| Co-Investigator(Kenkyū-buntansha) |
KURODA Kenji Osaka Prefecture University, School of Humanity and Social Science, Professor (70144491)
BABAZONO Akira Kyushu University, Dept. of Health Economics, Professor (90228685)
SHIMOEDA Shinji Kochi University, Medical School, Dept. of Neuropsydiatry, Associate Professor (20315005)
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| Research Abstract |
1. Patients numbers were investigated for the last few decades using the governmental statistics, Patient Survey Numbers of outpatients have been increased from 1980, while the numbers of inpatients have been from 3,300,00-3,400,000. According to analysis by diagnosis, the increases of numbers of outpatients were found not only in mood, disorders, and neurotic and stress disorders, but in schizophrenia. Among inpatients, proportion of old patients has become larger, particularly in schizophrenic patients. These findings suggest that community care for the mentally disabled has been developed in Japan.
2. According to analyses of medical costs, inpatient cost has been larger than other costs. When the costs were analyzed by diagnosis, cost for schizophrenia has been larger than others diseases. Effect of the increase of outpatient number on the cost structure was small. There have been some studies on the possibility of discharging mentally ill inpatients from mental hospitals. To invest
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igate how a psychiatrist judges whether an inpatient can be discharged. A survey regarding such judgments on discharge was-conducted involving-549 schizophrenic inpatients with- a hospital stay of 1 year or longer. Relationships between psychiatrists' judgments on discharge and the Brief Psychiatric Rating Scale (BPRS), Scales for the Assessment of Negative Symptoms (SANS), Global Assessment Scale (GAS), patients' attitudes to discharge, and other variables were investigated. A similar analysis was conducted regarding patients' attitudes toward discharge. After controlling for potential confounding factors using multiple logistic regression analysis, the judgments showed significant relationships with BPRS-P; SANS, GAS, and age. Patients' attitudes showed significant relationships with the length of the current hospital stay, SANS, and psychiatrists' judgments. A psychiatrist's judgment regarding discharge is a comprehensive decision that takes into account psychiatric symptoms, social function, and age. Such a judgment could also affect a patient's own attitude toward discharge.
3. Cost-benefit analysis of family psychoeducation for schizophrenia was conducted. Comparing brief and intensive psychoeducation, brief one was more cost-beneficial. According to the cost-effectiveness analysis, brief psychoeducation was also cost-effective. Considering limited resources, brief family psychoeducation is recommended in clinical practice.
4. Medical cost analysis was conducted for family psychoeducation for mood disorders. Although it prevents relapse in mood disorders, effect on the medical cost was small. Recently relapsed patients with mood disorders could be treated at outpatient clinics. This might be reduced the medical-cost for relapsed patients.
5. Care management for the mentally disabled was studied. Community placement program in Japan and Care Program Approach have been reviewed. Less
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