Hussain Maria, Seitz Dallas
Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
Psychosomatics. 2014 Jul-Aug;55(4):315-325. doi: 10.1016/j.psym.2013.08.003. Epub 2014 Apr 13.
Psychiatric disorders are common among medical inpatient settings and management of psychiatric disorders can be challenging in this setting. Integrated models of care (IMCs) combining psychiatric and medical specialties within a single service may improve psychiatric and medical outcomes, although evidence for IMCs in medical inpatient settings has not been well described.
We searched MEDLINE, Embase, and Google scholar for relevant articles. We included all randomized controlled trials or quasi-experimental studies in English that evaluated IMCs for medical inpatients with psychiatric disorders when compared with usual care. We defined IMCs as models of care where psychiatric and medical providers had joint responsibility for all patients within a given service. We extracted information on the characteristics of IMCs and on the effects of IMCs on psychiatric, medical, and health service outcomes.
Four studies met the inclusion criteria, thereby including 716 participants overall. All studies differed in the study design, models of IMCs, and outcomes reported. In 2 studies, IMCs improved psychiatric symptoms compared with those admitted to a general medical service. Two studies demonstrated reductions in length of stay with IMCs compared with usual care. One study reported an improvement in functional outcomes and a decreased likelihood of long-term care admission associated with IMCs when compared with usual care.
There is preliminary evidence that IMCs may improve a number of outcomes for medical inpatients with psychiatric disorders. Additional well-designed studies of IMCs are required to further evaluate the effect of IMCs on patient outcomes and costs of care.
精神疾病在住院患者中很常见，在这种情况下管理精神疾病可能具有挑战性。在单一服务中结合精神科和医学专科的综合护理模式（IMCs）可能会改善精神和医疗结局，尽管住院患者环境中IMCs的证据尚未得到充分描述。
我们检索了MEDLINE、Embase和谷歌学术以获取相关文章。我们纳入了所有英文的随机对照试验或准实验研究，这些研究评估了与常规护理相比，针对患有精神疾病的住院患者的IMCs。我们将IMCs定义为精神科和医学提供者对给定服务内的所有患者共同负责的护理模式。我们提取了有关IMCs特征以及IMCs对精神、医疗和卫生服务结局影响的信息。
四项研究符合纳入标准，总共纳入716名参与者。所有研究在研究设计、IMCs模式和报告的结局方面均有所不同。在两项研究中，与入住普通医疗服务的患者相比，IMCs改善了精神症状。两项研究表明，与常规护理相比，IMCs缩短了住院时间。一项研究报告称，与常规护理相比，IMCs改善了功能结局，并降低了长期护理入院的可能性。
有初步证据表明，IMCs可能会改善患有精神疾病的住院患者的一些结局。需要进一步设计良好的IMCs研究，以进一步评估IMCs对患者结局和护理成本的影响。
