Oxford community treatment order evaluation trial (OCTET)

Burns, Tom and Rugkåsa, Jorun and Yeeles, Ksenija (2017). Oxford community treatment order evaluation trial (OCTET). [Data Collection]. Colchester, Essex: UK Data Archive. 10.5255/UKDA-SN-852414

Background Compulsory supervision outside hospital has been developed internationally for the treatment of mentally ill people following widespread deinstitutionalisation. Its efficacy has not been proven. Community Treatment Orders (CTOs) were introduced in England and Wales in 2008. Evidence for their effectiveness was equivocal, much of it based on non-randomised studies. Two prior randomised controlled trials (RCTs) found that it did not reduce hospital readmission. Little is known about patients’ or family carers’ perspectives. Objective The primary objective was to test the hypothesis that patients with psychosis and a history of compulsory admissions in the CTO arm of the trial would experience a reduction in relapses and thus readmissions to hospital compared to those in the non-CTO arm. Secondary and tertiary objectives were to investigate whether they would experience a greater delay to readmission, shorter admissions or improvements in clinical and social outcomes. Design The OCTET Trial was a single-outcome, parallel-arm, non-blinded randomised trial. Participants Participants were patients (aged 18-65) with psychosis diagnoses currently admitted involuntarily and considered for ongoing community treatment under supervision. Interventions Our aim was to compare CTO use to voluntary outpatient treatment. This was modified on the basis of the legal analysis. We randomised patients to leave hospital either on a CTO or via Section 17 Leave. There was an understanding that Section 17 Leave was to be restricted to a short period of days, or at most weeks, before discharge to voluntary care. Main outcome measures The trial primary outcome was psychiatric readmission. Secondary and tertiary outcomes included hospitalisation and a range of clinical and social measures. Procedure Patients were assessed at baseline, six and 12 months. The primary outcome was analysed with a log-binomial regression model adjusted for the stratification factors. All analyses were intention-to-treat.

Data description (abstract)

This collection contains data collected by independent researchers through individual interviews with patients and from their medical record at baseline (index), six months and at twelve months (365 days). 1. Data collected from medical record: diagnosis, psychiatric medication, depot medication, legal status over 12 months, hospital admissions, CTO conditions, recalls tribunals (MHRTs), manager hearings. 2. Data collected from patients through interviews: socio-demographic characteristics, substance abuse history (CAGE alcohol and CAGE drugs), criminal history, leverage interview, perceived coerciveness of treatment (MacArthur AES Perceived Coercion Scale), types of pressures (persuasion, inducements, compulsion, interpersonal leverage, threats), autonomy preferences (Psychiatric Autonomy Preference Index (API)), insight into illness and need for treatment (Insight and Treatment Attitude Questionnaire (ITAQ)), Compliance with treatment (at 6 and 12 months only), therapeutic relationship with care coordinator (Scale to Assess Therapeutic Relationship (STAR-P)), satisfaction with service (Client Satisfaction Questionnaire (CSQ-8)), quality of life (Health Related Quality of Life (EQ-5D)), capabilities (Oxford Capabilities Questionnaire (OxCAP-MH), use of services (Client Service Receipt Inventory (CSRI), attitude toward drug (Drug Attitude Inventory (DAI). 3. Researcher-rated data: severity of symptoms (Brief Psychiatric rating Scale (BPRS) and global functioning (GAF).

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