Rawala Muffazal, Gupta Susham
South London and Maudsley NHS Foundation Trust, London.
East London NHS Foundation Trust, London.
Psychiatr Bull (2014). 2014 Feb;38(1):13-8. doi: 10.1192/pb.bp.112.042184.
Aims and method To compare admission rates and bed occupancy before and after the introduction of community treatment orders (CTOs) in 37 assertive outreach service patients. The effect of CTOs on treatment adherence and illicit drug use were also evaluated. The views of patients and care coordinators were obtained through a focus group. Results When CTOs were introduced, admission rates fell from 3.3 to 0.3 per year and average bed occupancy declined from 133.2 to 10.8 days per year. Treatment adherence improved from 4 (10.8%) to 31 (83.7%) patients, and an objective reduction in substance misuse was observed in 25 (67.5%) patients. Whereas patients expressed ambivalence towards CTOs, their care coordinators generally had a more positive view. Clinical implications The decline in hospital usage following the introduction of CTOs is encouraging and could reflect improved adherence and engagement through intensive case management, leading to a reduction in readmissions. However, further studies need to look at quality of life, cost-effectiveness and the impact on patients.
比较37名积极外展服务患者在引入社区治疗令（CTO）前后的住院率和床位占用情况。还评估了社区治疗令对治疗依从性和非法药物使用的影响。通过焦点小组获取患者和护理协调员的意见。结果：引入社区治疗令后，年住院率从3.3降至0.3，年平均床位占用天数从133.2降至10.8天。治疗依从性从4名（10.8%）患者提高到31名（83.7%）患者，25名（67.5%）患者的药物滥用情况客观上有所减少。患者对社区治疗令态度矛盾，而他们的护理协调员总体上看法更为积极。临床意义：引入社区治疗令后住院率下降令人鼓舞，这可能反映出通过强化个案管理提高了依从性和参与度，从而减少了再入院情况。然而，进一步的研究需要关注生活质量、成本效益以及对患者的影响。
