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Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia-spectrum and bipolar I disorders: Four-year follow-up of the ACCESS II study.

  • Schöttle D Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Schimmelmann BG University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland.
  • Ruppelt F Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Bussopulos A Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Frieling M Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Nika E Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Nawara LA Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Golks D Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Kerstan A Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Lange M Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Schödlbauer M Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Daubmann A Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Wegscheider K Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Rohenkohl A Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Sarikaya G Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Sengutta M Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Luedecke D Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Wittmann L Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Ohm G Strategic University Development Centre, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany.
  • Meigel-Schleiff C Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Gallinat J Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Wiedemann K Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Bock T Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Karow A Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Lambert M Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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  • 2018-02-28
Published in:
  • PloS one. - 2018
Adult
Ambulatory Care
Bipolar Disorder
Community Mental Health Services
Delivery of Health Care, Integrated
Female
Follow-Up Studies
Hospitalization
Humans
Involuntary Treatment
Male
Patient Dropouts
Patient Satisfaction
Psychotic Disorders
Quality of Life
Schizophrenia
Treatment Outcome
English The ACCESS-model offers integrated care including assertive community treatment to patients with psychotic disorders. ACCESS proved more effective compared to standard care (ACCESS-I study) and was successfully implemented into clinical routine (ACCESS-II study). In this article, we report the 4-year outcomes of the ACCESS-II study. Between May 2007 and December 2013, 115 patients received continuous ACCESS-care. We hypothesized that the low 2-year disengagement and hospitalization rates and significant improvements in psychopathology, functioning, and quality of life could be sustained over 4 years. Over 4 years, only 10 patients disengaged from ACCESS. Another 23 left for practical reasons and were successfully transferred to other services. Hospitalization rates remained low (13.0% in year 3; 9.1% in year 4). Involuntary admissions decreased from 35% in the 2 years prior to ACCESS to 8% over 4 years in ACCESS. Outpatient contacts remained stably high at 2.0-2.4 per week. We detected significant improvements in psychopathology (effect size d = 0.79), illness severity (d = 1.29), level of functioning (d = 0.77), quality of life (d = 0.47) and stably high client satisfaction (d = 0.02) over 4 years. Most positive effects were observed within the first 2 years with the exception of illness severity, which further improved from year 2 to 4. Within continuous intensive 4-year ACCESS-care, sustained improvements in psychopathology, functioning, quality of life, low service disengagement and re-hospitalization rates, as well as low rates of involuntary treatment, were observed in contrast to other studies, which reported a decline in these parameters once a specific treatment model was stopped. Yet, stronger evidence to prove these results is required.


TRIAL REGISTRATION
Clinical Trial Registration Number: NCT01888627.
Language
  • English
Open access status
gold
Identifiers
Persistent URL
https://sonar.ch/global/documents/185119
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