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Authors' reply

Published online by Cambridge University Press:  02 January 2018

Laura Castells-Aulet*
Affiliation:
Subacute Psychiatric Hospitalization, Benito Menni CASM, Sant Boi de Llobregat, Barcelona, Spain, email: lcastells@hospitalbenitomenni.org
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Abstract

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This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © Royal College of Psychiatrists, 2015

There is a lack of scientific evidence evaluating the efficacy of OPC Reference Kisely and Campbell1 and doubt around whether randomised controlled trials are realistically the best method of evaluating the impact of OPC. Reference Swanson and Swartz2 Our work is a retrospective case–control study, with all its limitations, and we welcome any contribution that could offer us some improvement for further studies.

Responding to the issues raised by Dr Mustafa, I would like to comment as follows.

First, we had considered in our study that there were differences in the motives for index admissions between the groups. In the OPC group the main reasons were clinical decompensation because of non-adherence to treatment (78%) and aggressive behaviour (22%). In the control group, admission occurred mainly because of clinical decompensation without a clear non-adherence to treatment (47%) and the reasons were inconsistent use of medication, changes in the pharmacological pattern or substance misuse. This could undermine the similarity of the two study groups and, therefore, the suitability for comparison.

Second, owing to the nature of the study, patients eligible for the control group were automatically excluded if within the subsequent 2 years of the study they were placed on OPC. Third, we agree there is a trend of reduced hospitalisation over the 4-year study period in both groups. This may have been driven by factors such as the improvement of community services or home services that could potentially confound the results of this study.

References

1 Kisely, S, Campbell, LA. Does compulsory or supervised community treatment reduce ‘revolving door’ care? Legislation is inconsistent with recent evidence. Br J Psychiatry 2007; 191: 373–4.Google Scholar
2 Swanson, JW, Swartz, MS. Why the evidence for outpatient commitment is good enough. Psychiatr Serv 2014; 65: 808–11.CrossRefGoogle ScholarPubMed
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