Abstract
Aims and methodTo examine the clinical outcome and bed usage in patients with comorbid substance misuse and psychosis. The patients were randomised to ordinary assertive outreach team care or to enhanced assertive outreach with nidotherapy. Ratings of clinical symptoms, social function, engagement with services, bed usage (primary outcome after 1 year) and economic costs were assessed at baseline and at 6 and 12 months after randomisation.ResultsPatients referred to nidotherapy had similar reduction in symptoms and engagement, with marginal superiority in social function (P= 0.045). There was a 110% reduction in hospital bed use after 1 year compared with control assertive care (P= 0.03). The mean cost savings for each patient allocated to nidotherapy was £14705 per year, mainly as a consequence of reduced psychiatric bed use.Clinical implicationsNidotherapy shows promise in the treatment of substance misuse and psychosis and may reduce hospital bed usage.
Highlights
Clinical implications Nidotherapy shows promise in the treatment of substance misuse and psychosis and may reduce hospital bed usage
There were no meaningful differences between the outcomes in each group for clinical symptomatology and engagement, and no evidence of inferiority for those allocated to nidotherapy
A trial of 37 patients can in no way be regarded as definitive, but the substantial impact of nidotherapy on bed usage was responsible for considerable cost savings that could be of clinical and economic importance
Summary
Of 52 patients included in the trial, there were 37 with substance misuse: 19 were allocated to the nidotherapy group and 18 to the control group. The difference in costs was primarily due to the substantial difference in the number of in-patient stays between the nidotherapy and treatment as usual groups, which is reflected in hospital costs of £10 938 in the nidotherapy group compared with £27 871 in the treatment as usual group. This was the main component behind the cost savings of £14 705 per patient overall
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