[Impact of a smoke free policy on smoking behaviour of clients in treatment for substance use disorder]

BACKGROUND

In 2018 Jellinek became a smoke free institution. By implementing ‘Jellinek Smoke free’ in all locations (15), a policy has been implemented to facilitate smoking cessation in clients with a comorbid tobacco use disorder seeking treatment for substance use disorders at Jellinek.

AIM

To investigate whether the implementation of the new policy impacted smoking behaviour of clients in treatment for substance use disorders at Jellinek.

METHOD

Based on data from anonymized client files, changes in smoking behaviour (cessation or reduction) were analysed for clients with other addictions who started treatment in 2016 versus clients who started in 2019 - after the implementation of the new smoke free policy. Comparative analyses were conducted on the population as a whole, per type of treatment (outpatient care, residential care, Minnesota, outreaching care) as well as per type of smoker (light, moderate, heavy).

RESULTS

In the client population as a whole, significantly more people stopped smoking in 2019 (22%) in comparison to 2016 (16%) and there was a trend toward statistical significance with regard to reduction. When a cessation period was part of treatment, significantly more clients stopped and decreased the number of cigarettes a day. Moreover, light and moderate smokers (≤ 20 cigarettes a day) stopped and reduced significantly more in 2019 (32%) than in 2016 (23%). In outpatient care, outreaching care and with heavy smokers (> 20 cigarettes a day), there was no significant difference in percentage of cessation and reduction between 2016 and 2019.

CONCLUSION

After implementing Jellinek Smoke free, significant changes in smoking behaviour occurred in the client population as a whole with a comorbid tobacco use disorder, in treatments where a cessation period was part of treatment as well as with light and moderate smokers.

Intensive home treatment in comparison with care as usual: Cost-utility analysis from a pre-randomized controlled trial in the netherlands

Introduction

The implementation of Intensive Home Treatment (IHT) aims to decrease the pressure on acute inpatient services that could lead to prevent hospitalization and reduce the number of hospitalization days and, ultimately, reduce cost in the mental health services. Although there are studies assessing the effectiveness of IHT, there is a shortage of research studying the cost-effectiveness.

Objectives

The aim of this study is to present an cost-utility analysis of IHT compared to care as usual (CAU)

Methods

Patients between 18 and 65 years of age whose mental health professionals considered hospitalization were included. These patients were pre-randomized in either IHT or CAU and followed up for 12-months. For this study, the base case analysis was performed from the societal and healthcare perspective. For the cost-utility analyses the Euroqol 5D was used to calculate quality adjusted life years (QALYs) as a generic measure of health gains.

Results

Data of 198 patients were used. From a sociatal perspective, the cost-utility analysis resulted in an incremental cost-effectiveness ratios (ICERs) of €58 730, and a 37% likelihood that IHT leads to higher QALYs at lower costs. The probability of IHT being cost-effective was >50% if there was no willingness to pay more for extra QALY than in the current situation under CAU.

Conclusions

Professionals working in crisis care are able to offer IHT with the same effect as other crisis care interventions at lower costs. IHT seem to be cost-effective compared with CAU over 52 weeks follow-up for patients who experience psychiatric crises.

Disclosure

No significant relationships.

[The importance of inter-rater reliability in psychopharmacological trials]

BACKGROUND

There are concerns about the declining efficacy of antidepressants and antipsychotics in clinical trials. A potential cause may be found in poor training practices to achieve sufficient inter-rater reliability (IRR). However, it is unknown whether IRR and training procedures are currently reported.

AIM

To determine the proportion of publications concerning double-blind randomized controlled trials (RCTs) investigating antipsychotics or antidepressants that report IRR and training procedures.

METHOD

We extracted all double-blind RCTs from five large meta-analyses concerning antidepressants and antipsychotics. Further, we conducted a Medline-search for double-blind RCTs investigating antidepressants from January 2016 - January 2020, and antipsychotics from January 2000 - January 2019.

RESULTS

In 179 double-blind RCTs with antidepressants, only 4.5% reported an IRR coefficient whereas 27.9% reported on training procedures. Further, in 207 double-blind RCTs with antipsychotics, 11.2% reported an IRR coefficient and 34.8% reported training procedures.

CONCLUSION

There is a substantial lack of reporting IRR and training procedures in RCTs with antidepressants and antipsychotics. Considering the implications of insufficient IRR, it is necessary to conduct and report training procedures and IRR. Reporting IRR and training procedures should be made mandatory by editorial boards of scientific journals.

[Mental health care in times of corona: experiences of professionals with eHealth]

BACKGROUND

Due to the COVID-19 pandemic, most treatments in mental health care are provided through video calling.

AIM

To poll what they think of remote care among 605 care providers of Arkin.

METHOD

We surveyed 605 professionals on their experiences.

RESULTS

Enthusiasm for remote care was found predominantly among psychologists who worked in curative care. They reported practical benefits for the patient and for the process of care provision. Psychiatrists and clinical psychologists who provided care to patients with complex and/or chronic problems. They feared a deterioration in quality of care and a decline in their job satisfaction. Nurses were also critical, especially those who provided FACT and outreaching care. Their patients often lacked the resources or skills required to access digital care.

CONCLUSION

This assessment of remote care was likely adversely affected by the corona measures. Employees were suddenly forced to alter their usual work habits and had not been optimally trained in the new method were more critical. Moreover, they were forced to work from home and lacked informal professional contact with colleagues. Nevertheless, professionals have a nuanced and predominantly positive opinion of video calling: it is not suitable for everyone or appropriate under all circumstances, but remote care is seen as a useful addition to the existing arsenal of treatment modalities.

[Smoking policy in mental health care]

BACKGROUND

People with mental illnesses tend to smoke more often and more heavily than other members of the public and their addiction to tobacco also has harmful effects on their physical health. So far, however, limited priority was given to smoking cessation in mental health care settings.

AIM

To provide insight into the formal and informal smoking policies of Dutch mental health care organisations and into the nature and extent of the smoking cessation support they offer, and, additionally, to look at the opportunities for improvement in clinical settings.

METHOD

Document research on formal policies of 61 mental health care facilities, interviews with workers directly involved (n = 10), and a survey on policy implementation among staff members of treatment facilities (n = 600).

RESULTS

One-third of the facilities did not have a formalised smoking policy document, and there was a marked difference between the smoking policies at the rest of the facilities. Treatment provision was limited, strongly dependent on the individual staff member, and was often not the most effective form of care (like medication).

CONCLUSION

Many mental health patients really do want to give up smoking and often respond well to treatment. Psychiatrists play a key role in integrating and implementing an anti-smoking policy which will benefit their patients.

[Benchmarking using different measurement instruments and the management of measurement variability]

BACKGROUND

In mental health care centres in the Netherlands outcome data are collected using a variety of outcome instruments. This may have implications for the comparability of outcome results between different centres.

AIM

To discuss recent findings regarding the extent to which the eight instruments currently used in clinical practice report comparable results.

METHOD

Our study is based on a combination of literature review and empirical research.

RESULTS

The results obtained with the eight instruments are not equivalent. Patients symptom reductions appear larger with some instruments than with others.

CONCLUSION

The current practice of benchmarking in the Dutch mental health system would have greater validity if the number of different instruments would be reduced. State-of-the-art calibration studies are necessary to validate the comparability of the remaining instruments. Ideally, all mental health centres will soon use one instrument per care domain to measure treatment outcome.

[Social return on internet interventions for alcohol use disorders]

One of the main reasons for treating patients using internet interventions is that this modality is considered highly efficient. However, little is known about the actual cost-effectiveness of internet interventions for alcohol use disorders (aud).<br/> AIM: To provide insight in the cost-effectiveness of internet interventions for the treatment of aud.<br/> METHOD: Review of the relevant literature in this area.<br/> RESULTS: A considerable amount of research has been performed on the effectiveness of internet interventions for aud, with mostly positive findings. However, research on the cost-effectiveness of these interventions has been relatively sparse. Based on the available evidence there are indications that internet interventions for aud can be cost-effective - although findings in the literature are mixed.<br/> CONCLUSION: More research is needed to make valid estimates of the cost-effectiveness of internet interventions for aud. Potential savings can only be estimated after the system has been used over a longer period. However, the evidence obtained thus far is promising.

Economic evaluations of Internet interventions for mental health: a systematic review

BACKGROUND

Internet interventions are assumed to be cost-effective. However, it is unclear how strong this evidence is, and what the quality of this evidence is.

METHOD

A comprehensive literature search (1990-2014) in Medline, EMBASE, the Cochrane Central Register of Controlled Trials, NHS Economic Evaluations Database, NHS Health Technology Assessment Database, Office of Health Economics Evaluations Database, Compendex and Inspec was conducted. We included economic evaluations alongside randomized controlled trials of Internet interventions for a range of mental health symptoms compared to a control group, consisting of a psychological or pharmaceutical intervention, treatment-as-usual (TAU), wait-list or an attention control group.

RESULTS

Of the 6587 abstracts identified, 16 papers met the inclusion criteria. Nine studies featured a societal perspective. Results demonstrated that guided Internet interventions for depression, anxiety, smoking cessation and alcohol consumption had favourable probabilities of being more cost-effective when compared to wait-list, TAU, group cognitive behaviour therapy (CBGT), attention control, telephone counselling or unguided Internet CBT. Unguided Internet interventions for suicide prevention, depression and smoking cessation demonstrated cost-effectiveness compared to TAU or attention control. In general, results from cost-utility analyses using more generic health outcomes (quality of life) were less favourable for unguided Internet interventions. Most studies adhered reasonably to economic guidelines.

CONCLUSIONS

Results of guided Internet interventions being cost-effective are promising with most studies adhering to publication standards, but more economic evaluations are needed in order to determine cost-effectiveness of Internet interventions compared to the most cost-effective treatment currently available.