Vanderlip Erik R, Henwood Benjamin F, Hrouda Debra R, Meyer Piper S, Monroe-DeVita Maria, Studer Lynette M, Schweikhard April J, Moser Lorna L
Dr. Vanderlip is with the Department of Psychiatry and Medical Informatics and Ms. Schweikhard is with the Schusterman Library, both with the University of Oklahoma School of Community Medicine, Tulsa (e-mail:
Psychiatr Serv. 2017 Mar 1;68(3):218-224. doi: 10.1176/appi.ps.201600100. Epub 2016 Dec 1.
Assertive community treatment (ACT) is one of the few evidence-based practices for adults with severe mental illness. Interest has slowly waned for ACT implementation. Yet ACT remains an appealing services platform to achieve the triple aim of health care reform (improved health outcomes, reduced cost, and improved satisfaction) through integration of primary care and behavioral health services. This review highlights the evidence for ACT to improve general medical outcomes, reduce treatment costs, and increase access to treatment.
Using a comprehensive list of relevant search terms, the authors performed a systematic literature database search for articles published through November 2015, resulting in ten articles for inclusion.
No studies reported on clinical outcomes of general medical comorbidities or on mortality of ACT clients. Half of the studies reporting utilization (three of six) found a decrease in emergency room usage, and three of four studies identified an increase in outpatient primary care visits. Most studies found no increase in overall medical care costs. Of the few studies reporting on quality of life, most found mild to moderate improvements.
To date, rigorous scientific examination of the effect of ACT on the general health of the populations it serves has not been undertaken. Given ACT's similarity to emerging chronic illness medical management models, the approach seems like a natural fit for improving general medical outcomes of persons with severe mental illnesses. More research is needed that investigates the current effect of ACT teams on general medical outcomes, treatment costs, and access to care.
积极社区治疗（ACT）是针对患有严重精神疾病的成年人的少数循证实践之一。对ACT实施的兴趣已逐渐减弱。然而，ACT仍然是一个有吸引力的服务平台，可通过整合初级保健和行为健康服务来实现医疗保健改革的三重目标（改善健康结果、降低成本和提高满意度）。本综述强调了ACT在改善一般医疗结果、降低治疗成本和增加治疗可及性方面的证据。
作者使用相关搜索词的综合列表，对截至2015年11月发表的文章进行了系统的文献数据库搜索，最终纳入了10篇文章。
没有研究报告ACT服务对象的一般医疗合并症的临床结果或死亡率。报告利用情况的研究中有一半（六项中的三项）发现急诊室使用率下降，四项研究中的三项发现门诊初级保健就诊次数增加。大多数研究发现总体医疗费用没有增加。在少数报告生活质量的研究中，大多数发现有轻度至中度改善。
迄今为止，尚未对ACT对其服务人群总体健康的影响进行严格的科学检验。鉴于ACT与新兴的慢性病医疗管理模式相似，这种方法似乎很自然地适合改善严重精神疾病患者的一般医疗结果。需要更多的研究来调查ACT团队目前对一般医疗结果、治疗成本和医疗可及性的影响。
