A Systematic Review of the Effect of Early Interventions for Psychosis on the Usage of Inpatient Service

Schizophrenia Bulletin vol. 41 no. 6 pp. 1379–1386, 2015

8 Pages Posted: 3 Nov 2015 Last revised: 4 Dec 2015

See all articles by Jason Randall

Jason Randall

University of Manitoba - Department of Community Health Sciences (CHS)

Sherry Vokey

Neil John Maclean Health Sciences Library

Hal Loewen

Neil John Maclean Health Sciences Library

Patricia Martens

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Marni D. Brownell

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Alan Katz

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Nathan Nickel

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Elaine Burland

University of Manitoba - Manitoba Centre for Health Policy

Dan Chateau

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Date Written: October 29, 2015

Abstract

Objectives: To review and synthesize the currently available research on whether early intervention for psychosis programs reduce the use of inpatient services.

Methods: A systematic review was conducted using keywords searches on PubMed, Embase (Ovid), PsycINFO (ProQuest), Scopus, CINAHL (EBSCO), Social Work Abstracts (EBSCO), Social Science Citations Index (Web of Science), Sociological Abstracts (ProQuest), and Child Development & Adolescent Studies (EBSCO). To be included, studies had to be peer-reviewed publications in English, examining early intervention programs using a variant of assertive community treatment, with a control/comparison group, and reporting inpatient service use outcomes. The primary outcome extracted number hospitalized and total N. Secondary outcome extracted means and standard deviations. Data were pooled using random effects models. Primary outcome was the occurrence of any hospitalization during treatment. A secondary outcome was the average bed-days used during treatment period.

Results: Fifteen projects were identified and included in the study. Results of meta-analysis supported the occurrence of a positive effect for intervention for both outcome measures (any hospitalization OR: 0.33; 95% CI 0.18–0.63, bed-days usage SMD: −0.38, 95% CI −0.53 to −0.24). There was significant heterogeneity of effect across the studies. This heterogeneity is due to a handful of studies with unusually positive responses.

Conclusion: These results suggest that early intervention programs are superior to standard of care, with respect to reducing inpatient service usage. Wider use of these programs may prevent the occurrence of admission for patients experiencing the onset of psychotic symptoms.

Keywords: psychosis, psychotic disorders, early intervention, health care utilization, treatment outcome

Suggested Citation

Randall, Jason and Vokey, Sherry and Loewen, Hal and Martens, Patricia and Brownell, Marni D. and Katz, Alan and Nickel, Nathan and Burland, Elaine and Chateau, Dan, A Systematic Review of the Effect of Early Interventions for Psychosis on the Usage of Inpatient Service (October 29, 2015). Schizophrenia Bulletin vol. 41 no. 6 pp. 1379–1386, 2015. Available at SSRN: https://ssrn.com/abstract=2683432

Jason Randall

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

Sherry Vokey

Neil John Maclean Health Sciences Library ( email )

501 F.A. Bldg
Winnipeg R3T 5V4, Manitoba R3T 5V5
Canada

Hal Loewen

Neil John Maclean Health Sciences Library ( email )

501 F.A. Bldg
Winnipeg R3T 5V4, Manitoba R3T 5V5
Canada

Patricia Martens

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Marni D. Brownell

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Alan Katz

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Nathan Nickel

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Elaine Burland

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Dan Chateau (Contact Author)

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

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