A comparison of health service use in two jurisdictions with and without compulsory community treatment

2005 ◽  
Vol 35 (9) ◽  
pp. 1357-1367 ◽  
Author(s):  
STEPHEN KISELY ◽  
MARK SMITH ◽  
NEIL J. PRESTON ◽  
JIANGUO XIAO
Keyword(s):  
Logistic Regression ◽  
Nova Scotia ◽  
Western Australia ◽  
Service Use ◽  
Cox Regression ◽  
Community Treatment ◽  
Psychiatric History ◽  
Admission Rates ◽  
Compulsory Community Treatment ◽  
Bed Days

Background. This study examines whether community treatment orders (CTOs) reduce psychiatric admission rates or bed-days for patients from Western Australia compared to control patients from a jurisdiction without this legislation (Nova Scotia).Method. A population-based record linkage analysis of an inception cohort using a two-stage design of matching and multivariate analyses to control for sociodemographics, clinical features and psychiatric history. All discharges from in-patient psychiatric services in Western Australia and Nova Scotia were included covering a population of 2·6 million people. Patients on CTOs in the first year of implementation in Western Australia were compared with controls from Nova Scotia matched on date of discharge from in-patient care, demographics, diagnosis and past in-patient psychiatric history. We analysed time to admission using Cox regression analyses and number of bed-days using logistic regression.Results. We matched 196 CTO cases with an equal number of controls. On survival analyses, CTO cases had a significantly greater readmission rate. Co-morbid personality disorder and previous psychiatric history were also associated with readmission. However, on logistic regression, patients on CTOs spent less time in hospital in the following year, with reduced in-patient stays of over 100 days.Conclusions. Although compulsory community treatment does not reduce hospital admission rates, increased surveillance of patients on CTOs may lead to earlier intervention such as admission, so reducing length of hospital stay. However, we do not know if it is the intensity of treatment, or its compulsory nature, that effects outcome.

scholarly journals Impact of compulsory community treatment on admission rates

2004 ◽  
Vol 184 (5) ◽  
pp. 432-438 ◽  
Author(s):  
Stephen R. Kisely ◽  
Jianguo Xiao ◽  
Neil J. Preston
Keyword(s):  
Health Service ◽  
Service Use ◽  
Psychiatric Patients ◽  
Community Treatment ◽  
Health Service Use ◽  
Community Treatment Orders ◽  
Stage Design ◽  
Admission Rates ◽  
Compulsory Community Treatment ◽  
Socio Demographic Factors

BackgroundThere is controversy as to whether compulsory community treatment for psychiatric patients reduces hospital admission rates.AimsTo examine whether community treatment orders (CTOs) reduce admission rates, using a two-stage design of matching and multivariate analyses to take into account socio-demographic factors, clinical factors, case complexity and previous psychiatric and forensic history.MethodSurvival analysis of CTO cases and controls from three linked Western Australian databases of health service use, involuntary treatment and forensic history. We used two control groups: one matched on demographic characteristics, diagnosis, past psychiatric history and treatment setting, and consecutive controls matched on date of discharge from in-patient care.ResultsWe matched 265 CTO cases with 265 matched controls and 224 consecutive controls (totaln=754). The CTO group had a significantly higher readmission rate: 72%v.65% and 59% for the matched and consecutive controls (log-rank χ2=4.7,P=0.03). CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were associated with increased admission rates.ConclusionsCommunity treatment orders alone do not reduce admissions.

Randomized and non-randomized evidence for the effect of compulsory community and involuntary out-patient treatment on health service use: systematic review and meta-analysis

2006 ◽  
Vol 37 (1) ◽  
pp. 3-14 ◽  
Author(s):  
STEPHEN KISELY ◽  
LESLIE ANNE CAMPBELL ◽  
ANITA SCOTT ◽  
NEIL J. PRESTON ◽  
JIANGUO XIAO
Keyword(s):  
Systematic Review ◽  
Service Use ◽  
Hospital Admissions ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Community Treatment ◽  
Patient Treatment ◽  
Wide Range ◽  
Compulsory Community Treatment ◽  
Bed Days

Background. There is limited randomized controlled trial (RCT) evidence for compulsory community treatment. Other study methods may clarify their effectiveness. We reviewed RCT and non-RCT evidence for the effect of compulsory community treatment on hospital admissions, bed-days, compliance and out-patient contacts.Method. A systematic review of RCTs, controlled before-and-after (CBA) studies, and interrupted time series (ITS) analyses. Meta-analysis of RCTs.Results. Eight papers covering five studies (two RCTs and three CBAs) met inclusion criteria (total n=1108). There was no statistical difference in 12-month admission rates between subjects on involuntary out-patient treatment and controls. Survival analyses of time to admission were equivocal. All five studies reported decreases in the number of bed-days following involuntary out-patient treatment but this only reached statistical significance in one situation; patients receiving the intervention were less likely to have admissions of over 100 days. There was no difference in treatment adherence between the intervention and control groups in either RCT or two of the CBA studies. However, the third CBA study reported a statistically significant increase of nearly five visits in the mean number of overall contacts in the involuntary out-patient treatment group.Conclusions. The evidence for involuntary out-patient treatment in reducing either admissions or bed-days is very limited. It therefore cannot be seen as a less restrictive alternative to admission. Other effects are uncertain. Evaluation of a wide range of outcomes should be included if this type of legislation is introduced.

scholarly journals Efficacy of compulsory community treatment and use in minority ethnic populations: A statewide cohort study

2019 ◽  
Vol 54 (1) ◽  
pp. 76-88 ◽  
Author(s):  
Steve Kisely ◽  
Katherine Moss ◽  
Melinda Boyd ◽  
Dan Siskind
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Linguistically Diverse ◽  
Community Treatment ◽  
Culturally And Linguistically Diverse ◽  
Community Treatment Orders ◽  
Diverse Backgrounds ◽  
Compulsory Community Treatment ◽  
Bed Days

Background: There is conflicting and equivocal evidence for the efficacy of compulsory community treatment within Australia and overseas, but no study from Queensland. In addition, although people from Indigenous or culturally and linguistically diverse backgrounds are over-represented in compulsory admissions to hospital, little is known about whether this also applies to compulsory community treatment. Aims: We initially investigated whether people from Indigenous or culturally and linguistically diverse backgrounds in terms of country of birth, or preferred language, were more likely to be on compulsory community treatment using statewide databases from Queensland. We then assessed the impact of compulsory community treatment on health service use over the following 12 months. Compulsory community treatment included both community treatment orders and forensic orders. Methods: Cases and controls from administrative health data were matched on age, sex, diagnosis and time of hospital discharge (the index date). Multivariate analyses were used to examine potential predictors of compulsory community treatment, as well as impact on bed-days, time to readmission or contacts with public mental health services in the subsequent year. Results: We identified 7432 cases and controls from January 2013 to February 2017 (total n = 14,864). Compulsory community treatment was more likely in Indigenous Queenslanders (adjusted odds ratio = 1.45; 95% confidence interval = [1.28, 1.65]) subjects coming from a culturally and linguistically diverse background (adjusted odds ratio = 1.54; 95% confidence interval = [1.37, 1.72]), or those who had a preferred language other than English (adjusted odds ratio = 1.66; 95% confidence interval = [1.30, 2.11]). While community contacts were significantly greater in patients on compulsory community treatment, there was no difference in bed-days while time to readmission was shorter. Restricting the analyses to just community treatment orders did not alter these results. Conclusion: In common with other coercive treatments, Indigenous Australians and people from culturally and linguistically diverse backgrounds are more likely to be placed on compulsory community treatment. The evidence for effectiveness remains inconclusive.

Assessing the effectiveness of compulsory community treatment

2016 ◽  
Author(s):  
Steve Kisely
Keyword(s):  
Health Service ◽  
Service Use ◽  
Community Treatment ◽  
Health Service Use ◽  
Compulsory Admission ◽  
Methodological Issues ◽  
Criminal Victimization ◽  
Compulsory Community Treatment ◽  
Legislative Framework ◽  
Research Findings

This chapter initially considers methodological issues that arise in assessing the effectiveness of compulsory community treatment. It then reviews the evidence from uncontrolled, controlled, and randomized studies of various types of intervention. Although uncontrolled studies suggest some reduction in health service use following compulsory community treatment, this is not generally confirmed in studies with matched or randomized controls. Although proponents of compulsory community treatment argue that it is less coercive than the alternatives of compulsory admission to hospital or arrest, research findings suggest that it remains an unproven way of reducing either procedure. Even where changes in outcome have been shown, such as decreased criminal victimization, it is not clear whether these are due to the legislative framework or to a greater intensity of contact.

scholarly journals Community treatment orders and reduced time in hospital: a nationwide study, 2007–2012

2016 ◽  
Vol 40 (3) ◽  
pp. 124-126 ◽  
Author(s):  
Mark Taylor ◽  
Melanie Macpherson ◽  
Callum Macleod ◽  
Donald Lyons
Keyword(s):  
Community Treatment ◽  
Clinical Implications ◽  
Routine Practice ◽  
Psychiatric History ◽  
Community Treatment Orders ◽  
Hospital Bed ◽  
Before And After ◽  
National Cohort ◽  
Bed Days ◽  
Reduced Time

Aims and methodCommunity treatment orders (CTOs) were introduced in Scotland in 2005, but are controversial owing to a lack of supportive randomised evidence. The non-randomised studies provide mixed results on their efficacy and utility. We aimed to examine hospital bed day usage across Scotland both before and after CTOs were initiated in a national cohort of patients, spanning 5 years.ResultsIn total, 1558 individuals who were subject to a CTO between 2007 and 2012, of whom 63% were male, were included. After CTO initiation the number of hospital bed days fell, on average, from 66 to 39 per annum per patient. Those with a longer psychiatric history appeared to benefit more from a CTO, in terms of reduced time in hospital.Clinical implicationsOur data offer cautious support for the use of CTOs in routine practice, in terms of reducing time spent in psychiatric hospital. This finding is balanced by the more rigorous randomised studies which do not find any benefit to CTOs.

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