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

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

Early detection and integrated care for adolescents and young adults with severe psychotic disorders: rationales and design of the Integrated Care in Early Psychosis Study (ACCESS III)

“…As ACT was designed for SMI, the RCT selection likely reduces the generalizability of the findings. The rate of refusers was not assessed, but in ACCESS II only 4.5% refused . A selection bias is limited due to using a historical control group.…”

“…Quality of care should be improved by the adaption and specialization of an established integrated care model for multiple‐episode patients with severe psychotic disorders to a new cross‐age and interdisciplinary integrated care model for adolescents and young adults aged 12–29 years (see Table ).…”

“…This integrated care model was evaluated in two studies: In 2006, it was examined in a 1‐year catchment area comparison study versus SC (ACCESS I) showing significantly better multidimensional clinical outcomes and cost‐effectiveness . The second study (ACCESS II) is to date an 8‐year open‐end cohort study of all patients being treated within integrated care . Results of the 2‐, 3‐ and 4‐year follow‐up showed greater effectiveness regarding service engagement, course of symptoms, functioning, quality of life, satisfaction with care, medication adherence, frequency of involuntary admissions and greater cost‐benefit efficiency …”

“…The second study (ACCESS II) is to date an 8‐year open‐end cohort study of all patients being treated within integrated care . Results of the 2‐, 3‐ and 4‐year follow‐up showed greater effectiveness regarding service engagement, course of symptoms, functioning, quality of life, satisfaction with care, medication adherence, frequency of involuntary admissions and greater cost‐benefit efficiency …”

“…49 The second study (ACCESS II) is to date an 8-year open-end cohort study of all patients being treated within integrated care. 6,50,51 Results of the 2-, 3-and 4-year follow-up showed greater effectiveness regarding service engagement, course of symptoms, functioning, quality of life, satisfaction with care, medication adherence, frequency of involuntary admissions and greater cost-benefit efficiency. 6,50,51 For the development of the new cross-age and interdisciplinary integrated care model for adolescent and young adult patients with psychotic disorders aged 12-29 years, the following adaptations and extensions were made:…”