O'Donnell M, Parker G, Proberts M, Matthews R, Fisher D, Johnson B, Hadzi-Pavlovic D
Psychiatry Unit, Prince of Wales Hospital, Randwick, New South Wales, Australia. o'
Aust N Z J Psychiatry. 1999 Oct;33(5):684-93. doi: 10.1080/j.1440-1614.1999.00629.x.
The study investigated the provision of client-focused services to community-based clients with schizophrenia and bipolar disorder. It hypothesised that the delivery of more client-focused services would improve client outcome in terms of functioning, disability and satisfaction with services. Client-focused services were developed using an empowerment model of case management and by the addition of consumer advocates.
Clients referred for case management were randomly allocated to one of three groups: standard case management (n = 35), client-focused case management (n = 39), or client-focused case management plus consumer advocacy (n = 45). Measures of functioning, disability, quality of life, burden of care and service satisfaction were measured at baseline and 12 months. Outcome data were collected concerning number and duration of hospital readmission, crisis intervention and compliance with treatment and services.
While there were no differences between the groups on quantitative measures of functioning, disability, quality of life, service satisfaction and burden of care, there were significant between-group differences on qualitative measures of satisfaction with services.
Several methodological difficulties hampered interpretation of the findings. Although clients did not differ on outcome measures of functioning and disability, the group receiving client-focused case management reported greater satisfaction with service delivery.
本研究调查了为社区中患有精神分裂症和双相情感障碍的患者提供以患者为中心的服务情况。研究假设，提供更多以患者为中心的服务将在功能、残疾状况以及对服务的满意度方面改善患者的治疗效果。以患者为中心的服务是通过采用赋权式个案管理模式并增加消费者权益倡导者来制定的。
被转介接受个案管理的患者被随机分配到三组中的一组：标准个案管理组（n = 35）、以患者为中心的个案管理组（n = 39）或以患者为中心的个案管理加消费者权益倡导组（n = 45）。在基线期和12个月时测量功能、残疾状况、生活质量、护理负担和服务满意度。收集了关于再次住院的次数和时长、危机干预以及对治疗和服务的依从性的结果数据。
虽然在功能、残疾状况、生活质量、服务满意度和护理负担的定量测量方面，各组之间没有差异，但在对服务满意度的定性测量方面，组间存在显著差异。
一些方法学上的困难妨碍了对研究结果的解读。虽然患者在功能和残疾状况的结果测量上没有差异，但接受以患者为中心的个案管理的组对服务提供的满意度更高。
