Effectiveness of Integrated Care Including Therapeutic Assertive Community Treatment in Severe Schizophrenia Spectrum and Bipolar I Disorders: The 24-Month Follow-Up ACCESS II Study

TY - JOUR

T1 - Effectiveness of Integrated Care Including Therapeutic Assertive Community Treatment in Severe Schizophrenia Spectrum and Bipolar I Disorders: The 24-Month Follow-Up ACCESS II Study

AU - Schöttle, Daniel

AU - Schimmelmann, Benno G

AU - Karow, Anne

AU - Ruppelt, Friederike

AU - Sauerbier, Anne-Lena

AU - Bussopulos-Orpin, Alexandra

AU - Frieling, Marietta

AU - Golks, Dietmar

AU - Kerstan, Andrea

AU - Nika, Evangelia

AU - Schödlbauer, Michael

AU - Daubmann, Anne

AU - Wegscheider, Karl

AU - Lange, Matthias

AU - Ohm, Gunda

AU - Lange, Benjamin

AU - Meigel-Schleiff, Christina

AU - Naber, Dieter

AU - Wiedemann, Klaus

AU - Bock, Thomas

AU - Lambert, Martin

N1 - © Copyright 2014 Physicians Postgraduate Press, Inc.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - OBJECTIVE: The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study.METHOD: All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization.RESULTS: Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002).CONCLUSIONS: ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01888627.

AB - OBJECTIVE: The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study.METHOD: All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization.RESULTS: Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002).CONCLUSIONS: ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01888627.

KW - Adolescent

KW - Adult

KW - Bipolar Disorder

KW - Community Mental Health Services

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Patient Satisfaction

KW - Quality of Life

KW - Schizophrenia

KW - Time Factors

KW - Treatment Outcome

KW - Young Adult

U2 - 10.4088/JCP.13m08817

DO - 10.4088/JCP.13m08817

M3 - SCORING: Journal article

C2 - 25188752

VL - 75

SP - 1371

EP - 1379

JO - J CLIN PSYCHIAT

JF - J CLIN PSYCHIAT

SN - 0160-6689

IS - 12

ER -