Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia-spectrum and bipolar I disorders: Four-year follow-up of the ACCESS II study
Autor: | Jürgen Gallinat, Marietta Frieling, Thomas Bock, Daniel Luedecke, Mary Sengutta, Alexandra Bussopulos, Luise Antonia Nawara, Gunda Ohm, Anne Karow, Andrea Kerstan, Anne Daubmann, Benno G. Schimmelmann, Linus Wittmann, Michael Schödlbauer, Daniel Schöttle, G Sarikaya, Friederike Ruppelt, Anja Rohenkohl, Dietmar Golks, Klaus Wiedemann, Martin Lambert, Evangelia Nika, Karl Wegscheider, Christina Meigel-Schleiff, Matthias Lange |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Male
Pediatrics Bipolar I disorder Bipolar Disorder lcsh:Medicine Social Sciences 0302 clinical medicine Outpatients Medicine and Health Sciences Ambulatory Care Psychology lcsh:Science Multidisciplinary Pharmaceutics Cognitive Neurology Delivery of Health Care Integrated Community Mental Health Services Hospitalization Treatment Outcome Neurology Schizophrenia Patient Satisfaction Female Psychopathology Cohort study Research Article Adult medicine.medical_specialty Patient Dropouts Patients Assertive community treatment Cognitive Neuroscience 03 medical and health sciences Patient satisfaction Drug Therapy Neuropsychology Severity of illness Mental Health and Psychiatry medicine Humans Bipolar disorder Neuropsychological Testing Inpatients business.industry Mood Disorders lcsh:R Psychoses Biology and Life Sciences medicine.disease Involuntary Treatment 030227 psychiatry Health Care Psychotherapy Psychotic Disorders Quality of Life Cognitive Science lcsh:Q business Mental Health Therapies 030217 neurology & neurosurgery Neuroscience Follow-Up Studies |
Zdroj: | PLoS ONE PLoS ONE, Vol 13, Iss 2, p e0192929 (2018) |
ISSN: | 1932-6203 |
Popis: | OBJECTIVE The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study. METHOD All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization. RESULTS Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002). CONCLUSIONS ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01888627. |
Databáze: | OpenAIRE |
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