| BackgroundSchizophrenia is a long-term,chronic and disabling mental disorder.The disease burden of schizophrenia is severe.The treatment of schizophrenia patients often presents a "revolving door" phenomenon.At the beginning of the 21 st century,China’s mental health resources are seriously inadequate and distribution is not balanceable.In order to protect patients’ basic right to mental health treatment,improve access to care,control patients’ condition,reduce the burden of disease,China has set up a "Central Government Support for the Local Management and Treatment of Serious Mental Illness" project,also called "686 Programme".As of the end of December 2019,"686 Programme " has been carried out for 15 years,but we have few studies on the proportion of actual registered patients in the total population with severe mental disorders(enrollment rate).Registration and filing of patients in the Information System is the premise for patients to enter the project management of "686 Programme ".The low proportion of registered patients indicates that the benefit group of patients is small and the implementation effect of the project is poor.To a certain extent,the enrollment rate can reflect the effective coverage of "686 Programme ".There was only one previous study,with the method of cuing among the community residents in Hunan Province,which diagnosed 720 cases of patients with severe mental disorders,among which 342 cases(47.5%)were not included in the management system of patients with severe mental disorders.The situation of enrollment rate is still unclear in the rest of the country."686 Programme" is a public health strategy.However,there are still a considerable number of patients who unable to obtain the right of public health services,which cannot fully reflect the fairness of the society.To improve the enrollment rate of schizophrenics,we first need to identify which patients are not under the management of "686 Programme".By comparing the characteristics of schizophrenics who were registered and not registered,and who were in and out of project’s management,we can find out the schizophrenics who were not in "686Programme".To increase the number of patients in the program and increase the opportunity for patients to obtain medical resources,which is conducive to improving the accessibility of mental health services.Objective.Our aim was to understand the influencing factors of "686 Programme " for discharged schizophrenics in Guangzhou,to provide scientific basis for the correct decision-making of relevant departments,to improve community mental health services in China,and to reduce the risk of high-risk risky behaviors of patients with severe mental disorders.Methods.This is a retrospective study.To collect the information of the schizophrenia discharged patients who were hospitalized on January 1 to December 31,in 2019,diagnosed by psychiatrists based on diagnostic standard of The International Classification of Diseases-10 Classification of mental and Behavioural Disorders through a hospital’s inpatient information system by well-trained investigators.We obtained survey data on 1658 cases with complete information which included by general demographic information(name,gender,id,age,occupation,household registration address,contact information,marital status,nationality,medical insurance,education background),clinical characteristics(onset age,the total course and the total attack times,the total number of hospitalizations,the form of onset,the course of the disease,history of major body disease,substance dependence history,family history of mental illness,a history of risky behavior and used long-acting preparations).We identified a total of 1160 patients included in the Information System and 498 patients not included in the system by comparing their names and ID numbers.We compared their differences in general demographic characteristics and clinical characteristics by monofactor analysis and logistic regression analysis.In addition,we use the same method to obtain the data of 626 patients who were included in the system and received community health services,72 patients included in the system without receiving community management.We also compared the differences of demographic characteristics and clinical characteristics between the two groups by monofactor analysis and logistic regression analysis.Results.Among 1658 respondents,1160 cases were included in the Information System,and the registered rate was 69.96%(1160/1658).The monofactor analysis showed that there were statistically significant differences among age,gender,household registration address,medical payment,onset age,the total course,total number of hospitalization,total number of attacks,a history of risky behavior,the form of onset,the course of the disease,history of major body disease,used long-acting preparations(all P < 0.05).The Logistic Regression Analysis of group which included and not included in the Information System showed that total duration of disease(OR=1.045,95%CI: 1.028-1.063),female(OR=0.628,95%CI: 0.491-0.804),current address non-native(OR=0.285,95%CI:0.207-0.392),the total number of hospitalizations was 3-4(OR=2.083,95%CI: 1.512-2.871),the total number of hospitalizations was 5 or more(OR=2.601,95%CI: 1.806-3.748),had risky behaviors(OR=1.840,95%CI:1.405-2.409),and used long-acting preparations(OR=0.329,95%CI: 0.163-0.667).Among the 698 subjects registered in Guangzhou’s Information System,626 cases received community health services,with the regular management rate of receiving services of schizophrenia in system was 89.68%(626/698).The monofactor analysis showed that there were statistically significant differences among age,education background,total course of disease,total hospitalization times,total number of attacks,a history of risky behavior,the course of disease characteristics(all P < 0.05).The Logistic Regression Analysis of group which reaccepted and unaccepted management show that total duration of disease(OR=1.087,95%CI:1.053-1.122),not in marriage(OR=1.708,95%CI: 1.019-2.863),a history of risky behavior(OR=1.934,95%CI: 1.082-3.458),Chronic progressive type(OR=2.080,95%CI: 1.110-3.897).Conclusion.The influence factors for registering in the Information System were total duration of disease,gender,current address,total number of hospitalizations,a history of risky behavior,and used long-acting preparations.total short duration of disease,female,non-local current address,fewer Hospitalizations,no history of risky behaviors,and did not use long-acting medications were less likely to be included in the Information System.The influence factors for receiving community management were total duration of disease,a history of risky behavior.Not marriage,nonchronic progressive course,no history of risky behaviors were less likely to receive community management. |
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