Department of Social Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Int Rev Psychiatry. 2010;22(2):130-7. doi: 10.3109/09540261003661841.
Assertive community treatment is one of the most researched and clinically replicated of all community mental health teams. It is clearly defined with established scales to measure its model fidelity. In the last decade its earlier claims to substantially reduce hospitalization have not been replicated in research studies. This inconsistency has generated considerable controversy. A careful systematic review and meta-regression analysis was conducted of 64 trials including 7,819 patients. The review included measures of model fidelity and hospitalization outcomes. Variation in reduced hospitalization was found to be mainly due to variation in control service practice but model fidelity to team organization principles was also associated with reduced hospitalization. Low caseloads and specified ACT staffing, however, had no effect at all on outcome. 'Ordinary CMHTs' share most of the organizational aspects of ACT and appear to deliver equal outcomes with much reduced resources. The value of investing in high fidelity ACT teams must, therefore, be in doubt.
坚定的社区治疗是所有社区心理健康团队中研究最多和临床复制最多的方法之一。它有明确的定义和既定的量表来衡量其模式的保真度。在过去的十年中，它早期声称可以大幅减少住院治疗的说法并没有在研究中得到证实。这种不一致性引起了相当大的争议。对包括 7819 名患者的 64 项试验进行了仔细的系统回顾和荟萃回归分析。该审查包括对模型保真度和住院治疗结果的衡量。住院治疗减少的差异主要归因于对照服务实践的差异，但团队组织原则的模式保真度也与住院治疗减少有关。然而，低病例数和指定的 ACT 人员配备对结果没有任何影响。“普通的 CMHTs”共享 ACT 的大部分组织方面，似乎可以在减少资源的情况下提供同等的结果。因此，投资于高度保真的 ACT 团队的价值必须受到质疑。
