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


METHODS
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.
Kisely
Stephen
S
Department of Psychiatry, Dalhousie University and Health Outcomes Unit, Capital District Health Authority, Halifax, Canada.
Smith
Mark
M
Preston
Neil J
NJ
Xiao
Jianguo
J
D000328:Adult; D016022:Case-Control Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006291:Health Policy; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D009674:Nova Scotia; D010343:Patient Admission / Q000706:statistics & numerical data; D014904:Western Australia