Cited by 106Healthcare Decision-Making and RestraintsPsychiatric care and mental health servicesSchizophrenia research and treatment

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A systematic review of the effect of community treatment orders on service use

Maughan, Daniel, Molodynski, Andrew, Rugkåsa, Jorun, Burns, Tom·2014·Social Psychiatry and Psychiatric Epidemiology

DOI 10.1007/s00127-013-0781-0

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Abstract

Purpose The evidence regarding community treatment order effectiveness has been conflicting. This systematic review aims to bring up to date the review performed by Churchill and colleagues in 2005 by assessing and interpreting evidence of CTO effectiveness defined by admission rates, number of inpatient days, community service use, and medication adherence published since 2006.Method Databases were searched to obtain relevant studies published from January 2006 to March 2013.Results 18 studies including one randomised controlled trial were included. There remains lack of evidence from randomised and non-randomised studies that CTOs are associated with or affected by admission rates, number of inpatient days or community service use. The most recent and largest RCT is included in this review and found no significant impact on admission rate (RR = 1.0, 95% CI 0.75-1.33) or number of days in hospital (IR = 0.90, 95% CI 0.65-1.26). Results from the two largest longitudinal datasets included in this review do not concur. Studies using the New York dataset found that CTOs were associated with reduced admission rates and inpatient days, while studies using the Victoria dataset generally found that they were associated with increased admission rates and inpatient days.Conclusion There is now robust evidence in the literature that CTOs have no significant effects on hospitalisation and other service use outcomes. Non-randomised studies continue to report conflicting results. Distinguishing between CTO recall and revocation and different patterns of community contact is needed in future research to ensure differentiation between CTO process and outcome.

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Authors: Maughan, D., Molodynski, A., Rugkåsa, J., & Burns, T.
Affiliations: Oxford Health NHS Foundation Trust (GB)
Akershus University Hospital (NO)
Corresponding author: Maughan, Daniel
ORCID: Maughan, Daniel
Molodynski, Andrew
Rugkåsa, Jorun
Venue: Social Psychiatry and Psychiatric Epidemiology
Publisher: Springer Science and Business Media LLC
Published: 2013-10-18
Volume: 49
Issue: 4
Pages: 651-663
ISSN: 0933-7954 (ISSN-L)
1433-9285
DOI: 10.1007/s00127-013-0781-0
OpenAlex: W2085305667
Cited by: 106
References: 44
Citations by year: 2026: 2 · 2025: 4 · 2024: 7 · 2023: 5 · 2022: 3 · 2021: 4 · 2020: 9 · 2019: 9 · 2018: 12 · 2017: 14 · 2016: 19 · 2015: 8 · 2014: 10
FWCI: 1.80
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute for Health and Care Research (RP-PG-0606-1006)
Topics: Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords: community treatment orders, psychiatric hospital admissions, inpatient days, medication adherence, community contacts
MeSH terms: Mental Disorders, Commitment of Persons with Psychiatric Disorders, Community Mental Health Services, Hospitalization, Humans, Antipsychotic Agents, Victoria, Treatment Outcome, Medication Adherence

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A systematic review of the effect of community treatment orders on service use

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