Community Treatment Orders: relationship to clinical care, medication compliance, behavioural disturbance and readmission

Objective: The objective of this study was to investigate the readmission r ate, and the level of patient disturbance and community care associated wit h readmission following Community Treatment Orders (CTOs) in New South Wale s, Australia. Method: The readmission rates of all patients given CTOs within a 4-year pe riod and a matched comparison group were investigated. The following factor s were compared before, during and following a CTO: medication non-complian ce, number of clinical services and duration of disturbed behaviour precedi ng hospitalisations. Results: Of 123 patients on CTOs (mean length, 288 days; SD, 210 days), 38 were readmitted during the CTO, the majority in the first 3 months and a fu rther 21 patients were readmitted following termination of the CTO. Evidenc e of lower severity of illness in the comparison patients prevented meaning ful evaluation of the readmission rates of the two groups. While on CTOs, p atients receiving depot medications showed high compliance and a significan tly reduced readmission rate compared with that of patients receiving oral medications. In the 2 months prior to hospitalisations during CTOs, compare d with those before or after CTOs, patients received more frequent consulta tions and showed a shorter duration of medication non-compliance and distur bed behaviour. The level of services in the 3 months following discharge we re comparable for patients on CTOs and the comparison group. Conclusions: CTOs may reduce rehospitalisations by use of depot medication. Earlier and possibly more frequent readmissions in the CTO group shortened the disturbance associated with illness recurrence. It would appear that t o establish a control group with equivalent severity of disorder necessary to evaluate the impact of CTOs requires a random allocation design.