Factors influencing use of community treatment orders and quality of care that people receive: results of a national survey in England and Wales.

Harry Lei,Krysia Zalewska,Alan Quirk,Stephen J Cooper,Mike J Crawford,Angela Etherington,Kirsten Barnicot,Emily Maynard,Rahil Sanatinia

doi:10.1192/bjb.2019.23

Harry Lei, Krysia Zalewska + Show 7 more

Open Access

https://doi.org/10.1192/bjb.2019.23

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Abstract

Aims and methodWe conducted a secondary analysis of data from the National Audit of Psychosis to identify factors associated with use of community treatment orders (CTOs) and assess the quality of care that people on CTOs receive. RESULTS: Between 1.1 and 20.2% of patients in each trust were being treated on a CTO. Male gender, younger age, greater use of in-patient services, coexisting substance misuse and problems with cognition predicted use of CTOs. Patients on CTOs were more likely to be screened for physical health, have a current care plan, be given contact details for crisis support, and be offered cognitive-behavioural therapy.Clinical implicationsCTOs appear to be used as a framework for delivering higher-quality care to people with more complex needs. High levels of variation in the use of CTOs indicate a need for better evidence about the effects of this approach to patient care.Declaration of interestNone.

Highlights

Data were collected from 9449 patients, Table 3 HONOS scores of 5960 patients according to whether treated on a community treatment orders (CTOs)
The results of this study suggest that, in England and Wales, age, gender, coexisting substance misuse and problems with cognition predict whether people are treated on a CTO
Whether the higher levels of cognitive problems rated on the Health of the Nation Outcome Scales (HoNOS) among those treated on CTOs resulted from coexisting intellectual impairment or were directly associated with their psychosis,[30] it seems that clinicians are more likely to use CTOs when patients with psychosis have difficulties with making decisions and organising their lives

Summary

Methods

This study was based on a secondary analysis of data from the third round of the National Clinical Audit of Psychosis.[21]. The sample size for each trust was between 100 and 300 patients, depending on the size of the trust.[22] For each selected patient, staff working in the trust extracted data from electronic and other patient records to complete a 49-item online data collection form This form included questions on demographic factors (including age, gender and ethnicity), clinical factors (including whether the patient had received in-patient treatment during the previous 12 months and whether the patient was currently in remission), data on the physical and mental healthcare that the patient had received, and scores from the Health of the Nation Outcome Scales (HoNOS) completed during the previous 12 months.[22] HoNOS is a clinician-rated outcome measure which assesses patients’ difficulties in a variety of mental health domains during the 2 weeks leading up to the point of rating.

Results

Discussion

Conclusion