Difficult-to-engage patients: a specific target for time-limited assertive outreach in a Swiss setting.
OBJECTIVE
Assertive community treatment (ACT) failed to develop in Europe, and its efficacy is debated. In Lausanne, Switzerland, ACT focuses on difficult-to-engage patients and aims to facilitate linkage with outpatient care through time-limited interventions. This study aimed to evaluate the applicability and efficiency of time-limited ACT.


METHODS
We retrospectively assessed social, clinical, and functional outcomes and motivation for treatment in 75 consecutively seen subjects treated between 2000 and 2002.


RESULTS
With 70% of the interventions lasting less than 6 months, we observed significant improvement in most clinical and social problems, in collaboration, in motivation for treatment, and in social network support, despite high baseline levels of clinical and social problems. The number of hospitalizations decreased significantly.


CONCLUSIONS
Time-limited ACT is a useful treatment for difficult-to-engage patients with severe clinical and social problems, and it facilitates linkage to care. This narrower target for ACT may facilitate its implementation in Europe.
Bonsack
Charles
C
Unité de Psychiatrie Communautaire, Département de Psychiatrie du CHUV, Faculté de Biologie et Médecine, Université de Lausanne, Switzerland. charles.bonsack@chuv.ch
Adam
Laurence
L
Haefliger
Thomas
T
Besson
Jacques
J
Conus
Philippe
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001242:Assertiveness; D003159:Community-Institutional Relations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011369:Professional-Patient Relations; D012189:Retrospective Studies; D012931:Social Environment; D012932:Social Facilitation; D012944:Social Support; D013557:Switzerland; D013997:Time Factors