人格障碍临床管理指南的制定与实施对减少精神科住院单元机械约束使用的影响

Impact of the creation and implementation of a clinical management guideline for personality disorders in reducing use of mechanical restraints in a psychiatric inpatient unit.

作者信息

Gonzalez-Torres Miguel Angel, Fernandez-Rivas Aranzazu, Bustamante Sonia, Rico-Vilademoros Fernando, Vivanco Esther, Martinez Karmele, Angel Vecino Miguel, Martín Melba, Herrera Sonia, Rodriguez Jorge, Saenz Carlos

机构信息

Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).

出版信息

Prim Care Companion CNS Disord. 2014 Dec 25;16(6). doi: 10.4088/PCC.14m01675. eCollection 2014.

DOI:10.4088/PCC.14m01675

PMID:25834763

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4374822/

Abstract

OBJECTIVE

To evaluate the impact of the implementation of a guideline for the management of personality disorders on reducing the frequency of use of mechanical restraints in a psychiatric inpatient unit.

METHOD

This retrospective study was conducted in a psychiatric inpatient unit with 42 beds, which serves an urban area of 330,000 inhabitants. The sample consisted of all patients with a clinical diagnosis of personality disorder (DSM-IV-TR criteria) who were admitted to the unit from January 2010 to December 2010 and from January 2011 to December 2011 (ie, before and after, respectively, the implementation of the guideline). The guideline focused on cluster B disorders and follows a psychodynamic perspective.

RESULTS

Restraint use was reduced from 38 of 87 patients with personality disorders (43.7%) to 3 of 112 (2.7%), for a relative risk of 0.06 (95% CI, 0.02-0.19) and an absolute risk reduction of 41% (95% CI, 29.9%-51.6%). The risk of being discharged against medical advice increased after the intervention, with a relative risk of 1.84 (95% CI, 0.96-3.51). Restraint use in patients with other diagnoses was also reduced to a similar extent.

CONCLUSIONS

The use of mechanical restraints was dramatically reduced after the implementation of a clinical practice guideline on personality disorders, suggesting that these coercive measures might be decreased in psychiatric inpatient units.

摘要

目的

评估实施人格障碍管理指南对减少精神科住院单元使用机械约束频率的影响。

方法

本回顾性研究在一个拥有42张床位、服务于33万居民城区的精神科住院单元进行。样本包括2010年1月至2010年12月以及2011年1月至2011年12月（即分别在指南实施前后）入住该单元且临床诊断为人格障碍（依据《精神疾病诊断与统计手册》第四版修订版标准）的所有患者。该指南聚焦于B类人格障碍，遵循精神动力学视角。

结果

人格障碍患者中使用约束的比例从87例中的38例（43.7%）降至112例中的3例（2.7%），相对风险为0.06（95%置信区间，0.02 - 0.19），绝对风险降低41%（95%置信区间，29.9% - 51.6%）。干预后违反医嘱出院的风险增加，相对风险为1.84（95%置信区间，0.96 - 3.51）。其他诊断患者的约束使用也有类似程度的减少。