Assertive Community Treatment as Part of Integrated Care Versus Standard Care

Lambert, Martin; Böck, Thomas; Schöttle, Daniel; Golks, Dietmar; Meister, Klara; Rietschel, Liz; Bussopulos, Alexandra; Frieling, Marietta; Schödlbauer, Michael; Burlon, Marc; Huber, Christian G.; Ohm, Gunda; Pakrasi, Manoshi; Chirazi-Stark, Michael Sadre; Schimmelmann, Benno G.

doi:10.4088/jcp.09m05113yel

Cited by 107 publications

(39 citation statements)

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“…The results are in accordance with previous studies reporting that antipsychotic treatment integrated with several components of psychosocial intervention is superior to traditional medication-alone treatments in terms of dealing with several problems (e.g., psychotic symptoms, social functioning, and compliance to medication) simultaneously in the treatment of schizophrenia [1, 23, 25, 27, 29, 48-50]. …”

Section: Discussionsupporting

confidence: 82%

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Psychotic Symptoms and Attitudes toward Medication Mediate the Effect of Insight on Personal-Social Functions in Patients with Schizophrenia: One-Year Randomized Controlled Trial and Follow-Up

et al. 2018

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Aims: This study aimed to investigate the mediating pathway of 3 factors (psychotic symptoms, attitude toward medication, and cognitive processing speed) on the effect of insight on personal-social functioning in patients with schizophrenia. Methods: Chinese inpatients with schizophrenia (n = 168; mean age 18 ± 50 years) diagnosed according to the DSM-IV were randomly assigned to treatment with antipsychotic medication alone or combined treatment. Positive and Negative Syndrome Scale (PANSS), Drug Attitude Inventory (DAI), Assessment of Insight (SAI), and Social-Personal Performance Scale (PSPS) scores were evaluated at baseline and at 3, 6, and 12 months. Cognitive function was assessed at baseline. Multiple mediation analyses were conducted with baseline data, end point data, and changes-in-scale scores between baseline and the end point, respectively. Results: At baseline and at 12 months, only psychotic symptoms mediated the effect of insight on personal-social functioning. For changes-in-scale scores over the 12-month follow-up, in patients receiving treatment with medication alone, the effect of improved insight on improved personal-social function was mediated by psychotic symptoms only; in patients receiving a combined treatment, the effect of improved insight on improved personal-social functioning was mediated by both psychotic symptoms and attitudes toward medication, independently. Conclusions: The link between insight and personal-social functions is mainly mediated by psychotic symptoms. Psychosocial intervention improves the predicting effect of insight on personal-social function by improving both the attitude toward medication and psychotic symptoms independently.

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Section: Discussionsupporting

confidence: 82%

“…Patients in the combined-treatment group and their family members received rehabilitation treatments which include 3 modules: medication management, symptom management, and social skill training [25, 27, 35-39]. Each therapy group consisted of 6–8 families.…”

Section: Methodsmentioning

confidence: 99%

Psychotic Symptoms and Attitudes toward Medication Mediate the Effect of Insight on Personal-Social Functions in Patients with Schizophrenia: One-Year Randomized Controlled Trial and Follow-Up

et al. 2018

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“…In Munich, the average length of stay decreased since the implementation of the new integrated care model and patients reported a high level of satisfaction, although the implementation process was not free of difficulties (9). In Hamburg, a new model that focused on severely ill patients (F2x und F3x ICD-10 diagnostic codes) contributed to an increase in the outpatient contacts, a decrease of the average inpatient length of stay, and higher patient satisfaction by maintaining cost-effectiveness (10–12). In Krefeld, a new home treatment-based implemented model proved to be effective in increasing the satisfaction of patients and their next of kin, while preserving a constant quality of care when compared to standard inpatient care (13, 14).…”

Section: Introductionmentioning

confidence: 99%

Challenges and Perspectives in Bridging In- and Outpatient Sectors: The Implementation of Two Alternative Models of Care and Their Effect on the Average Length of Stay

Wullschleger¹,

Wosniok

Timm

et al. 2017

Front. Psychiatry

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New models of care aimed at reinforcing the outpatient sector have been introduced in Germany over the last few years. Initially, a subscription-based model (“integrated care”) was introduced in 2012 in the Immanuel Klinik Rüdersdorf, wherein patients had to actively subscribe to the integrated care program. This integrated care model was replaced after 2 years by a subscription-free “model project,” in which all patients insured by the contracting insurance company took part in the program. Data showed that the introduction of the integrated care program in the inpatient setting led to an increase of the average length of stay in this group. The switch to the model project corrected this unwanted effect but failed in significantly decreasing the average length of stay when compared to standard care. However, both the integrated care program and model project succeeded in reducing the length of stay in the day care setting. When adjusting for the sex and diagnosis proportions of each year, it was shown that diagnosis strongly influenced the average length of stay in both settings, whereas sex only slightly influenced the duration of stay in the inpatient setting. Thus, in spite of strong financial and clinical incentives, the introduction of the model project couldn’t fulfill its primary purpose of shifting resources from the inpatient to the outpatient setting in the initial years. Possible explanations, including struggle against long-established traditions and reluctance to change, are discussed.

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“…This study also showed a reduction in expenses for inpatient treatment with a simultaneous increase in expenses for outpatient treatment and no significant differences in total costs between both programmes were revealed. However, as part of a cost-effectiveness analysis, the authors demonstrated that treatment efficiency (relationship between treatment costs and gain in quality of life) in the ACT group was better than in routine care [9,10]. …”

Section: Introductionmentioning

confidence: 99%

Effectiveness and efficiency of integrated mental health care programmes in Germany: study protocol of an observational controlled trial

et al. 2014

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BackgroundSince 2009 some German health insurance companies have implemented integrated mental health care services along the principles of assertive community treatment in collaboration with local mental health service providers across Germany. Focus of this study is the analysis of effectiveness and cost-effectiveness of this integrated care programme compared to care as usual in routine care surroundings in five regions in Germany.MethodsIn this 18-month multi-centre observational trial 250 patients enrolled in an integrated mental health care programme and 250 patients who receive treatment as usual from five catchment areas will be included. In addition, in each group about 125 relatives of the participating patients will be included. The primary outcome criterion is the improvement of empowerment; secondary outcomes are subjective quality of life, functional impairment and costs of illness. Data will be collected at baseline and three follow-ups after 6, 12 and 18 months. Data will be analysed by means of mixed effects regression models. Propensity score methods are used for selection bias control.DiscussionStudy results are expected to provide information about how integrated care programmes in their present form contribute to the improvement of mental health care. In addition, the study will provide hints to weaknesses of the current integrated care programme and options to overcome them. The major strengths of this study are the real-world character of the study intervention with a simultaneous high level of academic rigour. However, the fact that patients are not randomised to study groups and that there is no blinding might limit the study.Trial registrationGerman Clinical Trial Register DRKS00005111.

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Assertive Community Treatment as Part of Integrated Care Versus Standard Care

Abstract: clinicaltrials.gov Identifier: NCT01081418.

Cited by 107 publications

References 0 publications

Psychotic Symptoms and Attitudes toward Medication Mediate the Effect of Insight on Personal-Social Functions in Patients with Schizophrenia: One-Year Randomized Controlled Trial and Follow-Up

Psychotic Symptoms and Attitudes toward Medication Mediate the Effect of Insight on Personal-Social Functions in Patients with Schizophrenia: One-Year Randomized Controlled Trial and Follow-Up

Challenges and Perspectives in Bridging In- and Outpatient Sectors: The Implementation of Two Alternative Models of Care and Their Effect on the Average Length of Stay

Effectiveness and efficiency of integrated mental health care programmes in Germany: study protocol of an observational controlled trial

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