Evaluation of the impact of Comprehensive Medication Management on health outcomes in people living with hypertension: a pragmatic clinical trial.

Patients with schizophrenia often suffer from impaired social function, as reflected by their low employment rate varying from 8% to 35% [–], despite 55% to 70% of patients showing interest in work [–]. Employment is crucial for individual patients not only because it provides financial security, but also because it has sometimes been reported to increase quality of life (QOL) [–], elevate physical activity [], boost self-esteem [–], and deepen sense of connection with society [, ]. Recent studies further suggest that engagement in vocational activity—whether competitive or non-competitive—may support well-being, self-confidence, and a sense of purpose, although the magnitude of these benefits may differ across employment types []. While job seeking in the competitive labor market using the Individual Placement and Support (IPS) model has widely been regarded effective [–], non-competitive employment serves as an important option for those without successful IPS interventions and for those who have limited access to IPS. Several factors have been reported to be related to employment in general in patients with schizophrenia. Among these are lower levels of negative symptoms, better cognitive function, longer or higher level of education, premorbid employment, a married state or presence of a cohabitant, and low to moderate antipsychotic drug doses [–]. Previous studies have focused primarily on competitive employment, and very rarely have studies aimed to compare different vocational levels including non-competitive supported employment been investigated. The few studies that have done so have identified factors such as disorganization and processing speed to be associated with non-competitive employment [, ]. Further research is necessary to clarify what facilitates participation across different types of employment. This would be helpful in setting treatment goals to assist patients’ integration into society. Many countries around the world have implemented supported employment measures for individuals with disabilities in both non-competitive and competitive environments [–]. This comes at a time when emphasis is being placed on deinstitutionalization and outpatient treatment of psychiatric patients [–]. Initially, paid non-competitive work and vocational training, usually funded publicly, were the most common approach for providing patients with mental disabilities access to employment [–]. These are usually referred to as a “train then place” approach, in which participants are provided with vocational rehabilitation and training before seeking competitive jobs [, ]. Non-competitive employment including vocational workshops may confer a range of psychosocial benefits despite financial compensation. Previous studies have suggested that participation in structured work activity may support daily structure, social interactions, and sense of purpose [, ]. These studies highlight the potential value of such employment as a means of facilitating engagement in meaningful activity.