Dixon Lisa, Goldberg Richard, Iannone Virginia, Lucksted Alicia, Brown Clayton, Kreyenbuhl Julie, Fang Lijuan, Potts Wendy
Department of Psychiatry, University of Maryland School of Medicine, 737 West Baltimore St., Baltimore, MD 21201, USA.
Psychiatr Serv. 2009 Apr;60(4):451-8. doi: 10.1176/ps.2009.60.4.451.
This study assessed the effectiveness of a brief three-month critical time intervention (B-CTI) model in improving continuity of psychiatric outpatient care for individuals with serious mental illness who are discharged from inpatient psychiatric treatment facilities.
A total of 135 consenting veterans who were diagnosed as having serious mental illness and were discharged from an acute inpatient unit were randomly assigned to receive either B-CTI or usual care. The three-month B-CTI intervention begins before discharge. A B-CTI clinician meets with the patient, assesses needs, and maintains a high level of patient contact after discharge. Participants completed interviews at baseline and three months later. Chart reviews provided data on service utilization in the six months postdischarge.
Compared with the control group, the B-CTI group had significantly fewer days between their hospital discharge and their first outpatient service. B-CTI participants were more likely to have had an outpatient visit and to have had more total mental health and substance abuse visits within 30 and 180 days of discharge. They had greater continuity of care as evidenced by a greater number of two-month blocks with two or more outpatient visits over 180 days. Participants in the B-CTI group reported receiving more help in making and keeping medical and mental health appointments, making family contact and community connections, and receiving information on prescribed medications.
This study provides evidence that a B-CTI targeted at the point of inpatient discharge can be helpful in promoting postdischarge continuity of care for persons with serious mental illness. The limited association of improved continuity of care with patient outcomes in this brief intervention demands further study.
本研究评估了一种为期三个月的简短关键时间干预（B-CTI）模式在改善从住院精神科治疗机构出院的严重精神疾病患者的精神科门诊护理连续性方面的有效性。
共有135名被诊断患有严重精神疾病且从急性住院病房出院的退伍军人同意参与研究，他们被随机分配接受B-CTI或常规护理。为期三个月的B-CTI干预在出院前开始。一名B-CTI临床医生与患者会面，评估需求，并在出院后与患者保持高度联系。参与者在基线时和三个月后完成访谈。病历审查提供了出院后六个月内服务利用的数据。
与对照组相比，B-CTI组从出院到首次门诊服务的间隔天数明显更少。B-CTI参与者在出院后30天和180天内更有可能进行门诊就诊，并且总的精神健康和药物滥用就诊次数更多。在180天内有更多两个月时间段内有两次或更多次门诊就诊，这证明他们的护理连续性更强。B-CTI组的参与者报告在安排和遵守医疗及精神健康预约、与家人联系和建立社区联系以及获取处方药信息方面得到了更多帮助。
本研究提供了证据表明，针对住院出院时的B-CTI有助于促进严重精神疾病患者出院后的护理连续性。在这种简短干预中，护理连续性改善与患者结局之间的有限关联需要进一步研究。
