Lloyd-Evans Brynmor, Slade Mike, Jagielska Dorota, Johnson Sonia
Department of Mental Health Sciences, University College London, Charles Bell House, London W1W 7EJ, UK.
Br J Psychiatry. 2009 Aug;195(2):109-17. doi: 10.1192/bjp.bp.108.058347.
Reducing use of hospital wards and improving their quality are central aims of mental health service policy. However, no comprehensive synthesis is available of evidence on residential alternatives to standard acute psychiatric wards.
To assess the effectiveness and cost-effectiveness of and satisfaction with residential alternatives to standard acute in-patient mental health services.
A systematic search identified controlled studies comparing residential alternatives with standard in-patient services. Studies were described and assessed for methodological quality. Results from higher quality studies are presented and discussed.
Twenty-seven relevant studies were identified. Nine studies of moderate quality provide no contraindication to identified alternative service models and limited preliminary evidence that community-based alternatives may be cheaper and individuals more satisfied than in standard acute wards.
More research is needed to establish the effectiveness of service models and target populations for residential alternatives to standard acute wards. Community-based residential crisis services may provide a feasible and acceptable alternative to hospital admission for some people with acute mental illness.
减少医院病房的使用并提高其质量是精神卫生服务政策的核心目标。然而，目前尚无关于标准急性精神科病房住院替代方案证据的全面综述。
评估标准急性住院精神卫生服务的住院替代方案的有效性、成本效益及满意度。
通过系统检索，确定了比较住院替代方案与标准住院服务的对照研究。对研究进行描述并评估其方法学质量。呈现并讨论了高质量研究的结果。
共识别出27项相关研究。9项中等质量的研究未对已确定的替代服务模式提出反证，并有有限的初步证据表明，基于社区的替代方案可能比标准急性病房更便宜，且患者满意度更高。
需要更多研究来确定标准急性病房住院替代方案的服务模式及目标人群的有效性。基于社区的住院危机服务可能为一些急性精神疾病患者提供一种可行且可接受的替代住院治疗的方案。
