Reducing emergency medical service use in patients with chronic psychotic disorders: Results from the FAST intervention study

Abstract

Patients with schizophrenia have disproportionately high rates of emergency medical service use, likely contributing to the high cost this illness places on society. The aim of this study was to examine the impact of a theory-based, behavioral intervention on immediate and long-term use of emergency medical services. Older patients with schizophrenia (N=240) were randomized to receive either a behavioral, skills-building intervention known as Functional Adaptation and Skills Training (FAST) or to a time equivalent attention-control condition (AC). Logistic regression analyses indicated that AC participants were nearly twice as likely to use emergency medical services in general (OR = 2.54; p = 0.02) and emergency psychiatric services in particular (OR = 3.69; p = .05) during the active intervention phase of the study. However, there were no differences between the interventions in terms of emergency service use during the long-term follow-up phase of the study (i.e., 6-months to 18-months post-baseline). The FAST intervention appears efficacious for reducing short-term risk of using emergency medical services. However, the long-term efficacy of the FAST intervention appears less clear. Future studies may want to provide more powerful maintenance sessions to encourage continued use of skills in patients' real-world settings.

Burden of schizophrenia in recently diagnosed patients: healthcare utilisation and cost perspective

“…The introduction of more effective treatments, including new drug therapies, have played a role in reducing the average duration of hospitalisation for patients with schizophrenia. Thus the contribution of ER admissions to overall resource use, which has largely been overlooked in favour of hospital stays of 41 day duration, has increasing relevance to overall schizophrenia care and costs 34 . This is evident from the high proportion of patients in both patient cohorts requiring ER treatment during the retrospective and first prospective years.…”

The association of psychiatric comorbidity and use of the emergency department among persons with substance use disorders: an observational cohort study

“…[ 28 ] A recent randomized trial of a behavioral/skills-building intervention found short-term decreases in ED use among older patients with schizophrenia. [ 29 ] Clearly, future research will continue to show that the ED can serve as an important identification site for cost-effective intervention.…”

Psychosocial rehabilitation and quality of life for older adults with serious mental illness: recent findings and future research directions

“…A recently published report on a randomized trial (older patients [n = 240] with schizophrenia age 40 and older) found that FAST participants showed significant improvement in social skills and everyday functional skills compared to an attention controlled group. In addition, FAST participants were almost half as likely to use emergency medical services during the active six-month treatment phase of the study, though no difference in service use was found in the subsequent year of follow-up [17*]. …”