The Outcomes of High Risk Chronic Psychotic Patients’ Care in Nakhonpathom Hospital Network

Abstract

Objective : The aim was to study the outcomes of the care of chronic psychotic patients with high risk in Nakhonpathom Hospital Network 2016–2021.

          Method : This was a retrospective study. The studied group was 217 psychotic patients diagnosed in ICD-10 codes as F20–F29 with high risk to violence (SMI-V) who were enrolled to the Continuous Care of Chronic Psychotic Patients with SMI-V in Communities 2016–2021. The demographic data were collected including diagnoses, scores of 9-item assessment form for follow-ups of chronic psychotic patients at 1^st month and 12^th month, rate of admission and refer out (sessions/year) at duration of 1 year before project admission and during 1 year of the project. The descriptive data were described by frequency, percentage, mean, and SD; and comparison of the scores of 9-item assessment form, rate of admission, and rate of refer out between the above points of time were analyzed by using paired t test at the significant level of .05.

          Results : Of total 217 patients, 57.6% was male. The mean age of the studied group was 46.43 (SD 11.37). Majority of the patients graduated from primary school (57.6%), had single status (58.0%), and did not earn their living (46.5%). Most of the patients lived in the catchment areas of a sub-district health promoting hospitals (80.6%) and had their close relatives as caregivers (95.1%). The most diagnoses were F20.0 (paranoid schizophrenia), without co-morbidity (89.9%), and SMI-V 3 (89.4%). The overall scores of the 9-item assessment form for follow-ups of chronic psychotic patients at 12^th month was less than 1^st month with statistical significance (difference 2.493 ± 2.005; 95% CI 2.218, 2.768, p < .000), and so did in the each item with statistical significance (i.e., better features for the patients).  By comparing the scores between 1^st and 12^th month in each item and patient, it was found that 51.1–88.5% had the same scores, 11.5–44.2% had better features, and only 1% was worse. By comparing rate of admission and refer out, rates at 1 year during the project decreased with statistical significance (0.101 ± 0.317 vs. 0.055 ± 0.229 and 0.069 ± 0.254 vs. 0.032 ± 0.177 sessions/year, p = .047 and .044 respectively). The results were comparable to ones of the national project.

          Conclusion : High risk chronic psychotic patients’ care through the project of continuous care in communities, in Nakhonpathom Hospital Network, 2016–2021, has a good outcome; targeted patients has better mental health status and less relapse of the mental illness.