Clausen Hanne, Landheim Anne, Odden Sigrun, Šaltytė Benth Jūratė, Heiervang Kristin Sverdvik, Stuen Hanne Kilen, Killaspy Helen, Ruud Torleif
Department of Research and Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway ; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway ; Addiction Research, University of Oslo, Oslo, Norway.
Int J Ment Health Syst. 2016 Feb 29;10:14. doi: 10.1186/s13033-016-0052-z. eCollection 2016.
Assertive Community Treatment (ACT) is more successful in reducing hospitalization when baseline use is high. However, with a growing recovery-focus, ACT may be useful for people with severe mental illness who are difficult to engage but not high users of inpatient services. This study investigated hospitalization 2 years before and 2 years after ACT enrollment amongst patients both with and without high inpatient services use before enrollment into ACT.
This naturalistic observational study included 142 patients from 12 different ACT teams throughout Norway. Of these, 74 (52 %) were high users of inpatient services before ACT. The teams assessed the patients upon enrollment using clinician-rated and self-reported questionnaires. Hospitalization data from 2 years before and 2 years after enrollment into ACT were obtained from the Norwegian Patient Registry. Linear mixed models were used to assess changes in hospitalization and to explore associations between these changes and patient characteristics.
When the participants enrolled into the ACT teams, high users of inpatient care were younger, more often living alone and more often subject to involuntary outpatient treatment than low users. The participants spent significantly fewer days in hospital during the 2 years of ACT follow-up compared to the 2 years before enrollment. The reduction was more evident amongst high users, whereas low users had an initial increase in inpatient days in the first year of ACT and a subsequent decrease in the second year. More severe negative symptoms and previous high use of inpatient care were associated with a reduction in both total and involuntary inpatient days. Additionally, a reduction in involuntary inpatient days was associated with being subject to involuntary outpatient treatment upon enrollment into ACT.
The findings in this study may suggest that ACT contributes to more appropriate use of inpatient care, possibly by reducing the presumably avoidable hospitalization of high users and increasing the presumably needed inpatient care of low users.
当基线住院率较高时，积极社区治疗（ACT）在减少住院方面更为成功。然而，随着对康复的关注度不断提高，ACT对于那些难以参与治疗但住院服务使用率不高的严重精神疾病患者可能会有所帮助。本研究调查了在ACT登记之前和之后两年，登记前住院服务使用率高和低的患者的住院情况。
这项自然观察性研究纳入了来自挪威12个不同ACT团队的142名患者。其中，74名（52%）在ACT之前是住院服务的高使用者。各团队在患者登记时使用临床医生评定和自我报告问卷对患者进行评估。从挪威患者登记处获取了ACT登记前两年和登记后两年的住院数据。使用线性混合模型评估住院情况的变化，并探讨这些变化与患者特征之间的关联。
当参与者加入ACT团队时，住院护理高使用者比低使用者更年轻，更常独自生活，更常接受非自愿门诊治疗。与登记前的两年相比，参与者在ACT随访的两年中住院天数显著减少。这种减少在高使用者中更为明显，而低使用者在ACT的第一年住院天数最初增加，在第二年随后减少。更严重的阴性症状和以前较高的住院护理使用率与总住院天数和非自愿住院天数的减少有关。此外，非自愿住院天数的减少与ACT登记时接受非自愿门诊治疗有关。
本研究的结果可能表明，ACT有助于更合理地使用住院护理，可能是通过减少高使用者可能避免的住院，并增加低使用者可能需要的住院护理。
