Évaluation d’un an de parcours de patients schizophrènes en service psychiatrique liégeois: One-year follow-up and mobility assessment of schizophrenic patients in the liege psychiatric care network

Abstract

Cette étude a pour but d’évaluer à un an d’intervalle l’évolution symptomatologique et sanitaire des patients schizophrènes de l’échantillon de l’étude épidémiologique menée précédemment par la Plate-forme psychiatrique de Liège (Belgique) au sein de son réseau d’institutions. L’étude vise également à examiner la mobilité institutionnelle des patients, c’est-à-dire la mesure dans laquelle ceux-ci changent de structure ou de type de soins. Les outils utilisés furent le DSM IV pour les diagnostics, le RPM et le PECC pour la symptomatologie, ainsi qu’un questionnaire spécifique reprenant une ligne du temps pour la mobilité. Ces données ont été récoltées pour 178 patients constituant notre échantillon. Pendant l’année qui a séparé les deux prises d’information, le décès de 4 patients a été observé. Les données concernant la symptomatologie et celles concernant la mobilité sont décrites et ensuite analysées et mises en relation. Tant les résultats univariés que multivariés confirment que la mobilité est influencée surtout par l’âge des patients, le type de schizophrénie et la symptomatologie. Les proportions relatives du type de schizophrénie en fonction du type de structure de soins restent stables et la mobilité des patients présente certaines caractéristiques. Des hypothèses explicatives de ces relations sont présentées. The study was aimed at assessing the clinical evolution and mobility of schizophrenic patients within the healthcare network of the Psychiatric Platform of Liege (Belgium) after a one-year follow-up period. The study material consisted of a random sample of 184 patients with schizophrenia drawn from the population of schizophrenic patients treated in the Liege psychiatric care network. The characteristics of these patients have been described previously (18). The 184 patients were followed-up for one-year and reassessed at the end of this period. Mobility ( ie , changes between psychiatric care institutions, including home) was recorded for each patient within the institutional network. The diagnosis of schizophrenia was based on the DSM IV. Demographic, social and global functioning (GAF scale) data were collected from the « Résumé psychiatrique Minimum (RPM) », a clinical summary which has been imposed by the Belgian Ministry of Public Health for each psychiatric hospital stay. Symptom components were derived from the Psychosis Evaluation tool for Common Use by Caregivers (PECC). Among the 184 patients enrolled in the initial analysis, 6 refused to participate in the follow-up study. The 178 remaining schizophrenic patients included 131 men (74 %) and 47 women (26 %) with a mean age of 43.1 ± 13.6 and 48.8 ± 14.9 years, respectively (p < 0.05). The majority of patients (53 %) suffered from paranoid schizophrenia. At baseline, 63 % of the patients were hospitalised full-time, 6 % part-time and 31 % received ambulatory care. During the one-year follow-up period, 4 patients died, including one from suicide. When considering mobility, 48 % of the patients experienced at least one change of institution, whereas 52 % of the patients didn’t change at all (see figure 1 ). The total number of changes over the 1-year period amounted 189, yielding a mean value of 1.1 changes per patient per year. Changes mostly occurred between institutions of similar care setting (see figure 2 ). Transfers (30 %) were also observed directly between hospital and home. A multivariate Poisson regression analysis showed that the number of changes was unrelated to gender and initial care setting but decreased with age (p < 0.0001). It was also higher for patients with schizo-affective disorders (2.5 ± 1.9, p < 0.01) or with residual type (1.2 ± 1.8 ; p < 0.05) than for patients with other types of schizophrenia (ranging from 0.3 ± 0.5 to 0.9 ± 1.4). No association was found with initial GAF or PECC, except for negative symptoms (p < 0.05). After one year, despite the high proportion of institutional changes (48 % of the patients), the distribution of the patients according to care setting remained the same (p = 0.77). However, GAF scores significantly improved from 39.7 ± 16.1 to 44.4 ± 16.1 (p < 0.0001) and likewise for total PECC scores (70 ± 19.1 vs 63.2 19.4, p < 0.001). Excitatory and disease perception items of the PECC remained unchanged. The present study reveals that mobility within the institutional network did affect about half of the schizophrenic patients. Mobility was related to age, type of schizophrenia and disease evolution. Changes occur mainly between psychiatric structures of similar care setting but also directly from hospital to home without passing through an intermediate care structure. Further efforts should be made to provide schizophrenic patients with a more coordinated care provision throughout the course of their disease.