Hostname: page-component-6b989bf9dc-zrclq Total loading time: 0 Render date: 2024-04-15T03:27:05.365Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical and Functional Outcome of Assertive Outreach for Patients With Schizophrenic Disorder: Results of a Quasi-Experimental Controlled Trial

Published online by Cambridge University Press:  21 May 2015

D. Kästner ,
D. Büchtemann ,
I. Warnke ,
J. Radisch ,
J. Baumgardt ,
S. Giersberg ,
K. Kopke ,
J. Moock ,
W. Kawohl  and
W. Rössler
D. Kästner*
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf and Schön Clinic Hamburg Eilbek, Hamburg, Germany
D. Büchtemann
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany
I. Warnke
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany Medical Psychology Unit, Hannover Medical School, Hannover, Germany
J. Radisch
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany Medical Psychology Unit, Hannover Medical School, Hannover, Germany
J. Baumgardt
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany Department of Social Work, Faculty of Business and Social Sciences, University of Applied Sciences, Hamburg, Germany
S. Giersberg
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany
K. Kopke
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany
J. Moock
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany
W. Kawohl
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany Department for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
W. Rössler
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany Department for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil
*
*Corresponding author. University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Martinistr. 52, 20246 Hamburg, Germany. Tel.: +49 40 7410 5505 1. E-mail address: d.kaestner@uke.de (D. Kästner).
Get access

Abstract

Background

The majority of studies support modern assertive health service models. However, the evidence is limited for parts of continental Europe, as well as for the pharmacological adherence outcome parameter.

Method

We conducted a quasi-experimental controlled trial including adult patients with a schizophreniform disorder and a maximum of 60 points on the Global Assessment of Functioning Scale (GAF). Interventions (n = 176) and controls (TAU, n = 142) were assessed every six-month within one year in 17 study practices in rural areas. Mental and functional state were rated using the Brief Psychiatric Rating Scale (BPRS) and the GAF. Functional limitations and pharmacological adherence were patient-rated using the WHO-Disability Assessment Schedule II (WHODAS–II) and the Medication Adherence Report Scale (MARS). We computed multilevel mixed models.

Results

The GAF and BPRS of both groups improved significantly, yet the increase in the intervention group was significantly higher. In contrast, patient-rated variables – WHODAS–II and MARS – neither showed a stable temporal improvement nor a difference between groups.

Conclusion

Our findings only partly support the investigated AO intervention, because of conflicting results between clinician- and patient-ratings. Accordingly, the benefits of AO need to be further evaluated.

Keywords

Assertive outreachIntegrated careComplex interventionsSchizophreniaIntensive case management
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 6 , September 2015 , pp. 736 - 742
Copyright
Copyright © Elsevier Masson SAS 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aagaard, J., Müller-Nielsen, K.Clinical outcome of assertive community treatment (ACT) in a rural area in Denmark: a case–control study with a 2-year follow-up. Nordic J Psychiatry 2011;65(5):299–305.CrossRefGoogle Scholar
Andersen, J., et al.The Brief Psychiatric Rating Scale. Dimension of schizophrenia – reliability and construct validity. Psychopathology 1989;22(2–3):168–176.CrossRefGoogle ScholarPubMed
Bak, M., et al.An observational, ‘real life” trial of the introduction of assertive community treatment in a geographically defined area using clinical rather than service use outcome criteria. Soc Psychiatry Psychiatr Epidemiol 2007;42(2):125–130.CrossRefGoogle Scholar
Barkhof, E., et al.Interventions to improve adherence to antipsychotic medication in patients with schizophrenia – areview of the past decade. Eur Psychiatry 2012;27(1):9–18.CrossRefGoogle Scholar
Bell, M., et al.The Positive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale. Reliability, comparability, and predictive validity. J Nervous Mental Dis 1992;180(11):723–728.CrossRefGoogle ScholarPubMed
Bjorkman, T., Hansson, L.Case management for individuals with a severe mental illness: a 6-year follow-up study. Int J Soc Psychiatry 2007;53(1):12–22.CrossRefGoogle ScholarPubMed
Björkman, T., Hansson, L., Sandlund, M.Outcome of case management based on the strengths model compared to standard care. A randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol 2002;37(4):147–152.CrossRefGoogle Scholar
Bramesfeld, A., et al.Effectiveness and efficiency of assertive outreach for Schizophrenia in Germany: study protocol on a pragmatic quasi-experimental controlled trial. BMC Psychiatry 2013;13:56.CrossRefGoogle ScholarPubMed
Burns, T.Case management and assertive community treatment in Europe. Psychiatr Serv 2001;52(5):631–636.CrossRefGoogle ScholarPubMed
Burns, T., Firn, M.Assertive outreach in mental health: a manual for practitioners. Oxford, New York: Oxford medical publications, Oxford University Press; 2002. [345 p.].Google Scholar
Campbell, M., et al.Framework for design and evaluation of complex interventions to improve health. BMJ (Clinical research ed.) 2000;321(7262):694–696.CrossRefGoogle ScholarPubMed
Chakraborty, H., Gu, A.H.Mixed model approach for intent-to-treat analysis in longitudinal clinical trials with missing values. RTI Press publication; 2009. [No. MR-0009-0903]CrossRefGoogle ScholarPubMed
DGPPN. S3-Leitlinie Psychosoziale Therapien bei schweren psychischen Erkrankungen. .Berlin, Heidelberg: Springer Berlin Heidelberg; 2013.Google Scholar
Dieterich, M., et al.Intensive case management for severe mental illness. Cochrane Database Syst Rev 2010;6:10.Google Scholar
Drukker, M., et al.A real-life observational study of the effectiveness of FACT in a Dutch mental health region. BMC Psychiatry 2008;8:p93.CrossRefGoogle Scholar
Emsley, R., Chiliza, B., Asmal, L.The evidence for illness progression after relapse in schizophrenia. Schizophr Res 2013;148(1–3):117–121.CrossRefGoogle Scholar
Harrison-Read, P., et al.Heavy users of acute psychiatric beds: randomized controlled trial of enhanced community management in an outer London borough. Psychol Med 2002;32(3):403–416.CrossRefGoogle Scholar
Huguelet, P., et al.Effects of an assertive community program in patients with severe mental disorders and impact on their families. Psychiatry Clin Neurosci 2012;66(4):328–336.CrossRefGoogle ScholarPubMed
Jerrell, J.M., Ridgely, M.S.Comparative effectiveness of three approaches to serving people with severe mental illness and substance abuse disorders. J Nerv Ment Dis 1995;183(9):566–576.CrossRefGoogle ScholarPubMed
Jones, S.H., et al.A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). Br J Psychiatry 1995;166(5):654–659.CrossRefGoogle Scholar
Kane, J.M., et al.Clozapine in treatment-resistant schizophrenics. Psychopharmacol Bull 1988;24(1):62–67.Google ScholarPubMed
Kilian, R.Evaluation von Programmen zur integrierten psychiatrischen Versorgung. Zum Problem der Gewinnung von Evidenz für die Wirksamkeit und Effizienz komplexer Interventionen in der Gesundheitsversorgung. Nervenheilkunde 2013;32(5):287–292.Google Scholar
King, R.Intensive case management: a critical re-appraisal of the scientific evidence for effectiveness. Adm Policy Ment Health 2006;33(5):529–535.CrossRefGoogle ScholarPubMed
Kissling, W.Das “Münchner Modell”–Krankenkassen finanzieren Compliance–Programme. Psychoneuro 2008;34(9):410–415.CrossRefGoogle Scholar
Lambert, M., et al.Assertive community treatment as part of integrated care versus standard care. J Clin Psychiatry 2010;71(10):1313–1323.CrossRefGoogle ScholarPubMed
Mahler, C., et al.Assessing reported adherence to pharmacological treatment recommendations. Translation and evaluation of the Medication Adherence Report Scale (MARS) in Germany. J Eval Clin Pract 2010 574–579.Google ScholarPubMed
Manuel, J.I., et al.Does assertive community treatment increase medication adherence for people with co-occurring psychotic and substance use disorders?. J Am Psychiatr Nurses Assoc 2011;17(1):51–56.CrossRefGoogle ScholarPubMed
Marder, S.R.Monitoring treatment and managing adherence in schizophrenia. J Clin Psychiatry 2013;74(10):pe21.CrossRefGoogle Scholar
Mas-Expósito, L., et al.The World Health Organization Short Disability Assessment Schedule: a validation study in patients with schizophrenia. Comprehensive Psychiatry 2012;53(2):208–216.CrossRefGoogle ScholarPubMed
Mohamed, S.Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration. Psychiatr Q 2013;84(1):103–114.CrossRefGoogle ScholarPubMed
Morken, G., Grawe, R.W., Widen, J.H.Effects of integrated treatment on antipsychotic medication adherence in a randomized trial in recent-onset schizophrenia. J Clin Psychiatry 2007;68(4):566–571.CrossRefGoogle Scholar
Mortimer, A.M.Symptom rating scales and outcome in schizophrenia. Br J Psychiatry 2007;191(50):ps7–ps14.CrossRefGoogle Scholar
NICE. Psychosis and schizophrenia in adults: the NICE guideline on treatment and management. London: NICE; 2014.Google Scholar
Nordentoft, M., et al.From research to practice: how OPUS treatment was accepted and implemented throughout Denmark. Early Interv Psychiatry 2013.CrossRefGoogle Scholar
Oud, M.J., Meyboom-de Jong, B.Somatic diseases in patients with schizophrenia in general practice: their prevalence and health care. BMC Fam Pract 2009;10:32.CrossRefGoogle ScholarPubMed
Overall, J.E., Gorham, D.R.The Brief Psychiatric Rating Scale. Psychol Rep 1962;10:799–812.CrossRefGoogle Scholar
Rabe-Hesketh, S., Skrondal, A.Multilevel and longitudinal modeling using stata. 3 ed. Volume 1: Continuous Responses. Vol. 1. .Tex: College Station, Stata Press; 2012.Google Scholar
Rabe-Hesketh, S., Skrondal, A.Multilevel and longitudinal modeling using stata. 3 ed. Volume 2: Categorical Responses, Counts, and Survival. Vol. 2. .Tex: College Station, Stata Press; 2012.Google Scholar
Rössler, W., et al.Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol 2005;15(4):399–409.CrossRefGoogle ScholarPubMed
Schmid, P., Steinert, T., Borbe, R.[Implementing models of cross-sectoral mental health care (integrated health care, regional psychiatry budget) in Germany: systematic literature review]. Psychiatr Prax 2013;40(8):414–424.Google Scholar
Schmidt-Kraepelin, C., Janssen, B., Gaebel, W.Prevention of rehospitalization in schizophrenia: results of an integrated care project in Germany. Eur Arch Psychiatry Clin Neurosci 2009;259(S2):205–212.CrossRefGoogle ScholarPubMed
Schöttle, D., et al.Integrated care in patients with schizophrenia. Curr Opin Psychiatry 2013;26(4):384–408.CrossRefGoogle ScholarPubMed
Schwartz, R.C.Concurrent validity of the Global Assessment of Functioning Scale for clients with schizophrenia. Psychol Rep 2007;100(2):571–574.CrossRefGoogle ScholarPubMed
Spill, B., et al.Patientenzufriedenheit mit einem Programm der Integrierten Versorgung für die Indikationen Schizophrenie und Depression. Psychiatr Prax 2013;40(3):142–145.Google Scholar
Switaj, P., et al.Disability and schizophrenia: a systematic review of experienced psychosocial difficulties. BMC Psychiatry 2012;12:193.CrossRefGoogle ScholarPubMed
Sytema, S., et al.Assertive community treatment in the Netherlands: a randomized controlled trial. Acta Psychiatr Scand 2007;116(2):105–112.CrossRefGoogle ScholarPubMed
Ustün, T.B., et al.Developing the World Health Organization Disability Assessment Schedule 2.0. Bull World Health Organ 2010;88(11):815–823.CrossRefGoogle ScholarPubMed
Van Duin, D., et al.Bridging the science-to-service gap in schizophrenia care in the Netherlands: the Schizophrenia Quality Improvement Collaborative. Int J Qual Health Care 2013;25(6):626–632.CrossRefGoogle ScholarPubMed
van Os, J.Schizophrenia treatment: content versus delivery. Acta Psychiatr Scandin 2009;119:29–32.CrossRefGoogle Scholar
World Health, O., Measuring Health and Disability: Manual for WHO Disability Assessment Schedule WHODAS 2.0.Google Scholar
Submit a response

Comments

No Comments have been published for this article.