包括治疗性坚定社区治疗在内的综合护理对严重精神分裂症谱系和双相 I 障碍的疗效：ACCESS II 研究的 24 个月随访结果。

Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia spectrum and bipolar I disorders: the 24-month follow-up ACCESS II study.

机构信息

Department of Psychiatry and Psychotherapy, Psychosis Centre, Centre of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany

出版信息

J Clin Psychiatry. 2014 Dec;75(12):1371-9. doi: 10.4088/JCP.13m08817.

DOI:10.4088/JCP.13m08817

PMID:25188752

Abstract

OBJECTIVE

The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study.

METHOD

All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization.

RESULTS

Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002).

CONCLUSIONS

ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01888627.

摘要

目的

ACCESS 治疗模式为精神病患者提供了强化社区治疗，并将其嵌入到综合护理计划中。与标准护理相比，在一项为期 12 个月的对照研究中，它在精神分裂症谱系障碍患者的服务脱失和疾病结局方面更有效。ACCESS 已被纳入临床常规，并在一项队列研究中，对 24 个月内患有严重精神分裂症谱系障碍和伴有精神病特征的双相 I 障碍（DSM-IV）的患者进行了有效性评估。

方法

所有在 ACCESS 中接受治疗的 115 名患者（2007 年 5 月至 2009 年 10 月）均纳入 ACCESS II 研究。主要结局是服务脱失率。次要结局是精神病理学的变化、疾病严重程度、社会心理功能、生活质量、护理满意度、药物不依从性、住院时间和非自愿住院率。

结果

只有 4 名患者（3.4%）与服务脱失。另外 11 名（9.6%）因搬离服务区域而离开。患者每周接受平均 1.6 次门诊治疗。非自愿入院率从前 2 年的 34.8%降至 ACCESS 期间的 7.8%（P<.001）。混合模型重复测量分析显示，所有患者的精神病理学（效应大小 d = 0.64，P<.001）、疾病严重程度（d = 0.84，P =.03）、功能水平（d = 0.65，P<.001）、生活质量（d = 0.50，P<.001）和患者满意度（d = 0.11，P<.001）均显著改善。在 24 个月时，78.3%的患者完全遵医嘱服药，而基线时为 25.2%（P=.002）。