The home treatment enigma.
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Biomedical subjects
Publications and source records attributed to J Hoult.
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A total of 208 long-stay hospital patients in New South Wales, Australia, who were discharged to supported community accommodations were studied to determine their adjustment in the community. For 172 patients, measurements were obtained of the patients' satisfaction with their accommodations, the caretakers' perceptions of the patients' impairment and management difficulty, and the restrictiveness of practices in the various accommodations. Most patients were considered to be functioning well, although 22 of the more impaired and difficult patients were rehospitalized at the time of the study. Seventy-eight percent of the patients preferred living in the community, and only 7 percent preferred a hospital. The patients benefited from the supported, subsidized, permanent housing available in the community and required low levels of mental health care.
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One hundred and twenty patients presenting for admission to a state psychiatric hospital were randomly allocated into two groups. Control patients received standard hospital care and after-care. Experimental patients were not admitted if this could be avoided; instead they and their relatives were provided with comprehensive community treatment and a 24-hour crisis service. Patients with a primary diagnosis of alcohol or drug dependence, organic brain disorder or mental retardation were excluded. Most patients were suffering from psychotic disorders--more than half specifically from schizophrenia. During the 12 months study period 96% of the control patients were admitted--51% more than once. Of the experimental patients 60% were not admitted at all and only 8% were admitted more than once. Control patients spent an average of 53.5 days in psychiatric hospital, experimental patients spent an average of 8.4 days. Community treatment did not increase the burden upon the community, was considered to be significantly more satisfactory and helpful by patients and their relatives, achieved a clinically superior outcome, and cost less than standard care and after-care. The ingredients differentiating comprehensive community-based care from prevailing methods of psychiatric care are discussed.
Sixty-five schizophrenic patients presenting for admission were randomly allocated into two groups. Control patients received standard hospital care and after-care. Experimental patients were not admitted if this could be avoided; instead they were taken back to the community by the Community Treatment Team who provided them and their relatives with comprehensive community treatment and a 24-h crisis service. During the 12 months study period 68% of the schizophrenic patients in the experimental group were not admitted; 10% were admitted two or more times and for 5 weeks or longer. All the schizophrenic patients in the control group were admitted--two-thirds or more times and for 5 weeks or longer. It was feasible to treat most schizophrenic patients in the community. Community treatment was considered by patients and their relatives to be the more satisfactory and helpful form of treatment and achieved a superior clinical outcome.
One hundred and twenty patients presenting for admission were randomly allocated into two groups. Controls received standard hospital care and after-care. Projects were not admitted if this could be avoided; instead they and their relatives were provided with comprehensive community treatment and a 24-hour crisis service. Patients with a primary diagnosis of alcohol or drug dependence, organic brain disorder or mental retardation were excluded. During the 12 months study period, 96% of controls were admitted, 51% more than once. Of the projects, 60% were not admitted at all and only 8% were admitted more than once. Controls spent an average of 53.5 days in psychiatric hospitals; projects spent an average of 8.4 days. Community treatment did not increase the burden upon the community, was considered to be significantly more satisfactory and helpful by patients and their relatives, achieved a clinically superior outcome, and cost less than standard care and after-care.
One hundred and twenty patients presenting at Macquarie Hospital for admission were randomly allocated into two groups. The control group patients received standard hospital care and follow-up. The project group patients were not admitted if this could be avoided; instead they were taken back to the community by the project team who provided them and their relatives with comprehensive, assertive and prolonged follow-up treatment backed by a 24-hour crisis service. The majority (63%) of the project group had no admission during the 10 month study period. Initially, the burden on the relatives of the project group was higher, but by one month it was somewhat lower and by four months it was significantly lower than the burden on the control group relatives. Relatives of the project group patients were significantly more satisfied with the treatment than control group relatives. It is clearly feasible to treat most psychiatric patients in the community without increasing the burden on their relatives.
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