TY - JOUR

T1 - Effectiveness and Efficiency of Assertive Outreach for Schizophrenia in Germany

T2 - study protocol on a pragmatic quasi-experimental controlled trial

AU - Bramesfeld, Anke

AU - Moock, Jörn

AU - Kopke, Kirsten

AU - Büchtemann, Dorothea

AU - Kästner, Denise

AU - Radisch, Jeanett

AU - Rössler, Wulf

N1 - Funding Information: The study is part of the project “Basic Principles and Evaluation of Integrated Care for Mentally Ill Persons”. It is funded by a 2.3 million Euro grant (CCI NO 2007DE161PR001) from the Innovation-Incubator at Leuphana University Luneburg. The Innovation-Incubator is a large scale project at Leuphana University that aims for economic development through research in rural regions in North Lower Saxony. The Innovation-Incubator is funded by European Funds for Regional Development and by the Federal State of Lower Saxony. We are grateful to the colleagues at IVPNetworks GmbH who manage the intervention described in the study protocol, for supporting this study; also many thanks to Sharon Janicki for revising the language of the article.

PY - 2013/2/15

Y1 - 2013/2/15

N2 - Background: A model of assertive outreach (AO) in which office-based psychiatrists collaborate with ambulatory nursing services for providing intensive home-treatment is currently being implemented in rural areas of Lower Saxony, Germany. The costs of the model are reimbursed by some of the statutory health insurance companies active in Lower Saxony. Effectiveness and efficiency of this model for patients suffering from schizophrenia is evaluated in a pragmatic and prospective trial. Methods: Quasi-experimental controlled trial: patients receiving the intervention are all those receiving AO; controls are patients not eligible for AO based on their health insurance affiliation. Eligibility criteria: clinical diagnosis of schizophrenia (ICD-10 F.20), aged at least 18 years and being moderately to severely impaired in global functioning. Primary outcome: admission and days spent in psychiatric inpatient care; secondary outcomes: clinical and functional status; patient satisfaction with chronic care; health care costs. Follow-up time: 6 and 12 months. Discussion: The study faces many challenges typical to pragmatic trials such as the rejection of randomisation by service providers, the quality of treatment as usual (TAU) to which the intervention will be compared, and the impairment of the study subjects. Solutions of how to deal with these challenges are presented and discussed in detail. Trial registration: International Standard Randomised Controlled Trial Number: http://ISRCTN34900108, German Clinical Trial Register: http://DRKS00003351.

AB - Background: A model of assertive outreach (AO) in which office-based psychiatrists collaborate with ambulatory nursing services for providing intensive home-treatment is currently being implemented in rural areas of Lower Saxony, Germany. The costs of the model are reimbursed by some of the statutory health insurance companies active in Lower Saxony. Effectiveness and efficiency of this model for patients suffering from schizophrenia is evaluated in a pragmatic and prospective trial. Methods: Quasi-experimental controlled trial: patients receiving the intervention are all those receiving AO; controls are patients not eligible for AO based on their health insurance affiliation. Eligibility criteria: clinical diagnosis of schizophrenia (ICD-10 F.20), aged at least 18 years and being moderately to severely impaired in global functioning. Primary outcome: admission and days spent in psychiatric inpatient care; secondary outcomes: clinical and functional status; patient satisfaction with chronic care; health care costs. Follow-up time: 6 and 12 months. Discussion: The study faces many challenges typical to pragmatic trials such as the rejection of randomisation by service providers, the quality of treatment as usual (TAU) to which the intervention will be compared, and the impairment of the study subjects. Solutions of how to deal with these challenges are presented and discussed in detail. Trial registration: International Standard Randomised Controlled Trial Number: http://ISRCTN34900108, German Clinical Trial Register: http://DRKS00003351.

KW - Health sciences

KW - Controlled trial

KW - Home treatment

KW - Integrated care

KW - Psychiatry

KW - Seriously mentally ill

UR - http://www.scopus.com/inward/record.url?scp=84873743723&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/a0c64186-165f-34b0-bf46-ba0263f25ee4/

U2 - 10.1186/1471-244X-13-56

DO - 10.1186/1471-244X-13-56

M3 - Journal articles

C2 - 23414234

VL - 13

JO - BMC Psychiatry

JF - BMC Psychiatry

SN - 1471-244X

M1 - 56

ER -