Effect of increased compulsion on readmission to hospital or disengagement from community services for patients with psychosis: follow-up of a cohort from the OCTET trial

Burns, Tom; Yeeles, Ksenija; Koshiaris, Constantinos; Vazquez-Montes, M; Molodynski, Andrew; Puntis, Stephen; Vergunst, Francis; Forrest, Alexandra; Mitchell, Amy E.; Burns, Kiki; Rugkåsa, Jorun

doi:10.1016/s2215-0366(15)00231-x

Cited by 37 publications

(50 citation statements)

References 23 publications

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“…Patients were randomly allocated (50:50) to leave hospital on a CTO or to voluntary status via Section 17 leave of absence [10]. The OCTET Follow-Up Study then followed the cohort of 333 patients for a further 24 months (i.e., 36 months, 1095 days, in total) [12]. For the present observational prospective cohort study we selected those patients from the OCTET Follow-up Study who at any time during the follow-up period were on a CTO.…”

Section: Methodsmentioning

confidence: 99%

“…Data were collected, by independent researchers, from NHS medical records, including trusts’ Mental Health Act Offices, in the period from November 2008 to February 2014. Socio-demographic and clinical characteristics were collected through patient interviews at baseline [10, 12]. …”

Section: Methodsmentioning

confidence: 99%

“…A meta-analysis of the patients from the three RCTs also found no effect on admissions or bed days or any improvement in psychiatric symptoms or global functioning [7]. Additionally, the OCTET trial testing the English regime [10] found no effect on subgroups [11] or any long-term (36 months) effect on hospital outcomes or on engagement with services [12]. …”

Section: Introductionmentioning

confidence: 99%

“…We used data from the three year follow-up of the OCTET cohort [12]. A secondary aim was to examine the reasons for and outcomes of these recalls, and whether this changed over time.…”

Section: Introductionmentioning

confidence: 99%

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Recall of patients on community treatment orders over three years in the OCTET CTO cohort

et al. 2016

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BackgroundRandomised studies consistently show that Community Treatment Orders (CTOs) do not have the intended effect of preventing relapse and readmissions of patients with severe and enduring mental illness. Critics suggest this in part can be explained by RCTs studying newly introduced CTO regimes and that patients therefore were not brought back to hospital for short-term observations (‘recall’) as frequently as intended. Our purpose was (i) to test the hypothesis that CTO practice as regards recall of patients to hospital in England and Wales was as rigorous under the OCTET trial period as in current routine use and (ii) to investigate the reasons for and outcomes of recalls and whether this changed over time.MethodThirty six-month observational prospective study of 198 patients in the OCTET Follow-up Study.ResultsForty percent of patients were recalled, 19 % more than once. This is in line with current national use. Deterioration in clinical condition was the most common reason for recalls (49 %), and 68 % of recalls resulted in revocation of the order (i.e., retention in hospital under compulsion). This pattern remained stable over time.ConclusionThe use of recall cannot explain why RCTs have not confirmed any benefits from CTOs, and their continued use should be reconsidered.Trial registrationThe OCTET Trial was retrospectively registered on 12 November 2009 (ISRCTN73110773)

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…We used data from the three year follow-up of the OCTET cohort [12]. A secondary aim was to examine the reasons for and outcomes of these recalls, and whether this changed over time.…”

Section: Introductionmentioning

confidence: 99%

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Recall of patients on community treatment orders over three years in the OCTET CTO cohort

et al. 2016

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“…In this case, they are less of a worry given that the per-protocol analysis gave identical results and there was ''not an inkling'' of difference in outcomes between the 2 groups. 9,10,14 Kargianis is right that absence of evidence is not evidence of absence. But we examined the current evidence, using scientific criteria, and the weight does not favour CTOs.…”

Section: 2mentioning

confidence: 99%

Evidence-Based Practice in Use of CTOs

2016

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disagree with our assessment of the evidence on the effectiveness of community treatment orders (CTOs). In our reviews of studies from Canada and abroad, we apply recognised principles of evidence-based medicine (EBM) to assess the quality of the research. We found some studies show therapeutic benefits for CTOs. These include studies commissioned by governments, often conducted by nonacademic consultancies and not subject to peer review, and a number of small-scale, uncontrolled studies. These are the kinds of studies conducted in Canada. They do not provide robust evidence for efficacy of CTOs, especially when few high-quality studies report positive outcomes, and all the randomized studies and the best nonrandomized ones find no evidence of therapeutic benefit.

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Compulsory community and involuntary outpatient treatment for people with severe mental disorders

Kisely

Campbell

2014

Cochrane Database of Systematic Reviews

120

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CCT results in no significant difference in service use, social functioning or quality of life compared with standard voluntary care. People receiving CCT were, however, less likely to be victims of violent or non-violent crime. It is unclear whether this benefit is due to the intensity of treatment or its compulsory nature. Short periods of conditional leave may be as effective (or non-effective) as formal compulsory treatment in the community. Evaluation of a wide range of outcomes should be considered when this legislation is introduced. However, conclusions are based on three relatively small trials, with high or unclear risk of blinding bias, and evidence we rated as low to medium quality.

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Effect of increased compulsion on readmission to hospital or disengagement from community services for patients with psychosis: follow-up of a cohort from the OCTET trial

Cited by 37 publications

References 23 publications

Recall of patients on community treatment orders over three years in the OCTET CTO cohort

Recall of patients on community treatment orders over three years in the OCTET CTO cohort

Evidence-Based Practice in Use of CTOs

Compulsory community and involuntary outpatient treatment for people with severe mental disorders

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