Geriatric psychiatry home treatment (GHT): A pilot study on outcomes following hospital discharge for depressive and delusional patients

Klug, Günter; Hermann, Gerhard; Fuchs-Nieder, Brigitte; Stipacek, Andrea; Zapotoczky, H. G.

doi:10.1016/j.archger.2007.07.002

Cited by 11 publications

(14 citation statements)

References 20 publications

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“…Geriatric home treatment was delivered by a multidisciplinary team consisting of one psychiatrist with a psychotherapeutic qualification, two psychologists and one social worker who was also qualified as a psychiatric nurse. The team had already participated in the pilot study 16 and was trained in geriatric home treatment. The team worked Monday to Friday from 08.00 h to 17.00 h and routinely visited each participant once or twice a week.…”

Section: Interventionmentioning

confidence: 99%

“…7,9,14,15 A pilot study indicated that geriatric home treatment delivered by a multidisciplinary team is feasible and might be associated with positive clinical and functional outcomes over a 1-year period. 16 The aim of this subsequent trial was to test the clinical effectiveness and costs of geriatric home treatment in treating elderly people with depression who live independently in the community, assessing outcomes after 3 and 12 months.…”

mentioning

confidence: 99%

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Effectiveness of home treatment for elderly people with depression: randomised controlled trial

Klug¹,

Hermann²,

Fuchs-Nieder³

et al. 2010

Br J Psychiatry

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Section: Interventionmentioning

confidence: 99%

mentioning

confidence: 99%

Effectiveness of home treatment for elderly people with depression: randomised controlled trial

Klug¹,

Hermann²,

Fuchs-Nieder³

et al. 2010

Br J Psychiatry

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“…It has been used in studies of older people with schizophrenia. 72,73 METHODS NIHR Journals Library www.journalslibrary.nihr.ac.uk l Costs were calculated by attaching nationally applicable unit cost measures to health and social service use and medication data collected with a modified version of the Client Service Receipt Inventory (CSRI) 74 at baseline, 12 and 24 weeks. The study also collected data on unpaid carer inputs and attached imputed values to these.…”

Section: Outcome Measuresmentioning

confidence: 99%

Amisulpride for very late-onset schizophrenia-like psychosis: the ATLAS three-arm RCT

Howard

Cort

Bradley

et al. 2018

Health Technol Assess

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Background Very late-onset (aged ≥ 60 years) schizophrenia-like psychosis (VLOSLP) occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy or risks of antipsychotic treatment. Most patients are not prescribed treatment. Objectives The study investigated whether or not low-dose amisulpride is superior to placebo in reducing psychosis symptoms over 12 weeks and if any benefit is maintained by continuing treatment thereafter. Treatment safety and cost-effectiveness were also investigated. Design Three-arm, parallel-group, placebo-controlled, double-blind, randomised controlled trial. Participants who received at least one dose of study treatment were included in the intention-to-treat analyses. Setting Secondary care specialist old age psychiatry services in 25 NHS mental health trusts in England and Scotland. Participants Patients meeting diagnostic criteria for VLOSLP and scoring > 30 points on the Brief Psychiatric Rating Scale (BPRS). Intervention Participants were randomly assigned to three arms in a two-stage trial: (1) 100 mg of amisulpride in both stages, (2) amisulpride then placebo and (3) placebo then amisulpride. Treatment duration was 12 weeks in stage 1 and 24 weeks (later reduced to 12) in stage 2. Participants, investigators and outcome assessors were blind to treatment allocation. Main outcome measures Primary outcomes were psychosis symptoms assessed by the BPRS and trial treatment discontinuation for non-efficacy. Secondary outcomes were extrapyramidal symptoms measured with the Simpson–Angus Scale, quality of life measured with the World Health Organization’s quality-of-life scale, and cost-effectiveness measured with NHS, social care and carer work loss costs and EuroQol-5 Dimensions. Results A total of 101 participants were randomised. Ninety-two (91%) participants took the trial medication, 59 (64%) completed stage 1 and 33 (56%) completed stage 2 treatment. Despite suboptimal compliance, improvements in BPRS scores at 12 weeks were 7.7 points (95% CI 3.8 to 11.5 points) greater with amisulpride than with placebo (11.9 vs. 4.2 points; p = 0.0002). In stage 2, BPRS scores improved by 1.1 point in those who continued with amisulpride but deteriorated by 5.2 points in those who switched from amisulpride to placebo, a difference of 6.3 points (95% CI 0.9 to 11.7 points; p = 0.024). Fewer participants allocated to the amisulpride group stopped treatment because of non-efficacy in stages 1 (p = 0.01) and 2 (p = 0.031). The number of patients stopping because of extrapyramidal symptoms and other side effects did not differ significantly between groups. Amisulpride treatment in the base-case analyses was associated with non-significant reductions in combined NHS, social care and unpaid carer costs and non-significant reductions in quality-adjusted life-years (QALYs) in both stages. Including patients who were intensive users of inpatient services in sensitivity analyses did not change the QALY result but resulted in placebo dominance in stage 1 and significant reductions in NHS/social care (95% CI –£8923 to –£122) and societal costs (95% CI –£8985 to –£153) for those continuing with amisulpride. Limitations The original recruitment target of 300 participants was not achieved and compliance with trial medication was highly variable. Conclusions Low-dose amisulpride is effective and well tolerated as a treatment for VLOSLP, with benefits maintained by prolonging treatment. Potential adverse events include clinically significant extrapyramidal symptoms and falls. Future work Trials should examine the longer-term effectiveness and safety of antipsychotic treatment in this patient group, and assess interventions to improve their appreciation of potential benefits of antipsychotic treatment and compliance with prescribed medication. Trial registration Current Controlled Trials ISRCTN45593573 and EudraCT2010-022184-35. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 67. See the NIHR Journals Library website for further project information.

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“…The brief WHO QOL (WHOQOL-BREF) questionnaire was used to measure the QOL. The results showed significant improvement in both the physical and psychological domains compared to the time of discharge, while social and environmental domains remained unchanged [7]. A study in Germany examined the effect of educational nurse-led home visits on QOL and functional status using the WHOQOL-BREF.…”

Section: Introductionmentioning

confidence: 99%

Quality of life among home healthcare patients in Saudi Arabia: household-based survey

Al-Surimi

Alharbi

El-Metwally

et al. 2019

Health Qual Life Outcomes

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BackgroundThe need for home healthcare programs is an increasingly becoming important common component of healthcare worldwide, as an alternative to hospitalization, owing to the growing elderly population, chronic and acute diseases that need continuous monitoring and care. The overall aim of this study was to describe and assess the quality of life (QOL) and associated determinants among patients enrolled in the Home Health Care (HHC) program affiliated with the Ministry of National Guard Health Affairs in Riyadh, Saudi Arabia.MethodsThis cross-sectional study was conducted among patients enrolled at the HHC program. The World Health Organization QOL questionnaire (WHOQOL-BREF) was used to collect data about the different domains of patients’ QOL. Logistic regression models were fitted to determine factors associated with QOL low score.ResultsThe study included 253 patients. Mean age was 67.05 (± 20.0). The overall QOL for HHC patients was significantly affected by both socio-demographic and morbid characteristics. In the final Multivariate logistic regression models, marital status, and having psychological problems, stroke and number illness were independently associated with the overall QOL of HHC patients (p = .022, p = .002, p = .031, .057 respectively). The physical health domain score was significantly associated with education level, having psychological problems and stroke (p = .028, p = .002, p = .007 retrospectively) whereas the psychological domain score was significantly associated with age (p = < 0.001) and three types of chronic diseases: pulmonary (p = .002), psychological problems (p = < 0.001). The social domain score was significantly associated only with the marital status (p = .026). The environmental domain was significantly associated with the education level and having stroke (p = .017 vs .027).ConclusionsThe overall QOL and its domains are significantly associated with several different factors. Many of these factors can be monitored and enhanced by improving quality of HHC services, thus improving the QOL of patients.

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Geriatric psychiatry home treatment (GHT): A pilot study on outcomes following hospital discharge for depressive and delusional patients

Cited by 11 publications

References 20 publications

Effectiveness of home treatment for elderly people with depression: randomised controlled trial

Effectiveness of home treatment for elderly people with depression: randomised controlled trial

Amisulpride for very late-onset schizophrenia-like psychosis: the ATLAS three-arm RCT

Quality of life among home healthcare patients in Saudi Arabia: household-based survey

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