From Randomized Controlled Trials to Evidence-Based Clinical Care for Severe Mental Illness

摘要

From systematic Cochrane reviews of primary scientific research, we know that the most effective setting for the management of severe mental illness is the Assertive Community Treatment (ACT) model. The aim of this study was to evaluate the efficacy of treatment by the ACT program "Integrated Care" in comparison with the best established clinical care. The study was a randomized, controlled trial with two years of follow-up. The trial was carried out during 1994-2000 and included 84 patients with schizophrenic disorders (DSM-IV). Analysis was by both intention-to-treat and attention-to-content-of-care. Between-group comparisons indicated significantly improved consumer satisfaction and social function in favor of "Integrated Care" at follow-up. A technology achievement was a computer-aided tool kit for instantly delivered outcome reports for the monitoring and planning of mental health services. We conclude that good clinical care for patients with schizophrenic disorders can be improved by introducing the community-based program "Integrated Care." To promote putting effective services into practice, and achieving further improvements in outcome, structural changes in the delivery systems of services in harmony with the provider program have to be introduced.