Professor, School of Medicine, The University of Queensland, Brisbane, Australia; Professor, Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia.
Researcher, School of Medicine, The University of Queensland, Brisbane, Australia.
Can J Psychiatry. 2014 Oct;59(10):561-4. doi: 10.1177/070674371405901010.
It is unclear whether community treatment orders (CTOs) for people with severe mental illnesses can reduce health service use, or improve clinical and social outcomes. Randomized controlled trials of CTOs are rare because of ethical and logistical concerns. This meta-analysis updates available evidence.
A systematic literature search was performed of the Cochrane Schizophrenia Group Register, Science Citation Index, PubMed, MEDLINE, and Embase to November 2013. Inclusion criteria were studies comparing CTOs with standard care including those where control subjects received voluntary care, for most of the trial.
Three studies provided 749 subjects for the meta-analysis. Two compared compulsory treatment with entirely voluntary care, while the third had control subjects receiving voluntary treatment for the bulk of the time. Compared with control subjects, CTOs did not reduce readmissions (risk ratio 0.98, 95% CI 0.82 to 1.16) or bed days (mean difference [MD] -16.36; 95% CI -40.8 to 8.05) in the subsequent 12 months (n = 749). Moreover, there were no significant differences in psychiatric symptoms (standardized MD -0.03; 95% CI -0.25 to 0.19; n = 331) or the Global Assessment of Functioning (MD -1.36; 95% CI -4.07 to 1.35; n = 335). Only including the 2 studies that compared compulsory treatment with entirely voluntary care made no difference to the results.
CTOs may not lead to significant differences in readmission, social functioning, or symptomatology, compared with standard care. Their use should be kept under review.
目前尚不清楚针对严重精神疾病患者的社区治疗令（CTO）是否可以减少卫生服务的使用，或改善临床和社会结局。由于伦理和实际操作方面的考虑，针对 CTO 的随机对照试验非常少见。本项荟萃分析更新了现有证据。
系统检索了 Cochrane 精神分裂症组注册库、科学引文索引、PubMed、MEDLINE 和 Embase，检索日期截至 2013 年 11 月。纳入标准为比较 CTO 与标准治疗（包括对照组接受自愿治疗的试验）的研究，且大多数试验的对照组都接受自愿治疗。
有 3 项研究共纳入 749 例患者进行荟萃分析。其中 2 项研究比较了强制性治疗与完全自愿治疗，而第 3 项研究的对照组在大部分时间内都接受自愿治疗。与对照组相比，在接下来的 12 个月内，CTO 并未减少再入院率（风险比 0.98，95%CI 0.82 至 1.16）或住院天数（MD-16.36；95%CI-40.8 至 8.05；n=749）。而且，在精神病症状（标准化 MD-0.03；95%CI-0.25 至 0.19；n=331）或总体功能评估（MD-1.36；95%CI-4.07 至 1.35；n=335）方面，两组间也无显著差异。仅纳入比较强制性治疗与完全自愿治疗的 2 项研究，也未改变结果。
与标准治疗相比，CTO 可能不会导致在再入院率、社会功能或症状学方面有显著差异。应继续对 CTO 的使用进行审查。
