Kitcheman J, Adams C E, Pervaiz A, Kader I, Mohandas D, Brookes G
Academic Department of Psychiatry and Behavioural Sciences, University of Leeds, Leeds, UK.
Psychol Med. 2008 May;38(5):717-23. doi: 10.1017/S0033291707001766. Epub 2007 Oct 15.
The aim was to reduce non-attendance for first-time consultations at psychiatric out-patient clinics.
The study was a pragmatic randomized controlled trial; the setting was seven inner-city UK out-patient clinics in Leeds. The participants were 764 subjects of working age with an appointment to attend a psychiatric out-patient clinic for the first time. The intervention was an 'orientation statement' letter delivered 24-48 h before the first appointment compared with standard care. The primary outcome measure was attendance at the first appointment; secondary outcomes included hospitalization, transfer of care, continuing attendance, discharge, presentation at accident and emergency and death by 1 year.
Follow-up was for 763 out of 764 subjects (>99%) for primary and for 755 out of 764 subjects (98.8%) of secondary outcome data. The orientation statement significantly reduced the numbers of people failing to attend [79 out of 388 v. 101 out of 376 subjects, relative risk 0.76, 95% confidence interval (CI) 0.59-0.98, number needed to treat 16, 95% CI 10-187].
Prompting people to go to psychiatric out-patient clinics for the first time encourages them to attend. Pragmatic trials within a busy working environment are possible and informative.
旨在减少精神科门诊首次咨询的未就诊率。
该研究为一项实用的随机对照试验；研究地点为英国利兹市的7家市中心门诊诊所。参与者为764名处于工作年龄、首次预约前往精神科门诊就诊的受试者。干预措施为在首次预约前24 - 48小时发送一封“说明信”，并与标准护理进行比较。主要结局指标为首次预约时的就诊情况；次要结局包括住院治疗、护理转接、持续就诊、出院、急诊就诊以及1年内的死亡情况。
764名受试者中有763名（>99%）纳入主要结局随访，764名受试者中有755名（98.8%）纳入次要结局数据随访。说明信显著减少了未就诊人数[388名受试者中有79名未就诊，376名受试者中有101名未就诊，相对风险0.76，95%置信区间（CI）0.59 - 0.98，需治疗人数16，95% CI 10 - 187]。
促使人们首次前往精神科门诊就诊能鼓励他们按时就诊。在繁忙的工作环境中开展实用试验是可行且能提供有用信息的。
