Intensive home treatment effective in place of hospital admission for psychiatric crisis

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Intensive home treatment for those experiencing acute psychiatric crisis is a safe and effective substitute for conventional care, and led to a reduction in hospital admission days, according to a study published in Lancet Psychiatry.

“Treating patients in their social context means that intensive home treatment enables those involved to recognize psychiatric problems related to financial, social, and environmental factors better and address them more effectively than they can in a clinical setting,” Jurgen Cornelis, MD, of the Psychiatric Emergency Service at Arkin Mental Health Care in Amsterdam, and colleagues wrote.

Hospital beds

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Cornelis and colleagues sought to evaluate the potential of intensive home treatment to reduce the number of bed-days after hospital admission due to psychiatric crisis, as well as its clinical effectiveness compared with treatment as usual.

The study was a two-armed, two-center, open-label, Zelen, double-consent, pragmatic randomized controlled trial conducted between November 2016 and October 2018, and included 246 participants (mean age 46.1 years; 183 provided intensive home treatment, 63 given treatment as usual), who were recruited at the psychiatric emergency service and psychiatric emergency wards of the two major mental health institutions in Amsterdam.

Informed consent was obtained after randomization as soon as the patient was mentally capable within 14 days. All main analyses were intention-to-treat, and the primary outcome was the total number of admission days 12 months after randomization. Linear mixed modeling analyses using restricted maximum likelihood estimation were performed to investigate the effect of treatment conditions on outcome measures.

Results showed that, after 12 months, the mean number of admission days in the intensive home treatment condition was 42.47 days compared with 67.02 for treatment as usual, a reduction of 24.55 days or 36.6%. In addition, 26 adverse events were registered, 23 of which were suicide attempts. Five patients died by suicide (three in the intensive home treatment group, two in the treatment as usual group), however, no treatment-related deaths occurred.

“Overall, we found that intensive home treatment substantially reduces the use of hospital beds in acute psychiatry, without compromising patient safety,” Cornelis and colleagues wrote. “Contrary to the high expectations for the positive effects of intensive home treatment, the reduction of symptom severity, and improvement in quality of life or treatment satisfaction, we found no difference compared with treatment as usual.”

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