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Patient Outcome Research Team Study on Schizophrenia Offers Grim Indictment

Patient Outcome Research Team Study on Schizophrenia Offers Grim Indictment

A leader of a key mental illness patient advocacy group indirectly but pointedly criticized psychiatrists for the care they give schizophrenics. Laurie Flynn, the executive director of the National Alliance for the Mentally Ill (NAMI), said she was "appalled" by the results of face-to-face interviews with over 700 schizophrenics during a 16-month period. The interviews turned up evidence of under- and overdosing of patients and a failure to get patients into effective community treatment plans.

Neither Flynn nor any of the other speakers at the Washington, D.C., press conference on March 24 faulted psychiatrists by name. The blame for the poor care was laid at the doorstep of "clinicians" and "health professionals." But the implication was unmistakable.

The PORT Study

The press conference was called to announce preliminary results of the schizophrenia Patient Outcomes Research Team (PORT) study (Please see related article).

At the press conference, Flynn let fly with both barrels. "It's a disgrace that more than half of the [more than] 2 million Americans suffering from schizophrenia today receive substandard care," she said. NAMI introduced a new consumer guide called the NAMI Consumer and Family Guide to Schizophrenia, which is being sent to schizophrenia patients who, Flynn explained, could now "bring their demands" to clinicians.

Asked if he also was "appalled" at the results of the PORT study, John Eisenberg, M.D., administrator of the U.S. Agency for Health Care Policy and Research (AHCPR), said, "I'll let Laurie take credit for that word." Then he added, "You can be appalled, surprised or shocked. But you will definitely be a person who thinks we need to take action."

The PORT study, which began in 1992 is being run by Anthony Lehman, M.D., director of the Center for Mental Health Services Research at the University of Maryland. He and his team first weeded through 900 scientific studies that had been done on schizophrenia in order to identify treatment that works. The research was then fashioned into what Lehman referred to as a "statement of evidence," which he differentiated from treatment guidelines. The statement of evidence was used as a yardstick in the interviews, the schizophrenia patients.

"We did not take a poll of psychiatrists to see what they think works," he said, appearing to indirectly criticize the American Psychiatric Association's treatment guidelines on schizophrenia.

When asked later to comment on those guidelines, Lehman noted that they comprised a consensus document that included "a lot of expert opinion." He added, "They tend to emphasize treatment provided by psychiatrists."

Lehman went on to note that the act of publishing guidelines doesn't change the practice of medicine. "You have to do more than that," he emphasized.

In a follow-up phone conversation, Lehman said he doubted that the results of the final PORT study will differ from those obtained in the interviews for the earlier 16-month period.

During those interviews, Lehman and his team gauged how close treatment came to the general standards in the PORT scientific survey, which contained sections on medication, psychosocial counseling, family interventions, community continuum of care and other topics.

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