Cost-Effectiveness of 12-Month Therapeutic Assertive Community Treatment as Part of Integrated Care Versus Standard Care in Patients With Schizophrenia Treated With Quetiapine Immediate Release (ACCESS Trial)

Abstract

ClinicalTrials.gov identifier: NCT01081418.

Effectiveness of Integrated Care Including Therapeutic Assertive Community Treatment in Severe Schizophrenia Spectrum and Bipolar I Disorders

“…To this end, our group implemented and evaluated an integrated care treatment model including assertive community treatment (ACCESS model) for patients with schizophrenia spectrum disorders. 6,11 Compared to a reference catchment area offering standard care, the ACCESS I study showed a markedly better 1-year efficacy of the ACCESS model at comparable costs of both treatments. Furthermore, patients treated in ACCESS were less extensively hospitalized (11 days vs 33 days in standard care).…”

“…Importantly, the service disengagement rate was much lower in ACCESS (6.3%) compared to standard care (23.2%) within 1 year. 11 On the basis of these positive results, in May 2007, the ACCESS model was implemented in routine care in collaboration with health insurance agencies. The ACCESS was concurrently extended to patients with bipolar I disorder with psychotic features.…”

Continuity Across Inpatient and Outpatient Mental Health Care or Specialisation of Teams? A Systematic Review

“…No randomized controlled trials were identified. There were 13 nonrandomized comparative studies which compared outcomes of continuity and specialisation systems [2,1,14,16,[19][20][21][22]26,27,30,29,31,[36][37][38]40], three survey studies which investigated patient and staff views towards continuity and specialisation systems [3,15,35], and one qualitative semi-structured interview study on staff views towards the two systems [17]. NRT: non-randomized controlled trials; CBA: controlled before and after studies; C: continuity system; S: specialisation system.…”

“…This ranged from comparing systems in which all staff members either worked across inpatient and outpatient settings or within one particular setting; to consultant-based systems (mainly in the UK) which focused only on continuity versus specialisation of consultant psychiatrists. The majority of studies collected data on psychiatric patients [2,1,14,16,19,20,22,26,27,30,29,31,[36][37][38]40,3], although three focused on staff [21,15,17], and one study included both patients and staff [35].…”

“…Overall, nine of the studies were at high risk of selection bias [2,1,14,[20][21][22]27,30,29,31,36] due to uncontrolled confounders or, for before and after studies, due to having no control group for comparison. All studies were also unclear [20,30,29,31,40] or at high risk [2,1,14,16,19,21,22,26,27,[36][37][38] of performance bias due to an imbalance in treatment intensity or the existence of additional co-occurring interventions -such as one treatment group receiving extended 24-hour-care, assertive engagement, or home treatment whilst the other does not. Design specific issues, such as having only one site per intervention group in cluster-level studies or a lack of an appropriate concurrent control altogether, means all the studies were also at high risk of other potential sources of bias.…”