Abstract
Aims and methodTo evaluate the suitability of 80 patients referred for assertive outreach treatment (AOT) and their treatment outcomes, by comparing clinical and social data during the treatment period with data before treatment began. To control for service development across the board, patients on ordinary community treatment were identified and matched to patients undergoing AOT for age, gender, clinical diagnosis and duration, and data acquired for the same time period as the patients on AOT. This was a retrospective mirror-image evaluation with contemporaneous controls.ResultsThe patients referred for AOT were more socially disadvantaged and had used more clinical resources than the control patients. Overall, AOT reduced resource uptake markedly following referral, while resource uptake by control patients during the same period remained static or increased; AOT, however, did not lessen most aspects of social disadvantage.Clinical implicationsThe advantages of AOT include much reduced use of services but not the resolving of social exclusion. Some ordinary community provision may fail to afford the quality of AOT and thus suffer by comparison. The demise of AOT may be premature in such services.
Highlights
The patients referred for assertive outreach treatment (AOT) were more socially disadvantaged and had used more clinical resources than the control patients
This was not our impression of this study, ; for all patients ascertained, there was a plethora of paperwork, especially in respect to admissions. This does not exclude, that the notes may have missed some of the more peripheral data, such as offences. This naturalistic retrospective study demonstrates that patients transferred to the AOT service were appropriate to the service, compared with control patients with the same clinical diagnosis, gender, approximate age and approximate duration of psychosis, who were not referred
Patients on AOT were more disadvantaged than the control patients in terms of housing, occupation, relationships and substance misuse, and used more clinical resources
Summary
A total of 80 patients on AOT were ascertained; control patients were matched for 73 of these. Statistical scrutiny of the seven patients on AOT with no matched controls demonstrated they did not differ from the rest of the group in any respect, including duration, which was shorter Patients on AOT were less likely than the control patients to be living with their parents or in specialist mental health housing across all three time points (retrospective w2 = 10.84, P = 0.03; transfer w2 = 9.67, P = 0.05; ascertainment w2 = 11.90, P = 0.02). There were no differences in occupation status, except that 98% of the patients on AOT had no occupation, education, training or voluntary work at ascertainment, compared with 81% of the control patients This was statistically significant (w2 = 10.80, P50.01).
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