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Published in: BMC Psychiatry 1/2014

Open Access 01-12-2014 | Research article

Changes in individual needs for care and quality of life in Assertive Community Treatment patients: an observational study

Authors: Hans E Kortrijk, Astrid M Kamperman, Cornelis L Mulder

Published in: BMC Psychiatry | Issue 1/2014

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Abstract

Background

It is largely unknown which unmet needs in the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) need to be resolved in order to improve a patients’ subjective quality of life (QoL). We therefore investigated the pattern of individual unmet needs over time and its relation to QoL over time.

Methods

Using data gathered from 251 patients in a Routine Outcome Monitoring procedure in Assertive Community Treatment (ACT) teams, we used paired samples tests to analyze differences in QoL total scores and the number of unmet needs between baseline and follow-up data. Ordinal regression was used to analyze the relationship between outcome in individual unmet needs and QoL.

Results

As well as small improvements in QoL over time in patients in contact with ACT, we found a small to moderate decrease in unmet needs over time. While a decreasing number of unmet needs was associated with an increase in QoL, outcomes in QoL and individual unmet needs were weakly related (r ≤ .165). Ordinal regression analysis showed that a better outcome in individual unmet needs related to accommodation and day-time activities was weakly related to a better outcome in QoL.

Conclusions

Patients receiving ACT make small improvements in their QoL and ACT may help to solve some of their needs. QoL benefits from reducing needs for care, in particular the need for appropriate housing and meaningful daytime activities.
Appendix
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Literature
1.
go back to reference Slade M: Routine outcome assessment in mental health services. Psychol Med. 2002, 32 (8): 1339-1343. 10.1017/S0033291701004974.CrossRefPubMed Slade M: Routine outcome assessment in mental health services. Psychol Med. 2002, 32 (8): 1339-1343. 10.1017/S0033291701004974.CrossRefPubMed
2.
go back to reference Slade M, McCrone P, Kuipers E, Leese M, Cahill S, Parabiaghi A, Priebe S, Thornicroft G: Use of standardised outcome measures in adult mental health services: randomised controlled trial. Br J Psychiatry. 2006, 189: 330-336. 10.1192/bjp.bp.105.015412.CrossRefPubMed Slade M, McCrone P, Kuipers E, Leese M, Cahill S, Parabiaghi A, Priebe S, Thornicroft G: Use of standardised outcome measures in adult mental health services: randomised controlled trial. Br J Psychiatry. 2006, 189: 330-336. 10.1192/bjp.bp.105.015412.CrossRefPubMed
3.
go back to reference Drukker M, van Os J, Dietvorst M, Sytema S, Driessen G, Delespaul P: Does monitoring need for care in patients diagnosed with severe mental illness impact on psychiatric service use? comparison of monitored patients with matched controls.BMC Psychiatry 2011, 11:45., Drukker M, van Os J, Dietvorst M, Sytema S, Driessen G, Delespaul P: Does monitoring need for care in patients diagnosed with severe mental illness impact on psychiatric service use? comparison of monitored patients with matched controls.BMC Psychiatry 2011, 11:45.,
4.
go back to reference Wiersma D, van Busschbach J: Are needs and satisfaction of care associated with quality of life? an epidemiological survey among the severely mentally ill in the Netherlands. Eur Arch Psychiatry Clin Neurosci. 2001, 251 (5): 239-246. 10.1007/s004060170033.CrossRefPubMed Wiersma D, van Busschbach J: Are needs and satisfaction of care associated with quality of life? an epidemiological survey among the severely mentally ill in the Netherlands. Eur Arch Psychiatry Clin Neurosci. 2001, 251 (5): 239-246. 10.1007/s004060170033.CrossRefPubMed
5.
go back to reference Ochoa S, Haro JM, Autonell J, Pendàs A, Teba F, Màrquez M: Met and unmet needs of schizophrenia patients in a Spanish sample. Schizophr Bull. 2003, 29 (2): 201-210. 10.1093/oxfordjournals.schbul.a006998.CrossRefPubMed Ochoa S, Haro JM, Autonell J, Pendàs A, Teba F, Màrquez M: Met and unmet needs of schizophrenia patients in a Spanish sample. Schizophr Bull. 2003, 29 (2): 201-210. 10.1093/oxfordjournals.schbul.a006998.CrossRefPubMed
6.
go back to reference Slade M, Leese M, Ruggeri M, Kuipers E, Tansella M, Thornicroft G: Does meeting needs improve quality of life?. Psychother Psychosom. 2004, 73 (3): 183-189. 10.1159/000076456.CrossRefPubMed Slade M, Leese M, Ruggeri M, Kuipers E, Tansella M, Thornicroft G: Does meeting needs improve quality of life?. Psychother Psychosom. 2004, 73 (3): 183-189. 10.1159/000076456.CrossRefPubMed
7.
go back to reference Slade M, Leese M, Cahill S, Thornicroft G, Kuipers E: Patient-rated mental health needs and quality of life improvement. Br J Psychiatry. 2005, 187: 256-261. 10.1192/bjp.187.3.256.CrossRefPubMed Slade M, Leese M, Cahill S, Thornicroft G, Kuipers E: Patient-rated mental health needs and quality of life improvement. Br J Psychiatry. 2005, 187: 256-261. 10.1192/bjp.187.3.256.CrossRefPubMed
8.
go back to reference Ritsner MS, Lisker A, Arbitman M, Grinshpoon A: Factor structure in the Camberwell Assessment of Need-Patient Version: the correlations with dimensions of illness, personality and quality of life of schizophrenia patients. Psychiatry Clin Neurosci. 2012, 66 (6): 499-507. 10.1111/j.1440-1819.2012.02383.x.CrossRefPubMed Ritsner MS, Lisker A, Arbitman M, Grinshpoon A: Factor structure in the Camberwell Assessment of Need-Patient Version: the correlations with dimensions of illness, personality and quality of life of schizophrenia patients. Psychiatry Clin Neurosci. 2012, 66 (6): 499-507. 10.1111/j.1440-1819.2012.02383.x.CrossRefPubMed
9.
go back to reference Meesters PD, Comijs HC, Dröes RM, de Haan L, Smit JH, Eikelenboom P, Beekman AT, Stek ML: The care needs of elderly patients with schizophrenia spectrum disorders. Am J Geriatr Psychiatry. 2013, 21 (2): 129-137. 10.1016/j.jagp.2012.10.008.CrossRefPubMed Meesters PD, Comijs HC, Dröes RM, de Haan L, Smit JH, Eikelenboom P, Beekman AT, Stek ML: The care needs of elderly patients with schizophrenia spectrum disorders. Am J Geriatr Psychiatry. 2013, 21 (2): 129-137. 10.1016/j.jagp.2012.10.008.CrossRefPubMed
10.
go back to reference Wennström E, Wiesel FA: The Camberwell assessment of need as an outcome measure in routine mental health care. Soc Psychiatry Psychiatr Epidemiol. 2006, 41 (9): 728-733. 10.1007/s00127-006-0084-9.CrossRefPubMed Wennström E, Wiesel FA: The Camberwell assessment of need as an outcome measure in routine mental health care. Soc Psychiatry Psychiatr Epidemiol. 2006, 41 (9): 728-733. 10.1007/s00127-006-0084-9.CrossRefPubMed
11.
go back to reference Wiersma D, van den Brink R, Wolters K, McCabe R, Bullenkamp J, Hansson L, Lauber C, Martinez-Leal R, Rössler W, Salize H, Björkman T, Torres-Gonzales F, Wright DJ, Priebe S: Individual unmet needs for care: are they sensitive as outcome criterion for the effectiveness of mental health services interventions?. Soc Psychiatry Psychiatr Epidemiol. 2009, 44 (4): 317-324. 10.1007/s00127-008-0432-z.CrossRefPubMed Wiersma D, van den Brink R, Wolters K, McCabe R, Bullenkamp J, Hansson L, Lauber C, Martinez-Leal R, Rössler W, Salize H, Björkman T, Torres-Gonzales F, Wright DJ, Priebe S: Individual unmet needs for care: are they sensitive as outcome criterion for the effectiveness of mental health services interventions?. Soc Psychiatry Psychiatr Epidemiol. 2009, 44 (4): 317-324. 10.1007/s00127-008-0432-z.CrossRefPubMed
12.
go back to reference Landolt K, Rössler W, Burns T, Ajdacic-Gross V, Galderisi S, Libiger J, Naber D, Derks EM, Kahn RS, Fleischhacker WW: The interrelation of needs and quality of life in first-episode schizophrenia. Eur Arch Psychiatry Clin Neurosci. 2012, 262 (3): 207-216. 10.1007/s00406-011-0275-6.CrossRefPubMed Landolt K, Rössler W, Burns T, Ajdacic-Gross V, Galderisi S, Libiger J, Naber D, Derks EM, Kahn RS, Fleischhacker WW: The interrelation of needs and quality of life in first-episode schizophrenia. Eur Arch Psychiatry Clin Neurosci. 2012, 262 (3): 207-216. 10.1007/s00406-011-0275-6.CrossRefPubMed
13.
go back to reference Schellevis F: Medisch-ethische toetsing van observationeel onderzoek: een grijs gebied. HenW. 2009, 49: 198-199. Schellevis F: Medisch-ethische toetsing van observationeel onderzoek: een grijs gebied. HenW. 2009, 49: 198-199.
14.
go back to reference Teague GB, Bond GR, Drake RE: Program fidelity in assertive community treatment: development and use of a measure. Am J Orthopsychiatry. 1998, 68 (2): 216-232. 10.1037/h0080331.CrossRefPubMed Teague GB, Bond GR, Drake RE: Program fidelity in assertive community treatment: development and use of a measure. Am J Orthopsychiatry. 1998, 68 (2): 216-232. 10.1037/h0080331.CrossRefPubMed
15.
go back to reference Kortrijk HE, Mulder CL, Roosenschoon BJ, Wiersma D: Treatment outcome in patients receiving assertive community treatment. Community Ment Health J. 2010, 46 (4): 330-336. 10.1007/s10597-009-9257-9.CrossRefPubMed Kortrijk HE, Mulder CL, Roosenschoon BJ, Wiersma D: Treatment outcome in patients receiving assertive community treatment. Community Ment Health J. 2010, 46 (4): 330-336. 10.1007/s10597-009-9257-9.CrossRefPubMed
16.
go back to reference Phelan M, Slade M, Thornicroft G, Dunn G, Holloway F, Wykes T, Strathdee G, Loftus L, McCrone P, Hayward P: The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry. 1995, 167 (5): 589-595. 10.1192/bjp.167.5.589.CrossRefPubMed Phelan M, Slade M, Thornicroft G, Dunn G, Holloway F, Wykes T, Strathdee G, Loftus L, McCrone P, Hayward P: The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry. 1995, 167 (5): 589-595. 10.1192/bjp.167.5.589.CrossRefPubMed
17.
go back to reference Slade M, Beck A, Bindman J, Thornicroft G, Wright S: Routine clinical outcome measures for patients with severe mental illness: CANSAS and HoNOS. Br J Psychiatry. 1999, 174: 404-408. 10.1192/bjp.174.5.404.CrossRefPubMed Slade M, Beck A, Bindman J, Thornicroft G, Wright S: Routine clinical outcome measures for patients with severe mental illness: CANSAS and HoNOS. Br J Psychiatry. 1999, 174: 404-408. 10.1192/bjp.174.5.404.CrossRefPubMed
18.
go back to reference Trauer T, Tobias G, Slade M: Development and evaluation of a patient-rated version of the Camberwell Assessment of Need short appraisal schedule (CANSAS-P). Community Ment Health J. 2008, 44 (2): 113-124. 10.1007/s10597-007-9101-z.CrossRefPubMed Trauer T, Tobias G, Slade M: Development and evaluation of a patient-rated version of the Camberwell Assessment of Need short appraisal schedule (CANSAS-P). Community Ment Health J. 2008, 44 (2): 113-124. 10.1007/s10597-007-9101-z.CrossRefPubMed
19.
go back to reference Andresen R, Caputi P, Oades LG: Interrater reliability of the camberwell assessment of need short appraisal schedule. Aust N Z J Psychiatry. 2000, 34 (5): 856-861. 10.1080/j.1440-1614.2000.00814.x.CrossRefPubMed Andresen R, Caputi P, Oades LG: Interrater reliability of the camberwell assessment of need short appraisal schedule. Aust N Z J Psychiatry. 2000, 34 (5): 856-861. 10.1080/j.1440-1614.2000.00814.x.CrossRefPubMed
20.
go back to reference Drukker M, van Os J, Bak M, à Campo J, Delespaul P: Systematic monitoring of needs for care and global outcomes in patients with severe mental illness.BMC Psychiatry 2010, 10:36., Drukker M, van Os J, Bak M, à Campo J, Delespaul P: Systematic monitoring of needs for care and global outcomes in patients with severe mental illness.BMC Psychiatry 2010, 10:36.,
21.
go back to reference Drukker M, Bak M, Campo à J, Driessen G, Van Os J, Delespaul P: The cumulative needs for care monitor: a unique monitoring system in the south of the Netherlands. Soc Psychiatry Psychiatr Epidemiol. 2010, 45 (4): 475-485. 10.1007/s00127-009-0088-3.CrossRefPubMed Drukker M, Bak M, Campo à J, Driessen G, Van Os J, Delespaul P: The cumulative needs for care monitor: a unique monitoring system in the south of the Netherlands. Soc Psychiatry Psychiatr Epidemiol. 2010, 45 (4): 475-485. 10.1007/s00127-009-0088-3.CrossRefPubMed
22.
go back to reference Oliver JP, Huxley PJ, Priebe S, Kaiser W: Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile. Soc Psychiatry Psychiatr Epidemiol. 1997, 32 (2): 76-83. 10.1007/BF00788924.CrossRefPubMed Oliver JP, Huxley PJ, Priebe S, Kaiser W: Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile. Soc Psychiatry Psychiatr Epidemiol. 1997, 32 (2): 76-83. 10.1007/BF00788924.CrossRefPubMed
23.
go back to reference Priebe S, Huxley P, Knight S, Evans S: Application and results of the Manchester Short Assessment of Quality of Life (MANSA). Int J Soc Psychiatry. 1999, 45 (1): 7-12. 10.1177/002076409904500102.CrossRefPubMed Priebe S, Huxley P, Knight S, Evans S: Application and results of the Manchester Short Assessment of Quality of Life (MANSA). Int J Soc Psychiatry. 1999, 45 (1): 7-12. 10.1177/002076409904500102.CrossRefPubMed
24.
go back to reference Van Os J, Delespaul PAEG, Radstake S, Hilwig M, Bak M, Driessen G: Kernparameters ter evaluatie van een zorgprogramma voor psychotische patiënten. MGV. 2001, 56: 952-966. Van Os J, Delespaul PAEG, Radstake S, Hilwig M, Bak M, Driessen G: Kernparameters ter evaluatie van een zorgprogramma voor psychotische patiënten. MGV. 2001, 56: 952-966.
25.
go back to reference Lyons JS: The Severity and Acuity of Psychiatric Illness Scales. An Outcomes Management and Decision Support System. Adult Version. Manual. 1998, The Psychological Corporation, Harcourt Brace & Company, San Antonio Lyons JS: The Severity and Acuity of Psychiatric Illness Scales. An Outcomes Management and Decision Support System. Adult Version. Manual. 1998, The Psychological Corporation, Harcourt Brace & Company, San Antonio
26.
go back to reference Mulder CL, Koopmans GT, Hengeveld MW: Lack of motivation for treatment in emergency psychiatric patients. Soc Psychiatry Psychiatr Epidemiol. 2005, 40: 484-488. 10.1007/s00127-005-0913-2.CrossRefPubMed Mulder CL, Koopmans GT, Hengeveld MW: Lack of motivation for treatment in emergency psychiatric patients. Soc Psychiatry Psychiatr Epidemiol. 2005, 40: 484-488. 10.1007/s00127-005-0913-2.CrossRefPubMed
27.
go back to reference Mulder CL, Jochems E, Kortrijk HE: The motivation paradox: higher psychosocial problem levels in severely mentally ill patients are associated with less motivation for treatment.Soc Psychiatry Psychiatr Epidemiol 2013, Epub ahead of print., Mulder CL, Jochems E, Kortrijk HE: The motivation paradox: higher psychosocial problem levels in severely mentally ill patients are associated with less motivation for treatment.Soc Psychiatry Psychiatr Epidemiol 2013, Epub ahead of print.,
28.
go back to reference Wing JK, Beevor AS, Curtis RH: Health of the Nation Outcome Scales (HoNOS); research and development. Br J Psychiatry. 1998, 172: 11-18. 10.1192/bjp.172.1.11.CrossRefPubMed Wing JK, Beevor AS, Curtis RH: Health of the Nation Outcome Scales (HoNOS); research and development. Br J Psychiatry. 1998, 172: 11-18. 10.1192/bjp.172.1.11.CrossRefPubMed
29.
go back to reference Mulder CL, Staring ABP, Loos J, Buwalda VJA, Kuijpers D, Sytema S, Wierdsma AI: De Health of the Nations Outcome Scales in Nederlandse vertaling. Psychometrische kenmerken. (The HoNOS in Dutch translation; Psychometrics). Dutch J Psychiatr. 2004, 46: 273-285. Mulder CL, Staring ABP, Loos J, Buwalda VJA, Kuijpers D, Sytema S, Wierdsma AI: De Health of the Nations Outcome Scales in Nederlandse vertaling. Psychometrische kenmerken. (The HoNOS in Dutch translation; Psychometrics). Dutch J Psychiatr. 2004, 46: 273-285.
30.
go back to reference Eisen SV, Ranganathan G, Seal P, Spiro A: Measuring clinically meaningful change following mental health treatment. J Behav Health Serv Res. 2007, 34 (3): 272-289. 10.1007/s11414-007-9066-2.CrossRefPubMed Eisen SV, Ranganathan G, Seal P, Spiro A: Measuring clinically meaningful change following mental health treatment. J Behav Health Serv Res. 2007, 34 (3): 272-289. 10.1007/s11414-007-9066-2.CrossRefPubMed
31.
go back to reference Crosby RD, Kolotkin RL, Williams GR: Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol. 2003, 56 (5): 395-407. 10.1016/S0895-4356(03)00044-1.CrossRefPubMed Crosby RD, Kolotkin RL, Williams GR: Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol. 2003, 56 (5): 395-407. 10.1016/S0895-4356(03)00044-1.CrossRefPubMed
32.
go back to reference McHorney CA, Tarlov AR: Individual-patient monitoring in clinical practice: are available health status surveys adequate?. Qual Life Res. 1995, 4 (4): 293-307. 10.1007/BF01593882.CrossRefPubMed McHorney CA, Tarlov AR: Individual-patient monitoring in clinical practice: are available health status surveys adequate?. Qual Life Res. 1995, 4 (4): 293-307. 10.1007/BF01593882.CrossRefPubMed
33.
go back to reference McGlinchey JB, Atkins DC, Jacobson NS: Clinical significance methods: which one to use and how useful are they?. Behav Ther. 2002, 33 (4): 529-550. 10.1016/S0005-7894(02)80015-6.CrossRef McGlinchey JB, Atkins DC, Jacobson NS: Clinical significance methods: which one to use and how useful are they?. Behav Ther. 2002, 33 (4): 529-550. 10.1016/S0005-7894(02)80015-6.CrossRef
34.
go back to reference Jacobson NS, Truax P: Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991, 59 (1): 12-19. 10.1037/0022-006X.59.1.12.CrossRefPubMed Jacobson NS, Truax P: Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991, 59 (1): 12-19. 10.1037/0022-006X.59.1.12.CrossRefPubMed
35.
36.
go back to reference Cohen J: Statistical power analysis for the behavioral sciences. 1988, Lawrence Earlbaum Associates, Hillsdale NJ Cohen J: Statistical power analysis for the behavioral sciences. 1988, Lawrence Earlbaum Associates, Hillsdale NJ
37.
go back to reference Staring AB, Van der Gaag M, Van den Berge M, Duivenvoorden HJ, Mulder CL: Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorders. Schizophr Res. 2009, 115 (2-3): 363-369. 10.1016/j.schres.2009.06.015.CrossRefPubMed Staring AB, Van der Gaag M, Van den Berge M, Duivenvoorden HJ, Mulder CL: Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorders. Schizophr Res. 2009, 115 (2-3): 363-369. 10.1016/j.schres.2009.06.015.CrossRefPubMed
38.
go back to reference Lambri M, Chakraborty A, Leavey G, King M: Quality of life and unmet need in people with psychosis in the London Borough of Haringey, UK.ScientificWorld J 2012, Epub., Lambri M, Chakraborty A, Leavey G, King M: Quality of life and unmet need in people with psychosis in the London Borough of Haringey, UK.ScientificWorld J 2012, Epub.,
39.
go back to reference Dixon L: Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Schizophr Res. 1999, 35 (1): 93-100. 10.1016/S0920-9964(98)00161-3.CrossRef Dixon L: Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Schizophr Res. 1999, 35 (1): 93-100. 10.1016/S0920-9964(98)00161-3.CrossRef
Metadata
Title
Changes in individual needs for care and quality of life in Assertive Community Treatment patients: an observational study
Authors
Hans E Kortrijk
Astrid M Kamperman
Cornelis L Mulder
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2014
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-014-0306-8

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