Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia spectrum and bipolar I disorders: the 24-month follow-up ACCESS II study

Schimmelmann, Benno Karl Edgar; Schöttle, Daniel; Karow, Anne; Ruppelt, Friederike; Sauerbier, Anne-Lena; Bussopulos, Alexandra; Frieling, Marietta; Golks, Dietmar; Kerstan, Andrea; Nika, Evangelia; Schödlbauer, Michael; Daubmann, Anne; Wegscheider, Karl; Lange, Matthias; Ohm, Gunda; Lange, Benjamin; Meigel-Schleiff, Christina; Naber, Dieter; Wiedemann, Klaus; Bock, Thomas; ... (2014). Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia spectrum and bipolar I disorders: the 24-month follow-up ACCESS II study. Journal of clinical psychiatry, 75(12), pp. 1371-1379. Physicians Postgraduate Press 10.4088/JCP.13m08817

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OBJECTIVE

The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study.

METHOD

All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization.

RESULTS

Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002).

CONCLUSIONS

ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01888627.

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