Assertive community treatment versus standard treatment for severely mentally ill patients in Denmark: a quasi-experimental trial

TY - JOUR

T1 - Assertive community treatment versus standard treatment for severely mentally ill patients in Denmark

T2 - a quasi-experimental trial

AU - Thoegersen, Marie Hoegh

AU - Morthorst, Brit Reuter

AU - Nordentoft, Merete

PY - 2019/2/17

Y1 - 2019/2/17

N2 - BACKGROUND: The future of assertive community treatment is uncertain, and studies have questioned whether it continues to provide a more effective treatment model for severely mentally ill patients in a modern mental health context. Studies conducted in new settings can contribute to the debate.METHODS: This Danish study compares treatment from assertive community treatment with treatment by standard community mental health teams, using a non-blinded quasi-experimental multi-center trial. Outcomes included contact with mental health services, days of admission, days of involuntary admission, number of outpatient contacts, adherence to antipsychotic medication, social functioning, user satisfaction, and psychopathology.RESULTS: A total of 366 patients receiving treatment from assertive community treatment (n = 213) or continuation of care from community mental health teams (n = 153) were included in the trial. Assertive community treatment was significantly better in sustaining contact with patients. At 2-year follow-up, 16 (8%) of patients receiving assertive community treatment versus 22(14%) receiving care from standard treatment had lost contact with treatment. Patients who received assertive community treatment had a larger reduction in inpatient service-use, increased adherence to antipsychotic medication, improved social functioning, and higher user satisfaction. No differences in days of involuntary admission and psychopathology were found.CONCLUSIONS: The results suggest that a high fidelity assertive community treatment may be a valuable tool to strengthen contact between severely mentally ill patients and the treatment staff and may contribute to improving outcomes in a modern Danish mental health context.

AB - BACKGROUND: The future of assertive community treatment is uncertain, and studies have questioned whether it continues to provide a more effective treatment model for severely mentally ill patients in a modern mental health context. Studies conducted in new settings can contribute to the debate.METHODS: This Danish study compares treatment from assertive community treatment with treatment by standard community mental health teams, using a non-blinded quasi-experimental multi-center trial. Outcomes included contact with mental health services, days of admission, days of involuntary admission, number of outpatient contacts, adherence to antipsychotic medication, social functioning, user satisfaction, and psychopathology.RESULTS: A total of 366 patients receiving treatment from assertive community treatment (n = 213) or continuation of care from community mental health teams (n = 153) were included in the trial. Assertive community treatment was significantly better in sustaining contact with patients. At 2-year follow-up, 16 (8%) of patients receiving assertive community treatment versus 22(14%) receiving care from standard treatment had lost contact with treatment. Patients who received assertive community treatment had a larger reduction in inpatient service-use, increased adherence to antipsychotic medication, improved social functioning, and higher user satisfaction. No differences in days of involuntary admission and psychopathology were found.CONCLUSIONS: The results suggest that a high fidelity assertive community treatment may be a valuable tool to strengthen contact between severely mentally ill patients and the treatment staff and may contribute to improving outcomes in a modern Danish mental health context.

KW - Adult

KW - Community Mental Health Services/methods

KW - Denmark/epidemiology

KW - Female

KW - Follow-Up Studies

KW - Hospitalization/trends

KW - Humans

KW - Male

KW - Mental Disorders/epidemiology

KW - Mentally Ill Persons/psychology

KW - Middle Aged

KW - Severity of Illness Index

KW - Treatment Outcome

U2 - 10.1080/08039488.2019.1576765

DO - 10.1080/08039488.2019.1576765

M3 - Journal article

C2 - 30894038

SN - 0803-9488

VL - 73

SP - 149

EP - 158

JO - Nordic Journal of Psychiatry

JF - Nordic Journal of Psychiatry

IS - 2

ER -