1
|
Ramonet M, Genest P. [Can intensive home care solve the problem of overcrowded psychiatric beds?]. Soins Psychiatr 2023; 44:39-43. [PMID: 37479357 DOI: 10.1016/j.spsy.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
The growing demand for psychiatric care raises questions about the place and value of alternatives to hospitalization. Community-based intensive care, such as home-based intensive care teams, are models that have been extensively studied and precisely described in international literature. They make it possible to avoid or shorten hospital stays, and have interesting variations for providing access to care in rural areas.
Collapse
Affiliation(s)
- Marianne Ramonet
- Secteur 4, Pôle de psychiatrie, CHRU de Brest, CH Bohars, route de Ploudalmézeau, 29820 Bohars, France.
| | - Philippe Genest
- Secteur 4, Pôle de psychiatrie, CHRU de Brest, CH Bohars, route de Ploudalmézeau, 29820 Bohars, France
| |
Collapse
|
2
|
Receipt and targeting of evidence-based psychosocial interventions for people living with psychoses: findings from the second Australian national survey of psychosis. Epidemiol Psychiatr Sci 2019; 28:613-629. [PMID: 29893656 PMCID: PMC6998989 DOI: 10.1017/s2045796018000288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS. Clinical Practice Guidelines (CPGs) recommend evidence-based psychosocial interventions (EBPIs) to improve consumer recovery; however, availability appears limited. We describe receipt of six EBPIs, reported by people with psychoses, and associations with service and consumer characteristics, including indicators of need (eligibility) and benefit (suitability). METHODS. Participants in the 2010 Australian national survey of psychosis (n = 1825) were interviewed to assess demographic, functional, mental and physical health characteristics and service use in the previous year. Six EBPIs (Cognitive Behaviour Therapy for psychosis; Family Psycho-Education (FPE); Relapse Prevention Planning (RPP); Skills Training; Supported Employment; and Assertive Community Treatment) were chosen, based on the strength and consistency of CPG recommendations. Associations between receipt of interventions and eligibility and suitability indicators were examined via correlations and χ2. Logistic regression was used to predict receipt of one or more EBPIs and to identify predictors of each individual EBPI. RESULTS. Less than one-quarter of the sample reported receipt of an evidence-based level of any intervention: rates ranged from 3.4% (FPE) to 21.1% (RPP). The model predicting receipt of one or more EBPIs was statistically significant (χ2 (20, n = 1746) = 216.12, p < 0.01) and marginally useful. Nine variables contributed uniquely, of which six were service characteristics. The strongest predictors of receipt were being assigned a psychologist as a case manager (p < 0.01, OR(CI) = 2.36(1.50-3.72)) and accessing a non-clinical mental health support service in the past year (p < 0.01, OR(CI) = 2.01(1.60-2.51)). CONCLUSIONS. Prior reports of limited receipt of EBPIs are reinforced. There is patchy evidence for targeting of EBPIs to those who might benefit most. Service characteristics contribute more to the prediction of receipt than clinical characteristics. Greater implementation effort and better targeting are required to bridge evidence-practice gaps, including improved evidence-based practice literacy among professionals and needs-based service re-design to improve provision and optimise consumer outcomes.
Collapse
|
3
|
Affiliation(s)
- Samuel F Law
- Department of Psychiatry,University of Toronto,Toronto, Ontario,Canada
| | - Xingwei Luo
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| |
Collapse
|
4
|
Kido Y, Kawakami N, Kayama M. Comparison of hospital admission rates for psychiatric patients cared for by multidisciplinary outreach teams with and without peer specialist: a retrospective cohort study of Japanese Outreach Model Project 2011-2014. BMJ Open 2018; 8:e019090. [PMID: 30121587 PMCID: PMC6104750 DOI: 10.1136/bmjopen-2017-019090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study examined whether having peer specialists (PS) in psychiatric multidisciplinary outreach teams was associated with a lower risk of hospitalisation, improved social functioning and decreased problem behaviours. DESIGN AND SETTING This study was a retrospective cohort study based on medical records. This study was conducted as a part of the Japanese Outreach Model Project 2011-2014, which provides services for persons diagnosed mainly as ICD-10 F0, F2 and F3, who have a high possibility of hospital admission/readmission with regular Japanese outpatient care. PARTICIPANTS A total of 292 participants (clients) from 31 multidisciplinary outreach teams with and without PS (n=108 and 184, respectively) fulfilled the inclusion criteria and were included in the analysis. OUTCOME MEASURES The primary outcome measure was hospitalisation during follow-up. The difference in hospitalisation during the follow-up between teams with and without PS was analysed by Kaplan-Meier survival curves and a Cox proportional hazards model. The secondary outcome measures were social functioning (Global Assessment of Functioning, GAF) and problem behaviours (Social Behaviour Schedule, SBS) of clients, and were assessed at baseline and at 6-month follow-up. Changes in social functioning and problem behaviours were compared between clients cared for by the two team types. Amount and content of the service were also compared. RESULTS The clients cared by teams with PS had a significantly decreased probability of hospitalisation in Cox proportional hazards models adjusting for baseline characteristics (HR=0.53, 95% CI 0.31 to 0.89). The 6-month change in GAF or SBS was not significantly different between the two groups. CONCLUSION This is an observational study in which the presence of a PS appeared to be associated with a reduced rate of hospitalisation. A randomised study would be required to demonstrate a causal relationship.
Collapse
Affiliation(s)
- Yoshifumi Kido
- Department of Psychiatric and Mental Health Nursing, Mie Prefectural College of Nursing, Mie, Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mami Kayama
- Department of Psychiatric and Mental Health Nursing, Graduate School of Nursing, St Luke’s International University, Tokyo, Japan
| |
Collapse
|
5
|
Newberry K, Terrington C. Engaging the hard to engage: What contribution could occupational therapy make to an interdisciplinary approach? INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.8.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Karen Newberry
- Senior lecturer in occupational therapy, College of Health and Social Care, University of Derby, UK
| | - Claire Terrington
- Senior occupational therapist in assertive outreach, Birmingham and Solihull Mental Health Foundation Trust, UK
| |
Collapse
|
6
|
Predictors of Clinical Outcome of Assertive Community Treatment (ACT) in a Rural Area in Denmark: An Observational Study with a Two-Year Follow-Up. Community Ment Health J 2016; 52:908-913. [PMID: 26143244 DOI: 10.1007/s10597-015-9908-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
Assertive Community Treatment (ACT) is a multidisciplinary team approach to community care treatment, mainly characterised by small caseload and individualised care. The aim of the present study was to identify predictors of clinical outcome in ACT using an observational design. Three ACT Teams were established in The North Denmark Region to treat patients with severe mental illness. The patients were identified and followed in regional and national psychiatric registers, and in social and somatic case registers, 2 years before and 2 years after inclusion. The results showed that the use of psychiatric hospital services decreased significantly for the 240 included patients. Furthermore, the psychopharmacological profile was improved. No significant change occurred in the consumption of the somatic hospitals. Clinical outcome, defined as halving of admissions or bed days, was in a logistic analysis predicted by the patient's psychiatric use of inpatient service prior to inclusion in an ACT Team.
Collapse
|
7
|
Firn M, White SJ, Hubbeling D, Jones B. The replacement of assertive outreach services by reinforcing local community teams: a four-year observational study. J Ment Health 2016; 27:4-9. [PMID: 26850124 DOI: 10.3109/09638237.2016.1139073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mike Firn
- South West London & St. George’s Mental Health NHS Trust, London, UK, and
| | - Sarah Jane White
- Population Health Research Institute, St Georges University of London, London, UK
| | - Dieneke Hubbeling
- South West London & St. George’s Mental Health NHS Trust, London, UK, and
| | - Ben Jones
- South West London & St. George’s Mental Health NHS Trust, London, UK, and
| |
Collapse
|
8
|
Iredale C, Fornells-Ambrojo M, Jolley S. Psychological interventions for housebound people with psychosis: service user and therapist perspectives in South East London. J Ment Health 2015; 25:204-11. [PMID: 26472054 DOI: 10.3109/09638237.2015.1078882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND People with psychosis often have difficulty leaving their homes to perform tasks of daily living, which also limits their access to clinic-based interventions to support recovery. Home-based psychological therapy may offer a solution. AIM To examine service user and therapist perspectives on (i) houseboundness in psychosis and (ii) the value of home-based psychological interventions, as a first step towards a systematic evaluation. METHOD Semistructured interviews with 10 service users and 12 therapists from a large inner city mental health NHS Foundation Trust were thematically analysed. RESULTS Houseboundness most commonly resulted from anxiety, paranoia and amotivation, indicating the potential usefulness of targeted psychological therapies. Home-based therapy was offered unsystematically, with variable goals. Although beneficial for engagement and assessment, little gain was reported from undertaking a full course of therapy at home. CONCLUSION Home visits could be offered by psychological therapists to engage and assess housebound service users, but home-based therapy may be best offered on a short-term basis, targeting paranoia, anxiety and amotivation to increase access to other resources. Given the increased cost associated with home-based psychological interventions, a systematic evaluation of their impact is warranted.
Collapse
Affiliation(s)
- Catherine Iredale
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK .,b South London and Maudsley NHS Foundation Trust , London , UK , and
| | - Miriam Fornells-Ambrojo
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK .,b South London and Maudsley NHS Foundation Trust , London , UK , and.,c Department of Clinical , Educational and Health Psychology, University College London , London , UK
| | - Suzanne Jolley
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK
| |
Collapse
|
9
|
Hamilton I, Lloyd C, Bland JM, Savage Grainge A. The impact of assertive outreach teams on hospital admissions for psychosis: a time series analysis. J Psychiatr Ment Health Nurs 2015; 22:484-90. [PMID: 26118395 DOI: 10.1111/jpm.12239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 11/28/2022]
Abstract
Although the assertive outreach model was developed in the United States and imported to the United Kingdom to date, there is only limited evidence to support its wide-scale implementation within the United Kingdom. This is the first study to have combined a large dataset with this type of research method to explore the impact of assertive outreach teams on hospital admissions. The introduction and expansion of assertive outreach teams was associated with reducing hospital admissions for people with psychosis. This study found a consistent summer peak in hospital admissions which community and in-patient mental health nurses should take account of and plan for. Ever since the Mental Health Policy Implementation Policy Guide paved the way for the introduction of the Assertive Outreach Treatment (AOT) model in England, the impact of this approach has been the subject of considerable debate but limited evaluation. To date, most of the evidence supporting this model has originated from outside the United Kingdom. A central aim of the AOT was to reduce the need for in-patient treatment. We aimed to assess the impact of the AOT model on hospital admissions for people with psychosis in England. Interrupted time series analysis was used in this study to evaluate the impact of the policy change. Following the introduction of the AOT model, a statistically significant reduction in hospital admissions for psychosis was found. In addition, we observed a repeated, annual summer peak in admissions. This study adds to the international evidence which supports the effectiveness of the AOT model in reducing hospital admissions for people with severe mental health problems. We offer five suggested implications for mental health nurses and clients based on our findings.
Collapse
Affiliation(s)
- I Hamilton
- Health Sciences, University of York, York, UK
| | - C Lloyd
- Health Sciences, University of York, York, UK
| | - J M Bland
- Health Sciences, University of York, York, UK
| | | |
Collapse
|
10
|
Kayama M, Kido Y, Setoya N, Tsunoda A, Matsunaga A, Kikkawa T, Fukuda T, Noguchi M, Mishina K, Nishio M, Ito J. Community outreach for patients who have difficulties in maintaining contact with mental health services: longitudinal retrospective study of the Japanese outreach model project. BMC Psychiatry 2014; 14:311. [PMID: 25403680 PMCID: PMC4251924 DOI: 10.1186/s12888-014-0311-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Japan still has the highest ratio of beds devoted to psychiatric patients in the world. In 2011, in order to reduce re-hospitalization of patients who became disconnected from regular contact with outpatient medical services, the Japanese Ministry established the Japanese Outreach Model Project (JOMP). In this study, we will explicate the JOMP project protocol and investigate the rate and length of hospital admission, impairments of social function and problematic behavior at the follow-up period (6- and 12-month) and time of services provided by JOMP. METHOD This longitudinal retrospective study used survey data collected from 32 outreach teams of 21 prefectures in Japan during September 2011 to July 2013. The outcome variables were assessed at baseline, 6-month and 12-month as to whether or not participants had been admitted to the hospital. Data from 162 participants with mental illness who had difficulties in maintaining contact with mental health services were analyzed. Repeated measures analysis of variance provided a significant effect of the intervention over time. RESULTS The rate of hospital admission of JOMP participants was 24.1% at 6-months and 27.2% at the 12-month follow-up. The average length of hospital-stay at baseline and 12-months was 38.7 days (SD 84.7). Compared with the baseline, the average score of the Global Assessment Functioning and the Social Behavioral Schedule were significantly improved after the 6-month and 12-month follow-up. The activity log showed that among the most often delivered JOMP services were to "prevent exacerbation of somatic symptoms" and "care for families". CONCLUSION These results suggest that JOMP has a strong potential to both reduce readmission rates and the length of hospital stay compared with the Japanese regular outpatient care by public insurance, and improve social function and problematic behavior. The JOMP teams provided long-term support for families. As of April 2014 JOMP was included in the National Health Insurance program in a limited way therefore an evaluation of JOMP team fidelity on readmissions must be examined.
Collapse
Affiliation(s)
- Mami Kayama
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
| | - Yoshifumi Kido
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
- />Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan
| | - Nozomi Setoya
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
| | - Aki Tsunoda
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
| | - Asami Matsunaga
- />Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan
| | - Takahiro Kikkawa
- />Department of Nursing, School of Health Sciences, Tokai University, Kanagawa, Japan
| | | | | | - Keiko Mishina
- />Hanazono University, Clinical Psychology, Faculty of Social Welfare, Kyoto, Japan
| | - Masaaki Nishio
- />Tohoku Fukushi University, Social Welfare, Faculty of General Welfare, Miyagi, Japan
| | - Junichiro Ito
- />National Center of Neurology and Psychiatry, National Institute of Mental Health, Psychiatric Rehabilitation, Tokyo, Japan
| |
Collapse
|
11
|
Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use. Int J Ment Health Syst 2014; 8:40. [PMID: 25389446 PMCID: PMC4226907 DOI: 10.1186/1752-4458-8-40] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 10/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clients with severe mental illness (SMI) who use substances are less engaged in treatment than those who do not use substances, and assertive community treatment (ACT) engages and retains clients with SMI and concurrent substance use at a higher rate compared with traditional treatment. This qualitative study aimed to explore the experiences of being recruited to, and remaining in, ACT among recovering clients diagnosed with SMI and concurrent substance use. METHODS Twenty semi-structured interviews were undertaken among 11 clients with SMI and concurrent substance use who were included in ACT teams. The inclusion criteria were SMI and concurrent substance use and improvement after a minimum of 12 months in treatment regarding one or several of the following parameters: quality of life, general functioning and substance use. Systematic text condensation was applied in the analyses. RESULTS The experiences of building trust through enduring involvement and receiving benefits were most important for the acceptance of ACT by clients. A feeling of exclusiveness, perceiving ACT as a safety net and the clients' own personal responsibility for taking part in the treatment were stated as the most important factors for remaining in treatment. CONCLUSIONS The implications of the results of the present study are that service providers have to prove that they can be trusted in the initial phase of the clients' contact with the team. The feeling by clients with SMI and concurrent substance use that service providers in ACT believe they can improve their client's quality of life, is of importance for feeling exclusive, having hope for the future and remaining in treatment.
Collapse
|
12
|
Stobbe J, Wierdsma AI, Kok RM, Kroon H, Roosenschoon BJ, Depla M, Mulder CL. The effectiveness of assertive community treatment for elderly patients with severe mental illness: a randomized controlled trial. BMC Psychiatry 2014; 14:42. [PMID: 24528604 PMCID: PMC3928976 DOI: 10.1186/1471-244x-14-42] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to fragmented mental, somatic, and social healthcare services, it can be hard to engage into care older patients with severe mental illness (SMI). In adult mental health care, assertive community treatment (ACT) is an organizational model of care for treating patients with SMI who are difficult to engage. So far all outcome studies of assertive community treatment have been conducted in adults. METHODS In a randomized controlled trial design we compared the effectiveness of ACT for elderly patients with that of treatment as usual (TAU). Sixty-two outpatients (60 years and older) with SMI who were difficult to engage in psychiatric treatment were randomly assigned to the intervention or control group (32 to ACT for elderly patients and 30 to TAU). Primary outcomes included number of patients who had a first treatment contact within 3 months, the number of dropouts (i.e. those discharged from care due to refusing care or those who unintentionally lost contact with the service over a period of at least 3 months); and patients' psychosocial functioning (HoNOS65+ scores) during 18 months follow-up. Secondary outcomes included the number of unmet needs and mental health care use. Analyses were based on intention-to-treat. RESULTS Of the 62 patients who were randomized, 26 were lost to follow-up (10 patients in ACT for elderly patients and 16 in TAU). Relative to patients with TAU, more patients allocated to ACT had a first contact within three months (96.9 versus 66.7%; X2 (df = 1) = 9.68, p = 0.002). ACT for elderly patients also had fewer dropouts from treatment (18.8% of assertive community treatment for elderly patients versus 50% of TAU patients; X2 (df = 1) = 6.75, p = 0.009). There were no differences in the other primary and secondary outcome variables. CONCLUSIONS These findings suggest that ACT for elderly patients with SMI engaged patients in treatment more successfully. TRIAL REGISTRATION NTR1620.
Collapse
Affiliation(s)
- Jolanda Stobbe
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands.
| | - André I Wierdsma
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands
| | - Rob M Kok
- Parnassia Psychiatric Institute, department Parnassia, Centre for Mental Health Care, Monsterweg, The Hague, The Netherlands
| | - Hans Kroon
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Da Costakade, The Netherlands
| | - Bert-Jan Roosenschoon
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands,Parnassia Psychiatric Institute, department BavoEuropoort, Centre for Mental Health Care, Prins Constantijnweg, Rotterdam, The Netherlands
| | - Marja Depla
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorsstraat, Amsterdam, The Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands,Parnassia Psychiatric Institute, department BavoEuropoort, Centre for Mental Health Care, Prins Constantijnweg, Rotterdam, The Netherlands
| |
Collapse
|
13
|
Integrated care in patients with schizophrenia: results of trials published between 2011 and 2013 focusing on effectiveness and efficiency. Curr Opin Psychiatry 2013; 26:384-408. [PMID: 23722100 DOI: 10.1097/yco.0b013e328361ec3b] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Overview on integrated care trials focusing on effectiveness and efficiency published from 2011 to 2013. RECENT FINDINGS Eight randomized controlled trials (RCTs) and 21 non-RCT studies were published from 2011 to 2013. Studies differed in several methodological aspects such as study population, psychotherapeutic approaches used, outcome parameters, follow-up times, fidelities, and implementation of the integrated care model and the nation-specific healthcare context with different control conditions. This makes it difficult to draw firm conclusions. Most studies demonstrated relevant improvements regarding symptoms (P=0.001) and functioning (P=0.01), quality of life (P=0.01), adherence (P<.05) and patient's satisfaction (P=0.01), and reduction of caregiver's stress (P<0.05). Mean total costs were favoring or at least equalizing costs but with positive effects found on subjective health favoring integrated care models. SUMMARY There is an increasing interest in the effectiveness and efficiency of integrated care models in patients with mental disorders, specifically in those with severe and persistent mental illness. To increase generalizability, future trials should exactly describe rationales and content of integrated care model and control conditions.
Collapse
|
14
|
Firn M, Hindhaugh K, Hubbeling D, Davies G, Jones B, White SJ. A dismantling study of assertive outreach services: comparing activity and outcomes following replacement with the FACT model. Soc Psychiatry Psychiatr Epidemiol 2013; 48:997-1003. [PMID: 23086585 DOI: 10.1007/s00127-012-0602-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 09/28/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Financial constraints and some disappointing research evaluations have seen English assertive outreach (AO) teams subject to remodelling, decommissioning and integration into standard care. We tested a specific alternative model of integrating the AO function from two AO teams into six standard community mental health teams (CMHT). The Flexible Assertive Community Treatment model (FACT) was adopted from the Netherlands (Van Veldhuizen, Commun Mental Health J 43(4):421-433, 2007; Bond and Drake, Commun Mental Health J 43(4):435-438, 2007). We aimed to demonstrate non-inferiority in clinical effectiveness and thereby show cost efficiencies associated with FACT. METHODS Outcomes were compared in a mirror-image study of the 12 months periods pre- and post-service change with eligible individuals from the AO teams' caseloads (n = 112) acting as their own controls. We also conducted a cost-consequence analysis of the changes. Outcome data regarding admissions, use of crisis and home treatment, frequency of contact and DNA rate were extracted from the electronic patient record. RESULTS The results show AO patients (n = 112) transferred to standard CMHTs with FACT had significantly fewer admissions and a halving of bed use (21 fewer admission and 2,394 fewer occupied bed days) whilst being in receipt of a less intensive service (2,979 fewer contacts). This was offset by significantly poorer engagement but not by increased use of crisis and home treatment services. CONCLUSIONS Enhancing multi-disciplinary CMHTs with FACT provides a clinically effective alternative to AO teams. FACT offers a cost-effective model compared to AO.
Collapse
Affiliation(s)
- Mike Firn
- South West London and St George's Mental Health NHS Trust Service Development, Room 5, Building 14 Springfield University Hospital, 61 Glenburnie Road, London, SW17 7DJ, UK.
| | | | | | | | | | | |
Collapse
|