Assessing the efficacy of a modified assertive community-based treatment programme in a developing country

BMC Psychiatry

Research Article

Linda M Hering¹  John A Joska²  Piet P Oosthuizen³  Liezl Koen³  Ulla A Botha³ 

[1] Associated Psychiatric Hospitals, Cape Town, South Africa;Department of Psychiatry, University of Cape Town, Cape Town, South Africa;Department of Psychiatry, University of Stellenbosch, Tygerberg, South Africa;

关键词: Assertive Community Treatment;    Community Mental Health Service;    Assertive Community Treatment Team;    Assertive Community Treatment Program;    Depot Medication;   

DOI  :  10.1186/1471-244X-10-73

 received in 2010-04-19, accepted in 2010-09-15,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundA number of recently published randomized controlled trials conducted in developed countries have reported no advantage for assertive interventions over standard care models. One possible explanation could be that so-called "standard care" has become more comprehensive in recent years, incorporating some of the salient aspects of assertive models in its modus operandi. Our study represents the first randomised controlled trial assessing the effect of a modified assertive treatment service on readmission rates and other measures of outcome in a developing country.MethodsHigh frequency service users were randomized into an intervention (n = 34) and a control (n = 26) group. The control group received standard community care and the active group an assertive intervention based on a modified version of the international model of assertive community treatment. Study visits were conducted at baseline and 12 months with demographic and illness information collected at visit 1 and readmission rates documented at study end. Symptomatology and functioning were measured at both visits using the PANSS, CDSS, ESRS, WHO-QOL and SOFAS.ResultsAt 12 month follow-up subjects receiving the assertive intervention had significantly lower total PANSS (p = 0.02) as well as positive (p < 0.01) and general psychopathology (p = 0.01) subscales' scores. The mean SOFAS score was also significantly higher (p = 0.02) and the mean number of psychiatric admissions significantly lower (p < 0.01) in the intervention group.ConclusionsOur results indicate that assertive interventions in a developing setting where standard community mental services are often under resourced can produce significant outcomes. Furthermore, these interventions need not be as expensive and comprehensive as international, first-world models in order to reduce inpatient days, improve psychopathology and overall levels of functioning in patients with severe mental illness.

【 授权许可】

CC BY   
© Botha et al; licensee BioMed Central Ltd. 2010