Efficacy of Case Management for the Community Dwelling Schizophrenia Patients : A 36-Month Prospective Follow-Up Study

Jee Hoon Sohn; Seung-Hee Ahn; Su Jeong Sung; Ji Min Ryu; Ji Eun Park; Maeng Je Cho

doi:10.4306/jknpa.2015.54.4.578

Journal List > J Korean Neuropsychiatr Assoc > v.54(4) > 1017777

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Sohn, Ahn, Sung, Ryu, Park, and Cho: Efficacy of Case Management for the Community Dwelling Schizophrenia Patients : A 36-Month Prospective Follow-Up Study

Original Article

Journal of Korean Neuropsychiatric Association 2015; 54(4): 578-586.

Published online: 30 November 2015

DOI: https://doi.org/10.4306/jknpa.2015.54.4.578

Efficacy of Case Management for the Community Dwelling Schizophrenia Patients : A 36-Month Prospective Follow-Up Study

Jee Hoon Sohn, MD, PhD^1,^2,³, Seung-Hee Ahn, MSW³, Su Jeong Sung, MD⁴, Ji Min Ryu, MD², Ji Eun Park, MD², Maeng Je Cho, MD, PhD^2,⁵

¹Department of Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea.

²Department of Psychiatry, Seoul National University Hospital, Seoul, Korea.

³Jongno Community Mental Health Center, Seoul, Korea.

⁴Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.

⁵Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea.

Address for correspondence: Maeng Je Cho, MD, PhD. Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel +82-2-2072-3155, Fax +82-2-744-7241, mjcho@snu.ac.kr

Received 12 February 2015 Revised 23 June 2015 Accepted 15 July 2015

Abstract

Objectives

This study was conducted to observe a longitudinal course of patients with schizophrenia enrolled in a community mental health center (CMHC) in Seoul, Korea, and to evaluate the clinical efficacy of case management provided for them.

Methods

Study subjects, including 50 patients in a case-managed group, and 34 patients in the control group, were enrolled from a CMHC and followed up for 36 months. Annual length of hospitalization was compared between two groups by t-tests and time until hospitalization by Kaplan-Meier survival analysis.

Results

For the first year of observation, there was no significant difference in annual length of hospitalization between two groups (3.4 weeks vs. 2.9 weeks), but annual length of hospitalization of the case-managed group became significantly shorter for the second (1.7 weeks vs. 7.2 weeks) and third year (1.4 weeks vs. 7.8 weeks). In Kaplan-Meier survival analysis, no difference in time until hospitalization was observed between two groups, but time until hospitalization more than 3 months was significantly shorter in the control group.

Conclusion

At least two years of case management was required to reduce the length of hospitalization. Reduction in length of hospitalization was achieved by preventing long-term hospitalization.

Keywords: Case management, Community mental health services, Schizophrenia, Hospitalization

Figures and Tables

Fig. 1

Study flow chart. CMHC : Community mental health center.

Fig. 2

Comparison of mean Brief Psychiatric Rating Scale (BPRS) score between treatment groups during follow-up period. * : p<0.05 by independent t-tests. Significant difference of mean BPRS score between case-managed and control group were observed at baseline and at all three follow-up interviews. Additionally, there was no significant difference in the mean change of BPRS score (-6.0 vs. -2.5) between case-managed and control group during follow up period.

Fig. 3

Comparison of yearly hospitalized durations (weeks) between treatment groups during follow-up period. * : Significant difference by independent t-tests observed between case and control group at 24- and 36-month follow up points.

Fig. 4

Comparison of work-loss-days per month between treatment groups during follow-up period.

Fig. 5

Kaplan-Meier analysis of case and control groups for the first hospitalization event.

Fig. 6

Kaplan-Meier analysis of case and control groups for the first hospitalization event more than 3 months. * : p<0.01. Significant difference of survival between case managed and control groups observed by log-rank test.

Table 1

Details of 'case manage services' applied in this study

Table 2

Demographic profile of study subjects

* : Significance by χ² test

Table 3

Pre-enroll clinical characteristics of study subjects

* : Significance by independent t-test. SE : Standard error of means, WHODAS-II : World Health Organization Disability Assessment Scale, version 2

Table 4

Multivariate logistic regression analysis for the successful community maintaining

OR : Odds ratio, 95% CI : 95% confidential interval, GAF : Global Assessment of Functioning, BPRS : Brief Psychiatric Rating Scale

Notes

^{Conflicts of Interest} The authors have no financial conflicts of interest.

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