Veterans with schizophrenia who received treatment through the Department of Veterans Affairs (VA) between 1994 and 1996 were less likely on some measures to have access to state-of-the-art community-based, recovery-oriented services than similar patients treated in hospitals and clinics operated by State and local providers, although outcomes were similar. In a recent study, the Schizophrenia Patient Outcomes Research Team (supported by the Agency for Healthcare Research and Quality, PORT contract 290-92-0054) compared treatment of schizophrenia in two organizational systems: a national Government-operated health care system, the VA, and in facilities operated by State and local providers.
During the time of the study, VA care relied more on hospital-based services and less on community-based psychosocial services such as work therapy, job training, and case management. However, since that time, the VA has expanded its outpatient mental health care services and reduced the number of inpatient psychiatric beds. Because the data for this study were collected between 1994 and 1996, they probably do not reflect the most recent changes in either VA or non-VA care, cautions the PORT's principal investigator Anthony F. Lehman, M.D., of the University of Maryland School of Medicine.
The researchers used face-to-face patient interviews and review of medical records to compare patterns of care for 192 VA inpatients with 96 non-VA inpatients and 274 VA outpatients with 184 non-VA outpatients at VA and non-VA facilities in two States. All VA patients were veterans; about one-fifth of non-VA service users also were veterans.
Patients treated for schizophrenia by the VA had similar satisfaction and clinical outcomes as those not treated by the VA. However, VA outpatients were more likely to have been hospitalized during the previous year than non-VA outpatients. They also were less likely to have received services from a day hospital, from a case manager or social worker, or to have received crisis intervention services. Both inpatient and outpatient VA patients had seen a greater number of psychiatrists. Adherence to treatment recommendations for both VA and non-VA patients was generally quite low, with only 41 percent overall adherence among inpatients and 31 percent adherence among outpatients.
For more information, see "Benchmarking treatment of schizophrenia," by Robert A. Rosenheck, M.D., Rani Desai, Ph.D., Donald Steinwachs, Ph.D., and Dr. Lehman, in the April 2000 Journal of Nervous and Mental Disorders 11, pp. 209-216.