An observational, “real life” trial of the introduction of assertive community treatment in a geographically defined area using clinical rather than service use outcome criteria

Abstract

Assertive outreach methods of service delivery hold promise, but have been evaluated mostly in the context of short-lived experiments of limited sustainability and a focus on service use outcomes. The aim of the current investigation was to conduct an observational, "real life", pre-post comparison of the introduction of assertive outreach in a geographically defined area using clinical rather than service use outcome criteria. Assertive outreach was implemented in 2002 in a catchment area of 250,000, where cumulative routine outcome measurements had been in place since 1998. Clinical outcome, defined as making a transition to meeting the recently introduced remission criterion, was compared for two non-overlapping cohorts of patients treated in the period 1998-2001 and in the period 2002-2005. The proportion of patients that made the transition to remission increased from 19% in the period before the introduction of assertive outreach, to 31% in the period after (OR = 2.21, 95% CI 1.03-4.78). Assertive outreach in real life routine clinical practice brings about detectable changes in clinical outcome. ACT may bring improvement to the lives of patients living in countries characterised by fragmented and hospital-based mental health services.