Oliver P C, Piachaud J, Tyrer P, Regan A, Dack M, Alexander R, Bakala A, Cooray S, Done D J, Rao B
Department of Psychological Medicine, Faculty of Medicine, Imperial College London, Paterson Centre, London, UK.
J Intellect Disabil Res. 2005 Jul;49(Pt 7):507-15. doi: 10.1111/j.1365-2788.2005.00706.x.
There has been a policy shift away from hospital to community in the services of all those with psychiatric disorders, including those with intellectual disability (ID), in the last 50 years. This has been accompanied recently by the growth of assertive outreach services, but these have not been evaluated in ID services.
In a randomized controlled trial we compared assertive outreach with 'standard' community care, using global assessment of function (GAF) as the primary outcome measure, and burden and quality of life as secondary measures.
We recruited 30 patients, considerably less than expected; no significant differences were found between the primary and secondary outcomes in the two groups. The differences were so small that a Type II error was unlikely.
Reasons for this lack of specific efficacy of the assertive approach are discussed and it is suggested that there is a blurring of the differences between standard and assertive approaches in practice.
在过去50年里，包括智障患者在内的所有精神疾病患者的服务政策已从医院转向社区。最近，积极外展服务有所增加，但这些服务尚未在智障服务中得到评估。
在一项随机对照试验中，我们将积极外展服务与“标准”社区护理进行了比较，以功能总体评估（GAF）作为主要结局指标，以负担和生活质量作为次要指标。
我们招募了30名患者，远低于预期；两组的主要和次要结局均未发现显著差异。差异非常小，不太可能出现II类错误。
讨论了积极方法缺乏特定疗效的原因，并表明在实践中标准方法和积极方法之间的差异变得模糊。
