Home Treatment for Acute Psychiatric Care

Home Treatment for Acute Psychiatric Care in the Canton of Aargau (Switzerland): A Randomized Controlled Trial

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.

Study Overview

• Status: Completed
• Conditions: Mental Disorders
• Intervention / Treatment: Other: Home treatment; Other: Treatment As Usual

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.

• Study Type: Interventional
• Enrollment (Actual): 707
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Aargau
    • Brugg, Aargau, Switzerland, 5201
      • Psychiatric Services Aargau AG

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 64 years (ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: HEALTH_SERVICES_RESEARCH
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Home treatment; Patients in need of acute psychiatric inpatient care are treated at their houses by mobile treatment teams instead of treatment at mental hospitals whenever home treatment is possible and appropriate.	Other: Home treatment; Patients are treated at home whenever possible and appropriate
ACTIVE_COMPARATOR: Treatment as usual; Patients in need of acute psychiatric inpatient care are treated at a mental hospital.	Other: Treatment As Usual; Patients are treated at a mental hospital

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of inpatient days	2 years follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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)	Participants will be followed for the duration of hospital stay, an expected average of 4 weeks.	Intake and discharge from treatment episode (expected average of 4 weeks)
Brief Symptom Checklist (BSCL)	Participants will be followed for the duration of hospital stay, an expected average of 4 weeks.	Intake and discharge from treatment episode (expected average of 4 weeks)
Perceptions of Care-18	Participants will be assessed at discharge from hospital, after an expected average of 4 weeks.	Discharge from treatment episode (expected average of 4 weeks)
Satisfaction of patients' relatives	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.	Discharge from treatment episode (expected average of 4 weeks)
Number of rehospitalizations per patient		2 years follow-up
Number of patients with adverse events	E.g. suicide or attempted suicide.	2 years follow-up

Collaborators and Investigators

• Sponsor: Psychiatric Services Aargau AG
• Collaborators: Hugo & Elsa Isler Foundation
• Investigators: Principal Investigator: Niklaus Stulz, PhD, Psychiatric Services Aargau AG

Publications and helpful links

General Publications

• 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.

Study record dates

Study Major Dates

• Study Start (ACTUAL): April 1, 2015
• Primary Completion (ACTUAL): April 1, 2018
• Study Completion (ACTUAL): April 1, 2018

Study Registration Dates

• First Submitted: December 11, 2014
• First Submitted That Met QC Criteria: December 22, 2014
• First Posted (ESTIMATE): December 23, 2014

Study Record Updates

• Last Update Posted (ACTUAL): June 6, 2018
• Last Update Submitted That Met QC Criteria: June 3, 2018
• Last Verified: June 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders
• Other Study ID Numbers: PDAG-0001