Yulius Mental Health, PO Box 1001, 3300 BA, Dordrecht, The Netherlands.
Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
BMC Psychiatry. 2019 Aug 5;19(1):241. doi: 10.1186/s12888-019-2229-x.
On the basis of earlier experiences in Germany and England, we developed an intensive multimodal group programme (FACT Plus) for psychotic-spectrum patients. By combining it with regular Flexible Assertive Community Treatment (FACT) (care as usual), we intended to reduce psychiatric rehospitalizations and mental healthcare costs.
We included adult patients (>18 years) with a psychotic spectrum disorder who had had at least one psychiatric admission in the 2 years before inclusion. FACT Plus was delivered weekly for 9 months. The intervention group was recruited in northern Rotterdam (the Netherlands), and the control group was recruited in southern Rotterdam. The primary outcome measure was length of stay (LOS) and the secondary outcome measures were mental healthcare costs and compulsory admissions.
We included 52 patients in the intervention group and 61 patients in the control group. During the 12-month observation period, the mean LOS per patient was 15.2 (intervention group) and 34.6 (control group). This represents a difference of 19.4 days (56.1%). This result was statistically significant (B = -.859, SE = .497, p = .042) in a regression model correcting for baseline differences between the groups. Mean total mental healthcare costs per patient were €21,098 in the intervention group) versus €25,054 in the control group, a difference of about €4000 per patient (16%). In addition, there were zero compulsory admissions in the intervention group and nine in the control group.
After the addition of FACT Plus to regular FACT, psychiatric LOS was substantially lower in the intervention group than in the control group. This result was accompanied by a limited reduction in mental healthcare costs.
基于德国和英国的早期经验，我们为精神病谱系患者开发了一种强化的多模式团体方案（FACT Plus）。通过将其与常规的灵活主张社区治疗（FACT）（常规护理）相结合，我们旨在减少精神科住院和精神保健费用。
我们纳入了成年精神病谱系障碍患者（>18 岁），他们在纳入前的 2 年内至少有过一次精神科住院。FACT Plus 每周进行一次，共 9 个月。干预组在荷兰北部的鹿特丹招募，对照组在鹿特丹南部招募。主要结局指标是住院时间（LOS），次要结局指标是精神保健费用和强制入院。
我们纳入了干预组的 52 名患者和对照组的 61 名患者。在 12 个月的观察期内，每位患者的平均 LOS 为 15.2 天（干预组）和 34.6 天（对照组）。这代表了 19.4 天（56.1%）的差异。在对两组间基线差异进行校正的回归模型中，这一结果具有统计学意义（B=-.859，SE=.497，p=.042）。每位患者的平均总精神保健费用在干预组为 21098 欧元），对照组为 25054 欧元，差异约为 4000 欧元（16%）。此外，干预组无强制入院，对照组有 9 例。
在常规 FACT 中加入 FACT Plus 后，干预组的精神病 LOS 明显低于对照组。这一结果伴随着精神保健费用的有限减少。
