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Home treatment has been proposed as an alternative to acute in-patient care for mentally ill patients. However, there is only moderate evidence in support of home treatment.
To test whether and to what degree home treatment services would enable a reduction (substitution) of hospital use.
A total of 707 consecutively admitted adult patients with a broad spectrum of mental disorders (ICD-10: F2–F6, F8–F9, Z) experiencing crises that necessitated immediate admission to hospital, were randomly allocated to either a service model including a home treatment alternative to hospital care (experimental group) or a conventional service model that lacked a home treatment alternative to in-patient care (control group) (trial registration at ClinicalTrials.gov: NCT02322437).
The mean number of hospital days per patient within 24 months after the index crisis necessitating hospital admission (primary outcome) was reduced by 30.4% (mean 41.3 v. 59.3, P<0.001) when a home treatment team was available (intention-to-treat analysis). Regarding secondary outcomes, average overall treatment duration (hospital days + home treatment days) per patient (mean 50.4 v. 59.3, P = 0.969) and mean number of hospital admissions per patient (mean 1.86 v. 1.93, P = 0.885) did not differ statistically significantly between the experimental and control groups within 24 months after the index crisis. There were no significant between-group differences regarding clinical and social outcomes (Health of the Nation Outcome Scales: mean 9.9 v. 9.7, P = 0.652) or patient satisfaction with care (Perception of Care questionnaire: mean 0.78 v. 0.80, P = 0.242).
Home treatment services can reduce hospital use among severely ill patients in acute crises and seem to result in comparable clinical/social outcomes and patient satisfaction as standard in-patient care.
Declaration of interest
U.H. reports grants from the Hugo and Elsa Isler Foundation during the performance of the study.
Long-term data on post-traumatic stress disorder (PTSD) following
accidents are scarce.
To assess and predict PTSD in people 3 years after severe accidental
Severely injured patients were recruited consecutively from the intensive
care unit (n=121) and assessed within 1 month of the
trauma. Follow-up interviews were conducted 6 months, 12 months and 36
months later; 90 patients participated in all four interviews. Symptoms
were assessed using the Clinician-Administered PTSD Scale.
Post-traumatic stress disorder was diagnosed in 6% of patients 2 weeks
after the accident, in 2% after 1 year and in 4% after 3 years. Robust
predictors of later PTSD symptom level were intrusive symptoms shortly
after the accident and biographical risk factors. There were individual
changes over time between the categories PTSD, sub-threshold PTSD and no
PTSD. Whereas PTSD symptom severity was low or decreased for most of the
patients, some of them showed an increase or a delayed onset. Patients
with persisting PTSD symptoms at 6 months and patients with delayed onset
of symptoms are at risk of long-term PTSD.
The prevalence of PTSD was low over the whole period of 3 years.
Research on posttraumatic stress disorder (PTSD) relies mainly on self-reports of exposure to trauma and its consequences.
To analyse the consistency of the reporting of potentially traumatic events (PTEs) over time.
A community-based cohort, representative of the canton of Zurich, Switzerland, was interviewed at the ages of 34–35 years (in 1993) and 40–41 years (in 1999). A semi-structured diagnostic interview, including a section on PTSD, was administered.
Of the 342 participants who attended both interviews, 169 reported some PTE (1993, n=110; 1999, n=120). In 1999, 56 participants (33.1%) reported for the first time PTEs that actually occurred before 1993, but which had not been reported in the 1993 interview. In total, 68 participants (40.2%) who had reported a PTE in 1993 did not report it in 1999. The overall frequency of inconsistent reporting was 63.9%.
The high level of inconsistency in the reporting of PTEs has implications for therapy as well as for research.
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