Retrospective analysis of treatment effectiveness among patients in Mianyang Municipality enrolled in the national community management program for schizophrenia

BACKGROUND: Over the last six years China has developed the largest community-based service network for persons with serious mental illness in the world (the ‘686 Project’) but the effectiveness of this program has not been assessed in detail. AIM: Compare the characteristics of patients with schizophrenia enrolled in the program whose clinical status has improved with the characteristics of patients whose clinical status has not improved. METHODS: The records of 3090 patients with schizophrenia in Mianyang Municipality, Sichuan (a community with 60% rural residents) who participated in the 686 Project at any time during 2011 were extracted from the national electronic registry system for the project and the demographic and treatment characteristics of individuals rated by treating clinicians as ‘recovered’ or ‘improved’ at the time of their last evaluation in 2011 (n=1866) were compared to those of patients rated as ‘unchanged’ or ‘worsened’ (n=1224). The factors considered included gender, age, ethnicity, occupation, education, family economic status, marital status, family history of mental illness, duration of illness, time of enrolled in the 686 Program, and adherence to medication. RESULTS: In the univariate analysis there were significant differences between the two groups in all variables considered except for gender, ethnicity, and family history of mental illness. The recorded treatment outcome was better in patients who were younger, who had a shorter duration of illness, who were more educated, who came from better-off families, who were more adherent to treatment and who had participated in the program for a shorter period of time. Logistic regression analysis found that patients classified as unchanged or worsened were more likely to be non-adherent to drug treatment, to come from families living below the local poverty line, and to be enrolled in the 686 Program for a longer period of time. CONCLUSION: Poor treatment adherence and poverty seriously limit the effectiveness of the 686 Program. New approaches to improving adherence and for providing basic financial support to families with a mentally ill member will be needed to enhance the efficacy of the program.