Mental Disorders
Conditions
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.
Interventions
OTHERHome treatment
Patients are treated at home whenever possible and appropriate
OTHERTreatment As Usual
Patients are treated at a mental hospital
Sponsors
Hugo & Elsa Isler Foundation
Psychiatric Services Aargau AG
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 64 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of inpatient days | 2 years follow-up |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total days in treatment (inpatient + home treatment) | 2 years follow-up | — |
| Direct treatment costs | 2 years follow-up | — |
| Health of the Nation Outcome Scales (HoNOS) | Intake and discharge from treatment episode (expected average of 4 weeks) | Participants will be followed for the duration of hospital stay, an expected average of 4 weeks. |
| Satisfaction of patients' relatives | Discharge from treatment episode (expected average of 4 weeks) | Relatives' satisfaction will be assessed with an adapted version of the Perceptions of Care-18 questionnaire at discharge of the patients from hospital, after an expected average of 4 weeks. The proportion of satisfied relatives will be reported for both study arms. |
| Perceptions of Care-18 | Discharge from treatment episode (expected average of 4 weeks) | Participants will be assessed at discharge from hospital, after an expected average of 4 weeks. |
| Number of rehospitalizations per patient | 2 years follow-up | — |
| Number of patients with adverse events | 2 years follow-up | E.g. suicide or attempted suicide. |
| Brief Symptom Checklist (BSCL) | Intake and discharge from treatment episode (expected average of 4 weeks) | Participants will be followed for the duration of hospital stay, an expected average of 4 weeks. |
Countries
Switzerland
Outcome results
None listed