CPG for Psychosocial Interventions in Severe Mental ... - GuíaSalud

This CPG development group considers that the impact of the implementation of ACT teams
must be high because it would improve the care of patients who, if this service did not exist,
would not be attended by the system (they are left outside), and would permit providing more
efficient care for those patients who overload the short-stay units. People with SMI constitute a
relatively small population but they represent a considerable burden for the Spanish NHS and for
their families.
The specific problems of the design of this type of studies to assess the service level interventions
are related to the following difficulties:
• The difficulty in defining these interventions with precision.
• Variations relating to the application of one same model (or fidelity to the model).
• Variations between different settings and different moments, with respect to standard care
with respect to what it is compared with.
• The frequency with which some interventions and others overlap depending on the place.
5.3.1. Day Centres and/or Psychosocial Rehabilitation Centres
No randomised clinical trials have been found that assess these services 206
5.3.2. Community Mental Health Centres (CMHC)
CMHC vs. ST
Use of services
SR (1-)
In the NICE schizophrenia CPG 8 , it indicates that there is insufficient evidence
to determine if the CMHCs reduce hospital admissions when compared
with standard treatment (n = 100; RR = 0.711; 95% CI: between 0.42
to 1.19 and n = 155; RR = 0.88; 95% CI: between 0.76 and 1.01) These
results agree with those found in the SR by Malone et al 204 (n= 587; 3 RCT;
RR = 0.81; 95% CI: between 0.7 and 1.0).
No differences have been found, either, with respect to the use of
emergency services (n = 587; 3 RCT; RR = 0.86; 95% CI: between 0.7 and
1.1) or respect to the reduction of contacts with Primary Care (n = 587; 3
RCTs; RR = 0.94, 95% CI: between 0.8 and 1.1) 204 .
Deaths
SR (1-)
There is not sufficient evidence to determine if the CMHC are associated
with a reduction in the death ratios (n = 100; RR = 0.54, 95% CI: between
0.5 and 5.78; and n = 155; RR = 0.89; 95% CI: between 0.06 and 13.98) 8 .
It has not been found either in the SR by Malone et al 204 (n = 587; 3 RCT;
RR = 0.47; 95% CI: between 0.2 and 1.3) in the medium term assessment
(3 to 12 months).
96 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS