Moreno-Küstner, BertaMayoral, FermínRivas, FabioAngona, PedroRequena, JavierGarcía-Herrera, José MNavas, DesireeMoreno, PatriciaSerrano-Blanco, AntoniBellón, Juan A2013-05-092013-05-092011-10-07Moreno-Küstner B, Mayoral F, Rivas F, Angona P, Requena J, García-Herrera JM, et al. Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis. BMC Health Serv Res. 2011;11:257.http://hdl.handle.net/10668/957Journal Article; Research Support, Non-U.S. Gov't;BACKGROUND Persons with schizophrenia and related disorders may be particularly sensitive to a number of determinants of service use, including those related with illness, socio-demographic characteristics and organizational factors. The objective of this study is to identify factors associated with outpatient contacts at community mental health services of patients with schizophrenia or related disorders. METHODS This cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and use of service factors. Data were collected from clinical records. RESULTS The multilevel linear regression model explained 46.35% of the variance. Patients with significantly more contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p < 0.001), with one or more inpatient admissions (p < 0.001), and in contact with both types of professional (nurses and psychiatrists) (p < 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p < 0.001). CONCLUSIONS As expected, the variables that explained the use of community service could be viewed as proxies for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More research is needed to carefully examine how professional support networks interact to affect use of mental health.enatención ambulatoriaServicios Comunitarios de Salud Mentalestudios transversalesInvestigación sobre Servicios de SaludModelo linealesAnálisis de niveles múltiplesAceptación de la Atención de SaludEsquizofreniaÏndice de severidad de la enfermedadFactores de riesgoFactores SocioeconómicosEspañaMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Services::Patient Care::Ambulatory CareMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Services::Community Health ServicesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cross-Sectional StudiesMedical Subject Headings::Check Tags::FemaleMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Health Services ResearchMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Regression AnalysisMedical Subject Headings::Check Tags::MaleMedical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle AgedMedical Subject Headings::Health Care::Environment and Public Health::Public Health::Epidemiologic Methods::Statistics as Topic::Multilevel AnalysisMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Delivery of Health Care::Attitude to Health::Patient Acceptance of Health CareMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Epidemiologic Factors::Causality::Risk FactorsMedical Subject Headings::Psychiatry and Psychology::Mental Disorders::Schizophrenia and Disorders with Psychotic Features::SchizophreniaMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Health Surveys::Health Status Indicators::Severity of Illness IndexMedical Subject Headings::Health Care::Population Characteristics::Socioeconomic FactorsMedical Subject Headings::Geographicals::Geographic Locations::Europe::SpainMedical Subject Headings::Named Groups::Persons::Age Groups::Adultresearch article21982430open access10.1186/1472-6963-11-2571472-6963PMC3210099