Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia-spectrum and bipolar I disorders: Four-year follow-up of the ACCESS II study

Abstract

The ACCESS-model offers integrated care including assertive community treatment to patients with psychotic disorders. ACCESS proved more effective compared to standard care (ACCESS-I study) and was successfully implemented into clinical routine (ACCESS-II study). In this article, we report the 4-year outcomes of the ACCESS-II study. Between May 2007 and December 2013, 115 patients received continuous ACCESS-care. We hypothesized that the low 2-year disengagement and hospitalization rates and significant improvements in psychopathology, functioning, and quality of life could be sustained over 4 years. Over 4 years, only 10 patients disengaged from ACCESS. Another 23 left for practical reasons and were successfully transferred to other services. Hospitalization rates remained low (13.0% in year 3; 9.1% in year 4). Involuntary admissions decreased from 35% in the 2 years prior to ACCESS to 8% over 4 years in ACCESS. Outpatient contacts remained stably high at 2.0-2.4 per week. We detected significant improvements in psychopathology (effect size d = 0.79), illness severity (d = 1.29), level of functioning (d = 0.77), quality of life (d = 0.47) and stably high client satisfaction (d = 0.02) over 4 years. Most positive effects were observed within the first 2 years with the exception of illness severity, which further improved from year 2 to 4. Within continuous intensive 4-year ACCESS-care, sustained improvements in psychopathology, functioning, quality of life, low service disengagement and re-hospitalization rates, as well as low rates of involuntary treatment, were observed in contrast to other studies, which reported a decline in these parameters once a specific treatment model was stopped. Yet, stronger evidence to prove these results is required.

Trial registration: Clinical Trial Registration Number: NCT01888627.

Conflict of interest statement

Competing Interests: Daniel Schöttle has been a consultant and/or advisor to or has received honoraria from Astra Zeneca, Otsuka Pharma GmbH, Lundbeck GmbH, and Janssen Cilag. Benno G. Schimmelmann has been a consultant and/or advisor to or has received honoraria from AstraZeneca, Bristol-MeyersSquibb, Eli Lilly, and Janssen. Luise Antonia Nawara has received honoraria from Otsuka Pharma GmbH and Lundbeck GmbH. Thomas Bock and Michael Schödlbauer have received honoraria from Astra Zeneca. Martin Lambert has held lectures for AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck GmbH, Otsuka Pharma GmbH, Roche Deutschland Holding GmbH, Sanovi Aventis; Grants: AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck, Sanovi Aventis; Consultancy: AstraZeneca, Lilly Deutschland GmbH, Janssen Cilag GmbH, Roche Deutschland Holding GmbH, Trommsdorff GmbH & Co. KG. Anne Karow has received honoraria/grants and is on the speakers’ board of Astra Zeneca. Jürgen Gallinat has served as speaker for Janssen Cilag, Otsuka, and AstraZeneca. Friederike Ruppelt, Alexandra Bussopulos, Marietta Frieling, Evangelia Nika, Andrea Kerstan, Michael Schödlbauer, Anne Daubmann, Karl Wegscheider, Anja Rohenkohl, Gizem Sarikaya, Mary Sengutta, Daniel Luedecke, Linus Wittmann, Gunda Ohm, Dietmar Golks, Christina Meigel-Schleiff report no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Sample flow chart.

Patients of the study were recruited from 1st of May 2007 to 31st of October 2009. 115 patients with SSD or BD and severe mental illness were included for the study. All treated patients (N = 115) participated in the assessments, which were administered as part of the clinical routine.