Abstract
BackgroundOn the basis of earlier experiences in Germany and England, we developed an intensive multimodal group programme (FACT Plus) for psychotic-spectrum patients. By combining it with regular Flexible Assertive Community Treatment (FACT) (care as usual), we intended to reduce psychiatric rehospitalizations and mental healthcare costs.MethodsWe included adult patients (>18 years) with a psychotic spectrum disorder who had had at least one psychiatric admission in the 2 years before inclusion. FACT Plus was delivered weekly for 9 months. The intervention group was recruited in northern Rotterdam (the Netherlands), and the control group was recruited in southern Rotterdam. The primary outcome measure was length of stay (LOS) and the secondary outcome measures were mental healthcare costs and compulsory admissions.ResultsWe included 52 patients in the intervention group and 61 patients in the control group. During the 12-month observation period, the mean LOS per patient was 15.2 (intervention group) and 34.6 (control group). This represents a difference of 19.4 days (56.1%). This result was statistically significant (B = −.859, SE = .497, p = .042) in a regression model correcting for baseline differences between the groups. Mean total mental healthcare costs per patient were €21,098 in the intervention group) versus €25,054 in the control group, a difference of about €4000 per patient (16%). In addition, there were zero compulsory admissions in the intervention group and nine in the control group.ConclusionsAfter the addition of FACT Plus to regular FACT, psychiatric LOS was substantially lower in the intervention group than in the control group. This result was accompanied by a limited reduction in mental healthcare costs.
Highlights
On the basis of earlier experiences in Germany and England, we developed an intensive multimodal group programme (FACT Plus) for psychotic-spectrum patients
Aim Unaware of any other group-format interventions associated with reduced admissions in patients with severe mental illness at risk of rehospitalization, we aimed to replicate the German and English findings and decided to develop a Dutch adaptation of these programmes, which we implemented in Dutch Flexible Assertive Community Treatment (FACT) teams
Secondary outcomes The number of hospitalizations did not differ between the two groups (39 in the intervention group versus 38 in the control group)
Summary
On the basis of earlier experiences in Germany and England, we developed an intensive multimodal group programme (FACT Plus) for psychotic-spectrum patients By combining it with regular Flexible Assertive Community Treatment (FACT) (care as usual), we intended to reduce psychiatric rehospitalizations and mental healthcare costs. The success of community-based treatment as a means of preventing the admission of patients with severe mental illness [1, 2] remains disappointing. Assertive community treatment (ACT) [6] has been found to have some positive effect for patients with severe mental illness with regard to hospitalization, social outcome, and retention in. To reduce readmissions in this subgroup of severe mental illness patients, we sought an intervention that could be implemented in addition to FACT
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