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E u r o S c i C o n C o n f e r e n c e o n
PEDIATRICS
2017
Journal of Pediatric Care
ISSN 2471-805X
N o v e m b e r 1 3 - 1 4 , 2 0 1 7
L o n d o n , U K
Pediatrics 2017
Volume:3 Issue:4(Suppl) Page 20
Background: Clinical guidelines recommend intensive community treatment to
reduce dependency on adolescent psychiatric inpatient care, but no such provision
in the UK has been evaluated in a randomised controlled trial (RCT). We designed a
supported discharge service (SDS), an intensive community treatment team, and
compared this with treatment as usual (TAU).
Methods:106 patients younger than 18 years were admitted for inpatient care and
randomised (1:1) to either SDS or TAU. Intention-to-treat primary outcomes were
inpatient bed days, Strengths and Difficulties Questionnaire (SDQ) and Children’s
Global Assessment Scale (CGAS). Cost effectiveness was explored in terms of
CGAS scores and quality adjusted life years based on the EQ-5D-3L, taking a
health and social care perspective.
Findings: At six-month follow-up, there was a significant decline in hospital use
among patients randomised to SDS in unadjusted analyses (mean 47.25) vs
TAU (mean 84.32). The ratio of mean total of inpatient days of TAU to SDS was
1.67 (95% CI: 1.02 to 2.81), t (101) = 2.08, p=.04. However, in adjusted analyses,
considering baseline differences in inpatient bed days, treatment difference on the
log scale was no longer significant (-.05, 95%CI: -1.02 to .01, p=0.057). There were
no significant differences in SDQ, CGAS or treatment satisfaction. SDS patients
were significantly less likely to report multiple episodes of self-harm (OR = .18,
95% CI: .05 to .64) and more likely to reintegrate to community schools (.81 SDS
vs .51 TAU, OR= 4.14, 95% CI: 1.73 to 9.92). There was no evidence of differential
effect in patients with psychosis, severe disability or patients fromminority ethnic
groups. Cost-effectiveness acceptability curves based on both the CGAS and
QALYs suggested there was at least a 50% probability of SDS being cost effective.
Interpretation: The addition of SDS to adolescent inpatient care and standard
outpatient follow-up improved school reintegration and lowered the risk of
multiple self-harm. There is an implication of reduced bed usage at six-month
follow up, but this did not reach statistical significance after adjusting for baseline
differences. There were no differences in other clinical, functional and patient
satisfaction outcomes.
Biography
Dennis Ougrin graduated from a Medical School in Ukraine
in 1998 and underwent post-graduate training in England. He
completed his higher training in Child and Adolescent Psychi-
atry at Guy’s and Maudsley and is currently a Consultant Child
and Adolescent Psychiatrist leading Supported Discharge Ser-
vice at South London and Maudsley NHS Foundation Trust. He
is also a Clinical Senior Lecturer at the Institute of Psychiatry,
Psychology and Neuroscience. He leads a programme of infor-
mation exchange between the UK and Ukraine. His main pro-
fessional interests include prevention of Borderline Personality
Disorder and effective interventions for self-harm. He is the au-
thor of Therapeutic Assessment, a novel model of assessment
for young people with self-harm. He is the Chief Investigator of a
randomised controlled trial of Supported Discharge Service ver-
sus Treatment as Usual in adolescents admitted for in-patient
care and a Principal Investigator of a randomised controlled
trial comparing intensive mental health intervention versus usu-
al social care in Looked After Children. He is also working on
developing a modular psychotherapeutic intervention for self-
harm and on understanding the pathophysiology of self-harm
in young people
Intensive Community Treatment
versus Usual Treatment for
Adolescents Admitted to Inpatient
Care: a Randomised Controlled Trial
Dennis Ougrin, King’s College London, UK
Dennis Ougrin, J Pediatr Care 2017, 3:4(Suppl)
DOI: 10.21767/2471-805X-C1-001