Abstract
ObjectiveTo establish whether patients with a crisis plan had fewer voluntary or involuntary admissions, or fewer outpatient emergency visits, than patients without such a plan.DesignMulticenter randomized controlled trial with two intervention conditions and one control condition.ParticipantsAdult outpatients diagnosed with psychotic or bipolar disorder who had experienced at least one psychiatric crisis in the previous two years.InterventionTwo types of advance statement were used: (1) a crisis plan formulated by the patient with the help of a patient advocate (Patient Advocate Crisis Plan: PACP); and (2) a crisis plan developed together with the clinician (Clinician-facilitated Crisis Plan: CCP).OutcomeThe percentages of patients admitted voluntarily or involuntarily (on an emergency basis or by court order), and the percentage who made outpatient emergency visits over an 18-month follow-up period.ResultsA total of 212 patients were included: 69 in the PACP condition, 70 in the CCP condition, and 73 in the control condition. No effects of the two interventions were found on the numbers of voluntary admissions, involuntary admissions and emergency visits. Regarding involuntary admissions, there was no significant effect on emergency admissions, which were 17% (12/69) in the PACP condition, 10% (7/70) in the CCP condition, and 19% (14/73) in the control condition. There was a significant effect on planned court-ordered admissions, with 16% (11/69) in the PACP condition, 10% (7/70) in the CCP condition, and 26% (19/73) in the control condition. Finally, the interventions had no effect on outpatient emergency visits, with 32% (22/69) in the PACP group, 31% (22/70) in the CCP group, and 34% (25/73) in the control group.ConclusionsCrisis plans may be an effective intervention for reducing court-ordered admissions in patients with psychotic and bipolar disorders.Trial registrationCurrent Controlled Trails NTR1166.
Highlights
Voluntary and involuntary admissions have a strong impact on patients and their relatives [1,2]
No effects of the two interventions were found on the numbers of voluntary admissions, involuntary admissions and emergency visits
There was no significant effect on emergency admissions, which were 17% (12/69) in the PACP condition, 10% (7/70) in the CCP condition, and 19% (14/73) in the control condition
Summary
Patient characteristics During the recruitment period we selected 537 patients, 212 of whom (40%) enrolled in the study; 151 (28%) refused to be contacted by the researcher or refused to participate in the study after the explanation of the research goals, and 174 (32%) could not be contacted after several unsuccessful attempts. The percentages of overall admissions, emergency admissions and outpatient emergency visits were lower in both or either the PACP and CCP conditions compared to the control condition. For those admitted (N = 90), the number of bed days did not differ significantly between the three conditions (Kruskal-Wallis test, Chi-2 (2) = 2,1; p = 0.35).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
