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The Use of the Japanese Public Financial Support Has Positive Impact on Persistence with Outpatient Treatments for Schizophrenia: Single-center Retrospective Cohort Study in Japan

Authors Arikawa M, Ota K, Azekawa T, Ohashi S, Funaoka Y, Yoshiie H, Koshi H, Takaishi Y, Nakao S

Received 3 October 2020

Accepted for publication 4 January 2021

Published 2 February 2021 Volume 2021:15 Pages 169—175


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Masatoshi Arikawa,1 Kazumi Ota,2 Takaharu Azekawa,1 Shizuko Ohashi,1 Yoichi Funaoka,1 Hiroshi Yoshiie,1 Haruka Koshi,1 Yohei Takaishi,1 Saeka Nakao1

1Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan; 2Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan

Correspondence: Masatoshi Arikawa
Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan

Purpose: One of the challenges of treating schizophrenia is how to improve persistence with outpatient treatments. Lengthening community life by improving persistence and preventing relapse and rehospitalization can have positive influence on the patients’ personal recovery and well-being. In Japan, there is “Medical Expenses for Services and Supports for Persons with Disabilities” (“Jiritsu-shien-iryo-hi” in Japanese) which is the public financial support system for psychiatric outpatient treatments. However, it is not clear how this financial support affects persistence with outpatient treatments for patients with schizophrenia. The purpose of the study is to investigate how the financial support affects persistence with outpatient treatments for schizophrenia.
Patients and Methods: Data of outpatients who visited the clinic between October 1, 2006 and September 30, 2016 was collected. The variables for the analysis were continuation and discontinuation of treatment of those who used the financial support (user) and those who did not (nonuser). The covariates were sex, age, time from onset of the disease to first visit to the clinic, number of hospitalizations in the past, use of psychiatric day care, and use of psychiatric home nursing care. Kaplan–Meier analysis was performed using propensity score matching. The observation period was five years from the first visit to the clinic.
Results: Among 1155 patients who were diagnosed with schizophrenia, 718 were excluded, based on the exclusion criteria. The propensity score matching was performed for 437 patients, and the subjects for the final analysis were 278. Average survival period was 1.09 (SD ± 1.66) years for nonuser, 3.02 (SD ± 1.77) years for users, and users exhibited a significantly longer number of years of outpatient treatments (P< 0.001).
Conclusion: The results indicated that use of the financial support can contribute to persistence with outpatient treatments.

Keywords: schizophrenia, treatment persistence, financial support, jiritsu-shien-iryo-hi

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