Department of Health Sciences, University of Leicester, Leicester, UK.
Soc Psychiatry Psychiatr Epidemiol. 2012 Feb;47(2):313-22. doi: 10.1007/s00127-010-0338-4. Epub 2011 Feb 1.
Assertive community treatment for the severely mentally ill is being implemented increasingly internationally. It is unclear whether recommended characteristics of assertive outreach (AO) teams influence care and outcomes. We hypothesised that recommended characteristics of AO teams such as joint health and social care management would predict reduced hospitalisation in the first year of an AO client programme and related outcomes throughout England.
A two-stage design was used: a stratified sample of 100 of the 186 'stand-alone' AO teams in England and a systematic sample of clients from each team with stratification for black and ethnic minority patients. Team characteristics, treatment and outcomes were collected from teams. Analyses took account of patients' histories, clustering and ethnic minority over-sampling.
Under AO the proportion of time spent in hospital following admission decreased. Only 3/1,096 patients went missing in 9 months. Although patient' histories significantly predicted outcomes almost no team characteristics predicted re-admission or other patient outcomes after 1 and 3 years. Ethnic minority clients were more likely to be on compulsory orders only on jointly managed teams (P = 0.030). Multidisciplinary teams and teams not working out of hours significantly predicted that patients received psychological interventions, but only 17% of sampled patients received such treatments.
Characteristics of AO teams do not explain long-term patient outcomes. Since recommended team characteristics are not effective new models of care should be developed and the process of care tested. Managing teams to implement evidence-based psychological interventions might improve outcomes.
积极社区治疗（assertive community treatment，ACT）正在越来越多地在国际上被用于严重精神疾病患者。目前尚不清楚 ACT 外展团队（AO）的推荐特征是否会影响护理和结果。我们假设，AO 团队的推荐特征，如共同的医疗和社会保健管理，将预测在 AO 客户计划的第一年减少住院治疗，以及整个英格兰相关的结果。
采用两阶段设计：对英格兰 186 个“独立”AO 团队中的 100 个进行分层抽样，并对每个团队的患者进行系统抽样，对黑人和少数民族患者进行分层。从团队收集团队特征、治疗和结果数据。分析考虑了患者的病史、聚类和少数民族的过度抽样。
在 ACT 下，入院后在医院花费的时间比例减少。在 9 个月内，只有 3/1096 名患者失踪。尽管患者的病史显著预测了结果，但几乎没有团队特征预测了 1 年和 3 年后的再次入院或其他患者结果。只有共同管理的团队上，少数民族患者更有可能只接受强制性命令（P = 0.030）。多学科团队和不在工作时间内工作的团队显著预测患者将接受心理干预，但只有 17%的抽样患者接受了此类治疗。
AO 团队的特征不能解释长期的患者结果。由于推荐的团队特征无效，应开发新的护理模式并测试护理过程。管理团队实施基于证据的心理干预可能会改善结果。
