Implementation of the modified NAVIGATE program for early schizophrenia in Shanghai through the specialized hospital and community integration: A comparative study

Abstract

Background:

The modified NAVIGATE program for early schizophrenia, called the Recovery program, was implemented in the Minhang district of Shanghai, China, with a population of approximately 2.7 million, representing 11% of the city’s population of about 24 million. The specialized hospital and communities integrated to form multidisciplinary treatment teams to provide multi-component treatment and services, and to receive group training and supervision together. The aim of the study is to evaluate and compare the effects of the Recovery program with conventional care on psychiatric symptoms and social functioning.

Method:

A total of 128 participants with a diagnosis of schizophrenia, aged 15 to 40 years, and illness duration ⩽5 years were enrolled. Patients living in the Minhang district were assigned to the Recovery program, and those living in other districts of Shanghai received the conventional care. Patients were followed up at baseline and after 2, 4, 6, 8, 10, and 12 months with assessments of symptoms, social functioning, treatment adherence, relapse, community activities, and school/work attendance using the Positive and Negative Symptom Scale (PANSS), the Clinical Global Impression Scale (CGI), and the Personal Social Functioning Scale (PSP).

Results:

Sixty-three participants receiving the Recovery program care showed greater improvement in psychotic symptoms and social functioning than 65 participants receiving conventional care. Participants in the Recovery program had lower rates of missed psychiatric visits >2 months (3.2% vs. 49.2%), antipsychotic discontinuation (7.9% vs. 36.9%), and relapse (4.8% vs. 26.2%) compared with conventional care.

Conclusions:

The modified NAVIGATE program can be implemented in the Minhang district of Shanghai, China, through the integration of the specialized hospital and community, and improves clinical outcomes for patients with early schizophrenia compared to conventional care. It has great potential for implementation in other districts in China.