Clinical trial NCT02322437: Home Treatment for Acute Psychiatric Care
Official title: Home Treatment for Acute Psychiatric Care in the Canton of Aargau (Switzerland): A Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Mental Disorders
Lead sponsor: Psychiatric Services Aargau AG
Sponsor class: OTHER
Collaborators: name: Hugo & Elsa Isler Foundation
First posted: 2014-12-23
Enrollment: 707
Sex: ALL
Minimum age (years): 18
Maximum age (years): 64
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This study aims to evaluate whether psychiatric home treatment is an effective and efficient alternative to acute inpatient care in mental hospitals. A one-year prevalence cohort of psychiatric patients in need of hospitalization are randomly assigned to either treatment at inpatient wards (treatment as usual) or a new care model with the additional option of treating patients at their homes by mobile care teams. The primary focus is on checking whether optional home treatment leads to a reduction of inpatient days during a two-year follow-up period. In addition, the two service models will be compared regarding treatment cost and outcomes as well as satisfaction of patients and their relatives with psychiatric care.

Furthermore, a sub-cohort of randomly chosen patients from the prevalence-cohort will be examined by a highly trained clinical assessor to test and verify the diagnoses and the clinical ratings made by the staff members of the mental hospital under routine everyday conditions.

Detailed description: This study aims to evaluate whether psychiatric home treatment is an effective and efficient alternative to acute inpatient care in mental hospitals. A one-year prevalence cohort of psychiatric patients in need of hospitalization are randomly assigned to either treatment at inpatient wards (treatment as usual) or a new care model with the additional option of treating patients at their homes by mobile care teams. The primary focus is on checking whether optional home treatment for crisis intervention leads to a reduction of inpatient days during a two-year follow-up period. In addition, the two service models will be compared regarding treatment cost and outcomes as well as satisfaction of patients and their relatives with psychiatric care.

Furthermore, a sub-cohort of randomly chosen patients from the prevalence-cohort will be examined by a highly trained clinical assessor to test and verify the diagnoses (SCID-I and SCID-II) and the clinical ratings (HoNOS) made by the staff members of the mental hospital under routine everyday conditions.

Eligibility criteria: Inclusion Criteria:

* Need for acute psychiatric inpatient care
* Residence in the canton of Aargau
* Living within 30 minutes (by car) from the headquarters of the home treatment team
* Health insurance with tarifsuisse

Exclusion Criteria:

* Insufficient proficiency in German
* Main diagnosis F0 or F1 (ICD-10)
* Patients of the forencic departement
* Patients of the child and adolescent department

Primary outcomes:
measure: Number of inpatient days
timeFrame: 2 years follow-up
Secondary outcomes:
measure: Total days in treatment (inpatient + home treatment)
timeFrame: 2 years follow-up
measure: Direct treatment costs
timeFrame: 2 years follow-up
measure: Health of the Nation Outcome Scales (HoNOS)
timeFrame: Intake and discharge from treatment episode (expected average of 4 weeks)
measure: Brief Symptom Checklist (BSCL)
timeFrame: Intake and discharge from treatment episode (expected average of 4 weeks)
measure: Perceptions of Care-18
timeFrame: Discharge from treatment episode (expected average of 4 weeks)
measure: Satisfaction of patients' relatives
timeFrame: Discharge from treatment episode (expected average of 4 weeks)
measure: Number of rehospitalizations per patient
timeFrame: 2 years follow-up
measure: Number of patients with adverse events
timeFrame: 2 years follow-up
Other outcomes:
Locations:
city: Brugg
country: Switzerland
facility: Psychiatric Services Aargau AG
state: Aargau
Study officials:
affiliation: Psychiatric Services Aargau AG
name: Niklaus Stulz, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Stulz N, Wyder L, Maeck L, Hilpert M, Lerzer H, Zander E, Kawohl W, Grosse Holtforth M, Schnyder U, Hepp U. Home treatment for acute mental healthcare: randomised controlled trial. Br J Psychiatry. 2020 Jun;216(6):323-330. doi: 10.1192/bjp.2019.31.