Patients With Schizophrenia, Bipolar Improve More With Integrated Care

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Patients suffering from schizophrenia or bipolar disorder who were treated in a community and integrated care setting were less likely to disengage from treatment and more likely to stay on medication compared to standard care.

Daniel Schöttle, MD, of the University Medical Center Hamburg-Eppendorf, Germany, and colleagues found that having family members involved in treatment, involvement in self-help groups, and more active involvement of patients in their treatment also contributed to more positive outcomes in the program.

“The positive effect of assertive community treatment on sustained service engagement may be explained by the high team fidelity, lower and shared case load, higher contact frequency, no drop-out policy, 24-hour-per-day availability, and possibility of visiting patients in the community, especially if at risk for disengagement,” the researchers wrote in the The Journal of Clinical Psychiatry.

Patients with schizophrenia were treated under the ACCESS program for 12 months, which is described as “assertive community treatment embedded in an integrated care program to patients with schizophrenia spectrum disorders.”

The success of that trial led investigators to start the ACCESS II study to include more patients, including those with bipolar I, and see if results could be sustained over a period of 24 months.

Involuntary admissions decreased from 34.8% in the two previous years to 7.8% during ACCESS II (P<0.001). At 24 months, 78.3% of patients were fully adherent to medication, compared to 25.2% at baseline (P=0.002). There were also significant improvements in the group in terms of illness severity, functioning, quality of life, and satisfaction.

Patients With Schizophrenia, Bipolar Improve More With Integrated Care
Patients With Schizophrenia, Bipolar Improve More With Integrated Care

Patients treated for schizophrenia or bipolar I disorder under the ACCESS model have low levels of service disengagement, high levels of medication adherence and improvements in clinical outcomes, researchers report.

Daniel Schöttle (University Medical Center Hamburg-Eppendorf, Germany) and colleagues explain that ACCESS "was created to offer assertive community treatment embedded in an integrated care program to patients with schizophrenia spectrum disorders."

Following positive results in an initial 12-month comparative trial (ACCESS I), the ACCESS model was implemented into routine care and extended to patients with bipolar I disorder with psychotic features.

The current ACCESS II Study assessed the efficacy of the model in a new sample of patients over 24 months to test whether treatment effects can be sustained over longer periods under “real-life” conditions.

 
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