University of Queensland, School of Medicine, Level 4, Building 1, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia; Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia.
Department of Health, Western Australia, Perth, Australia.
Psychiatry Res. 2015 Dec 15;230(2):400-5. doi: 10.1016/j.psychres.2015.09.027. Epub 2015 Sep 18.
Differences in patient characteristics, legislation and service setting may explain variations in the reported efficacy of compulsory treatment orders (CTOs). Our objective was to investigate factors associated with CTO placement in Western Australia and see if there were any changes over the 11 years following their introduction. We used three linked Western Australian databases to compare 2958 patients on community treatment orders with an equal number of controls matched on age, sex and diagnosis, as well as 2832 consecutive controls selected on date of discharge from inpatient care or CTO placement. Multivariate analyses were used to further examine potential predictors of a CTO. The incidence of CTOs, and the characteristics of patients placed on these orders, showed little change over 11 years. They tended to be younger and male with schizophrenia or other non-affective psychotic disorders. Previous health service use as an inpatient or outpatient also predicted compulsory community treatment. Psychiatrists in Western Australia appear to be applying community treatment orders to similar types of patient as elsewhere, but unlike other jurisdictions, use has not increased. We need further research to establish the relative contribution of patient characteristics, legislation and service setting toward the use and outcome of CTOs.
患者特征、立法和服务环境的差异可能解释了强制治疗令（CTO）报告疗效的差异。我们的目的是调查与西澳大利亚 CTO 安置相关的因素，并观察在引入 CTO 后的 11 年内是否有任何变化。我们使用三个链接的西澳大利亚数据库，将 2958 名接受社区治疗令的患者与年龄、性别和诊断相匹配的 2832 名连续对照患者进行比较，以及 2832 名连续对照患者按住院或 CTO 安置出院日期选择。多变量分析用于进一步检查 CTO 的潜在预测因素。在 11 年内，CTO 的发生率以及接受这些命令的患者的特征几乎没有变化。他们往往更年轻，是男性，患有精神分裂症或其他非情感性精神病障碍。以前作为住院患者或门诊患者的卫生服务使用情况也预测了强制性社区治疗。西澳大利亚的精神科医生似乎将社区治疗令应用于与其他地方类似的患者，但与其他司法管辖区不同，使用量并未增加。我们需要进一步的研究来确定患者特征、立法和服务环境对 CTO 的使用和结果的相对贡献。
