与普通全科医生对常见精神障碍的常规护理相比，社区精神卫生护士进行的一般护理或解决问题治疗转诊的成本效益：随机对照试验。

Cost-effectiveness of referral for generic care or problem-solving treatment from community mental health nurses, compared with usual general practitioner care for common mental disorders: Randomised controlled trial.

作者信息

Kendrick T, Simons L, Mynors-Wallis L, Gray A, Lathlean J, Pickering R, Harris S, Rivero-Arias O, Gerard K, Thompson C

机构信息

Primary Medical Care Group, Community Clinical Sciences Division, University of Southampton School of Medicine, Aldermoor Health Centre, Southampton SO16 5ST, UK.

出版信息

Br J Psychiatry. 2006 Jul;189:50-9. doi: 10.1192/bjp.bp.105.012435.

DOI:10.1192/bjp.bp.105.012435

PMID:16816306

Abstract

BACKGROUND

UK general practitioners (GPs) refer patients with common mental disorders to community mental health nurses.

AIMS

To determine the effectiveness and cost-effectiveness of this practice.

METHOD

Randomised trial with three arms: usual GP care, generic mental health nurse care, and care from nurses trained in problem-solving treatment; 98 GPs in 62 practices referred 247 adult patients with new episodes of anxiety, depression and life difficulties, to 37 nurses.

RESULTS

There were 212 (86%) and 190 (77%) patients followed up at 8 and 26 weeks respectively. No significant differences between groups were found in effectiveness at either point. Mean differences in Clinical Interview Schedule - Revised scores at 26 weeks compared with GP care were -1.4 (95% CI -5.5 to 2.8) for generic nurse care, and 1.1 (-2.9 to 5.1) for nurse problem-solving. Satisfaction was significantly higher in both nurse-treated groups. Mean extra costs per patient were 283 pound (95% CI154-411) for generic nurse care, and 315 pound (183-481) for nurse problem-solving treatment.

CONCLUSIONS

GPs should not refer unselected patients with common mental disorders to specialist nurses. Problem-solving should be reserved for patients who have not responded to initial GP care.

摘要

背景

英国全科医生（GPs）将患有常见精神障碍的患者转介给社区精神科护士。

目的

确定这种做法的有效性和成本效益。

方法

采用三臂随机试验：常规全科医生护理、普通精神科护士护理以及接受过解决问题疗法培训的护士提供的护理；62家诊所的98名全科医生将247名患有焦虑、抑郁新发作和生活困难的成年患者转介给37名护士。

结果

分别有212名（86%）和190名（77%）患者在8周和26周时接受了随访。在这两个时间点，各组之间在有效性方面均未发现显著差异。与全科医生护理相比，普通护士护理在26周时临床访谈时间表修订版得分的平均差异为-1.4（95%可信区间-5.5至2.8），解决问题的护士护理为1.1（-2.9至5.1）。两个护士治疗组的满意度均显著更高。普通护士护理每位患者的平均额外费用为283英镑（95%可信区间154 - 411），解决问题的护士治疗为315英镑（183 - 481）。