title: Community treatment orders: relationship to clinical care, medication compliance, behavioural disturbance and readmission.
abstract: OBJECTIVE
  The objective of this study was to investigate the readmission rate, and the level of patient disturbance and community care associated with readmission following Community Treatment Orders (CTOs) in New South Wales, Australia.
  
  
  METHODS
  The readmission rates of all patients given CTOs within a 4-year period and a matched comparison group were investigated. The following factors were compared before, during and following a CTO: medication non-compliance, number of clinical services and duration of disturbed behaviour preceding hospitalisations.
  
  
  RESULTS
  Of 123 patients on CTOs (mean length, 288 days; SD, 210 days), 38 were readmitted during the CTO, the majority in the first 3 months and a further 21 patients were readmitted following termination of the CTO. Evidence of lower severity of illness in the comparison patients prevented meaningful evaluation of the readmission rates of the two groups. While on CTOs, patients receiving depot medications showed high compliance and a significantly reduced readmission rate compared with that of patients receiving oral medications. In the 2 months prior to hospitalisations during CTOs, compared with those before or after CTOs, patients received more frequent consultations and showed a shorter duration of medication non-compliance and disturbed behaviour. The level of services in the 3 months following discharge were comparable for patients on CTOs and the comparison group.
  
  
  CONCLUSIONS
  CTOs may reduce rehospitalisations by use of depot medication. Earlier and possibly more frequent readmissions in the CTO group shortened the disturbance associated with illness recurrence. It would appear that to establish a control group with equivalent severity of disorder necessary to evaluate the impact of CTOs requires a random allocation design.
authors.affiliation: Department of Psychological Medicine, The University of Sydney, Australia. kvaughan@med.usyd.edu.au
authors.forename: K
authors.initials: K
authors.lastname: Vaughan
authors.forename: N
authors.initials: N
authors.lastname: McConaghy
authors.forename: C
authors.initials: C
authors.lastname: Wolf
authors.forename: C
authors.initials: C
authors.lastname: Myhr
authors.forename: T
authors.initials: T
authors.lastname: Black
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019090:Case Management; D016022:Case-Control Studies; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D015986:Confounding Factors, Epidemiologic; D003692:Delayed-Action Preparations; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000523:psychology; D008875:Middle Aged; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations