title: Effect of crisis plans on admissions and emergency visits: a randomized controlled trial.
abstract: OBJECTIVE
  To establish whether patients with a crisis plan had fewer voluntary or involuntary admissions, or fewer outpatient emergency visits, than patients without such a plan.
  
  
  METHODS
  Multicenter randomized controlled trial with two intervention conditions and one control condition.
  
  
  METHODS
  Adult outpatients diagnosed with psychotic or bipolar disorder who had experienced at least one psychiatric crisis in the previous two years.
  
  
  METHODS
  Two types of advance statement were used: (1) a crisis plan formulated by the patient with the help of a patient advocate (Patient Advocate Crisis Plan: PACP); and (2) a crisis plan developed together with the clinician (Clinician-facilitated Crisis Plan: CCP).
  
  
  RESULTS
  The percentages of patients admitted voluntarily or involuntarily (on an emergency basis or by court order), and the percentage who made outpatient emergency visits over an 18-month follow-up period.
  
  
  RESULTS
  A total of 212 patients were included: 69 in the PACP condition, 70 in the CCP condition, and 73 in the control condition. No effects of the two interventions were found on the numbers of voluntary admissions, involuntary admissions and emergency visits. Regarding involuntary admissions, there was no significant effect on emergency admissions, which were 17% (12/69) in the PACP condition, 10% (7/70) in the CCP condition, and 19% (14/73) in the control condition. There was a significant effect on planned court-ordered admissions, with 16% (11/69) in the PACP condition, 10% (7/70) in the CCP condition, and 26% (19/73) in the control condition. Finally, the interventions had no effect on outpatient emergency visits, with 32% (22/69) in the PACP group, 31% (22/70) in the CCP group, and 34% (25/73) in the control group.
  
  
  CONCLUSIONS
  Crisis plans may be an effective intervention for reducing court-ordered admissions in patients with psychotic and bipolar disorders.
  
  
  BACKGROUND
  Current Controlled Trails NTR1166.
authors.affiliation: Epidemiological and Social Psychiatric Research institute, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Asia
authors.initials: A
authors.lastname: Ruchlewska
authors.affiliation: Epidemiological and Social Psychiatric Research institute, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Andre I
authors.initials: AI
authors.lastname: Wierdsma
authors.affiliation: Epidemiological and Social Psychiatric Research institute, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Astrid M
authors.initials: AM
authors.lastname: Kamperman
authors.affiliation: Parnassia Psychiatric Institute, The Hague, The Netherlands; VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: van der Gaag
authors.affiliation: Landelijk Crisiskaart (O)GGZ Informatie en ondersteuningspunt, Utrecht, The Netherlands.
authors.forename: Renee
authors.initials: R
authors.lastname: Smulders
authors.affiliation: Epidemiological and Social Psychiatric Research institute, Erasmus MC, Rotterdam, The Netherlands; BavoEuropoort, Centre for Mental Health Care, Rotterdam, The Netherlands.
authors.forename: Bert-Jan
authors.initials: BJ
authors.lastname: Roosenschoon
authors.affiliation: Epidemiological and Social Psychiatric Research institute, Erasmus MC, Rotterdam, The Netherlands; BavoEuropoort, Centre for Mental Health Care, Rotterdam, The Netherlands.
authors.forename: Cornelis L
authors.initials: CL
authors.lastname: Mulder
mesh_terms: D000328:Adult; D003710:Demography; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D010045:Outpatients; D010344:Patient Advocacy; D010347:Patient Care Planning; D012944:Social Support