Strengths and limitations
psychiatric
PAD
The strengths of our study lie in our design and methodology. First, this research was deployed through seven psychiatric facilities, each with several services. The wide range of practices across these services reflects the diversity of practice in France. Between and within countries and regions, large variations have been found between services in rates of inpatient admissions and compulsion (Gandré This trial had several limitations. First among them is the short follow-up period. Given the short-term nature of PAD fulfilment, the uncertainty surrounding long-term use and long-term consequences on health utility of PADs and the limited impact of PADs on survival, the 12-month randomized controlled trial timeline was deemed appropriate to capture most of the relevant costs and benefits associated with the intervention. Most of the incremental cost of PW-PAD is spent in the first 3 months, so this intervention might become even more cost-effective after 1 year if participants receiving the intervention continue to improve more than those receiving usual care without additional costs.Second, we assumed the same costs for compulsory and standard hospitalizations. We may have underestimated the costs in the control group, although this reinforces the conservative costing approach. The accounting costs provided by French health agencies for hospitalization are not differentiated between compulsory or freely admitted patients, whereas compulsory hospitalization appears more expensive, especially at the beginning, often requiring more staff and special facilities such as isolation rooms (Flood Finally, discontinuation rates were around one-third in both groups. Unfortunately, the COVID-19 pandemic generated a crisis that suddenly widened the gap in access to healthcare, especially for vulnerable populations. Our attrition rates were mainly due to lost to follow-up in periods of lockdown.