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Clinical and Functional Outcome of Assertive Outreach for Patients With Schizophrenic Disorder: Results of a Quasi-Experimental Controlled Trial

Published online by Cambridge University Press:  21 May 2015

D. Kästner ,
D. Büchtemann ,
I. Warnke ,
J. Radisch ,
J. Baumgardt ,
S. Giersberg ,
K. Kopke ,
J. Moock ,
W. Kawohl  and
W. Rössler
D. Kästner*
Affiliation:
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
D. Büchtemann
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany
I. Warnke
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany Medical Psychology Unit, Hannover Medical School, Hannover, Germany
J. Radisch
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany Medical Psychology Unit, Hannover Medical School, Hannover, Germany
J. Baumgardt
Affiliation:
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
S. Giersberg
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany
K. Kopke
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany
J. Moock
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany
W. Kawohl
Affiliation:
Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany Department for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
W. Rössler
Affiliation:
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
*
*Corresponding author. University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Martinistr. 52, 20246 Hamburg, Germany. Tel.: +49 40 7410 5505 1. E-mail address: [email protected] (D. Kästner).
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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 outreachIntegrated careComplex interventionsSchizophreniaIntensive case management
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 6 , September 2015 , pp. 736 - 742
Copyright
Copyright © Elsevier Masson SAS 2015

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