• Philip Burgess, Jonathan Bindman, Morven Leese, Claire Henderson, and George Szmukler.
• The University of Queensland, Queensland Centre for Mental Health Research, Richlands, QLD, Australia.
• Soc Psychiatry Psychiatr Epidemiol. 2006 Jul 1; 41 (7): 574-9.

BackgroundIt has been suggested that community treatment orders (CTOs) will prevent readmission to hospital, but controlled studies have been inconclusive. We aimed to test the hypothesis that hospital discharges made subject to CTOs are associated with a reduced risk of readmission. The use of such a measure is likely to change after its introduction as clinicians acquire familiarity with it, and we also tested the hypothesis that the characteristics of patients subject to CTOs changed over time in the first decade of their use in Victoria, Australia.MethodA database from Victoria, Australia (total population 4.8 million) was used. Cox proportional hazard models compared the hazard ratios of readmission to hospital before the end of the study period (1992-2000) for 16,216 discharges subject to a CTO and 112,211 not subject to a CTO.ResultsCommunity treatment orders used on discharge from a first admission to hospital were associated with a higher risk of readmission, but CTOs following subsequent admissions were associated with lower readmission risk. The risk also declined over the study period.ConclusionsThe effect of using a CTO depends on the patient's history. At a population level their introduction may not reduce readmission to hospital. Their impact may change over time.Declaration Of InterestNone.

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