Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
Department of Neuroscience, University of Turin, Turin, Italy.
Acta Psychiatr Scand. 2024 Aug;150(2):78-90. doi: 10.1111/acps.13709. Epub 2024 May 25.
The community treatment order (CTO) is designed to deliver mental healthcare in the community and has been introduced in around 75 jurisdictions worldwide. It constitutes a legal obligation in which individuals with severe mental illness must adhere to out-of-hospital treatment plans. Despite intense criticism and the debated nature of published evidence, it has emerged as a clinical and policy response to frequent hospital readmissions and to enhance adherence in cases where there is refusal of pharmacological treatments. This systematic review outlines findings on CTO long-term adherence, after mandatory outpatient treatment has ended, in studies that include people with psychiatric disorders.
Following PRISMA guidelines, we performed a review of published articles from PubMed, PsycINFO, EMBASE, and CINAHL up to January 15, 2023. We included studies that assessed adherence after CTO ends. The study is registered with PROSPERO number CRD42022360879.
Six independent studies analyzing the main indicators of long adherence: engagement with services and medication adherence, were included. The average methodological quality of the studies included is fair. Long-term adherence was assessed over a period ranging from 11 to 28 months. Only two studies reported a statistically significant improvement. Regarding the remaining studies, no positive correlation was observed, except for certain subgroup samples, while in one study, medication adherence decreased.
Scientific evidence supporting the hypothesis that CTO has a positive role on long-term adherence post-obligation is currently not sufficient. Given the importance of modern recovery-oriented approaches and the coercive nature of compulsory outpatient treatment, it is necessary that future studies ensure the role of CTO in effectively promoting adherence.
社区治疗令（CTO）旨在提供社区精神卫生保健，已在全球约 75 个司法管辖区引入。它构成了一项法律义务，要求患有严重精神疾病的个人必须遵守院外治疗计划。尽管受到强烈批评和已发表证据的争议，它已成为应对频繁住院和增强拒绝药物治疗病例的依从性的临床和政策反应。本系统评价概述了在强制性门诊治疗结束后，对包括精神障碍患者在内的研究中 CTO 长期依从性的研究结果。
根据 PRISMA 指南，我们对截至 2023 年 1 月 15 日从 PubMed、PsycINFO、EMBASE 和 CINAHL 发表的文章进行了审查。我们纳入了评估 CTO 结束后依从性的研究。该研究已在 PROSPERO 注册，注册号为 CRD42022360879。
纳入了 6 项独立研究，分析了主要的长期依从性指标：参与服务和药物依从性。所纳入研究的平均方法学质量为中等。长期依从性评估时间范围从 11 到 28 个月不等。只有两项研究报告了统计学上的显著改善。对于其余研究，没有观察到积极的相关性，除了某些亚组样本外，而在一项研究中，药物依从性下降。
目前，没有足够的科学证据支持 CTO 对义务后长期依从性有积极作用的假设。鉴于现代以康复为导向的方法的重要性和强制性门诊治疗的强制性，未来的研究有必要确保 CTO 在有效促进依从性方面的作用。
