Puntis Stephen Robert, Rugkåsa Jorun, Burns Tom
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
BMC Psychiatry. 2017 Apr 28;17(1):151. doi: 10.1186/s12888-017-1319-x.
Most studies investigating the effectiveness of Community Treatment Orders (CTOs) use readmission to hospital as the primary outcome. Another aim of introducing CTOs was to improve continuity of care. Our study was a 3-year prospective follow-up which tested for associations between CTOs and continuity of care.
Our study sample included 333 patients recruited to the Oxford Community Treatment Order Trial (OCTET). We collected data on continuity of care using eight previously operationalized measures. We analysed the association between CTOs and continuity of care in two ways. First, we tested the association between continuity of care and OCTET randomisation arm (CTO versus voluntary care via Section 17 leave). Second, we analysed continuity of care and CTO exposure independent of randomisation; using any exposure to CTO, number of days on CTO, and proportion of outpatient days on CTO as outcomes.
197 (61%) patients were made subject to CTO during the 36-month follow-up. Randomisation to CTO arm was significantly associated with having a higher proportion of clinical documents copied to the user but no other measures of continuity. Having a higher proportion of outpatient days on CTO (irrespective of randomisation) was associated with fewer 60 day breaks without community contact. A sensitivity analysis found that any exposure to CTO and a higher proportion of outpatient days on CTO were associated with fewer days between community mental health team contacts and 60 day breaks without contact.
We found some evidence of an association between CTO use and better engagement with the community team in terms of increased contact and fewer breaks in care. Those with CTO experience had a higher number of inpatient admissions which may have acted as a mediator of this association. We found limited evidence for an association between CTO use and other measures of continuity of care.
大多数调查社区治疗令（CTO）有效性的研究将再次入院作为主要结果。引入CTO的另一个目的是改善护理的连续性。我们的研究是一项为期3年的前瞻性随访，测试了CTO与护理连续性之间的关联。
我们的研究样本包括招募到牛津社区治疗令试验（OCTET）的333名患者。我们使用八项先前实施的措施收集了护理连续性的数据。我们通过两种方式分析了CTO与护理连续性之间的关联。首先，我们测试了护理连续性与OCTET随机分组臂（CTO与通过第17条请假的自愿护理）之间的关联。其次，我们独立于随机分组分析了护理连续性和CTO暴露情况；将任何CTO暴露、CTO上的天数以及CTO上门诊天数的比例作为结果。
在36个月的随访期间，197名（61%）患者被下达了CTO。随机分配到CTO组与有更高比例的临床文件抄送给使用者显著相关，但与其他护理连续性指标无关。CTO上门诊天数比例较高（无论随机分组情况如何）与无社区接触的60天间隔较少相关。一项敏感性分析发现，任何CTO暴露以及CTO上门诊天数比例较高与社区精神卫生团队接触之间的天数较少以及无接触的60天间隔较少相关。
我们发现了一些证据，表明使用CTO与在增加接触和减少护理中断方面更好地与社区团队合作之间存在关联。有CTO经历的患者住院次数较多，这可能是这种关联的一个调节因素。我们发现使用CTO与其他护理连续性指标之间存在关联的证据有限。
