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BMC Psychiatry

, 8:93

First Online: 04 December 2008Received: 29 April 2008Accepted: 04 December 2008

Abstract

BackgroundACT is an effective community treatment but causes discontinuity of care between acutely ill and currently stable patient groups. The Dutch variant of ACT, FACT, combines both intensive ACT treatment and care for patients requiring less intensive care at one time point yet likely to need ACT in the future. It may be hypothesised that this case mix is not beneficial for patients requiring intensive care, as other patient groups may -dilute- care provision. The effectiveness of FACT was compared with standard care, with a particular focus on possible moderating effects of patient characteristics within the case mix in FACT.

MethodsIn 2002, three FACT teams were implemented in a Dutch region in which a cumulative routine outcome measurement system was in place. Patients receiving FACT were compared with patients receiving standard treatment, matched on -baseline- symptom severity and age, using propensity score matching. Outcome was the probability of being in symptomatic remission of psychotic symptoms.

ResultsThe probability of symptomatic remission was higher for SMI patients receiving FACT than for controls receiving standard treatment, but only when there was an unmet need for care with respect to psychotic symptoms OR = 6.70, p = 0.002; 95% CI = 1.97 – 22.7.

ConclusionCompared to standard care, FACT was more rather than less effective, but only when a need for care with respect to psychotic symptoms is present. This suggests that there is no adverse effect of using broader patient mixes in providing continuity of care for all patients with severe mental illness in a defined geographical area.

AbbreviationsACTAssertive Community Treatment

BPRSBrief Psychiatric Rating Scale

CNCRCumulative Needs for Care Register

FACTFunction-ACT a Dutch variant on ACT

GAFGlobal Assessment of Functioning

MMIModerately Mental Ill

PCRPsychiatric Case Register

SMISevere Mental Illness.

Marjan Drukker, Myrte Maarschalkerweerd contributed equally to this work.

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Autor: Marjan Drukker - Myrte Maarschalkerweerd - Maarten Bak - Ger Driessen - Joost à Campo - Arthur de Bie - Giovanni Poddighe

Fuente: https://link.springer.com/







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