Evaluation of a Community Case-Management Program for patients with Schizophrenia-Spectrum Disorder: a prospective 1-year case-control study

Abstract

BACKGROUND: The Personalized Care Programme (PCP) is a government funded community psychiatric service in Hong Kong. PCP, which was launched in three pilot districts in 2010, adopts intensive case-management and multi-disciplinary approaches involving community partners to deliver individualized, recovery-oriented care to adult patients with severe mental illness, in particular psychotic disorders. This study aimed to systematically evaluate the effectiveness of PCP in community-dwelling patients with schizophrenia-spectrum disorder (schizophrenia, schizophreniform disorder or schizoaffective disorder) using concurrent case-control design. METHODS: This prospective 1-year follow-up study compared patients receiving PCP (n=81) with those managed by non-PCP community psychiatric care (control treatment, n=80). The two groups were matched in terms of age, sex and DSM-IV diagnosis. Comprehensive evaluation on multiple outcome domains encompassing symptom (Positive and Negative Syndrome Scale, PANSS; Calgary Depression Scale, CDS), psychosocial functioning (Social and Occupational Functioning Assessment Scale, SOFAS), needs (Camberwell Assessment of Need, CAN), subjective quality of life (WHO-QoL Brief version) and service satisfaction (Patient Satisfaction Questionnaire, PSQ) was conducted at study entry and at 12 months of follow-up. RESULTS: There were no significantly differences between the two groups in socio-demographics, past illness history characteristics, baseline clinical and functional ratings. At 12 months, Patients in PCP group had significantly fewer number of unmet needs (t=3.9, p<0.05) (in particular social needs of care: t=7.2, p<0.01) and greater degree of service satisfaction than those in non-PCP group (t=0.7, p=0.50). No significant between-group differences were noted in 12-months outcome on symptoms severity, functioning and subjective quality of life. Longitudinal analysis revealed a trend (though statistically non-significant) suggesting that patients in PCP group had greater improvement in depressive symptom (CDS) and general psychopathology (PANSS) ratings, and various domains of WHO-QoL measures than those in non-PCP group over 1-year follow-up period. DISCUSSION: This study provided supportive evidence to the 1-year pilot implementation of PCP for patients with schizophrenia-spectrum disorder in HK with regard to improvement in unmet need management and service satisfaction. Further research is required to evaluate the longer-term effects of this community-oriented case-management service on clinical and functional outcomes.