Merson S, Tyrer P, Onyett S, Lack S, Birkett P, Lynch S, Johnson T
Academic Unit of Psychiatry, St Charles' Hospital (St Mary's Hospital Medical School), London, UK.
Lancet. 1992 May 30;339(8805):1311-4. doi: 10.1016/0140-6736(92)91959-c.
In the UK, psychiatric care of patients with acute and chronic disorders has increasingly moved from hospital to the community. We have evaluated in a controlled trial patients with severe mental illness, who were assigned to early intervention by community services or to standard hospital treatment. 100 patients aged 16 to 65 years presenting as psychiatric emergencies to an inner London teaching hospital were randomly allocated to a multidisciplinary community-based team (n = 48) or conventional hospital-based psychiatric services (n = 52) and assessed over a 3-month period. Ratings of psychopathology and social functioning were made before treatment and after 2, 4, and 12 weeks by independent assessors. 85 patients completed all assessments, and all patients had evaluable data beyond 2 weeks. 3 patients died during the study, 2 from natural causes and 1 from an accident. Patients referred to the community service showed greater improvement in symptoms and were more satisfied with services than those in the hospital-based service. Patients treated in the hospital-based service spent eight times as many days as psychiatric inpatients as those treated in the community-based service. Patients both prefer and seem to benefit from community-based psychiatric care, and our early-intervention community service might be a good model for such care.
在英国，急慢性精神疾病患者的精神科护理越来越多地从医院转向社区。我们在一项对照试验中评估了重度精神疾病患者，这些患者被分配接受社区服务的早期干预或标准的医院治疗。100名年龄在16至65岁之间、以内伦敦教学医院精神科急诊形式就诊的患者被随机分配到一个多学科社区团队（n = 48）或传统的医院精神科服务组（n = 52），并在3个月的时间内进行评估。独立评估人员在治疗前以及治疗2周、4周和12周后对精神病理学和社会功能进行评分。85名患者完成了所有评估，所有患者在2周后都有可评估的数据。3名患者在研究期间死亡，2名死于自然原因，1名死于意外事故。转至社区服务的患者症状改善更大，对服务的满意度也高于接受医院服务的患者。接受医院服务治疗的患者作为精神科住院患者的天数是接受社区服务治疗患者的8倍。患者既倾向于接受社区精神科护理，而且似乎也从中受益，我们的早期干预社区服务可能是此类护理的一个良好模式。
