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Treatment Engagement of Psychotic Patients with a Mobile Mental Health Unit in Rural Areas in Greece: A Five-Year Study

DOI: 10.1155/2013/613956

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Abstract:

Objectives. Treatment of psychotic disorders is impended by high rates of disengagement from mental health services and poor adherence to antipsychotic medication. This study examined the engagement rates of psychotic patients with a community mental health service during a 5-year period. Methods. The Mobile Mental Health Unit of Ioannina and Thesprotia (MMHU I-T) delivers services in remote, rural, mountainous areas using the resources of the primary care system. Clinical and demographic information for patients with a diagnosis of schizophrenia and related psychoses was obtained from the medical records of our unit. Results. A total of 74 psychotic patients initially engaged in treatment with our unit. In half of cases treatment was home-based. With the exclusion of patients who died or discharged, engagement rates were 67.2%. Statistical analysis was performed for 64 patients, and no differences were found between engaged and disengaged patients regarding clinical and demographic parameters. All engaged patients regularly refilled their antipsychotic prescriptions. Conclusion. Engagement rates in our study were comparable to previous research, involving urban settings and shorter follow-up duration. Community mental health teams may ensure treatment continuation for psychotic patients in deprived, remote areas. This is important for low-income countries, affected by economic crisis, such as Greece. 1. Introduction Schizophrenia and related disorders are chronic and disabling and have a major impact on the person, the family, and the society in general. Continuity of care is considered essential in the effective management of such long-term disorders by service users, clinicians, and health care policy makers [1]. Previous studies have suggested that continuity of care is positively associated with health outcomes among persons with severe mental illness [2]. More recently, continuity of care was linked to better social functioning of people with chronic psychotic disorders [3]. However, despite the availability of effective pharmacological and psychosocial treatments for the management of psychotic disorders, treatment is impended by high rates of disengagement from mental health services and poor adherence to antipsychotic medication. Treatment discontinuation has severe consequences for the patients, such as relapse, hospitalization, homelessness, suicide, and violence [4, 5]. This may be particularly the case of psychotic patients living in poor and deprived remote rural areas who may not receive appropriate mental health care. Evidence from

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