Papageorgiou Alexia, King Michael, Janmohamed Anis, Davidson Oliver, Dawson John
Royal Free and University College Medical School, London, UK.
Br J Psychiatry. 2002 Dec;181:513-9. doi: 10.1192/bjp.181.6.513.
An advance directive is a statement of a person's preferences for treatment, should he or she lose capacity to make treatment decisions in the future.
To evaluate whether use of advance directives by patients with mental illness leads to lower rates of compulsory readmission to hospital.
In a randomised controlled trial in two psychiatric services in inner London, 156 in-patients about to be discharged from compulsory treatment under the Mental Health Act were recruited. The trial compared usual psychiatric care with usual care plus the completion of an advance directive. The primary outcome was the rate of compulsory readmission.
Fifteen patients (19%) in the intervention group and 16 (21%) in the control group were readmitted compulsorily within 1 year of discharge. There was no difference in the numbers of compulsory readmissions, numbers of patients readmitted voluntarily, days spent in hospital or satisfaction with psychiatric services.
Users' advance instruction directives had little observable impact on the outcome of care at 12 months.
预先指示是指一个人对未来失去做出治疗决定能力时的治疗偏好声明。
评估精神疾病患者使用预先指示是否会降低强制再次入院率。
在伦敦市中心两个精神科服务机构进行的一项随机对照试验中，招募了156名即将根据《精神健康法》结束强制治疗出院的住院患者。该试验将常规精神科护理与常规护理加完成一份预先指示进行了比较。主要结局是强制再次入院率。
干预组有15名患者（19%），对照组有16名患者（21%）在出院后1年内被强制再次入院。强制再次入院人数、自愿再次入院患者人数、住院天数或对精神科服务的满意度方面没有差异。
用户的预先指示指令在12个月时对护理结果几乎没有明显影响。
