Service models

No.Primary review questions
1.2.1In people with psychosis and coexisting substance misuse, does an integrated service model (usually involving the model of assertive community treatment) when compared with an alternative management strategy lead to:

Critical outcomes:
  • Reduced mortality (all causes)
  • Reduced relapse rates (measured by exacerbation of symptoms requiring change in healthcare management)
  • Reduced substance misuse (however measured)
  • Improved global and social functioning (for example, employment, accommodation)
  • Improved subjective quality of life
  • Improved satisfaction with care
  • Reduced physical morbidity
Secondary outcomes:
  • Insight
  • Improved medication adherence
  • Improved access to services (reduced dropout)
  • Reduced relapse rates (measured by admission to hospital; number of bed days)
  • Improved mental state with respect to psychosis (for example, Positive and Negative Syndrome Schedule [PANSS])
  • Reduced offending behaviour.
Sub-question 1: What are the elements in an integrated service model that are most likely to be associated with better outcomes?

Sub-question 2: Are there any subgroups of people (for example, young people, BME groups) that benefit from some elements of the service model more than others?

Sub-question 3: Are there subgroups of people (for example, based on severity of substance misuse and severity of psychosis; young people, BME groups) who may benefit from alternatives strategies (non-integrated service models, serial treatment, for example)
1.2.2In people with psychosis and coexisting substance misuse, do the psychological/psychosocial interventions listed below (delivered within an integrated service model) when compared with an alternative management strategy lead to improved outcomes? (for outcomes see 1.2.1)
1.2.3In people with psychosis and coexisting substance misuse, does staffed accommodation when compared with an alternative management strategy lead to improved outcomes? (for outcomes see 1.2.1)

From: APPENDIX 6, ANALYTIC FRAMEWORK AND REVIEW QUESTIONS

Cover of Psychosis with Coexisting Substance Misuse
Psychosis with Coexisting Substance Misuse: Assessment and Management in Adults and Young People.
NICE Clinical Guidelines, No. 120.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2011.
Copyright © 2011, The British Psychological Society & The Royal College of Psychiatrists.

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