A comparison of health service use in two jurisdictions with and without compulsory community treatment

Kisely, Stephen, Smith, Mark, Preston, Neil J. and Xiao, Jianguo (2005) A comparison of health service use in two jurisdictions with and without compulsory community treatment. Psychological Medicine, 35 9: 1357-1367. doi:10.1017/S0033291705004824

Author Kisely, Stephen
Smith, Mark
Preston, Neil J.
Xiao, Jianguo
Title A comparison of health service use in two jurisdictions with and without compulsory community treatment
Journal name Psychological Medicine   Check publisher's open access policy
ISSN 1469-8978
Publication date 2005-09
Sub-type Article (original research)
DOI 10.1017/S0033291705004824
Volume 35
Issue 9
Start page 1357
End page 1367
Total pages 11
Place of publication Cambridge, England
Publisher Cambridge University Press
Language eng
Subject 111708 Health and Community Services
111711 Health Information Systems (incl. Surveillance)
111799 Public Health and Health Services not elsewhere classified
Formatted abstract
Background. This study examines whether community treatment orders (CTOs) reduce psychiatric admission rates or bed-days for patients from Western Australia compared to control patients from a jurisdiction without this legislation (Nova Scotia).

Method. A population-based record linkage analysis of an inception cohort using a two-stage design of matching and multivariate analyses to control for sociodemographics, clinical features and psychiatric history. All discharges from in-patient psychiatric services in Western Australia and Nova Scotia were included covering a population of 2·6 million people. Patients on CTOs in the first year of implementation in Western Australia were compared with controls from Nova Scotia matched on date of discharge from in-patient care, demographics, diagnosis and past in-patient psychiatric history. We analysed time to admission using Cox regression analyses and number of bed-days using logistic regression.

Results. We matched 196 CTO cases with an equal number of controls. On survival analyses, CTO cases had a significantly greater readmission rate. Co-morbid personality disorder and previous psychiatric history were also associated with readmission. However, on logistic regression, patients on CTOs spent less time in hospital in the following year, with reduced in-patient stays of over 100 days.

Conclusions. Although compulsory community treatment does not reduce hospital admission rates, increased surveillance of patients on CTOs may lead to earlier intervention such as admission, so reducing length of hospital stay. However, we do not know if it is the intensity of treatment, or its compulsory nature, that effects outcome.
Keyword Involuntary Outpatient Commitment
Australian psychiatric patients
Abdominal Aortic-aneurysm
Linked mental health
Western Australia
Treatment orders
Offender databases
Record linkage
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Health and Rehabilitation Sciences Publications
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Citation counts: TR Web of Science Citation Count  Cited 14 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 18 Nov 2009, 12:21:37 EST