Do community treatment orders for mental illness reduce readmission to hospital? - An epidemiological study

被引:43
作者
Burgess, Philip
Bindman, Jonathan
Leese, Morven
Henderson, Claire
Szmukler, George
机构
[1] Kings Coll London, Hlth Serv Res Dept, Sect Community Psychiat, PRiSM, London WC2R 2LS, England
[2] Univ Queensland, Queensland Ctr Mental Hlth Res, Richlands, Qld, Australia
关键词
compulsory community treatment; involuntary outpatient treatment;
D O I
10.1007/s00127-006-0063-1
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Background It has been suggested that community treatment orders (CTOs) will prevent readmission to hospital, but controlled studies have been inconclusive. We aimed to test the hypothesis that hospital discharges made subject to CTOs are associated with a reduced risk of readmission. The use of such a measure is likely to change after its introduction as clinicians acquire familiarity with it, and we also tested the hypothesis that the characteristics of patients subject to CTOs changed over time in the first decade of their use in Victoria, Australia. Method A database from Victoria, Australia (total population 4.8 million) was used. Cox proportional hazard models compared the hazard ratios of readmission to hospital before the end of the study period (1992-2000) for 16,216 discharges subject to a CTO and 112,211 not subject to a CTO. Results Community treatment orders used on discharge from a first admission to hospital were associated with a higher risk of readmission, but CTOs following subsequent admissions were associated with lower readmission risk. The risk also declined over the study period. Conclusions The effect of using a CTO depends on the patient's history. At a population level their introduction may not reduce readmission to hospital. Their impact may change over time.
引用
收藏
页码:574 / 579
页数:6
相关论文
共 12 条
[1]   Thinking carefully about outpatient commitment [J].
Appelbaum, PS .
PSYCHIATRIC SERVICES, 2001, 52 (03) :347-350
[2]   Involuntary outpatient treatment in England and Wales [J].
Bindman, J .
CURRENT OPINION IN PSYCHIATRY, 2002, 15 (06) :595-598
[3]  
*DEP HLTH, 2000, REF MENT HLTH ACT 1, P17
[4]   Involuntary outpatient treatment [J].
Holloway, F ;
Szmukler, G ;
Sullivan, D .
CURRENT OPINION IN PSYCHIATRY, 2000, 13 (06) :689-692
[5]   Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy [J].
Kisely, S ;
Campbell, LA ;
Skerritt, P .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2005, (01)
[6]   Assessing the outcome of compulsory psychiatric treatment in the community: epidemiological study in Western Australia [J].
Preston, NJ ;
Kisely, S ;
Xiao, JG .
BRITISH MEDICAL JOURNAL, 2002, 324 (7348) :1244-+
[7]  
*STATA CORP, 2002, STATA STAT SOFTW
[8]   Assessing the New York City involuntary outpatient commitment pilot program [J].
Steadman, HJ ;
Gounis, K ;
Dennis, D ;
Hopper, K ;
Roche, B ;
Swartz, M ;
Robbins, PC .
PSYCHIATRIC SERVICES, 2001, 52 (03) :330-336
[9]   Effects of involuntary outpatient commitment and depot antipsychotics on treatment adherence in persons with severe mental illness [J].
Swartz, MS ;
Swanson, JW ;
Wagner, HR ;
Burns, BJ ;
Hiday, VA .
JOURNAL OF NERVOUS AND MENTAL DISEASE, 2001, 189 (09) :583-592
[10]   A randomized controlled trial of outpatient commitment in North Carolina [J].
Swartz, MS ;
Swanson, JW ;
Hiday, VA ;
Wagner, HR ;
Burns, BJ ;
Borum, R .
PSYCHIATRIC SERVICES, 2001, 52 (03) :325-329