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Predicting outcome of assertive outreach across England
1Department of Health Sciences, University of Leicester, Leicester, UK. tsb@le.ac.uk
Social Psychiatry and Psychiatric Epidemiology
|February 3, 2011
Summary
Assertive outreach (AO) team characteristics do not predict long-term outcomes for severely mentally ill patients. New care models are needed to improve patient results and psychological intervention delivery.
Area of Science:
- Mental Health Services Research
- Psychiatric Epidemiology
- Community Psychiatry
Background:
- Assertive community treatment (ACT) is increasingly used globally for severe mental illness.
- The impact of recommended assertive outreach (AO) team characteristics on patient care and outcomes remains unclear.
- This study investigated if specific AO team features predict reduced hospitalisation and improved outcomes.
Purpose of the Study:
- To determine if recommended assertive outreach (AO) team characteristics influence patient hospitalisation and outcomes.
- To test the hypothesis that joint health and social care management predicts reduced hospitalisation.
- To examine the relationship between AO team characteristics and patient outcomes over 1 and 3 years.
Main Methods:
- A two-stage design sampled 100 assertive outreach (AO) teams in England.
- Systematic sampling of clients, with over-sampling for ethnic minority patients, was employed.
- Data on team characteristics, treatment, and patient outcomes were collected and analyzed, accounting for patient history and clustering.
Main Results:
- Hospitalisation time decreased under AO; few patients went missing.
- Patient history significantly predicted outcomes, but team characteristics did not predict re-admission or long-term outcomes.
- Jointly managed teams had more ethnic minority clients on compulsory orders; multidisciplinary teams facilitated psychological interventions, though uptake was low.
Conclusions:
- Assertive outreach (AO) team characteristics do not explain long-term patient outcomes.
- Current recommended team characteristics are ineffective; new care models and process testing are required.
- Improved patient outcomes may result from managing teams to deliver evidence-based psychological interventions.
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