Assertive community treatment versus standard treatment for severely mentally ill patients in Denmark: a quasi-experimental trial

Thoegersen, M; Morthorst, Brit Reuter; Nordentoft, Merete

doi:10.1080/08039488.2019.1576765

Cited by 15 publications

(13 citation statements)

References 26 publications

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“…2 There is strong international evidence for the efficacy of ACT in reducing patients' use of inpatient care and improving engagement and satisfaction with services. 2,3 Assertive outreach is a central component of the ACT model, which involves a continuous effort to contact and offer services to patients who are reluctant to engage in treatment. 4 To achieve this, ACT teams operate with a team approach (where all staff are familiar with all the team's patients), low caseloads, extended hours of operation, and frequent home visits.…”

Section: Research In Context Panelmentioning

confidence: 99%

“…Contacts are less frequent than in ACT, with most appointments offered at the team office and within usual office hours. 3 Although the FACT model has been taken up in many countries [5][6][7] , there is a lack of good quality studies investigating its effectiveness. [8][9][10] To date, no studies have compared FACT with ACT or CMHT control groups .…”

Section: Research In Context Panelmentioning

confidence: 99%

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The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study

Nielsen

Hjorthøj

Killaspy

et al. 2021

The Lancet Psychiatry

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Background: A community-based treatment model for patients with severe mental illness called Flexible Assertive Community Treatment (FACT) has been widely implemented despite limited evidence for its effectiveness. We aimed to evaluate the effect of FACT on mental health care outcomes compared with treatment from standard Community Mental Health Teams (CMHTs) or Assertive Community Treatment (ACT) teams in Denmark. Methods:We conducted a quasi-experimental controlled study from May 2016 to November 2018, comparing outcomes for patients under the care of CMHTs or ACT teams that were reconfigured to FACT teams (CMHT-FACT or ACT-FACT) with patients that remained under the care of CMHTs and ACT teams.A total of 2094 individuals were included and followed up for two years using Danish registries on multiple mental health care outcomes. Patients who received FACT were matched using propensity scores with control patients from CMHTs and ACT teams to balance differences in baseline characteristics.Findings: The number of outpatient contacts was higher for patients receiving FACT than controls (CMHT-

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Section: Research In Context Panelmentioning

confidence: 99%

Section: Research In Context Panelmentioning

confidence: 99%

The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study

Nielsen

Hjorthøj

Killaspy

et al. 2021

The Lancet Psychiatry

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“…Assertive outreach is a central feature of ACT which involves persistent attempts to contact patients to make or maintain engagement with services. To achieve this, the ACT team operates with low caseloads [9]. In many countries, patients are transferred from ACT teams to Community Mental Health teams (CMHTs) when they no longer need intensive services.…”

Section: Introductionmentioning

confidence: 99%

“…The key aspect of individual case management is that each practitioner work independently with a group of patients. CMHTs have higher caseloads than ACT, so contacts with the patient are primarily offered at the team office, and more services are provided by external providers [9].…”

Section: Introductionmentioning

confidence: 99%

“…One Swedish study showed that FACT was well received by clinicians, which may be a significant driver of the rapid implementation of FACT [18]. FACT was implemented in Sweden by replacing CMHT; however, in Denmark and other countries, FACT was established by merging ACT and CMHTs (9,17). To date, there is little knowledge about the clinical experiences of this fusion in the establishment of FACT, and the only study that has examined the implementation of FACT has focused on identifying contextual factors contributing to rapid dissemination and implementation with high fidelity [19].…”

Section: Introductionmentioning

confidence: 99%

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A Qualitative Study on the Implementation of Flexible Assertive Community Treatment – an Integrated Community-based Treatment Model for Patients with Severe Mental Illness

Nielsen¹,

Hjorthøj²,

Nordentoft³

et al. 2021

Int J Integr Care

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Introduction: Flexible Assertive Community Treatment (FACT) is a model of integrated care aiming to increase continuity of care for individuals with severe mental illness. FACT teams have been implemented in many countries by merging Assertive Community Treatment (ACT) and standard care from Community Mental Health teams (CMHTs). However, there has been little research on how practitioners experienced the fusion of these teams. Aim: This study explores how former ACT and CMHT practitioners perceived the implementation of FACT. Method: Perceptions of the FACT model, implementation strategies and adaptations of the model were investigated through 17 semi-structured interviews with FACT practitioners. Results: Perceived positive contributions of FACT included the recognition that FACT addressed a service gap for a group of patients who could benefit from increased support and improved integration of outpatient and hospital care. Perceived disadvantages of FACT included the experience that FACT drew away resources from ACT patients with the highest psychiatric needs. The findings also describe barriers to implementation, such as lack of perceived benefit of FACT, the maintenance of traditional work culture and insufficient organisational capacity. These challenges required the negotiation of local implementation strategies and adaptations. Conclusion: FACT increases access to intensive care for a broader group of patients with severe mental illness. However, findings from this study also suggest that the increased caseload in FACT compared with ACT and a changed mindset may not reflect the needs of the smaller group of patients who find it difficult to engage with mental health care services.

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Geographic variation in the utilisation of specialist healthcare for patients with severe mental illness in Norway: a population-based registry study

Bedane

Lien

Holsen

et al. 2023

Res Health Serv Reg

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Purpose The aim of this study is to measure geographic variations in mental healthcare service utilisation among patients with severe mental illness in Norway. Method We analysed data from the Norwegian patient registry for 2014–2018 for patients with severe mental illness. The outcomes measured in this study were: outpatient contact, admission, bed days and total contact rates. Total contacts were calculated as the sum of observed outpatient contacts plus four times the hospital bed days for each hospital catchment area based on the Norwegian health director’s report on clinical activity and patient treatment cost. Geographic variations were measured using extreme quotient (EQ), coefficient of variation (CV) and systematic component of variation (SCV). Maps, figures, and tables were used to visualise geographic variation. Results The geographic variations saw a six-fold increase in the outpatient contact rate and a three-fold increase in the admission rate between the areas with lowest rate and areas with the highest rate. However, there was low geographic variation in calculated total contact rates (Eqs. 5 − 95 =1.77). The low-level geographic variation in the total calculated contact rate was also confirmed with an SCV of less than three. Conclusion The levels of geographic variations in the utilisation of outpatient and inpatient mental healthcare services among patients with severe mental illness are high. However, the geographic variation in total services provided by hospital catchment areas calculating the two service modalities together using their treatment cost ratio, is low. This may reflect the relatively equal performance of hospital catchment areas in terms of resource utilisation regardless which service modality they prioritise. Factors contributing to high geographic variation in individual service modalities need further investigation.

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Assertive community treatment versus standard treatment for severely mentally ill patients in Denmark: a quasi-experimental trial

Cited by 15 publications

References 26 publications

The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study

The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study

A Qualitative Study on the Implementation of Flexible Assertive Community Treatment – an Integrated Community-based Treatment Model for Patients with Severe Mental Illness

Geographic variation in the utilisation of specialist healthcare for patients with severe mental illness in Norway: a population-based registry study

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