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Ten year outcomes of participants in the REACT (Randomised Evaluation of Assertive Community Treatment in North London) study.

Killaspy H, Mas-Expósito L, Marston L, King M - BMC Psychiatry (2014)

Bottom Line: We found no statistically significant differences in outcomes by original treatment group over the 10 years.Being subject to a Community Treatment Order was associated with a greater chance of being under ACT at 10 year follow-up (OR 6.39, 95% CI 2.98 to 13.70, p <0.001).We also found that the ACT teams accrued patients from the original study sample who had more complex needs than those who remained with or transferred to the CMHTs or primary care during this period.

View Article: PubMed Central - PubMed

Affiliation: Division of Psychiatry, University College London (UCL), Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UK. h.killaspy@ucl.ac.uk.

ABSTRACT

Background: A previous randomised controlled trial that investigated Assertive Community Treatment (ACT) in the UK (the REACT Study) found no clinical advantage over usual care delivered by Community Mental Health Teams (CMHTs) at 18 and 36 month follow-ups. No studies have investigated long term clinical and social outcomes for patients receiving ACT.

Method: We investigated inpatient service use, social outcomes, service contact and adverse events for the 251 REACT study participants 10 years after randomisation through case note review. Data were analysed using regression models adjusted for original treatment group allocation and changes in treatment group.

Results: We found no statistically significant differences in outcomes by original treatment group over the 10 years. Those whose care remained with ACT, or transferred to ACT or forensic services, had more inpatient days over the 10 years (coefficient 223, 95% CI 83 to 363, p = 0.002) than those whose care remained with the CMHTs or were discharged to primary care. Being subject to a Community Treatment Order was associated with a greater chance of being under ACT at 10 year follow-up (OR 6.39, 95% CI 2.98 to 13.70, p <0.001).

Conclusions: The ACT teams in this study showed no clinical advantage over usual care provided by CMHTs at 10 year follow-up. We also found that the ACT teams accrued patients from the original study sample who had more complex needs than those who remained with or transferred to the CMHTs or primary care during this period. Further well conducted trials are needed to identify the most cost-effective approaches to supporting successful community living and optimum long term outcomes for this group.

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REACT study participant flows 10 years after randomisation.
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Fig1: REACT study participant flows 10 years after randomisation.

Mentions: The original REACT study required 250 participants to detect a difference of 60 (SD 169) bed days between the ACT and CMHT groups with 80% power. Of 251 study participants recruited, 127 were allocated to ACT and 124 to CMHT care. Eighteen months after randomisation, three ACT and four CMHT participants had died and one CMHT participant had emigrated, so primary outcome data for the original trial were available for 124 ACT and 119 CMHT participants. Ten years after randomisation, a further 17 ACT and 13 CMHT participants had died and 8 ACT and 2 CMHT participants had emigrated or Cere out of contact with mental health services. Hence 10 year outcome data were available for 99 ACT and 104 CMHT participants. Forty-three of the original ACT participants had been transferred back to the care of a CMHT, 4 had been transferred to forensic services and 8 had been discharged to primary care between the 18 month and 10 year follow-up. Of the CMHT participants, 23 had been transferred to an ACT team, 2 had been transferred to forensic services and 17 had been discharged to primary care during this period. See Figure 1 for further details.Figure 1


Ten year outcomes of participants in the REACT (Randomised Evaluation of Assertive Community Treatment in North London) study.

Killaspy H, Mas-Expósito L, Marston L, King M - BMC Psychiatry (2014)

REACT study participant flows 10 years after randomisation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4210468&req=5

Fig1: REACT study participant flows 10 years after randomisation.
Mentions: The original REACT study required 250 participants to detect a difference of 60 (SD 169) bed days between the ACT and CMHT groups with 80% power. Of 251 study participants recruited, 127 were allocated to ACT and 124 to CMHT care. Eighteen months after randomisation, three ACT and four CMHT participants had died and one CMHT participant had emigrated, so primary outcome data for the original trial were available for 124 ACT and 119 CMHT participants. Ten years after randomisation, a further 17 ACT and 13 CMHT participants had died and 8 ACT and 2 CMHT participants had emigrated or Cere out of contact with mental health services. Hence 10 year outcome data were available for 99 ACT and 104 CMHT participants. Forty-three of the original ACT participants had been transferred back to the care of a CMHT, 4 had been transferred to forensic services and 8 had been discharged to primary care between the 18 month and 10 year follow-up. Of the CMHT participants, 23 had been transferred to an ACT team, 2 had been transferred to forensic services and 17 had been discharged to primary care during this period. See Figure 1 for further details.Figure 1

Bottom Line: We found no statistically significant differences in outcomes by original treatment group over the 10 years.Being subject to a Community Treatment Order was associated with a greater chance of being under ACT at 10 year follow-up (OR 6.39, 95% CI 2.98 to 13.70, p <0.001).We also found that the ACT teams accrued patients from the original study sample who had more complex needs than those who remained with or transferred to the CMHTs or primary care during this period.

View Article: PubMed Central - PubMed

Affiliation: Division of Psychiatry, University College London (UCL), Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UK. h.killaspy@ucl.ac.uk.

ABSTRACT

Background: A previous randomised controlled trial that investigated Assertive Community Treatment (ACT) in the UK (the REACT Study) found no clinical advantage over usual care delivered by Community Mental Health Teams (CMHTs) at 18 and 36 month follow-ups. No studies have investigated long term clinical and social outcomes for patients receiving ACT.

Method: We investigated inpatient service use, social outcomes, service contact and adverse events for the 251 REACT study participants 10 years after randomisation through case note review. Data were analysed using regression models adjusted for original treatment group allocation and changes in treatment group.

Results: We found no statistically significant differences in outcomes by original treatment group over the 10 years. Those whose care remained with ACT, or transferred to ACT or forensic services, had more inpatient days over the 10 years (coefficient 223, 95% CI 83 to 363, p = 0.002) than those whose care remained with the CMHTs or were discharged to primary care. Being subject to a Community Treatment Order was associated with a greater chance of being under ACT at 10 year follow-up (OR 6.39, 95% CI 2.98 to 13.70, p <0.001).

Conclusions: The ACT teams in this study showed no clinical advantage over usual care provided by CMHTs at 10 year follow-up. We also found that the ACT teams accrued patients from the original study sample who had more complex needs than those who remained with or transferred to the CMHTs or primary care during this period. Further well conducted trials are needed to identify the most cost-effective approaches to supporting successful community living and optimum long term outcomes for this group.

Show MeSH
Related in: MedlinePlus