Martin Rotenberg, Ling Zhuang, Raquel Williams, Diane Versace, Michelle DeSanti, Dan Harren, Alex Raben, Farooq Naeem, Frances Abela-Dimech, Paul Kurdyak, Farhat Farrokhi, George Foussias
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引用次数: 0
Abstract
Objective: In the context of increased uptake of flexible assertive community treatment (FACT)-despite a dearth of evidence on its outcomes-the authors aimed to compare the effectiveness of FACT with that of assertive community treatment (ACT) or intensive case management (ICM) for community-dwelling people experiencing serious mental illness.
Methods: This quasi-experimental study, using propensity score matching to minimize confounding factors, examined outcomes of acute psychiatric service use among individuals who received FACT (vs. ACT or ICM) at a large Canadian mental health hospital. Data from a period of transition to FACT and an implementation period were analyzed.
Results: The matched cohort consisted of 237 FACT and 237 ACT or ICM service users. During the transition period, no significant differences between the two groups were observed in emergency department (ED) visits, hospital admissions, or inpatient days. During the period of full FACT implementation, the FACT group had a significant increase in ED visits, compared with the group that received ACT or ICM (incidence rate ratio=1.65, 95% CI=1.02-2.67), but no significant differences were observed between the two groups in the rate of hospital admissions or inpatient days.
Conclusions: To the authors' knowledge, this study is the first of its kind in Canada. Its findings suggest generally comparable outcomes of FACT (vs. ACT or ICM) in acute mental health services use. Although the rate of ED service use increased in the FACT group after implementation, inpatient service use did not increase. The higher rate of ED service use in the FACT group warrants further study.
期刊介绍：
Psychiatric Services, established in 1950, is published monthly by the American Psychiatric Association. The peer-reviewed journal features research reports on issues related to the delivery of mental health services, especially for people with serious mental illness in community-based treatment programs. Long known as an interdisciplinary journal, Psychiatric Services recognizes that provision of high-quality care involves collaboration among a variety of professionals, frequently working as a team. Authors of research reports published in the journal include psychiatrists, psychologists, pharmacists, nurses, social workers, drug and alcohol treatment counselors, economists, policy analysts, and professionals in related systems such as criminal justice and welfare systems. In the mental health field, the current focus on patient-centered, recovery-oriented care and on dissemination of evidence-based practices is transforming service delivery systems at all levels. Research published in Psychiatric Services contributes to this transformation.
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