Open Access Scheduling for Patients at High Risk of Hospitalization and Incarceration

To discuss the origins of assertive community treatment (ACT) and the adoption of its framework by a Northeast Florida Community Outreach Center, Sulzbacher, through the Mental Health Offender Program (MHOP). With recent changes to health policy and resource funding, MHOP implemented an alternative approach to providing patient care through Open Access Scheduling (OAS). This article examines the hypothesis that OAS may improve the outcomes on rates of missed long-acting injectable (LAI) antipsychotics, overdue psychiatric appointments, and incarceration.

A retrospective comparative analysis was conducted among participants of the MHOP 12 months before and 12 months after implementation of OAS. With Institutional Review Board (IRB) exemption status granted, de-identified data obtained from the electronic medical record and publicly available arrest rates were compiled into a Microsoft Excel spreadsheet and subjected to statistical analysis using the Data ToolPak software. Primary outcomes measured were the percentage of overdue psychiatric appointments and missed LAI antipsychotics, and rates of incarceration before and after the implementation of OAS.

Using a paired t-test design, the mean weekly percent of overdue psychiatric appointments and missed LAI antipsychotics increased from 51.7% pre-intervention to 57.0% post-intervention with a t-value of approximately 2.22 and a statistically significant p-value (0.032). However, rates on incarceration remained roughly the same. An unpaired t-test, assuming unequal variances, yielded a t-value of approximately 0.26 and a non-statistically significant p-value of 0.796.

Data analysis of 52 weeks before and after the implementation of OAS highlights the potential role of OAS as a viable alternative to psychiatric follow-up.