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Open Access Highly Accessed Research article

Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis

Berta Moreno-Küstner1*, Fermín Mayoral2, Fabio Rivas3, Pedro Angona4, Javier Requena5, José M García-Herrera5, Desiree Navas6, Patricia Moreno6, Antoni Serrano-Blanco7 and Juan A Bellón8

Author Affiliations

1 Research Unit Distrito Sanitario Malaga, IMABIS Fundation. Department of Personality, Evaluation and Psychological Treatment, University of Malaga, Spain. (Research network "redIAPP", "SAMSERAP" group

2 Psychiatric Service, University Hospital Carlos Haya, Malaga, Spain, (Research network "redIAPP", "SAMSERAP" group

3 Psychiatric Service, University Hospital Carlos Haya, Malaga, Spain

4 Community Mental Health Centre "Guadalmedina". University Hospital Carlos Haya, Malaga, Spain (Research network "redIAPP", "SAMSERAP" group

5 Community Mental Health Centre "Centro". University Hospital Carlos Haya, Malaga, Spain, (Research network "redIAPP", "SAMSERAP" group

6 Research Unit Distrito Sanitario Malaga, IMABIS Foundation, Malaga, Spain, (Research network "redIAPP", "SAMSERAP" group

7 Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain, (Research network "redIAPP", "SM-SJ de Déu" group

8 Health Centre El Palo. Research Unit Distrito Sanitario Málaga (Research network "redIAPP", "SAMSERAP" group). Department of Preventive Medicine, University of Malaga, Spain

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BMC Health Services Research 2011, 11:257  doi:10.1186/1472-6963-11-257

Published: 7 October 2011

Abstract

Background

Persons with schizophrenia and related disorders may be particularly sensitive to a number of determinants of service use, including those related with illness, socio-demographic characteristics and organizational factors. The objective of this study is to identify factors associated with outpatient contacts at community mental health services of patients with schizophrenia or related disorders.

Methods

This cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and use of service factors. Data were collected from clinical records.

Results

The multilevel linear regression model explained 46.35% of the variance. Patients with significantly more contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p < 0.001), with one or more inpatient admissions (p < 0.001), and in contact with both types of professional (nurses and psychiatrists) (p < 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p < 0.001).

Conclusions

As expected, the variables that explained the use of community service could be viewed as proxies for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More research is needed to carefully examine how professional support networks interact to affect use of mental health.