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Soldini E, Alippi M, Zufferey MC, Lisi A, Lucchini M, Albanese E, Colombo RA, Rossa S, Bolla E, Mellacqua ZB, Larghi G, Cordasco S, Kawohl W, Crivelli L, Traber R. Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography. BMC Psychiatry 2022; 22:405. [PMID: 35715789 PMCID: PMC9204869 DOI: 10.1186/s12888-022-04020-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis Resolution Home Treatment (CRHT) is an alternative to inpatient treatment for acute psychiatric crises management. However, evidence on CRHT effectiveness is still limited. In the Canton of Ticino (Southern Switzerland), in 2016 the regional public psychiatric hospital replaced one acute ward with a CRHT. The current study was designed within this evaluation setting to assess the effectiveness of CRHT compared to standard inpatient treatment. METHODS CRHT was offered to patients aged 18 to 65 with an acute psychiatric crisis that would have required hospitalization. We used a natural experiment based on geography, where intervention and control groups were formed according to the place of residence. Primary endpoints were reduction of psychiatric symptoms at discharge measured using the Health of the Nation Outcome Scales, treatment duration in days, and rate and length of readmissions during a two-year follow-up period after discharge. Safety during the treatment period was measured with the number of serious adverse events (suicide/suicide attempts, major self-harm episodes, acute alcohol/drug intoxications, aggressions to caregivers or family members). We used linear, log-linear and logistic regression models with propensity scores for the main analysis. RESULTS We enrolled 321 patients; 67 were excluded because the treatment period was too short and 17 because they were transferred before the end of the treatment. Two hundred thirty-seven patients were available for data analysis, 93 in the intervention group and 144 in the control group. No serious adverse event was observed during the treatment period in both groups. Reduction of psychiatric symptoms at discharge (p-value = 0.359), readmission rates (p-value = 0.563) and length of readmissions (p-value = 0.770) during the two-year follow-up period did not differ significantly between the two groups. Treatment duration was significantly higher in the treatment group (+ 29.6% on average, p-value = 0.002). CONCLUSIONS CRHT was comparable to standard hospitalization in terms of psychiatric symptoms reduction, readmission rates and length of readmissions, but it was also characterized by a longer first treatment period. However, observational evidence following the study indicated that CRHT duration constantly lowered over time since its introduction in 2016 and became comparable to hospitalization, showing therefore to be an effective alternative also in terms of treatment length. TRIAL REGISTRATION ISRCTN38472626 (17/11/2020, retrospectively registered).
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Affiliation(s)
- Emiliano Soldini
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928, Manno, Switzerland.
| | - Maddalena Alippi
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Maria Caiata Zufferey
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Angela Lisi
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Mario Lucchini
- grid.7563.70000 0001 2174 1754Department of Sociology and Social Research, Università Degli Studi Di Milano Bicocca, piazza dell’Ateneo nuovo 1, 20126 Milan, Italy
| | - Emiliano Albanese
- grid.29078.340000 0001 2203 2861Institute of Public Health (IPH), Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via Giuseppe Buffi 13, CH-6900 Lugano, Switzerland
| | - Raffaella Ada Colombo
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Simona Rossa
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Emilio Bolla
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Zefiro Benedetto Mellacqua
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Giuseppina Larghi
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Severino Cordasco
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Wolfram Kawohl
- Clienia Schlössli, Psychiatric Hospital, Schlösslistrasse 8, 8618 Oetwil Am See, Switzerland
| | - Luca Crivelli
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Rafael Traber
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
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