Intensive home treatment for patients in acute psychiatric crisis situations: a multicentre randomized controlled trial

Abstract

Background: Hospitalization is a common method to intensify care for patients experiencing a psychiatric crisis. A short-term, specialised, out-patient crisis intervention by a Crisis Resolution Team (CRT) in the Netherlands, called Intensive Home Treatment (IHT), is a viable intervention which may help reduce hospital admission days. However, research on the (cost-)effectiveness of alternatives to hospitalisation such as IHT are scarce. In the study presented in this protocol, IHT will be compared to care-as-usual (CAU) in a randomized controlled trial (RCT). CAU comprises low-intensity outpatient care and hospitalisation if necessary. In this RCT it is hypothesized that IHT will reduce inpatient days by 33% compared to CAU while safety and clinical outcomes will be non-inferior. Secondary hypotheses are that treatment satisfaction of patients and their relatives are expected to be higher in the IHT condition compared to CAU. Methods: A 2-centre, 2-arm Zelen double consent RCT will be employed. Participants will be recruited in the Amsterdam area, the Netherlands. Clinical assessments will be carried out at baseline and at 6, 26 and 52 weeks post treatment allocation. The primary outcome measure is the number of admission days. Secondary outcomes include psychological well-being, safety and patients' and their relatives' treatment satisfaction. Alongside this RCT an economic evaluation will be carried out to assess the cost-effectiveness and cost-utility of IHT compared to CAU. Discussion: RCTs on the effectiveness of crisis treatment in psychiatry are scarce and including patients in studies performed in acute psychiatric crisis care is a challenge due to the ethical and practical hurdles. The Zelen design may offer a feasible opportunity to carry out such an RCT. If our study finds that IHT is a safe and cost-effective alternative for CAU it may help support a further decrease of in-patient bed days and may foster the widespread implementation of IHT by mental health care organisations internationally.

From research to practice: Implementing an experimental home treatment model into routine mental health care

“…From a clinical perspective, HT is intended to be more acceptable to certain service users than hospital admission and may provide better opportunities to address social factors potentially contributing to many crises [1]. Crisis resolution and HT teams have been widely implemented in various mental health systems worldwide [4][5][6][7][8][9]. Evidence to support their effectiveness has remained moderate, however [10].…”

Trashing Property: Characteristics of Psychiatric Patients Who Engage in Domestic Property Damaging

“…appointment with the regular treatment team of the patient ( within 1 or 2 days ), new appointment with the EPS ( within 1 or 2 days ), back-referral to the general practitioner’. In The Netherlands, with short geographical distances to care facilities, there is an increasing reliance on high frequent, acute out-patient care (such as Intensive Home Treatment; Cornelis et al 2018).…”

Stationsäquivalente Behandlung

“…B. Entgeltgruppe 9), verzichten aber gleichzeitig auf Nachtdienstzuschläge, wenn sie vollständig in der StäB arbeiten. Eine detaillierte und valide ökonomische Gesamtbewertung von StäB an sich und umso mehr gerontopsychiatrischer StäB steht aufgrund der Vielzahl von ökonomischen Einflussfaktoren, aber auch der Akzeptanz [ 14 ] der Behandlungsform durch Kranken- und Pflegekassen, Patienten, Angehörige und Pflegeeinrichtungen noch aus [ 15 ] Modellprojekte beziehen sich insbesondere auf schizophrene Krankheitsbilder [ 16 , 17 ] und fokussieren mehr inhaltliche als ökonomische Vorteile [ 18 ]; neueste angloamerikanische Forschung weist hier auf eine Kosteneffizienz unter Berechnung der lebensqualitätsadjustierten Lebensjahre (QUALY) hin [ 19 ]. Diese Studie weist aber auch auf die Herausforderung einer solchen Evaluation hin, in der neben den akuten Effekten wie Behandlungsdauer auch langfristige Evaluation von QUALY, Wiederaufnahmen, Pflegeaufwand, Autonomie, Demenzentwicklung, Belastung pflegender Angehöriger etc.…”