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Tijdschrift voor Psychiatrie 50 (2008) 5, 253 - 262

New research

An observational study of 'assertive outreach' with remission as outcome measure

M. Bak, M. Drukker, A. de Bie, J. à Campo, G. Poddighe, J. van Os, PH. Delespaul

summary
background Systems of intensive care such as the Function Assertive Community Treatment (Function-act) are advocated because they are reported to have achieved very promising results. However, comparative studies aimed at measuring the efficacy of such systems are mainly of short duration and the outcome measure is nearly always the amount of care provided.
aim To investigate, via an observational study, changes that occurred in the number of patients going into remission and in the amount of care provided before and after the introduction of f-act.
method f-act was introduced in Maastricht and the surrounding area (population 220,000) at the beginning of 2002. Cumulative routine measurements of the effect of care in the region had been performed since 1998. These measurements were used to compare the proportion of patients in remission in two non-overlapping patients cohorts, each covering a 4-year period, namely 1998-2001 and 2002-2005.
results The proportion of patients who made the transition to remission increased from 19% in the period before the introduction of f-act to 31% in the period after its introduction (or = 2.21; 95% ci: 1.03-4.78), but after controlling for confounders the difference was no longer statistically significant.
conclusion In routine clinical practice f-act can reduce the intensity of psychopathological symptoms, possibly because the care provided under f-act is less fragmented. However, more research is needed before the claimed beneficial effects of f-act can be proved conclusively.

keywords care monitoring, care requirements, F-ACT, remission