Harrison Judy, Marshall Sarah, Marshall Pete, Marshall John, Creed Francis
Manchester Mental Health partnership and University of Manchester, Manchester, UK.
Soc Psychiatry Psychiatr Epidemiol. 2003 Oct;38(10):541-6. doi: 10.1007/s00127-003-0672-x.
Acute home treatment services, providing short-term intensive input as an alternative to in-patient admission, have been recommended by the Department of Health as part of a spectrum of care. The lack of research evidence for such services is in contrast to acute day hospital care which has been better researched, but not widely adopted. This paper compares the patients treated in a randomised controlled trial (RCT) of day hospital vs. in-patient care with patients treated several years later in the home treatment service which developed from the original acute day hospital.
In the original RCT, patients were randomised at the point of admission to day hospital or in-patient care. The home treatment sample consisted of a consecutive series of admissions. Severity of illness was assessed at admission using the Comprehensive Psychopathological Rating Scale (CPRS). Both samples were followed up for 12 months to monitor service use and costs.
Symptom severity among the home treatment sample (n = 71) was greater than the day hospital sample (n = 94) (mean CPRS score 31.6 vs. 25.5, p < 0.0001). This difference remained significant following adjustment for other socio-demographic and illness variables. Secondary care costs for the home treatment sample (including in-patient, home treatment and out-patient costs) were intermediate between the costs for the day hospital and in-patient samples from the RCT, but the differences were not statistically significant.
Extending the remit of an acute day hospital to provide 24-h care and a choice of treatment location is associated with an increase in the severity of illness treated. The impact on costs is unclear and the total cost of the new service may not be significantly less than in-patient care. The results need to be interpreted with caution because of differences in recruitment methods.
急性家庭治疗服务作为住院治疗的替代方案，提供短期密集干预，已被卫生部推荐为一系列护理服务的一部分。此类服务缺乏研究证据，这与已得到更好研究但未被广泛采用的急性日间医院护理形成对比。本文比较了在一项日间医院与住院护理的随机对照试验（RCT）中接受治疗的患者，以及数年后在由原急性日间医院发展而来的家庭治疗服务中接受治疗的患者。
在原RCT中，患者在入院时被随机分配至日间医院或住院护理。家庭治疗样本由一系列连续入院患者组成。入院时使用综合精神病理学评定量表（CPRS）评估疾病严重程度。对两个样本均进行了12个月的随访，以监测服务使用情况和成本。
家庭治疗样本（n = 71）中的症状严重程度高于日间医院样本（n = 94）（CPRS平均得分31.6对25.5，p < 0.0001）。在对其他社会人口统计学和疾病变量进行调整后，这种差异仍然显著。家庭治疗样本的二级护理成本（包括住院、家庭治疗和门诊成本）介于RCT中日间医院和住院样本的成本之间，但差异无统计学意义。
扩大急性日间医院的服务范围以提供24小时护理和治疗地点选择，与所治疗疾病严重程度的增加相关。对成本的影响尚不清楚，新服务的总成本可能并不显著低于住院护理。由于招募方法的差异，对结果的解释需谨慎。
