Assertive Community Treatment for Patients Suffering From Substance Use Disorders

Substance Use Disorders Clinical Trial

Official title:

Assertive Community Treatment for Patients Suffering From Substance Use

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03623178
• Other study ID #: ID 2017-01087
• Status: Recruiting
• Start date: December 1, 2017
• Est. completion date: April 1, 2019

Study information

• Verified date: August 2018
• Source: University Hospital, Geneva
• Contact: Louise Penzenstadler, MD
• Phone: +41 22 3725750
• Email: Louise.E.Penzenstadler[@]hcuge.ch
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

According to the World Health Organization the population suffering from addiction problems is increasing. This population is characterized by multiple needs at the medico-psychosocial level. However, some of these patients, a particular subgroup that we are going to be interested in the so-called "high need" user group, find it difficult to access and stay in outpatient treatment programs. Persons with substance use disorder often present a chaotic use of the health system, including a high number of hospitalizations in times of crisis. These individuals also show very low utilization of health care services, accompanied by social marginalization. This can be related to relapses and poor social functioning. A high number of relapses occur particularly at the end of hospitalization. Community Interventions, such as Assertive Community Treatment (ACT) should increase the adherence of these patients to treatment by accompanying them in the community and helping them during sensitive and crisis periods. One of the objectives of the study is to evaluate the impact of ACT on the time until service disengagement, measuring treatment adherence. The secondary objectives of this study will be to see the effect of ACT on duration and type of hospitalizations, as well as the number of emergency room visits. The investigators will focus on the impact of ACT on the participant's medico-psycho-social network, substance use and other psychological variables. The investigators will also evaluate his or her psychiatric symptoms and global and social functioning. Life satisfaction and satisfaction with the care received will also be measured. The investigators will compare the population treated with ACT with sex, age and substance-matched controls which do not respond to ACT inclusion criteria chosen from new admissions of our addictology consultation. The study will investigate this through questionnaires at the beginning of care, at three months, six months and 12 months after the start of the ACT intervention.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 66
• Est. completion date: April 1, 2019
• Est. primary completion date: January 1, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Substance use disorder

• Competent subjects, able to give informed consent

• French speaking

Exclusion Criteria:

• Evidence of organic brain disease or learning disability based on the chart review.

Related Conditions & MeSH terms

• Substance Use Disorders
• Substance-Related Disorders

Intervention

Other:
• Assertive Community Treatment
The intervention program is a type of very flexible community treatment. This is facilitated by a small case load ratio per health care professional (1:10). The healthcare workers are specialized in SUD treatment. The time of the intervention differs, there is no prefixed limitation but the duration of the intervention depends on the goals agreed on with the patient. The main objective of this intervention is to ensure an adherence to an addiction treatment program and establish or consolidate a stable healthcare and social network for the patient. The intervention aims to prevent service disengagement. The healthcare workers will explore specific patient needs and ensure that health and social services are better coordinated to fit their needs.
• Treatment As Usual
The treatment as usual is the intervention given in our outpatient addictology unit. It consists of an individual treatment program at our outpatient unit with regular appointments with psychiatrists and nurses. The patient can also take part in therapeutic groups and receive help from a psychologist for a targeted program or psychotherapy. The multidisciplinary team also comprises a social worker and an occupational therapist.

Locations

Country	Name	City	State
Switzerland	Service d'addictologie, HUG	Geneva

Sponsors (1)

Lead Sponsor	Collaborator
University Hospital, Geneva

Country where clinical trial is conducted

Switzerland, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Patient satisfaction with Assertive Community Treatment	Patient satisfaction with Assertive Community Treatment (very satisfied, satisfied, more or less satisfied, not satisfied	at 3, 6, 12 months
Other	Duration of Assertive Community Treatment intervention	Daily contact log (Relevé quotidien des contacts (RQC)) in minutes spent with patient	at 12 months
Other	Type of Assertive Community Treatment intervention	Daily contact log (Relevé quotidien des contacts (RQC)): documentation of type of activity done with patient	at 12 months
Primary	Treatment adherence	Number of days until service disengagement	at 12 months
Secondary	Service use	Number of hospital admissions and number of days in hospital	at 12 months
Secondary	Patient network	Number of persons in network	0, 3, 6, 12 months
Secondary	Number of ER visits	Number of ER visits reviewed on patient file	0, 3, 6, 12 months
Secondary	Addictive behaviour	Alcohol, Smoking and Substance Involvement Screening Test (ASSIST. V.3 French)	0, 3, 6, 12 months
Secondary	General psychiatric symptoms	Health of Nation Outcome Scale - French version (HoNOS-F): scores 0 - 52 (higher score = more psychiatric symptoms)	0, 3, 6, 12 months
Secondary	Global Functioning	World Health Organization Disability Assessment Schedule (WHODAS)	0, 3, 6, 12 months
Secondary	General life satisfaction: Satisfaction With Life Scale	Satisfaction With Life Scale: scores 5 - 35 (higher score = higher life satisfaction)	0, 3, 6, 12 months
Secondary	Advance directives written by the participant	Advance directives written by the participant (yes - no)	at Baseline