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
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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