Gilbody S M, House A O, Sheldon T
NHS Centre for Reviews and Dissemination and Department of Health Studies, University of York.
Psychol Med. 2002 Nov;32(8):1345-56. doi: 10.1017/s0033291702006001.
Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments has been advocated as part of clinical care to aid the recognition of psychosocial problems, to inform clinical decision making, to monitor therapeutic response and to facilitate patient-doctor communication. However, their adoption is not without cost and the benefit of their use is unclear.
A systematic review was conducted. We sought experimental studies that examined the addition of routinely administered measures of HRQoL to care in both psychiatric and non-psychiatric settings. We searched the following databases: MEDLINE, EMBASE, CINAHL, PsycLIT and Cochrane Controlled Trials Register (to 2000). Data were extracted independently and a narrative synthesis of results was presented.
Nine randomized and quasi-randomized studies conducted in non-psychiatric settings were found. All the instruments used included an assessment of mental well-being, with specific questions relating to depression and anxiety. The routine feedback of these instruments had little impact on the recognition of mental disorders or on longer term psychosocial functioning. While clinicians welcomed the information these instruments imparted, their results were rarely incorporated into routine clinical decision making. No studies were found that examined the value of routine assessment and feedback of HRQoL or patient needs in specialist psychiatric care settings.
Routine HRQoL measurement is a costly exercise and there is no robust evidence to suggest that it is of benefit in improving psychosocial outcomes of patients managed in non-psychiatric settings. Major policy initiatives to increase the routine collection and use of outcome measures in psychiatric settings are unevaluated.
提倡将健康相关生活质量（HRQoL）和需求评估工具的常规管理作为临床护理的一部分，以帮助识别心理社会问题、为临床决策提供信息、监测治疗反应并促进医患沟通。然而，采用这些工具并非没有成本，其使用的益处尚不清楚。
进行了一项系统评价。我们寻找在精神科和非精神科环境中检验将HRQoL常规测量添加到护理中的实验研究。我们检索了以下数据库：MEDLINE、EMBASE、CINAHL、PsycLIT和Cochrane对照试验注册库（至2000年）。数据由独立提取，并对结果进行了叙述性综合。
在非精神科环境中进行了9项随机和半随机研究。所使用的所有工具都包括对心理健康的评估，有与抑郁和焦虑相关的特定问题。这些工具的常规反馈对精神障碍的识别或长期心理社会功能几乎没有影响。虽然临床医生欢迎这些工具提供的信息，但他们的结果很少被纳入常规临床决策。未发现有研究检验在专科精神科护理环境中HRQoL或患者需求的常规评估和反馈的价值。
常规HRQoL测量成本高昂，且没有有力证据表明其对改善非精神科环境中患者的心理社会结局有益。在精神科环境中增加常规收集和使用结局测量的重大政策举措尚未得到评估。
