Global assessment of functioning following assertive community treatment in Edmonton, Alberta: a longitudinal study

Assertive community treatment of the mentally ill: service model and effectiveness

OBJECTIVE

To provide a description of the service delivery model of an assertive community treatment (ACT) team in the management of a group of severely mentally ill patients and examine the effectiveness of this team in reducing readmissions to a psychiatric inpatient service.

METHOD

A clinical case audit was performed on a single day in September 2001. Admission episodes and duration were collected for patients registered with the team in the 12 month period prior to ACT and for a period of 12 months ending on the day of the audit. Forty-three patients were registered with the team at the time of data collection. The majority (79%) were diagnosed with schizophrenia and there were high rates of comorbidity (76%) and disability (mean Global Assessment of Functioning score 45.9). The main outcome measures were the number of readmissions and readmission days before and after the institution of ACT.

RESULTS

The mean number of readmission days reduced from 70.9 to 10.2 (p<0.05) following the institution of ACT.

CONCLUSION

Assertive community treatment conducted in a naturalistic clinical environment is effective in significantly reducing the number of readmission days in a group of patients suffering from long-term and persistent severe mental illness.

Client and community services satisfaction with an assertive community treatment subprogram for inner-city clients in Edmonton, Alberta

OBJECTIVES

To evaluate client and agency satisfaction with a specific assertive community treatment subprogram, known as inner-city support, developed in Edmonton to target the inner-city population, and to determine the demographics and potential needs of this population.

METHOD

Clients were administered questionnaires based on the Client Satisfaction Questionnaire and the Satisfaction With Life Scale. We also conducted a face-to-face interview. We contacted and similarly surveyed 18 community agencies.

RESULTS

The program was well received, although areas for improvements included dissemination of information and hours of operation. Clients also requested more input regarding the development of activities. Clients were predominantly male with a diagnosis of schizophrenia comorbid with substance abuse and antisocial personality disorders, a history of forensic contact, homeless, and dependent on social assistance.

CONCLUSION

Among the population with serious and persistent mental illness, inner-city clients represent a particularly disadvantaged subpopulation that may benefit from specialized community programs.

A systematic review evaluating health-related quality of life, work impairment, and healthcare costs and utilization in bipolar disorder

BACKGROUND

Bipolar disorder greatly impacts health-related quality of life (HRQoL), physical and social functioning, employment, and work productivity, and greatly increases health-care utilization and costs. Our objective was to characterize how bipolar disorder impacts HRQoL, work impairment, and health-care utilization and costs.

DATA SOURCES AND STUDY SELECTION

A systematic literature review was conducted to identify bipolar disorder studies of HRQoL, functioning, work impairment, and health-care utilization and costs. We searched Medline, ClinPSYC, and HealthSTAR for English-language articles published between January 1985 and November 2002 using MeSH headings and keywords. Additional articles were identified from references of relevant articles.

RESULTS

We identified 65 HRQoL articles, 14 work-impairment articles, and 28 utilization-and-care-cost articles. For all HRQoL instruments used, bipolar disorder patients' HRQoL was rated similarly to that of unipolar depression patients, and equal to or lower compared with patients with other chronic nonmental illnesses. Current treatments have been shown to improve HRQoL and physical and social functioning; some data indicate that management may improve selfreported work impairment and absenteeism. Bipolar disorder patients have been found to utilize health-care services more than do patients with depression or chronic medical conditions. Inpatient costs are the largest cost contributor; treatment to prevent recurrence has been shown to be the most effective way to reduce costs.

CONCLUSIONS

Bipolar disorder imposes a tremendous burden on patients and the health-care system, resulting in decreased HRQoL and increased medical and work impairment costs. Limited data suggest that appropriate management can improve HRQoL and functioning while reducing utilization and cost.

Socio-economic differences in psychiatric in-patient care

OBJECTIVE

We seek to investigate socio-economic differences in psychiatric in-patient care regarding admission, treatment and outcome.

METHOD

This study is undertaken on a comprehensive and exhaustive psychiatric case register of all psychiatric in-patient care carried out in Belgium in 1997 and 1998 (n=144 754).

RESULTS

Lower socio-economic groups were more likely to be compulsorily admitted, to be cared for in a non-teaching or psychiatric hospital, to be admitted in a hospital with unexpectedly long average length of stay and to be admitted to a ward with a more severe case-mix. They were less likely to receive antidepressants and psychotherapies. The improvements in functioning and in symptoms were also less favourable for these groups. The lowest group had a higher risk of dying in the hospital.

CONCLUSION

Psychiatric in-patient care is associated with moderate socio-economic differences in access, treatment and outcome. Further research is needed to clarify the causes of such disparities.