Hospital days in risperidone-treated patients.

OBJECTIVE: To compare inpatient hospital days of a group of "real world" schizophrenia-spectrum patients for 3 years prior to and 3 years after risperidone initiation. METHOD: This is a retrospective cohort study using a mirror-image design of hospital days in 120 patients over a 6-year period. Hospital admission and discharge information was obtained from chart review and database extraction at 3 outpatient treatment sites. The sample comprised all patients attending these clinics who were prescribed risperidone during the first year of the drug's release. RESULTS: Patients separated into 3 treatment groups: those who were prescribed risperidone for 3 uninterrupted years (N = 35), those who interrupted but resumed risperidone use and were prescribed the drug at 3 years (N = 8), and those who discontinued risperidone during the 3-year follow-up period (N = 77). The group continuing risperidone to 3 years demonstrated a significant decrease in hospital days after risperidone treatment, in contrast to the other 2 groups. The reduction in inpatient days for the total sample was not statistically significant. CONCLUSION: In this outpatient clinic sample, the 29% of patients who continued on risperidone showed a significant reduction in inpatient hospital days, from an average of 17.2 days per year in the 3 years before risperidone treatment to an average of 2.1 days per year for the 3 years of risperidone treatment.

Development of an integrated clinical database system for a regional mental health service.

The authors describe development of an automated system to provide caregivers in a regional mental health service in Calgary, Alberta, with access to information about persons with chronic mental illness served by the system. All participating organizations provided input about system design features and data elements. Issues of confidentiality of records were addressed. A working model demonstrated to caregivers was rated as useful and understandable by more than 90 percent of respondents.

Teaching biopsychosocial integration and formulation.

This paper describes the mental processes by which the psychiatrist organizes and integrates data to produce a case formulation. The biopsychosocial formulation uses three perspectives (biological, psychological and social) to view the data and integrates these viewpoints into one broad, complex and dynamic appreciation of the patient. Guidelines for creating and communicating a case formulation are proposed.

Family physician registration at locally produced short courses.

Physicians who do not take advantage of short courses that are offered within their community may miss the opportunity to learn about new services and consultants as well as to validate new information or practices with trusted colleagues. The registration patterns at short courses of all 505 family physicians in Calgary were assessed to determine whether the sociodemographic characteristics of attendees differed from those of nonattendees and whether the sociodemographic data were predictive of attendance or nonattendance. Four variables were predictive of attendance or nonattendance: certification status with the College of Family Physicians of Canada (CFPC), year of graduation, sex and hospital affiliation. Physicians who had attended four or more courses were more likely to be graduates of Canadian or US schools, to have graduated after 1969, and to be women, certificants of the CFPC and affiliated with a hospital. Universities, hospitals and professional associations planning continuing education must determine if the needs of nonattending physicians are being met through other means or if new strategies are required to ensure that these physicians have opportunities for upgrading their knowledge. Practitioners who frequently attend short courses can help planners ensure that programming is relevant.

The effect of structure on attendance in a day-hospital program.

The effects of program structure on patient attendance rates within a day-hospital program were studied. It has been recognized that regular attendance at partial-hospitalization programs is necessary to facilitate improvement in patient skill deficits. In this study, three different program structures were offered in a 40-person day program. Significant differences in attendance rates were achieved.

A conjoint medical/nursing diabetes education program: impact on care in a rural community.

This paper describes the planning, teaching format, and evaluation of an interdisciplinary education program in diabetes mellitus for physicians and nurses in a rural Canadian community. Most participants preferred the conjoint teaching format to the unidisciplinary didactic programs traditionally offered. An evaluation, by chart review, of the management of diabetic patients cared for before and at 3, 6, and 12 months after the teaching program revealed significant changes in the referral practices of both the home care nurses and the physicians. Our findings suggest the occurrence of a program-related change in collaborative care practiced by the physicians and nurses who participated. A more extensive three year project has been initiated to further document the effectiveness of interdisciplinary continuing education in this community.

Two years of prelicensure training: observations from the alberta experience.

Alberta is the only jurisdiction in North America which requires two years of training between receipt of the MD degree and licensure to practice medicine. Definitive studies to evaluate the validity of this decision are contemplated, since the legislation is now seven years old. Although several different bodies support the concept of two years' training rather than one, they disagree over how those two years should be spent, and there remain several interested parties which are not convinced about the necessity for two years' training. This article examines the data from seven years experience.