Abstract
BackgroundACT is an effective community treatment but causes discontinuity of care between acutely ill and currently stable patient groups. The Dutch variant of ACT, FACT, combines both intensive ACT treatment and care for patients requiring less intensive care at one time point yet likely to need ACT in the future. It may be hypothesised that this case mix is not beneficial for patients requiring intensive care, as other patient groups may "dilute" care provision. The effectiveness of FACT was compared with standard care, with a particular focus on possible moderating effects of patient characteristics within the case mix in FACT.MethodsIn 2002, three FACT teams were implemented in a Dutch region in which a cumulative routine outcome measurement system was in place. Patients receiving FACT were compared with patients receiving standard treatment, matched on "baseline" symptom severity and age, using propensity score matching. Outcome was the probability of being in symptomatic remission of psychotic symptoms.ResultsThe probability of symptomatic remission was higher for SMI patients receiving FACT than for controls receiving standard treatment, but only when there was an unmet need for care with respect to psychotic symptoms (OR = 6.70, p = 0.002; 95% CI = 1.97 – 22.7).ConclusionCompared to standard care, FACT was more rather than less effective, but only when a need for care with respect to psychotic symptoms is present. This suggests that there is no adverse effect of using broader patient mixes in providing continuity of care for all patients with severe mental illness in a defined geographical area.
Highlights
assertive community treatment (ACT) is an effective community treatment but causes discontinuity of care between acutely ill and currently stable patient groups
FACT was developed for the Dutch mental health care system, it has been noted that its features may be applicable in other countries, such as the U.S [9]
This study showed that FACT was significantly better than standard care in maintaining contact with patients
Summary
ACT is an effective community treatment but causes discontinuity of care between acutely ill and currently stable patient groups. The Dutch variant of ACT, FACT, combines both intensive ACT treatment and care for patients requiring less intensive care at one time point yet likely to need ACT in the future. FACT combines two approaches within one multidisciplinary recovery-oriented team: (a) individual case management and home visits for extensive care SMI-patients who are mostly stable; (b) shared caseload with intensive full ACT approach for patients in need for intensive care. The latter group receives care according to ACT directives including daily review in staff meetings. FACT was developed for the Dutch mental health care system, it has been noted that its features may be applicable in other countries, such as the U.S [9]
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