In pursuit of the added value of Intensive Home Treatment: The effects and costs of outpatient care for patients experiencing an acute psychiatric crisis

Mental disorders are of concern because of their high prevalence rate, the burden of the disease and the attendant high social expenditure. Hospitalisation has been the standard care modality for people with mental disorders who experience an acute psychiatric crisis, a situation in which the severity of someone’s current clinical problems, social problems, and associated risk factors necessitates acute admission to a psychiatric ward. Nevertheless, there is an extensive history of attempting to avoid hospitalising patients when treating an acute psychiatric crisis. Intensive Home Treatment (IHT) is one of the more recent care modalities that focuses on stabilising acute psychiatric crises in order to either prevent hospitalisation or facilitate early discharge from hospital. In order to widely implement IHT as an alternative to acute hospital care, high-quality evidence from randomised controlled trials (RCTs) was needed to evaluate both its therapeutic effectiveness and cost-effectiveness. Therefore, it is important to assess both the effects and costs of IHT in comparison to care as usual (CAU), and evaluate the added value of IHT for both patients and mental healthcare. Patients experiencing an acute psychiatric crisis severe enough to be considered for hospital admission by a psychiatrist, were pre-randomised to the treatment group IHT or CAU. Between November 2016 and November 2018, patients were recruited from either the psychiatric emergency service or inpatient wards in Amsterdam. In total, 246 patients participated in the RCT, which resulted in the several studies that are presented in this thesis

In pursuit of the added value of Intensive Home Treatment: The effects and costs of outpatient care for patients experiencing an acute psychiatric crisis

Mental disorders are of concern because of their high prevalence rate, the burden of the disease and the attendant high social expenditure. Hospitalisation has been the standard care modality for people with mental disorders who experience an acute psychiatric crisis, a situation in which the severity of someone’s current clinical problems, social problems, and associated risk factors necessitates acute admission to a psychiatric ward. Nevertheless, there is an extensive history of attempting to avoid hospitalising patients when treating an acute psychiatric crisis. Intensive Home Treatment (IHT) is one of the more recent care modalities that focuses on stabilising acute psychiatric crises in order to either prevent hospitalisation or facilitate early discharge from hospital. In order to widely implement IHT as an alternative to acute hospital care, high-quality evidence from randomised controlled trials (RCTs) was needed to evaluate both its therapeutic effectiveness and cost-effectiveness. Therefore, it is important to assess both the effects and costs of IHT in comparison to care as usual (CAU), and evaluate the added value of IHT for both patients and mental healthcare. Patients experiencing an acute psychiatric crisis severe enough to be considered for hospital admission by a psychiatrist, were pre-randomised to the treatment group IHT or CAU. Between November 2016 and November 2018, patients were recruited from either the psychiatric emergency service or inpatient wards in Amsterdam. In total, 246 patients participated in the RCT, which resulted in the several studies that are presented in this thesis

Beeldzorg bevorderen: een kwestie van ervaring opdoen

Beeldzorg is zorg verlenen op afstand, via een beeldscherm. Deze technologie wordt in Nederland nog maar mondjesmaat toegepast. Een belangrijke oorzaak daarvan is weerstand onder professionals. Het lectoraat Vraaggestuurde Zorg heeft onderzocht waar deze weerstand vandaag komt en hoe die overwonnen kan worden. Weerstand tegen beeldzorg komt vooral voort uit onbekendheid met de gebruiksvoorwaarden en het nut voor de cliënt. Daar kunnen thuiszorg- en onderwijsinstellingen iets aan doen

eHealth technology competencies for health professionals working in home care to support older adults to age in place:outcomes of a two-day collaborative workshop

\u3cp\u3eBackground: The demand for care is increasing, whereas in the near future the number of people working in professional care will not match with the demand for care. eHealth technology can help to meet the growing demand for care. Despite the apparent positive effects of eHealth technology, there are still barriers to technology adoption related to the absence of a composite set of knowledge and skills among health care professionals regarding the use of eHealth technology. Objective: The objective of this paper is to discuss the competencies required by health care professionals working in home care, with eHealth technologies such as remote telecare and ambient assisted living (AAL), mobile health, and fall detection systems. Methods: A two-day collaborative workshop was undertaken with academics across multiple disciplines with experience in working on funded research regarding the application and development of technologies to support older people. Results: The findings revealed that health care professionals working in home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in eHealth care. This paper argues that eHealth care technology skills must be instilled in health care professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age in place. Educating health care professionals with the necessary skill training in eHealth care will improve service delivery and optimise the eHealth care potential to reduce costs by improving efficiency. Moreover, embedding eHealth care competencies within training and education for health care professionals ensures that the benefits of new technologies are realized by casting them in the context of the larger system of care. These care improvements will potentially support the independent living of older persons at home. Conclusions: This paper describes the health care professionals' competencies and requirements needed for the use of eHealth technologies to support elderly adults to age in place. In addition, this paper underscores the need for further discussion of the changing role of health care professionals working in home care within the context of emerging eHealth care technologies. The findings are of value to local and central government, health care professionals, service delivery organizations, and commissioners of care to use this paper as a framework to conduct and develop competencies for health care professionals working with eHealth technologies.\u3c/p\u3

Dutch Nurses’ Willingness to Use Home Telehealth: Implications for Practice and Education

Home telehealth (HT) refers to the use of videoconferencing to provide care to patients remotely and can help older adults age in place. However, these technologies are unlikely to impact care unless health care providers are motivated to use them. Education may play a key role in increasing motivation to use and competence regarding HT. To help guide the development of nursing education to facilitate adoption and use, the current study examined predictors of Dutch nurses’ willingness to use HT, based on a survey of 67 Dutch nurses with and 126 without HT experience. Nurses’ willingness to use this technology was predicted by HT’s (a) perceived usefulness to the client, (b) effort expectancy, (c) social influence, and (d) cost expectations. These observed relationships are anticipated to help with the development of effective educational programs to increase HT use and, therefore, improve older adults’ quality of life

Exploring factors influencing U.S. nurses' willingness to use telehealth technology

Telehealth technologies have the potential to increase access to care and better manage older adults’ chronic conditions, yet will only be effective to the extent that healthcare providers are willing to use them. We examined predictors of nurses’ (N = 67) willingness to use telehealth in the context of three models: the Unified Theory of Acceptance and Use of Technology (UTAUT, Venkatesh et al., 2012), the technology acceptance model of the Center for Research and Education on Aging and Technology Enhancement (Czaja et al. 2006), and a combined model. The strongest predictor of willingness to use was the belief that telehealth would improve job performance (β = .46, p < .001); beliefs about how much effort telehealth requires was also a strong predictor (β = .27, p < .05). Willingness to use was also related to social influences and privacy concerns. Results inform potential interventions to boost telehealth use

The effects of intensive home treatment on self-efficacy in patients recovering from a psychiatric crisis

Background: This study evaluated whether providing intensive home treatment (IHT) to patients experiencing a psychiatric crisis has more effect on self-efficacy when compared to care as usual (CAU). Self-efficacy is a psychological concept closely related to one of the aims of IHT. Additionally, differential effects on self-efficacy among patients with different mental disorders and associations between self-efficacy and symptomatic recovery or quality of life were examined. Methods: Data stem from a Zelen double consent randomised controlled trial (RCT), which assesses the effects of IHT compared to CAU on patients who experienced a psychiatric crisis. Data were collected at baseline, 6 and 26 weeks follow-up. Self-efficacy was measured using the Mental Health Confidence Scale. The 5-dimensional EuroQol instrument and the Brief Psychiatric Rating Scale (BPRS) were used to measure quality of life and symptomatic recovery, respectively. We used linear mixed modelling to estimate the associations with self-efficacy. Results: Data of 142 participants were used. Overall, no difference between IHT and CAU was found with respect to self-efficacy (B = − 0.08, SE = 0.15, p = 0.57), and self-efficacy did not change over the period of 26 weeks (B = − 0.01, SE = 0.12, t (103.95) = − 0.06, p = 0.95). However, differential effects on self-efficacy over time were found for patients with different mental disorders (F(8, 219.33) = 3.75, p < 0.001). Additionally, self-efficacy was strongly associated with symptomatic recovery (total BPRS B = − 0.10, SE = 0.02, p < 0.00) and quality of life (B = 0.14, SE = 0.01, p < 0.001). Conclusions: Although self-efficacy was associated with symptomatic recovery and quality of life, IHT does not have a supplementary effect on self-efficacy when compared to CAU. This result raises the question whether, and how, crisis care could be adapted to enhance self-efficacy, keeping in mind the development of self-efficacy in depressive, bipolar, personality, and schizophrenia spectrum and other psychotic disorders. The findings should be considered with some caution. This study lacked sufficient power to test small changes in self-efficacy and some mental disorders had a small sample size. Trial registration This trial is registered at Trialregister.nl, number NL6020

Intensive home treatment for patients in acute psychiatric crisis situations:A multicentre randomized controlled trial

Hospitalization is a common method to intensify care for patients experiencing a psychiatric crisis. A short-term, specialised, out-patient crisis intervention by a Crisis Resolution Team (CRT) in the Netherlands, called Intensive Home Treatment (IHT), is a viable intervention which may help reduce hospital admission days. However, research on the (cost-)effectiveness of alternatives to hospitalisation such as IHT are scarce. In the study presented in this protocol, IHT will be compared to care-as-usual (CAU) in a randomized controlled trial (RCT). CAU comprises low-intensity outpatient care and hospitalisation if necessary. In this RCT it is hypothesized that IHT will reduce inpatient days by 33% compared to CAU while safety and clinical outcomes will be non-inferior. Secondary hypotheses are that treatment satisfaction of patients and their relatives are expected to be higher in the IHT condition compared to CAU. A 2-centre, 2-arm Zelen double consent RCT will be employed. Participants will be recruited in the Amsterdam area, the Netherlands. Clinical assessments will be carried out at baseline and at 6, 26 and 52 weeks post treatment allocation. The primary outcome measure is the number of admission days. Secondary outcomes include psychological well-being, safety and patients' and their relatives' treatment satisfaction. Alongside this RCT an economic evaluation will be carried out to assess the cost-effectiveness and cost-utility of IHT compared to CAU. RCTs on the effectiveness of crisis treatment in psychiatry are scarce and including patients in studies performed in acute psychiatric crisis care is a challenge due to the ethical and practical hurdles. The Zelen design may offer a feasible opportunity to carry out such an RCT. If our study finds that IHT is a safe and cost-effective alternative for CAU it may help support a further decrease of in-patient bed days and may foster the widespread implementation of IHT by mental health care organisations internationally. The trial is registered in the Netherlands Trial Register as # NTR-6151 . Registered 23 November 201