Effectiveness of Personalized Care Programme (PCP) for patients with severe mental illness (SMI) in

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  Introduction: Kwun Tong district is one of the pilot sites for Personalized Care Programme in Hong Kong.It involves multidisciplinary mental health professional input which (1) proactively assists patients in community, (2) provides them with tailor-made treatment to meet individuals strengths and deficits, (3) delivers outreaching services to strengthen skill generalization, and (4) offers easy accessibility and availability of assertive clinical support.PCP has accomplished the above goals by equipping staff from various professional backgrounds to become case managers, who provide clinical care with extended accessibility.Standard risk identification and needs assessment have been incorporated into the PCP in order to prevent any negative event (i.e.violence, suicide or neglect to self/others) from occurring or, if this is not possible, minimising the harm caused.Objective: (1) to evaluate the effectiveness of PCP over a 6-month period, (2) to investigate the clinical outcome of individuals with severe mental illness including suicide/ parasuicide and violent incidents, and (3) to explore the view of service users and caregivers on PCP.Methods: From April 2010 to February 2011, one-hundred persons with schizophrenia diagnosed according to ICD-10 criteria were recruited.The six-month outcome of the individuals under care of PCP was compared to their own six-month outcome within the past year under community psychiatric nurse service (CPNS).Feedback of service users and caregivers on PCP was explored by means of a questionnaire.Results: PCP has enhanced community psychiatric service by significantly increasing the mean number of home visits within and outside office hours, the mean number of joint visits, the frequency of patients participating in community rehabilitation activities and the number of multidisciplinary case conferences held.Violence incident in patients under care of PCP was reduced from 18% to 9%, whereas psychiatric admission in patients under care of PCP was reduced from 34% to 25% respectively.Suicide attempt incident was splendidly reduced from 2% to 1% under the care of PCP.There are cases of successful suicide prevention and abortion of self harm acts during the period.Feedback from service users/caregivers revealed that readily accessible case managers, enhanced community rehabilitation activities, and extended duration and quality of patient contact during home visits are advantages of PCP.Conclusion: PCP is effective in reducing violence rate and hospitalization rate in patients with SMI, with positive response from service users and caregivers.However, current data is too narrow for the drawing of conclusion about the reduction of suicide rate.Longer follow-up and larger sample size would be advisable in order to improve our understanding of this problem.Study on potential savings on health care cost after implementation of PCP is recommended.
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