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

PLoS One. 2018 Feb 27;13(2):e0192929. doi: 10.1371/journal.pone.0192929. eCollection 2018.

Abstract

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.

Publication types

  • Clinical Trial
  • Observational Study

MeSH terms

  • Adult
  • Ambulatory Care / methods
  • Bipolar Disorder / therapy*
  • Community Mental Health Services* / methods
  • Delivery of Health Care, Integrated* / methods
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Involuntary Treatment
  • Male
  • Patient Dropouts
  • Patient Satisfaction
  • Psychotic Disorders / therapy*
  • Quality of Life
  • Schizophrenia / therapy*
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT01888627

Grant support

The author have no funding to report.