Timko C, Yu K, Moos R H
Center for Health Care Evaluation, Department of Veterans Affairs Health Care System (152-MPD), 795 Willow Road, Menlo Park, CA 94025, USA.
J Subst Abuse. 2000;12(4):387-403. doi: 10.1016/s0899-3289(01)00056-6.
This study examined the objective demand characteristics of treatment programs in which substance abuse patients, or psychiatric patients, were residing. It also examined associations of objective demand with substance abuse patients' perceived expectations for functioning during treatment and patients' in-program participation.
A total of 994 patients living in 79 programs took part.
When patients had a substance abuse rather than a psychiatric problem, objective demand was higher: program policies had higher requirements for functioning and more resident control; programs offered fewer health-treatment services; and the physical design provided fewer safety features and social-recreational aids. Compared to substance abuse patients in low-demand programs, patients in high-demand programs perceived the program to have higher expectations, in that the treatment climate exerted more press to develop relationships, set goals, and be organized. Patients in high-demand programs engaged more in self-initiated activities and participated more in treatment services and program-organized events. Substance abuse patients' activity and participation levels were determined jointly by the level of demand and by the expectations for patients' expressiveness and self-understanding of their personal problems.
The findings illustrate the importance of considering objective indices of demand in conjunction with perceived expectations to improve patients' treatment outcomes.
本研究考察了收治药物滥用患者或精神疾病患者的治疗项目的客观需求特征。同时也考察了客观需求与药物滥用患者对治疗期间功能的预期以及患者在项目中的参与度之间的关联。
共有来自79个项目的994名患者参与。
当患者存在药物滥用而非精神疾病问题时，客观需求更高：项目政策对功能有更高要求且居民控制更多；项目提供的健康治疗服务更少；建筑设计提供的安全设施和社会娱乐辅助更少。与低需求项目中的药物滥用患者相比，高需求项目中的患者认为项目有更高的期望，即治疗氛围对建立人际关系、设定目标和保持条理施加了更大压力。高需求项目中的患者更多地参与自发活动，更多地参与治疗服务和项目组织的活动。药物滥用患者的活动和参与水平由需求水平以及对患者表达能力和对自身问题自我理解的期望共同决定。
研究结果表明，结合感知到的期望来考虑客观需求指标对于改善患者的治疗效果具有重要意义。
