Clinical and functional outcome of assertive outreach for patients with schizophrenic disorder: Results of a quasi-experimental controlled trial

D Kästner; D Büchtemann; I Warnke; J Radisch; J Baumgardt; S Giersberg; K Kopke; J Moock; W Kawohl; W Rössler

doi:10.1016/j.eurpsy.2015.04.003

Clinical and functional outcome of assertive outreach for patients with schizophrenic disorder: Results of a quasi-experimental controlled trial

Eur Psychiatry. 2015 Sep;30(6):736-42. doi: 10.1016/j.eurpsy.2015.04.003. Epub 2015 May 21.

Authors

D Kästner¹, D Büchtemann², I Warnke³, J Radisch³, J Baumgardt⁴, S Giersberg², K Kopke², J Moock², W Kawohl⁵, W Rössler⁶

Affiliations

¹ Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf and Schön Clinic Hamburg Eilbek,, Hamburg, Germany. Electronic address: d.kaestner@uke.de.
² Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany.
³ Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany; Medical Psychology Unit, Hannover Medical School, Hannover, Germany.
⁴ Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany; Department of Social Work, Faculty of Business and Social Sciences, University of Applied Sciences, Hamburg, Germany.
⁵ Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany; Department for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
⁶ Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany; Department for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil.

PMID: 26003931
DOI: 10.1016/j.eurpsy.2015.04.003

Abstract

Background: The majority of studies support modern assertive health service models. However, the evidence is limited for parts of continental Europe, as well as for the pharmacological adherence outcome parameter.

Method: We conducted a quasi-experimental controlled trial including adult patients with a schizophreniform disorder and a maximum of 60 points on the Global Assessment of Functioning Scale (GAF). Interventions (n=176) and controls (TAU, n=142) were assessed every six-month within one year in 17 study practices in rural areas. Mental and functional state were rated using the Brief Psychiatric Rating Scale (BPRS) and the GAF. Functional limitations and pharmacological adherence were patient-rated using the WHO-Disability Assessment Schedule II (WHODAS-II) and the Medication Adherence Report Scale (MARS). We computed multilevel mixed models.

Results: The GAF and BPRS of both groups improved significantly, yet the increase in the intervention group was significantly higher. In contrast, patient-rated variables - WHODAS-II and MARS - neither showed a stable temporal improvement nor a difference between groups.

Conclusion: Our findings only partly support the investigated AO intervention, because of conflicting results between clinician- and patient-ratings. Accordingly, the benefits of AO need to be further evaluated.

Keywords: Assertive outreach; Complex interventions; Integrated care; Intensive case management; Schizophrenia.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Brief Psychiatric Rating Scale
Disability Evaluation*
Europe
Female
Humans
Male
Medication Adherence
Middle Aged
Models, Organizational
Outcome Assessment, Health Care
Psychotic Disorders* / diagnosis
Psychotic Disorders* / therapy
Psychotropic Drugs / therapeutic use*
Rural Health Services / organization & administration

Substances

Psychotropic Drugs