An Examination of Treatment Outcomes at State Licensed Mental Health Clinics
Mental health clinics that are licensed and regulated by their respective states constitute a vast mental health delivery system. Yet these programs, while operating for the last 40 years, have not been subject to systematic review. This retrospective study of archival data investigated the relationship between intensity of clinic treatment and hospital-based treatment episodes and polypharmacy. The sample was comprised of 562 patients with diagnoses of MDD, bipolar disorder, or a schizophrenia spectrum disorder, drawn from four state-licensed community clinics. These clinics provided a relatively heterogeneous model of care consisting of psychotherapy, medication management, and critical case tracking. Subjects with the highest number of treatment visits (31 or more) had a 62 % reduction in the incidence rate ratio of hospital-based treatment episodes compared to subjects with the least visits (15 or less). Subjects with 15–30 visits also fared well with an 82 % reduction in the incidence rate ratio of hospital-based treatment. Secondarily, a diagnosis of schizophrenia or bipolar disorder resulted in a significantly higher incidence of hospital treatment than a diagnosis of MDD. Polypharmacy, measured at the .01 level, was not found to be associated with treatment intensity. The findings lend support to the outpatient clinic treatment model as a viable system that can significantly reduce costly hospital-based psychiatric care. At least for the diagnoses examined, early drop out is detrimental and increases the probability that hospital-based treatment will become necessary.
KeywordsOutpatient treatment Community clinics Hospitalizations Polypharmacy
- Javitt, D. C. (2014). Balancing therapeutic safety and efficacy to improve clinical and economic outcomes in schizophrenia: A cinical overview. American Journal of Managed Care, 20(8), 160–165.Google Scholar
- New York State OMH. (2011). Patient characteristic report. Retrieved January 10, 2015 from http://bi.omh.ny.gov/pcs/Summary%20Reports?pageval=prog-smi&yearval=2011®ionname=4&p_agegrp=All&p_categ=Outpatient#ProgramTypechart.
- New York State OMH. (2013). PSYCKES-Frequently asked questions. Retrieved January 10, 2015 from https://www.omh.ny.gov/omhweb/psyckes_medicaid/faq/#D2.
- Piza, E. L. (2012). Using poisson and negative binomial regression models to measure the influence of risk on crime incident counts. Rutgers Center on Public Security. Retrieved from http://rutgerscps.weebly.com/uploads/2/7/3/7/27370595/countregressionmodels.pdf.