Tinland Aurelie, Fortanier Cecile, Girard Vincent, Laval Christian, Videau Benjamin, Rhenter Pauline, Greacen Tim, Falissard Bruno, Apostolidis Themis, Lançon Christophe, Boyer Laurent, Auquier Pascal
Aix-Marseille University, EA 3279 Research Unit, Marseille 13385, France.
Trials. 2013 Sep 24;14:309. doi: 10.1186/1745-6215-14-309.
Recent studies in North American contexts have suggested that the Housing First model is a promising strategy for providing effective services to homeless people with mental illness. In the context of the highly generous French national health and social care system, which is easily accessible and does not require out-of-pocket payment, the French Health Ministry insists on rigorous techniques, including randomized protocols, to evaluate the impact of Housing First approaches in France.
A prospective randomized trial was designed to assess the impact of a Housing First intervention on health outcomes and costs over a period of 24 months on homeless people with severe mental illness, compared to Treatment-As-Usual. The study is being conducted in four cities in France: Lille, Marseille, Paris and Toulouse. The inclusion criteria are as follows: over 18 years of age, absolutely homeless or in precarious housing, and possessing a 'high' level of need: diagnosis of schizophrenia or bipolar disorder and moderate to severe disability according to the Multnomah Community Ability Scale (score ≤ 62) and at least one of the following three criteria: 1) having been hospitalized for mental illness two or more times in any one year during the preceding five years; 2) co-morbid alcohol or substance use; and 3) having been recently arrested or incarcerated. Participants will be randomized to receiving the Housing First intervention or Treatment-As-Usual. The Housing First intervention provides immediate access to independent housing and community care. The primary outcome criterion is the use of high-cost health services (that is,, number of hospital admissions and number of emergency department visits) during the 24-month follow-up period. Secondary outcome measures include health outcomes, social functioning, housing stability and contact with police services. An evaluation of the cost-effectiveness and cost-utility of Housing First will also be conducted. A total of 300 individuals per group will be included.
This is the first study to examine the impact of a Housing First intervention compared to Treatment-As-Usual in France. It should provide key information to policymakers concerning the cost-effectiveness and health outcomes of the Housing First model in the French context.
The current clinical trial number is NCT01570712.
北美地区最近的研究表明，“先住房后治疗”模式是为患有精神疾病的无家可归者提供有效服务的一项很有前景的策略。在法国国家医疗和社会护理体系极为慷慨、易于获得且无需自付费用的背景下，法国卫生部坚持采用包括随机方案在内的严格技术，以评估“先住房后治疗”方法在法国的影响。
一项前瞻性随机试验旨在评估“先住房后治疗”干预措施在24个月期间对患有严重精神疾病的无家可归者的健康结局和成本的影响，并与常规治疗进行比较。该研究在法国的四个城市进行：里尔、马赛、巴黎和图卢兹。纳入标准如下：年龄超过18岁，完全无家可归或居住在不稳定住房中，且有“高度”需求：诊断为精神分裂症或双相情感障碍，根据摩特诺玛社区能力量表（得分≤62）为中度至重度残疾，以及满足以下三个标准中的至少一项：1）在过去五年中的任何一年因精神疾病住院两次或更多次；2）合并酒精或药物使用；3）最近被逮捕或监禁。参与者将被随机分配接受“先住房后治疗”干预或常规治疗。“先住房后治疗”干预措施提供立即入住独立住房和社区护理的机会。主要结局标准是在24个月随访期内使用高成本医疗服务（即住院次数和急诊就诊次数）。次要结局指标包括健康结局、社会功能、住房稳定性以及与警察部门的接触。还将对“先住房后治疗”的成本效益和成本效用进行评估。每组将纳入总共300人。
这是法国第一项比较“先住房后治疗”干预措施与常规治疗影响的研究。它应为政策制定者提供有关法国背景下“先住房后治疗”模式的成本效益和健康结局的关键信息。
当前临床试验编号为NCT01570712。
