South West London and St George's Mental Health NHS Trust Service Development, Room 5, Building 14 Springfield University Hospital, 61 Glenburnie Road, London, SW17 7DJ, UK.
Soc Psychiatry Psychiatr Epidemiol. 2013 Jun;48(6):997-1003. doi: 10.1007/s00127-012-0602-x. Epub 2012 Oct 21.
Financial constraints and some disappointing research evaluations have seen English assertive outreach (AO) teams subject to remodelling, decommissioning and integration into standard care. We tested a specific alternative model of integrating the AO function from two AO teams into six standard community mental health teams (CMHT). The Flexible Assertive Community Treatment model (FACT) was adopted from the Netherlands (Van Veldhuizen, Commun Mental Health J 43(4):421-433, 2007; Bond and Drake, Commun Mental Health J 43(4):435-438, 2007). We aimed to demonstrate non-inferiority in clinical effectiveness and thereby show cost efficiencies associated with FACT.
Outcomes were compared in a mirror-image study of the 12 months periods pre- and post-service change with eligible individuals from the AO teams' caseloads (n = 112) acting as their own controls. We also conducted a cost-consequence analysis of the changes. Outcome data regarding admissions, use of crisis and home treatment, frequency of contact and DNA rate were extracted from the electronic patient record.
The results show AO patients (n = 112) transferred to standard CMHTs with FACT had significantly fewer admissions and a halving of bed use (21 fewer admission and 2,394 fewer occupied bed days) whilst being in receipt of a less intensive service (2,979 fewer contacts). This was offset by significantly poorer engagement but not by increased use of crisis and home treatment services.
Enhancing multi-disciplinary CMHTs with FACT provides a clinically effective alternative to AO teams. FACT offers a cost-effective model compared to AO.
财务限制和一些令人失望的研究评估导致英语积极外展（AO）团队进行了重组、退役和整合到标准护理中。我们测试了一种将 AO 功能从两个 AO 团队整合到六个标准社区心理健康团队（CMHT）的特定替代模式。灵活的自信社区治疗模式（FACT）是从荷兰引进的（Van Veldhuizen， Commun Mental Health J 43(4):421-433, 2007；Bond 和 Drake， Commun Mental Health J 43(4):435-438, 2007）。我们旨在证明临床效果非劣效性，从而显示与 FACT 相关的成本效益。
在服务变更前后的 12 个月期间，对 AO 团队病例量中的合格个体进行镜像研究（n=112），将他们自己作为对照，比较结果。我们还对变化进行了成本效益分析。从电子患者记录中提取有关入院、危机和家庭治疗的使用、联系频率和 DNA 率的结果数据。
结果显示，转移到具有 FACT 的标准 CMHT 的 AO 患者（n=112）入院次数明显减少，床位使用率减半（减少 21 次入院和 2394 个占用床位日），同时接受的服务强度降低（减少 2979 次联系）。这被显著较差的参与所抵消，但并没有增加危机和家庭治疗服务的使用。
通过增强多学科 CMHT 的 FACT，为 AO 团队提供了一种具有临床效果的替代方案。与 AO 相比，FACT 提供了一种具有成本效益的模式。
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