WITHDRAWN: Assertive community treatment for people with severe mental disorders.

摘要: Background Assertive Community Treatment (ACT) was developed in the early 1970s as a response to closing down of psychiatric hospitals. ACT is team-based approach aiming at keeping ill people contact with services, reducing hospital admissions and improving outcome, especially social functioning quality life. Objectives To determine effectiveness an alternative i. standard community care, ii. traditional hospital-based rehabilitation, iii. case management. For each three comparisons main outcome indices were remaining extent admissions, clinical iv. costs. Search strategy Electronic searches CINAHL (1982-1997), Cochrane Schizophrenia Group's Register trials (1997), EMBASE (1980-1997), MEDLINE (1966-1997), PsycLIT (1974-1997) SCISEARCH (1997) undertaken. References all identified studies searched for further trial citations. Selection criteria The inclusion that should be randomised controlled trials, have compared or management been carried out on severe mental disorder majority whom aged from 18 65. Studies defined those which investigators described intervention "Assertive Treatment" one its synonyms. admission, diversion programmes, crisis, excluded. reliability evaluated. Data collection analysis Three types data available: categorical data, numerical based counts real life events (count data) collected by standardised instruments (scale data). Categorical extracted twice then cross-checked. Peto Odds Ratios number needed treat (NNT) calculated. Numerical count Count could not combined across technical reasons (the skewed) but relevant observations reported review. scale subject assessment. validity assessment itself assessed. suitable using mean difference statistic where possible, otherwise text 'Other tables' Main results versus care Those receiving more likely remain services than (OR 0.51, 99%CI 0.37-0.70). People allocated less admitted 0.59, 0.41-0.85) spent time hospital. In terms significant robust differences between found accommodation status, employment patient satisfaction. There no control treatments state functioning. invariably reduced cost did clear cut advantage over when other costs taken into account.ACT rehabilitation confidence intervals odds ratio wide. getting significantly 0.2, 0.09-0.46) living independently (for independently) 0.19, 0.06-0.54), there outcome. insufficient permit comparison.ACT numbers consistently fewer days given ACT, account. Authors' conclusions clinically effective managing severely mentally community. if correctly targeted high users in-patient can substantially reduce whilst Policy makers, clinicians, consumers support setting up teams.