title: Clinical and functional outcome of assertive outreach for patients with schizophrenic disorder: Results of a quasi-experimental controlled trial.
abstract: BACKGROUND
  The majority of studies support modern assertive health service models. However, the evidence is limited for parts of continental Europe, as well as for the pharmacological adherence outcome parameter.
  
  
  METHODS
  We conducted a quasi-experimental controlled trial including adult patients with a schizophreniform disorder and a maximum of 60 points on the Global Assessment of Functioning Scale (GAF). Interventions (n=176) and controls (TAU, n=142) were assessed every six-month within one year in 17 study practices in rural areas. Mental and functional state were rated using the Brief Psychiatric Rating Scale (BPRS) and the GAF. Functional limitations and pharmacological adherence were patient-rated using the WHO-Disability Assessment Schedule II (WHODAS-II) and the Medication Adherence Report Scale (MARS). We computed multilevel mixed models.
  
  
  RESULTS
  The GAF and BPRS of both groups improved significantly, yet the increase in the intervention group was significantly higher. In contrast, patient-rated variables - WHODAS-II and MARS - neither showed a stable temporal improvement nor a difference between groups.
  
  
  CONCLUSIONS
  Our findings only partly support the investigated AO intervention, because of conflicting results between clinician- and patient-ratings. Accordingly, the benefits of AO need to be further evaluated.
authors.affiliation: Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf and Schön Clinic Hamburg Eilbek,, Hamburg, Germany. Electronic address: d.kaestner@uke.de.
authors.forename: D
authors.initials: D
authors.lastname: Kästner
authors.affiliation: Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Büchtemann
authors.affiliation: Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany; Medical Psychology Unit, Hannover Medical School, Hannover, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Warnke
authors.affiliation: Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany; Medical Psychology Unit, Hannover Medical School, Hannover, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Radisch
authors.affiliation: Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany; Department of Social Work, Faculty of Business and Social Sciences, University of Applied Sciences, Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Baumgardt
authors.affiliation: Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Giersberg
authors.affiliation: Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Kopke
authors.affiliation: Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Moock
authors.affiliation: Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany; Department for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Kawohl
authors.affiliation: Competence Tandem Integrated Care, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany; Department for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: W
authors.initials: W
authors.lastname: Rössler
mesh_terms: D000328:Adult; D010054:Brief Psychiatric Rating Scale; D004185:Disability Evaluation; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D011618:Psychotic Disorders / Q000175:diagnosis / Q000628:therapy; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D019035:Rural Health Services / Q000458:organization & administration
chemical_list: D011619:Psychotropic Drugs
keywords: Assertive outreach; Complex interventions; Integrated care; Intensive case management; Schizophrenia