Schizophrenia treatment improved with ACCESS

Patients treated for schizophrenia or bipolar I disorder under the ACCESS model have low levels of service disengagement, high levels of medication adherence and improvements in clinical outcomes, researchers report.

Daniel Schöttle (University Medical Center Hamburg-Eppendorf, Germany) and colleagues explain that ACCESS “was created to offer assertive community treatment embedded in an integrated care program to patients with schizophrenia spectrum disorders.”

Following positive results in an initial 12-month comparative trial (ACCESS I), the ACCESS model was implemented into routine care and extended to patients with bipolar I disorder with psychotic features.

The current ACCESS II Study assessed the efficacy of the model in a new sample of patients over 24 months to test whether treatment effects can be sustained over longer periods under “real-life” conditions.

A total of 115 patients (mean age 41.8 years, 44.3% men) with schizophrenia spectrum disorders or bipolar I disorder with psychotic features were included in the study. They received an average of 1.6 treatment contacts per week, and over the 24-month treatment period 3.4% became service disengaged after a median of 36.9 weeks. A further 9.6% dropped out of the study because they moved away from the catchment area.

“The positive effect of assertive community treatment on sustained service engagement may be explained by the high team fidelity, lower and shared case load, higher contact frequency, no drop-out policy, 24-hour-per-day availability, and possibility of visiting patients in the community, especially if at risk for disengagement”, write Schöttle et al in TheJournal of Clinical Psychiatry.

Psychotherapeutic orientation, intensive involvement of family members, a good relationship with self-help groups and active involvement of patients towards recovery may also have played a part, the researchers say.

They add that these factors may also explain the much lower number of involuntary admissions compared with the 2 years prior to ACCESS treatment (7.8 vs 34.8%) the low mean number of inpatient days (11.6, compared with a benchmark of 63 days per 2 years in the study catchment area) and the higher rates of medication adherence compared with baseline (78.3 vs 25.2%).

Other benefits of ACCESS included medium to large improvements in satisfaction with care within the first 6 weeks, quality of life within the first 3 months, illness severity and global functioning within the first 6 months and psychopathology within the first 18 months. Furthermore, all of these improvements were sustained for the duration of the study.

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