title: CTOs: what is the state of the evidence?
abstract: OBJECTIVE
  Community Treatment Orders (CTOs) require outpatients to adhere to treatment and permit rapid hospitalisation when necessary. They have become a clinical and policy solution to repeated hospital readmissions despite some strong opposition and the contested nature of published evidence. In this article, we appraise the current literature on CTOs from the viewpoint of Evidence-Based Medicine and discuss the way forward for using and researching CTOs.
  
  
  RESULTS
  Non-randomised outcome studies show conflicting results, but their lack of standardisation of methods and measures makes it difficult to draw conclusions. In contrast, all three randomised controlled trials (RCTs) conducted concur in their findings that CTOs do not impact on hospital outcomes. No systematic review or meta-analysis has identified any clear clinical advantage to CTOs.
  
  
  CONCLUSIONS
  The evidence-base does not support the use of CTOs in their current form. Involuntary clinical interventions must conform to the highest standard of evidence-based care. To enable clinicians to take an evidence-based approach and to settle remaining uncertainties about the current evidence, high-quality RCTs should be designed and undertaken, using standardised outcome measures.
authors.affiliation: Health Services Research Unit, Akershus University Hospital, 1478, Lørenskog, Norway, jorun.rugkasa@ahus.no.
authors.forename: Jorun
authors.initials: J
authors.lastname: Rugkåsa
authors.forename: John
authors.initials: J
authors.lastname: Dawson
authors.forename: Tom
authors.initials: T
authors.lastname: Burns
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D003156:Community Mental Health Services; D019317:Evidence-Based Medicine; D006760:Hospitalization; D006801:Humans; D015201:Meta-Analysis as Topic; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010359:Patient Readmission / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012196:Review Literature as Topic