Department of Psychiatry, University of Stellenbosch, Tygerberg, South Africa.
BMC Psychiatry. 2010 Sep 15;10:73. doi: 10.1186/1471-244X-10-73.
A number of recently published randomized controlled trials conducted in developed countries have reported no advantage for assertive interventions over standard care models. One possible explanation could be that so-called "standard care" has become more comprehensive in recent years, incorporating some of the salient aspects of assertive models in its modus operandi. Our study represents the first randomised controlled trial assessing the effect of a modified assertive treatment service on readmission rates and other measures of outcome in a developing country.
High frequency service users were randomized into an intervention (n = 34) and a control (n = 26) group. The control group received standard community care and the active group an assertive intervention based on a modified version of the international model of assertive community treatment. Study visits were conducted at baseline and 12 months with demographic and illness information collected at visit 1 and readmission rates documented at study end. Symptomatology and functioning were measured at both visits using the PANSS, CDSS, ESRS, WHO-QOL and SOFAS.
At 12 month follow-up subjects receiving the assertive intervention had significantly lower total PANSS (p = 0.02) as well as positive (p < 0.01) and general psychopathology (p = 0.01) subscales' scores. The mean SOFAS score was also significantly higher (p = 0.02) and the mean number of psychiatric admissions significantly lower (p < 0.01) in the intervention group.
Our results indicate that assertive interventions in a developing setting where standard community mental services are often under resourced can produce significant outcomes. Furthermore, these interventions need not be as expensive and comprehensive as international, first-world models in order to reduce inpatient days, improve psychopathology and overall levels of functioning in patients with severe mental illness.
一些最近在发达国家进行的随机对照试验报告称，果断干预措施并不优于标准护理模式。一种可能的解释是，所谓的“标准护理”近年来变得更加全面，在其运作模式中纳入了果断模型的一些显著方面。我们的研究代表了第一个在发展中国家评估改良果断治疗服务对再入院率和其他结果衡量指标的影响的随机对照试验。
高频服务使用者被随机分为干预组（n=34）和对照组（n=26）。对照组接受标准社区护理，而活跃组则接受基于国际果断社区治疗模式的改良版本的果断干预。在基线和 12 个月进行研究访问，在访问 1 时收集人口统计学和疾病信息，并在研究结束时记录再入院率。在两次访问时使用 PANSS、CDSS、ESRS、WHO-QOL 和 SOFAS 测量症状和功能。
在 12 个月的随访中，接受果断干预的受试者的 PANSS 总分（p=0.02）以及阳性（p<0.01）和一般精神病学（p=0.01）子量表的得分显著降低。干预组的 SOFAS 评分也显著升高（p=0.02），精神科入院人数显著减少（p<0.01）。
我们的结果表明，在标准社区精神卫生服务往往资源不足的发展环境中，果断干预措施可以产生显著的结果。此外，这些干预措施不必像国际第一世界模式那样昂贵和全面，就可以减少住院天数，改善严重精神疾病患者的精神病学和整体功能水平。
