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                  <mods:namePart>Moreno, Patricia</mods:namePart>
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                  <mods:namePart>Serrano, Antoni</mods:namePart>
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                  <mods:namePart>Bellón, Juan A</mods:namePart>
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                  <mods:dateIssued encoding="iso8601">2011-10-07</mods:dateIssued>
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               <mods:identifier type="citation">Moreno-Küstner et al.: Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis. BMC Health Services Research 2011 11:257. doi:10.1186/1472-6963-11-257</mods:identifier>
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               <mods:identifier type="doi">10.1186/1472-6963-11-257</mods:identifier>
               <mods:abstract>Background: Persons with schizophrenia and related disorders may be particularly sensitive to a number of&#xd;
determinants of service use, including those related with illness, socio-demographic characteristics and&#xd;
organizational factors. The objective of this study is to identify factors associated with outpatient contacts at&#xd;
community mental health services of patients with schizophrenia or related disorders.&#xd;
Methods: This cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of&#xd;
outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and&#xd;
use of service factors. Data were collected from clinical records.&#xd;
Results: The multilevel linear regression model explained 46.35% of the variance. Patients with significantly more&#xd;
contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal&#xd;
education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p &lt; 0.001), with&#xd;
one or more inpatient admissions (p &lt; 0.001), and in contact with both types of professional (nurses and&#xd;
psychiatrists) (p &lt; 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent&#xd;
delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p &lt; 0.001).&#xd;
Conclusions: As expected, the variables that explained the use of community service could be viewed as proxies&#xd;
for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also&#xd;
independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More&#xd;
research is needed to carefully examine how professional support networks interact to affect use of mental health.</mods:abstract>
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               <mods:accessCondition type="useAndReproduction">Attribution-NonCommercial-NoDerivatives 4.0 Internacional</mods:accessCondition>
               <mods:subject>
                  <mods:topic>Esquizofrenia</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Salud mental, Servicios comunitarios de</mods:topic>
               </mods:subject>
               <mods:titleInfo>
                  <mods:title>Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis</mods:title>
               </mods:titleInfo>
               <mods:genre>journal article</mods:genre>
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