Monday, October 26, 2020

Flexible Assertive Community Treatment Shows Promise for Patients With SMI

A model of assertive community treatment that provides flexible, multidisciplinary support to people with serious mental illness (SMI) in crisis may be able to reduce the number of times these patients are hospitalized, suggests a study by Danish researchers in Lancet Psychiatry. The flexible treatment model did not impact total time patients spent in hospitals, however.

Community-based approaches for people with SMI in Denmark typically involve two tracks: frequent outreach, including home visits, by assertive community treatment (ACT) teams to patients with the most serious mental illness or less frequent contact between stabilized patients and members of community mental health teams (CMHT). Flexible assertive community treatment (FACT) was designed as a team-based approach that could adjust the intensity of care quickly depending on the patient’s status.

Camilla Munch Nielsen, M.P.H., of Copenhagen University Hospital and colleagues compared the mental health outcomes of 887 CMHT patients and 130 ACT patients who were transitioned to FACT teams with 1,210 patients who continued with CMHT and 333 patients who continued with ACT, respectively. Participants were followed for two years, and outcomes included the frequency of outpatient visits, number of inpatient admissions, total bed days, the use of coercive measures in hospitals, self-harm attempts, and death by any cause.

The researchers found that outpatient contacts were about 15% higher for those patients who received FACT compared with their respective control groups. In addition, patients who transitioned from CMHT to FACT had 16% fewer hospital admissions than those who remained in CMHT, while patients who transitioned from ACT to FACT had 29% fewer hospital admissions than those who remained in ACT. There were no statistically significant differences in any of the other four outcomes assessed.

“The relative costs and benefits of the FACT model need to be evaluated, particularly considering that our results suggest that its implementation might facilitate more intensive support to be delivered but no reduction in psychiatric bed days,” Nielsen and colleagues wrote. “Furthermore, we recommend that ongoing research consider clinical outcomes such as functional or symptomatic outcomes, quality of life, and patient satisfaction.”

For related information, see the Psychiatric Services report “Association Between Hospitalization and Delivery of Assisted Outpatient Treatment With and Without Assertive Community Treatment.”

(Image: iStock\Pornpak Khunatorn)

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