Home Treatment for Acute Mental Health Care: Protocol for the Financial Outputs, Risks, Efficacy, Satisfaction Index and Gatekeeping of Home Treatment (FORESIGHT) Study

Levati, Sara; Mellacqua, Zefiro; Zufferey, Maria Caiata; Soldini, Emiliano; Albanese, Emiliano; Alippi, Maddalena; Bolla, Emilio; Colombo, Raffaella Ada; Cordasco, Severino; Kawohl, Wolfram; Larghi, Giuseppina; Lisi, Angela; Lucchini, Mario; Rossa, Simona; Traber, Rafael; Crivelli, Luca

doi:10.2196/28191

Cited by 1 publication

(1 citation statement)

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“…The study design of this effectiveness evaluation, extensively described in the recently published protocol of the study [39], was based on the approach used to assess the CRHT experience in the canton of Aargau [20] and adapted to the regional setting of Canton Ticino. The CRHT intervention, the quantitative study design and the statistical analysis to assess the effectiveness of CRHT in comparison with standard inpatient treatment are described in details here below.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography

et al. 2022

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Background Crisis Resolution Home Treatment (CRHT) is an alternative to inpatient treatment for acute psychiatric crises management. However, evidence on CRHT effectiveness is still limited. In the Canton of Ticino (Southern Switzerland), in 2016 the regional public psychiatric hospital replaced one acute ward with a CRHT. The current study was designed within this evaluation setting to assess the effectiveness of CRHT compared to standard inpatient treatment. Methods CRHT was offered to patients aged 18 to 65 with an acute psychiatric crisis that would have required hospitalization. We used a natural experiment based on geography, where intervention and control groups were formed according to the place of residence. Primary endpoints were reduction of psychiatric symptoms at discharge measured using the Health of the Nation Outcome Scales, treatment duration in days, and rate and length of readmissions during a two-year follow-up period after discharge. Safety during the treatment period was measured with the number of serious adverse events (suicide/suicide attempts, major self-harm episodes, acute alcohol/drug intoxications, aggressions to caregivers or family members). We used linear, log-linear and logistic regression models with propensity scores for the main analysis. Results We enrolled 321 patients; 67 were excluded because the treatment period was too short and 17 because they were transferred before the end of the treatment. Two hundred thirty-seven patients were available for data analysis, 93 in the intervention group and 144 in the control group. No serious adverse event was observed during the treatment period in both groups. Reduction of psychiatric symptoms at discharge (p-value = 0.359), readmission rates (p-value = 0.563) and length of readmissions (p-value = 0.770) during the two-year follow-up period did not differ significantly between the two groups. Treatment duration was significantly higher in the treatment group (+ 29.6% on average, p-value = 0.002). Conclusions CRHT was comparable to standard hospitalization in terms of psychiatric symptoms reduction, readmission rates and length of readmissions, but it was also characterized by a longer first treatment period. However, observational evidence following the study indicated that CRHT duration constantly lowered over time since its introduction in 2016 and became comparable to hospitalization, showing therefore to be an effective alternative also in terms of treatment length. Trial registration ISRCTN38472626 (17/11/2020, retrospectively registered).

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Section: Methodsmentioning

confidence: 99%