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An observational, “real life” trial of the introduction of assertive community treatment in a geographically defined area using clinical rather than service use outcome criteria

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Abstract

Introduction

Assertive outreach methods of service delivery hold promise, but have been evaluated mostly in the context of short-lived experiments of limited sustainability and a focus on service use outcomes. The aim of the current investigation was to conduct an observational, “real life”, pre-post comparison of the introduction of assertive outreach in a geographically defined area using clinical rather than service use outcome criteria.

Method

Assertive outreach was implemented in 2002 in a catchment area of 250,000, where cumulative routine outcome measurements had been in place since 1998. Clinical outcome, defined as making a transition to meeting the recently introduced remission criterion, was compared for two non-overlapping cohorts of patients treated in the period 1998–2001 and in the period 2002–2005.

Results

The proportion of patients that made the transition to remission increased from 19% in the period before the introduction of assertive outreach, to 31% in the period after (OR = 2.21, 95% CI 1.03–4.78).

Conclusion

Assertive outreach in real life routine clinical practice brings about detectable changes in clinical outcome. ACT may bring improvement to the lives of patients living in countries characterised by fragmented and hospital-based mental health services.

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Authors and Affiliations

  1. Dept. of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO BOX 616 (Vijverdal), 6200, MD, Maastricht, The Netherlands

    Maarten Bak MD, PhD, Jim van Os MD, PhD, Philippe Delespaul PhD & Marian Drukker PhD

  2. Psycope, Assertive Community Teams, Maastricht, The Netherlands

    Maarten Bak MD, PhD & Philippe Delespaul PhD

  3. Division of Psychological Medicine, Institute of Psychiatry, London, UK

    Jim van Os MD, PhD

  4. Prins Claus Centrum (Mental health Centre), Sittard, The Netherlands

    Arthur de Bie MD

  5. Mondriaan zorggroep, Heerlen, The Netherlands

    Joost á Campo MD, PhD

  6. Community Mental Health Centre, Maastricht, The Netherlands

    Giovanni Poddighe MD

  7. Youth Health Care Division, Public Health Service South Limburg, Maastricht, The Netherlands

    Marian Drukker PhD

Authors
  1. Maarten Bak MD, PhD
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  2. Jim van Os MD, PhD
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  3. Philippe Delespaul PhD
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  4. Arthur de Bie MD
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  5. Joost á Campo MD, PhD
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  6. Giovanni Poddighe MD
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  7. Marian Drukker PhD
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Corresponding author

Correspondence to Maarten Bak MD, PhD.

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Bak, M., van Os, J., Delespaul, P. et al. An observational, “real life” trial of the introduction of assertive community treatment in a geographically defined area using clinical rather than service use outcome criteria. Soc Psychiat Epidemiol 42, 125–130 (2007). https://doi.org/10.1007/s00127-006-0147-y

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  • DOI: https://doi.org/10.1007/s00127-006-0147-y

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