《 对于有严重精神疾病的老年患者，采用坚定的社区治疗的效果：一项随机对照试验》
The effectiveness of assertive community treatment for elderly patients with severe mental illness: a randomized controlled trial.
机构信息
Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands.
出版信息
BMC Psychiatry. 2014 Feb 15;14:42. doi: 10.1186/1471-244X-14-42.
BACKGROUND
Due to fragmented mental, somatic, and social healthcare services, it can be hard to engage into care older patients with severe mental illness (SMI). In adult mental health care, assertive community treatment (ACT) is an organizational model of care for treating patients with SMI who are difficult to engage. So far all outcome studies of assertive community treatment have been conducted in adults.
METHODS
In a randomized controlled trial design we compared the effectiveness of ACT for elderly patients with that of treatment as usual (TAU). Sixty-two outpatients (60 years and older) with SMI who were difficult to engage in psychiatric treatment were randomly assigned to the intervention or control group (32 to ACT for elderly patients and 30 to TAU). Primary outcomes included number of patients who had a first treatment contact within 3 months, the number of dropouts (i.e. those discharged from care due to refusing care or those who unintentionally lost contact with the service over a period of at least 3 months); and patients' psychosocial functioning (HoNOS65+ scores) during 18 months follow-up. Secondary outcomes included the number of unmet needs and mental health care use. Analyses were based on intention-to-treat.
RESULTS
Of the 62 patients who were randomized, 26 were lost to follow-up (10 patients in ACT for elderly patients and 16 in TAU). Relative to patients with TAU, more patients allocated to ACT had a first contact within three months (96.9 versus 66.7%; X2 (df = 1) = 9.68, p = 0.002). ACT for elderly patients also had fewer dropouts from treatment (18.8% of assertive community treatment for elderly patients versus 50% of TAU patients; X2 (df = 1) = 6.75, p = 0.009). There were no differences in the other primary and secondary outcome variables.
CONCLUSIONS
These findings suggest that ACT for elderly patients with SMI engaged patients in treatment more successfully.
TRIAL REGISTRATION
NTR1620.
背景
由于精神、躯体和社会医疗服务碎片化，难以让患有严重精神疾病（SMI）的老年患者参与治疗。在成人精神卫生保健中，倡导性社区治疗（ACT）是一种针对难以参与治疗的 SMI 患者的护理组织模式。迄今为止，所有倡导性社区治疗的结果研究都是在成年人中进行的。
方法
我们采用随机对照试验设计，比较了 ACT 对老年 SMI 患者的疗效与常规治疗（TAU）的疗效。62 名（60 岁及以上）难以接受精神科治疗的 SMI 门诊患者被随机分配到干预组或对照组（32 名接受老年 ACT，30 名接受 TAU）。主要结局包括在 3 个月内首次治疗接触的患者人数、脱落人数（即因拒绝治疗或在至少 3 个月的时间内无意与服务失去联系而被护理机构开除的患者）；以及 18 个月随访期间患者的社会心理功能（HoNOS65+评分）。次要结局包括未满足的需求和精神卫生保健的使用。分析基于意向治疗。
结果
在随机分组的 62 名患者中，有 26 名失访（ACT 老年组 10 名，TAU 组 16 名）。与接受 TAU 的患者相比，更多接受 ACT 治疗的患者在三个月内进行了首次接触（96.9%比 66.7%；X2（df=1）=9.68，p=0.002）。ACT 老年组的治疗脱落人数也较少（ACT 老年组 18.8%，TAU 组 50%；X2（df=1）=6.75，p=0.009）。其他主要和次要结局变量无差异。
结论
这些发现表明，ACT 老年患者更成功地让 SMI 患者参与治疗。
试验注册
NTR1620。
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