Assessment of the need for care 15 years after onset of a Dutch cohort of patients with schizophrenia, and an international comparison

Abstract

Assessment of needs for care is crucial in the evaluation of ongoing changes from institutional care to various forms of day- and outpatient treatment. Do patients really do better in the community and are they adequately cared for? The 15-year follow-up of a Dutch incidence cohort of patients with schizophrenia and other functional non-affective psychoses showed that 47 (out of 63) patients had positive ratings of symptoms and disabilities. They were assessed by means of the Needs for Care Assessment Schedule, which articulates the problems and corresponding interventions resulting in a judgement of met or unmet need for treatment or assessment. There was a mean of 2.1 clinical problems and 2.1 social problems per patient. Few problems were considered to generate unmet needs: 14% of the clinical problems and only 7% of the social problems. Nevertheless, 32% of the patients had one or more unmet needs. These results were compared with data from six research centres in the United Kingdom (Camberwell, Oxford and South Glamorgan), Canada (Montreal), Italy (Verona) and Finland (Tampere). Despite differences in health care settings in the four countries, the ratio of met to unmet needs (about 4-5 to 1) among chronic, mostly schizophrenic patients is more or less the same with the exception of an apparently underserved hostel population in Oxford and the Finnish patient population probably due to high expectations with respect to independent community living.

Assessment of needs for care among patients with schizophrenic disorders 15 and 17 years after first onset of psychosis

“…No systematical differences with respect to gender and age were on evidence between the remaining group of 50 patients the patients lost in the course of the study (Wiersma et al, 1996;1997). Nine had died, six could not be traced (two had moved abroad), and four refused further collaboration.…”

“…In addition, we used the Needs for Care Assessment Schedule (NFCAS) (Brewin & Wing, 1989) as an investigator or professional based instrument assessing 20 problems in clinical and social functioning: psychotic symptoms, slowness and underactivity, tardive dyskinesia, neurotic symptoms, dementia/organic psychosis, physical symptoms, dangerous behaviour, embarrassing behaviour, distress, personal hygiene, household shopping, getting meals, doing household chores, use of public transport, use of public amenities, education, occupation, communication skills, manage money, and manage own affairs. We reported earlier about the procedures and the results at the 15 years follow-up (see Wiersma et al, 1996). The presence of a problem is recorded on a 3-or 4-point scale (depending its clinical or social nature).…”

“…Many studies provide only a cross-sectional view of the clinical and social problems of the patient population, for example at intake or admission to a mental hospital. Our investigation on the long-term course of schizophrenia (Wiersma et al, 1996;1997) enables us to study over a period of two years, from 15 to 17 years since first onset of psychosis, the stability or variability of needs in schizophrenic disorder. Nienhuis et al, 1994), but as far as only chronic patients are concerned such a positive change is much less noted.…”

“…Health economists argued that in the context of limited resources there is often a trade-off between needs and that needs are relative, dynamic changing and context-depended (Netten & Beecham, 1993). We used the MRC Needs for Care Assessment (NCFAS) (Brewin et al, 1987; see also Wiersma et al, 1996) as an instrument focused on an expert-based problem and need definition taking into account a person's sociocultural background and the interventions effectiveness.…”

Epidemiology of schizophrenia. A thriving discipline at the turn of the century

“…Within the framework of the transnational WHO disability projects, first systematic and methodologically sound studies into the epidemiology of the long-term course and outcome of schizophrenia were conducted (an der Heiden et al 1995, Wiersma et al 1996, Mason et al 1996, Harrison 2000, Jablensky this volume, an der Heiden & Häfner this volume). Their results obliterated the "process" paradigm of progressive deterioration (Kraepelin), according to which schizophrenia is characterised by social and cognitive decline, and gave birth to a static vulnerability model showing no discernible long-term trend in group means.…”