the first year of treatment for schizophrenia in Nova Scotia and identified factors that might influence those rates.

Methods

We accessed administrative health data for the province of Nova Scotia (population 940 000) through the Population Health Research Unit at Dalhousie University, Halifax. …