Determinants of Outcome in Residential Homes for Special Care

Abstract

<p>This study is a partial evaluation of a program of foster care for chronic psychiatric patients (Residential Homes for Special Care) in 41 homes in Hamilton and surrounding area, Ontario.</p> <p>A review of the development of foster care and of controversies over its value, as well as a review of the existing evaluative literature is included.</p> <p>An attempt was made to use adequacy of neuroleptic maintenance is chronic schizophrenic residents as a tracer condition for evaluation of quality of care given by primary care physicians.</p> <p>The objectives of the program were examined and operating definitions evolved for measures to evaluate some of these objectives. These included a field worker's rating of the quality of hostesses and an audit of prescription written by attending physicians for adequacy of neuroleptic maintenance, occurrence of drug interactions and prescribing frequency.</p> <p>The cohort studied was all 178 residents first admitted to foster care in the area in the years 1966 to 1969. These residents were followed for a three year period using existing health records. Data were complete on every resident for all variables excepts some drug prescription measures.</p> <p>Home factors such as rural location and inferior quality of hostesses were important determinants of rehospitalisation. Residents first placed in rural homes had many more rehospitalisations than those first placed in urban homes, although there were no significant differences in the age, sex, number and duration of previous psychiatric hospitalisation or diagnosis between these groups.</p> <p>Resident factors such as younger age, female sex and shorter duration of previous psychiatric hospitalisation were significant determinants of discharges from the program.</p> <p>The prescription audit measures did not predict outcome, but examination of the prescriptions did reveal 17 patients on prolonged tricyclic antiderressant therapy, 10 for more than four years.</p>