Mike Firn1, Sarah Jane White2, Dieneke Hubbeling1, Ben Jones1. 1. a South West London & St. George's Mental Health NHS Trust , London , UK , and. 2. b Population Health Research Institute, St Georges University of London , London , UK.
Abstract
BACKGROUND: The introduction of specialist Assertive Outreach (AO) teams has produced only modest differential findings from English studies compared to standard care. Providers have gradually closed AO services over the last 8 years. We previously studied outcomes at 12 months following the dismantling of two AO teams in London. We now report on the longer term outcomes for these patients. AIMS: To evaluate the longer term outcomes, activity and costs for patients receiving a less intensive service. METHODS: Observational service level evaluation of 112 patients comparing baseline of AO care with each year of routine care subsequent to the team closure. RESULTS: Patients transferred to standard teams reinforced with the Flexible Assertive Community Treatment (FACT) approach had significantly fewer admissions and bed days at each of the four subsequent years compared to baseline, offset by a significant rise in missed face-to-face appointments. There was no significant change in the use of crisis services. Predictably patients had significantly fewer contacts under standard care. CONCLUSIONS: AO patients are remarkably resilient to substantial reductions in the intensity of care. Reinforcing multi-disciplinary community mental health teams (CMHTs) with FACT appears to provide an integrated service that is clinically effective and an affordable alternative to orthodox AO teams.
BACKGROUND: The introduction of specialist Assertive Outreach (AO) teams has produced only modest differential findings from English studies compared to standard care. Providers have gradually closed AO services over the last 8 years. We previously studied outcomes at 12 months following the dismantling of two AO teams in London. We now report on the longer term outcomes for these patients. AIMS: To evaluate the longer term outcomes, activity and costs for patients receiving a less intensive service. METHODS: Observational service level evaluation of 112 patients comparing baseline of AO care with each year of routine care subsequent to the team closure. RESULTS:Patients transferred to standard teams reinforced with the Flexible Assertive Community Treatment (FACT) approach had significantly fewer admissions and bed days at each of the four subsequent years compared to baseline, offset by a significant rise in missed face-to-face appointments. There was no significant change in the use of crisis services. Predictably patients had significantly fewer contacts under standard care. CONCLUSIONS: AO patients are remarkably resilient to substantial reductions in the intensity of care. Reinforcing multi-disciplinary community mental health teams (CMHTs) with FACT appears to provide an integrated service that is clinically effective and an affordable alternative to orthodox AO teams.
Authors: Marieke Broersen; Nynke Frieswijk; Hans Kroon; Ad A Vermulst; Daan H M Creemers Journal: Front Psychiatry Date: 2020-11-25 Impact factor: 4.157