Heavy users of acute psychiatric beds: randomized controlled trial of enhanced community management in an outer London borough

Harrison-Read, Phil; Lucas, Benjamin; Tyrer, Peter; Ray, Jodi A.; Shipley, Katherine; Simmonds, Shaeda; Knapp, Martín; Lowin, Ana; Patel, Anita; Hickman, Matthew

doi:10.1017/s0033291702005305

Cited by 70 publications

(40 citation statements)

References 18 publications

(27 reference statements)

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“…Burns et al (1999) found no differences between outcomes for ICM clients and usual care clients across five categories of clinical and social functioning. Harrison-Read et al (2002) likewise failed to find differences between outcomes for ICM and usual care clients across five categories of clinical and social functioning. Issakidis, Sanderson, Teesson, Johnston, and Buhrich (1999) found an advantage for ICM clients over standard care clients in respect of one of five indices of functioning.…”

Section: Clinical And/or Social Impact In Recent Icm Studiesmentioning

confidence: 90%

“…Assertive Community Treatment (ACT) is the most standardized (Allness & Knoedler, 2003;Salyers et al, 2003) and extensively researched (Drake et al, 2000;Herdelin & Scott, 1999) form of ICM. Other related forms include Enhanced Community Management (ECM) (Harrison-Read et al, 2002) and Mobile Intensive Treatment (MITT) (Abbott et al, 1997). Intensive case management is likely to include most of the following key features (Allness & Knoedler, 2003;McGrew & Bond, 1995;Teague et al, 1998):…”

Section: Introductionmentioning

confidence: 99%

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Intensive Case Management: A Critical Re-Appraisal of the Scientific Evidence for Effectiveness

King

2006

Adm Policy Ment Health

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Intensive Case Management (ICM) is widely claimed to be an evidence-based and cost effective program for people with high levels of disability as a result of mental illness. However, the findings of recent randomized controlled trials comparing ICM with 'usual services' suggest that both clinical and cost effectiveness of ICM may be weakening. Possible reasons for this, including fidelity of implementation, researcher allegiance effects and changes in the wider service environment within which ICM is provided, are considered. The implications for service delivery and research are discussed.

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Section: Clinical And/or Social Impact In Recent Icm Studiesmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Intensive Case Management: A Critical Re-Appraisal of the Scientific Evidence for Effectiveness

King

2006

Adm Policy Ment Health

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“…Exclusion criteria were involvement in clinical drug trials in the preceding 30 days and follow-up considered unlikely by the clinical team. This latter condition was added to avoid including the up to one-fifth of inner city patients (Harrison-Read et al, 2002) who are transient and for whom follow-up data were highly unlikely to be obtained. The diagnosis of schizophrenia was confirmed by the local investigator by clinical assessment and examination of case notes against DSM-IV criteria (American Psychiatric Association, 1994).…”

Section: Methodsmentioning

confidence: 99%

NICE guidance in schizophrenia: how generalisable are drug trials?

Burns¹

2006

Psychiatr. bull.

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Aims and MethodTo test the National Institute for Clinical Excellence (NICE) assertion that characteristics of participants in the majority of clinical drug trials in schizophrenia do not reflect clinical practice. In particular they were concerned about the relative exclusion of women, older adults and patients with comorbidity. The baseline characteristics of a sample of 600 patients with schizophrenia recruited to be as representative as possible of UK community practice were compared with those from one of the largest international drug trials of an atypical antipsychotic.ResultsAlthough comparisons could only be made on a limited range of characteristics the two samples were broadly comparable.Clinical ImplicationsCurrent drug trials from pharmaceutical companies may have more relevance to clinical practice than their stated exclusion criteria may indicate.

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“…According to the results of randomized controlled trials in the United States, ACT was effective in managing patients with severe mental illness and could reduce the cost of hospital care, promote better treatment outcomes, and lead to increased patient satisfaction [1]. However, other studies performed in United Kingdom did not show significant advantages for ACT and did not replicate the results of studies in the United States [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Fifteen-Month Follow-Up of an Assertive Community Treatment Program for Chronic Patients With Mental Illness

2016

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Background: The aim of this study was to evaluate the effect of an Assertive Community Treatment (ACT) program on psychiatric symptoms, global functioning, life satisfaction, and recovery-promoting relationships among individuals with mental illness. Methods: Participants were patients at the Suwon Mental Health Center. Thirty-two patients were part of the ACT program and 32 patients matched for age, sex, and mental illness were in a standard case-management program and served as a control group. Follow-up with patients occurred every 3 months during the 15 months after a baseline interview. Participants completed the Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF) Scale, Life Satisfaction Scale, and Recovery-Promoting Relationship Scale (RPRS). Results: No significant differences were noted in the sociodemographic characteristics of the ACT and the case-management group. According to the BPRS, the ACT group showed a significant reduction in symptom severity, but the ACT program was not significantly more effective at reducing psychiatric symptoms from baseline to the 15-month follow-up compared to the case-management approach. The ACT group showed more significant improvement than the control group in terms of the GAF Scale. Both groups showed no significant differences in the change of life satisfaction and in the change of recovery-promoting relationships. We observed a significant increase in recovery-promoting relationships in the control group, but the degree of change of recovery-promoting relationships through time flow between groups was not significantly different. Discussion: In this study, we observed that ACT was significantly better at improving the GAF than case management and that participation in ACT was associated with a significant decrease in BPRS scores. However, ACT did not demonstrate an absolute superiority over the standard case-management approach in terms of the BPRS and the measures of life satisfaction and recovery-promoting relationships. Conclusions: ACT may have some advantages over a standard case management approach.

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Heavy users of acute psychiatric beds: randomized controlled trial of enhanced community management in an outer London borough

Abstract: Providing additional intensive community focused care to a group of heavy users of psychiatric in-patient services in an outer London borough does not lead to any important clinical gains or reduced costs of psychiatric care.

Cited by 70 publications

References 18 publications

Intensive Case Management: A Critical Re-Appraisal of the Scientific Evidence for Effectiveness

Intensive Case Management: A Critical Re-Appraisal of the Scientific Evidence for Effectiveness

NICE guidance in schizophrenia: how generalisable are drug trials?

Fifteen-Month Follow-Up of an Assertive Community Treatment Program for Chronic Patients With Mental Illness

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