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      Treatment Outcome in Patients Receiving Assertive Community Treatment

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          Abstract

          In an observational study of severely mentally ill patients treated in assertive community treatment (ACT) teams, we investigated how treatment outcome was associated with demographic factors, clinical factors, and motivation for treatment. To determine psychosocial outcome, patients were routinely assessed using the Health of the Nation Outcome Scales (HoNOS). Trends over time were analyzed using a mixed model with repeated measures. The HoNOS total score was modeled as a function of treatment duration and patient-dependent covariates. Data comprised 637 assessments of 139 patients; mean duration of follow-up was 27.4 months (SD = 5.4). Substance abuse, higher age, problems with motivation, and lower educational level were associated with higher HoNOS total scores (i.e., worse outcome). To improve treatment outcome, we recommend better implementation of ACT, and also the implementation of additional programs targeting subgroups which seem to benefit less from ACT.

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          Substance abuse treatment entry, retention, and outcome in women: a review of the literature.

          Shelly F Greenfield, Audrey Brooks, Susan M. Gordon … (2007)
          This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.
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            Health of the Nation Outcome Scales (HoNOS). Research and development.

            A Beevor, Jeffrey Curtis, Mary-Anne A. Burns … (1997)
            An instrument was required to quantify and thus potentially measure progress towards a Health of the Nation target, set by the Department of Health, "to improve significantly the health and social functioning of mentally ill people". A first draft was created in consultation with experts and on the basis of literature review. This version was improved during four stages of testing: two preliminary stages, a large field trial involving 2706 patients (rated by 492 clinicians) and tests of the final Health of the Nation Outcome Scales (HoNOS), which included an independent study (n = 197) of reliability and relationship to other instruments. The resulting 12-item instrument is simple to use, covers clinical problems and social functioning with reasonable adequacy, has been generally acceptable to clinicians who have used it, is sensitive to change or the lack of it, showed good reliability in independent trials and compared reasonably well with equivalent items in the Brief Psychiatric Rating Scales and Role Functioning Scales. The key test for HoNOS is that clinicians should want to use it for their own purposes. In general, it has passed that test. A further possibility, that HoNOS data collected routinely as part of a minimum data set, for example for the Care Programme Approach, could also be useful in anonymized and aggregated form for public health purposes, is therefore testable but has not yet been tested.
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              Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles.

              Ian Shrier, Jean-François Boivin, Russell Steele … (2007)
              Some authors argue that systematic reviews and meta-analyses of intervention studies should include only randomized controlled trials because the randomized controlled trial is a more valid study design for causal inference compared with the observational study design. However, a review of the principal elements underlying this claim (randomization removes the chance of confounding, and the double-blind process minimizes biases caused by the placebo effect) suggests that both classes of study designs have strengths and weaknesses, and including information from observational studies may improve the inference based on only randomized controlled trials. Furthermore, a review of empirical studies suggests that meta-analyses based on observational studies generally produce estimates of effect similar to those from meta-analyses based on randomized controlled trials. The authors found that the advantages of including both observational studies and randomized studies in a meta-analysis could outweigh the disadvantages in many situations and that observational studies should not be excluded a priori.
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                Author and article information

                Contributors
                : H.Kortrijk@Bavo-Europoort.nl
                Journal
                Journal ID (nlm-ta): Community Ment Health J
                Title: Community Mental Health Journal
                Publisher: Springer US (Boston )
                ISSN (Print): 0010-3853
                ISSN (Electronic): 1573-2789
                Publication date (Electronic): 22 October 2009
                Publication date PMC-release: 22 October 2009
                Publication date (Print): August 2010
                Volume: 46
                Issue: 4
                Pages: 330-336
                Affiliations
                [1 ]Parnassia Bavo Group, BavoEuropoort, Westersingel 94, 3015 LC Rotterdam, The Netherlands
                [2 ]Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
                [3 ]Municipal Health Center Rotterdam Rijnmond, Rotterdam, The Netherlands
                [4 ]University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, The Netherlands
                Article
                Publisher ID: 9257
                DOI: 10.1007/s10597-009-9257-9
                PMC ID: 2910892
                PubMed ID: 19847646
                SO-VID: 8dc09836-6692-4846-bc39-8017d026c9e8
                Copyright © © The Author(s) 2009
                History
                Date received : 10 February 2009
                Date accepted : 2 October 2009
                Categories
                Subject: Original Paper
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media, LLC 2010

                ScienceOpen disciplines: Health & Social care
                Keywords: honos,smi,assertive community treatment,treatment outcome
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: honos, smi, assertive community treatment, treatment outcome

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