精神病医院规模缩减：当前及已出院长期住院患者的护理与服务需求

Downsizing psychiatric hospitals: needs for care and services of current and discharged long-stay inpatients.

作者信息

Lesage A D, Morissette R, Fortier L, Reinharz D, Contandriopoulos A P

机构信息

Centre de recherche Fernand-Seguin, Hôpital Louis-H Lafontaine, QC.

出版信息

Can J Psychiatry. 2000 Aug;45(6):526-32. doi: 10.1177/070674370004500602.

DOI:10.1177/070674370004500602

PMID:10986569

Abstract

BACKGROUND

With the psychiatric deinstitutionalization movement in its fourth decade, questions are being raised concerning its relevance for long-stay inpatients with severe disabilities and the risk that those discharged into the community may be abandoned.

METHODS

A random sample taken in 1989 of long-stay inpatients at Louis-H Lafontaine Hospital made it possible to examine 96 pairs of patients. Each pair included 1 patient discharged between 1989 and 1998 and 1 patient hospitalized. Pairs were matched for sex, age, length of stay, and level of psychiatric care in 1989. Patients and staff were interviewed using standardized questionnaires, and case notes were reviewed to assess symptoms, daily living skills, residential status, quality of residential setting, and clinical and social problems and needs.

RESULTS

The investigation revealed that discharged patients moved to highly supervised settings, which included professionally supervised group homes, supervised hostels, and foster families. About 20% went to nursing homes owing to loss of autonomy from physical disorders. Only 4 discharged patients were lost to follow-up, of whom 2 were probable vagrants. Both those discharged and those remaining as inpatients presented with major clinical problems and daily living skill deficits. The care needs of discharged patients were generally met, and placement in the community was considered appropriate. Of those who had remained hospitalized, over one-half could be moved to supervised settings immediately, or after 1 to 2 years' preparation in a discharge unit, while 13% could be moved to nursing homes. Over 25% required intensive, individualized rehabilitation treatment targeting engagement, psychotic symptoms, withdrawal, and dangerous and socially embarrassing behaviours.

CONCLUSION

Deinstitutionalization in the largest Canadian psychiatric hospital did not lead to patient abandonment in the community.

摘要

背景

随着精神科去机构化运动进入第四个十年，人们开始质疑其对于重度残疾长期住院患者的适用性，以及那些被社区接纳的患者可能被遗弃的风险。

方法

1989年从路易斯 - H·拉方丹医院的长期住院患者中随机抽取样本，得以对96对患者进行研究。每对包括一名在1989年至1998年间出院的患者和一名仍住院的患者。根据1989年的性别、年龄、住院时长以及精神科护理水平对配对患者进行匹配。使用标准化问卷对患者和工作人员进行访谈，并查阅病历以评估症状、日常生活技能、居住状况、居住环境质量以及临床和社会问题与需求。

结果

调查显示，出院患者转移至监管严格的环境，包括专业监管的集体之家、监管宿舍和寄养家庭。约20%的患者因身体疾病导致自主能力丧失而进入养老院。仅有4名出院患者失访，其中2名可能沦为流浪汉。出院患者和住院患者均存在重大临床问题和日常生活技能缺陷。出院患者的护理需求总体上得到满足，且社区安置被认为是合适的。在仍住院的患者中，超过一半的患者可立即转移至监管环境，或在出院单元经过1至2年的准备后转移，而13%的患者可转移至养老院。超过25%的患者需要针对参与度、精神病症状、退缩行为以及危险和社会尴尬行为进行强化、个性化的康复治疗。