Intellectual functioning and outcome of patients with severe psychotic illness randomised to intensive case management

Hassiotis, Angela; Ukoumunne, Obioha C; Byford, Sarah; Tyrer, Peter; Harvey, Kate; Piachaud, Jack; Gilvarry, K.; Fraser, Janelle

doi:10.1192/bjp.178.2.166

Cited by 66 publications

(46 citation statements)

References 31 publications

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“…After exclusion of 613 articles for various reasons (Figure 1), we included 36 RCTs (total 7 494 patients) plus an additional 14 companion reports. [61][62][63][64][65][66][67][68][69][70][71][72][73][74] The studies were published between 1987 and 2014 by researchers in North America (n = 24), Europe (n = 8), Australia (n = 2), Israel (n = 1) and South Africa (n = 1) ( Table 1). One study was a cluster RCT.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis

Tricco

Antony

Ivers

et al. 2014

CMAJ

133

101

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Background: Frequent users of health care services are a relatively small group of patients who account for a disproportionately large amount of health care utilization. We conducted a metaanalysis of the effectiveness of interventions to improve the coordination of care to reduce health care utilization in this patient group. Methods:We searched MEDLINE, Embase and the Cochrane Library from inception until May 2014 for randomized clinical trials (RCTs) assessing quality improvement strategies for the coordination of care of frequent users of the health care system. Articles were screened, and data abstracted and appraised for quality by 2 reviewers, independently. Random effects meta-analyses were conducted. Results:We identified 36 RCTs and 14 companion reports (total 7494 patients). Significantly fewer patients in the intervention group than in the control group were admitted to hospital (relative risk [RR] 0.81, 95% confidence interval [CI] 0.72-0.91). In subgroup analyses, a similar effect was observed among patients with chronic medical conditions other than mental illness, but not among patients with mental illness. In addition, significantly fewer patients 65 years and older in the intervention group than in the control group visited emergency departments (RR 0.69, 95% CI 0.54-0.89). Interpretation:We found that quality improvement strategies for coordination of care reduced hospital admissions among patients with chronic conditions other than mental illness and reduced emergency department visits among older patients. Our results may help clinicians and policy-makers reduce utilization through the use of strategies that target the system (team changes, case management) and the patient (promotion of self-management). AbstractSee related commentary, www.cmaj.ca/lookup

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Section: Resultsmentioning

confidence: 99%

Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis

Tricco

Antony

Ivers

et al. 2014

CMAJ

133

101

View full text Add to dashboard Cite

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“…The only randomized controlled trial that could be found comparing a novel with standard general service provision for people with ID was conducted by Hassiotis et al. (2001).…”

Section: Resultsmentioning

confidence: 99%

General psychiatric services for adults with intellectual disability and mental illness

Chaplin

2003

J intellect Disabil Res

105

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Background Adults with intellectual disability (ID) and mental illness may use general or specialist psychiatric services. This review aims to assess if there is evidence for a difference in outcome between them. Methods A literature review was conducted using a variety of electronic databases and hand-search strategies to identify all studies evaluating the outcome of people with ID and mental illness using general psychiatric services. Results There is no conclusive evidence to favour the use of general or specialist psychiatric services. People with ID stay less time on general psychiatric than specialist inpatient units. People with severe ID appear not to be well served in general services. Older studies of inpatient samples suggest a worse outcome for people with ID. Novel specialist services generally improve upon pre-existing general services. Assertive outreach in general services may preferentially benefit those with ID. Recent studies suggest similar lengths

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“…However, this is to be expected in the evaluation of complex interventions. Thus, for example, in assertive community treatment one of the robust findings from the largest of the controlled trials the UK700 Study, whose general findings were essentially negative (Burns et al, 1999) was that those with borderline intellectual disability, when treated by intensive case management spent significantly less time in hospital and also had improved quality of life and functioning, compared with those who were treated with standard treatment Hassiotis et al, 2001). In both assertive community teams, home treatment services and crisis resolutions teams, as well as with the 12-step treatment for alcoholism and many other interventions the first phase is unfortunately ignored.…”

Section: Problems Of Evaluating Interventions In Community Servicesmentioning

confidence: 99%

The future of specialist community teams in the care of those with severe mental illness

Tyrer

2007

Epidemiol Psichiatr Soc

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SummaryAims – Specialist interventions in community psychiatry for severe mental illness are expanding and their place needs to be re-examined. Methods – Recent literature is reviewed to evaluate the advantages and disadvantages of specialist teams. Results – Good community mental health services reduce drop out from care, prevent suicide and unnatural deaths, and reduce admission to hospital. Most of these features have been also demonstrated by assertive community outreach and crisis resolution teams when good community services are not available. In well established community services assertive community teams do not reduce admission but both practitioners and patients prefer this service to other approaches and it leads to better engagement. Crisis resolution teams appear to be more successful than assertive community teams in preventing admission to hospital, although head- to-head comparisons have not yet been made. All specialist teams have the potential of fragmenting services and thereby reducing continuity of care. Conclusions – The assets of improved engagement and greater satisfaction with assertive, crisis resolution and home treatment teams are clear from recent evidence, but to improve integration of services they are probably best incorporated into community mental health services rather than standing alone.Declaration of Interest: The author has been the sole consultant in two assertive outreach teams since 1994 and might there- fore be expected to be in favour of this genre of service. He has received grants for evaluation of different services models from the Department of Health (UK) and the Medical Research Council (UK).

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Intellectual functioning and outcome of patients with severe psychotic illness randomised to intensive case management

Abstract: ICM appears to be a cost-effective strategy for a subgroup of patients with severe psychosis with cognitive deficits.

Cited by 66 publications

References 31 publications

Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis

Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis

General psychiatric services for adults with intellectual disability and mental illness

The future of specialist community teams in the care of those with severe mental illness

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