横断面前瞻性研究：精神科急性病房的隔离、约束和非自愿药物治疗：患者、工作人员和病房特点。
A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics.
机构信息
SINTEF Health Services Research, PB 124, 0314 Oslo, Norway.
出版信息
BMC Health Serv Res. 2010 Apr 6;10:89. doi: 10.1186/1472-6963-10-89.
BACKGROUND
Previous research on mental health care has shown considerable differences in use of seclusion, restraint and involuntary medication among different wards and geographical areas. This study investigates to what extent use of seclusion, restraint and involuntary medication for involuntary admitted patients in Norwegian acute psychiatric wards is associated with patient, staff and ward characteristics. The study includes data from 32 acute psychiatric wards.
METHODS
Multilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization.
RESULTS
The total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint.
CONCLUSIONS
The substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors.
背景
先前的心理健康护理研究表明，不同病房和地理区域在使用隔离、约束和非自愿药物方面存在相当大的差异。本研究调查了挪威急性精神病病房中，非自愿入院患者使用隔离、约束和非自愿药物的情况在多大程度上与患者、工作人员和病房特征有关。该研究包括来自 32 个急性精神病病房的数据。
方法
使用 Stata 进行多水平逻辑回归分析，将数据与来自 1016 名非自愿入院患者的数据相关联，该样本包含两个层次（患者和病房），因变量有两个值（0=未使用和 1=使用）。强制性措施定义为住院期间使用隔离、约束和非自愿储药。
结果
非自愿入院患者总数为 1214 人（占总样本的 35%）。各病房使用强制性措施的患者比例从 0%到 88%不等。在非自愿入院患者中，有 424 人（35%）被隔离，117 人（10%）被约束，113 人（9%）在出院时接受了非自愿药物治疗。可以对 1016 名患者的数据进行多水平分析。在使用强制性措施方面存在很大的病房间差异；然而，这在一定程度上受到病房间构成差异的影响，特别是在约束的使用方面。
结论
即使在调整了患者个体精神病理学的情况下，病房之间仍存在很大的差异，这表明病房因素会影响隔离、约束和非自愿药物的使用，而且有些病房有提高质量的潜力。因此，减少隔离、约束和非自愿药物使用的干预措施应考虑组织和环境因素。
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