Department of Psychiatry, The University of Melbourne & North Western Mental Health, Psychosocial Research Centre, 130 Bell Street, Coburg, VIC, 3058, Australia.
Community Ment Health J. 2012 Oct;48(5):652-61. doi: 10.1007/s10597-011-9466-x. Epub 2011 Nov 17.
The impact of variable implementation of the Assertive Community Treatment (ACT) model on patient outcomes is increasingly recognised. We conducted the first study of four established Australian ACT teams, examining team composition, processes and model fidelity, using previously validated questionnaires. Demographic and clinical details of patients and their own experiences of ACT were gathered from staff. Associations between burnout and work experiences were examined. All teams were ACT-like (mean DACTS score = 3.7, SD = 0.3) with few significant patient differences between teams, except diagnosis (schizophrenia 61-93%, co-morbid substance abuse 16-33%) and proportion living alone (23-72%). Clinicians were fairly satisfied, but inter-team differences in staffing profile and experience emerged and one team scored highly on emotional exhaustion. Increased burnout was associated with greater stress due to taking a team approach. Inter-team differences suggested that attention to effective team working and leadership, as well as model fidelity, may be warranted.
越来越多的人认识到，灵活实施坚定社区治疗（ACT）模式对患者结果的影响。我们对四个成熟的澳大利亚 ACT 团队进行了首次研究，使用先前经过验证的问卷，检查了团队组成、流程和模型保真度。从工作人员那里收集了患者的人口统计学和临床细节及其对 ACT 的个人体验。还检查了倦怠与工作经历之间的关联。所有团队都具有 ACT 特征（平均 DACTS 评分=3.7，标准差=0.3），除了诊断（精神分裂症 61-93%，合并物质滥用 16-33%）和独居比例（23-72%）外，团队之间的患者差异不大。临床医生比较满意，但团队人员配置和经验方面存在差异，一个团队在情绪疲惫方面得分较高。由于采用团队方法，倦怠增加与压力增大有关。团队之间的差异表明，可能需要关注有效的团队合作和领导力，以及模型保真度。
