Puntis Stephen Robert, Rugkåsa Jorun, Burns Tom
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
Soc Psychiatry Psychiatr Epidemiol. 2016 Dec;51(12):1633-1643. doi: 10.1007/s00127-016-1287-3. Epub 2016 Oct 25.
Providing good continuity of care to patients is considered a vital component of community mental health services, but there is limited evidence that it is associated with good outcomes. We measured service use and a multidimensional concept of continuity of care in 323 patients who were to be discharged from hospital following compulsory treatment for psychosis to investigate the association between continuity and rehospitalisation.
We conducted a 36-month prospective cohort study of the patients recruited to the Oxford Community Treatment Order Trial (OCTET). We collected data from medical records on eight previously operationalized measures of continuity. We conducted regression analyses to determine the association between these measures and readmission to hospital, time to readmission, and the number of days spent in hospital.
Almost two thirds (n = 206, 63.8%) of patients were readmitted. Patients were seen frequently, with a mean of 2.9 (SD = 2.47) contacts a month throughout the follow-up. Less frequent contact was significantly associated with lower odds of rehospitalisation and fewer days in hospital. More changes in the patient's care coordinator were associated with more time in hospital. Patients who had a higher proportion of clinical correspondence copied to them spent fewer days in hospital.
Patients with severe and relapsing psychotic illness are seen frequently and consistently in community mental health services. Higher levels of patient contact could be a response to the severity of illness rather than a marker of quality of care. Using a simple linear interpretation of contact frequency as a measure of continuity of care in this patient group may be of limited value in modern services.
为患者提供良好的连续性护理被视为社区精神卫生服务的重要组成部分，但仅有有限的证据表明其与良好的治疗效果相关。我们对323名因精神病接受强制治疗后即将出院的患者的服务利用情况及连续性护理的多维概念进行了测量，以调查连续性与再次入院之间的关联。
我们对招募到牛津社区治疗令试验（OCTET）中的患者进行了为期36个月的前瞻性队列研究。我们从医疗记录中收集了关于八项先前已实施的连续性测量指标的数据。我们进行了回归分析，以确定这些指标与再次入院、再次入院时间以及住院天数之间的关联。
近三分之二（n = 206，63.8%）的患者再次入院。患者接受频繁就诊，在整个随访期间每月平均就诊2.9次（标准差 = 2.47）。就诊频率较低与再次入院几率降低及住院天数减少显著相关。患者护理协调员的更换次数越多，住院时间越长。收到更高比例临床通信副本的患者住院天数较少。
在社区精神卫生服务中，患有严重复发性精神病的患者接受频繁且持续的诊疗。较高的患者接触水平可能是对疾病严重程度的一种反应，而非护理质量的标志。在现代服务中，将接触频率简单线性地解释为该患者群体护理连续性的衡量标准可能价值有限。
