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Abstract

Objective:

This demonstration project examined whether medication management coordinators enhanced continuity of care from inpatient facilities to an outpatient public mental health clinic.

Methods:

From 2004 to 2008, patients (N=325) hospitalized with schizophrenia or schizoaffective or bipolar disorder enrolled in a medication management program before discharge or at their first clinic appointment. Medication management coordinators supplemented existing clinic practices by identifying recently hospitalized patients, providing inpatient and outpatient prescribing clinicians with patients' complete medication history, meeting with patients for six months postdischarge to assess clinical status and provide medication education, and advocating guideline-concordant prescribing. Recently discharged patients (N=345) assigned to a different outpatient clinic within the same agency served as the comparison group. Intent-to-treat, repeated-measures analyses for mixed models compared the groups' number of hospital admissions, hospital days, and medication appointments kept and use of nurse or case manager contact hours and emergency or crisis services during the 12 months before enrollment, the six-month intervention, and the six-month follow-up period.

Results:

After discharge, individuals enrolled in medication management were more likely than comparison patients to attend outpatient appointments, and they had more medication visits and nurse or case manager treatment hours than the comparison group. Use of hospital and crisis or emergency services by all patients decreased. Almost one-third of patients never attended an outpatient appointment after hospital discharge.

Conclusions:

Although this program succeeded in improving continuity of care, additional interventions may be required to reduce rehospitalization and crisis care. (Psychiatric Services 63:554–560, 2012; doi: 10.1176/appi.ps.201100264)

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Figures and Tables

Figure 1 Survival estimates for days to first medication visit postdischarge by patients enrolled in medication management (N=207) and a comparison group (N=345)
Table 1 Demographic characteristics of patients enrolled in medication management and a comparison group
Table 2 Hospital utilization and use of crisis or emergency services by patients enrolled in medication management and a comparison group
Table 3 Use of outpatient services by patients enrolled in medication management and a comparison group
Table 4 Predictors of use of outpatient medication visits during the medication management intervention

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 554 - 560
PubMed: 22476107

History

Published online: 1 June 2012
Published in print: June 2012

Authors

Details

Natalie J. Maples, M.A., L.P.A. [email protected]
Ms. Maples, Ms. Li, Dr. Moore, Dr. Velligan, and Dr. Miller are affiliated with the Department of Psychiatry, Division of Schizophrenia and Related Disorders, UT Health Science Center San Antonio, 7703 Floyd Curl Dr., MS 7797, San Antonio, TX 78229 (e-mail: [email protected]).
Laurel Anne Copeland, Ph.D., M.P.H.
Dr. Copeland and Dr. Zeber are with the Center for Applied Health Research, Scott & White Healthcare, and with Central Texas Veterans Health Care System, both in Temple, Texas.
John E. Zeber, Ph.D., M.H.A.
Dr. Copeland and Dr. Zeber are with the Center for Applied Health Research, Scott & White Healthcare, and with Central Texas Veterans Health Care System, both in Temple, Texas.
Xueying Li, M.S. [email protected]
Ms. Maples, Ms. Li, Dr. Moore, Dr. Velligan, and Dr. Miller are affiliated with the Department of Psychiatry, Division of Schizophrenia and Related Disorders, UT Health Science Center San Antonio, 7703 Floyd Curl Dr., MS 7797, San Antonio, TX 78229 (e-mail: [email protected]).
Troy A. Moore, Pharm.D., M.S.Pharm. [email protected]
Ms. Maples, Ms. Li, Dr. Moore, Dr. Velligan, and Dr. Miller are affiliated with the Department of Psychiatry, Division of Schizophrenia and Related Disorders, UT Health Science Center San Antonio, 7703 Floyd Curl Dr., MS 7797, San Antonio, TX 78229 (e-mail: [email protected]).
Albana Dassori, M.D.
Dr. Dassori is with the South Texas Veterans Health Care System, San Antonio.
Dawn Irene Velligan, Ph.D. [email protected]
Ms. Maples, Ms. Li, Dr. Moore, Dr. Velligan, and Dr. Miller are affiliated with the Department of Psychiatry, Division of Schizophrenia and Related Disorders, UT Health Science Center San Antonio, 7703 Floyd Curl Dr., MS 7797, San Antonio, TX 78229 (e-mail: [email protected]).
Alexander L. Miller, M.D. [email protected]
Ms. Maples, Ms. Li, Dr. Moore, Dr. Velligan, and Dr. Miller are affiliated with the Department of Psychiatry, Division of Schizophrenia and Related Disorders, UT Health Science Center San Antonio, 7703 Floyd Curl Dr., MS 7797, San Antonio, TX 78229 (e-mail: [email protected]).

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