Moljord I E O, Lara-Cabrera M L, Salvesen Ø, Rise M B, Bjørgen D, Antonsen D Ø, Olsø T M, Evensen G H, Gudde C B, Linaker O M, Steinsbekk A, Eriksen L
Nidaros Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.
Tiller Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.
Patient Educ Couns. 2017 Jun;100(6):1144-1152. doi: 10.1016/j.pec.2017.01.008. Epub 2017 Jan 11.
To investigate the effect of having a contract for self-referral to inpatient treatment (SRIT) in patients with severe mental disorders.
A randomized controlled trial with 53 adult patients; 26 participants received a SRIT contract, which they could use to refer themselves into a Community Mental Health Centre up to five days for each referral without contacting a doctor in advance. Outcomes were assessed after 12 months with the self-report questionnaires Patient Activation Measure (PAM-13), Recovery Assessment Scale (RAS), and the Behavior and Symptom Identification Scale (BASIS-32) and analyzed using linear mixed and regression models.
There was no significant effect on PAM-13 (estimated mean difference (emd) -0.41, 95% CI (CI):-7.49-6.67), nor on the RAS (emd 0.02, CI:-0.27-0.31) or BASIS-32 (0.09, CI:-0.28-0.45). An exploratory post hoc analysis showed effect of SRIT in those with low PAM below ≤47 (p=0.049).
There were no group differences after 12 months, but both groups maintained their baseline levels.
SRIT contracts can be recommended as it supports the rights to self-determination, promote user participation in decision-making in own treatment without any indication of adverse effects.
探讨签订自我转诊接受住院治疗（SRIT）合同对重症精神障碍患者的影响。
一项随机对照试验，纳入53名成年患者；26名参与者签订了SRIT合同，他们可在无需提前联系医生的情况下，每次使用该合同自我转诊至社区精神卫生中心，最长为期五天。12个月后，使用患者激活量表（PAM - 13）、康复评估量表（RAS）和行为与症状识别量表（BASIS - 32）自我报告问卷评估结果，并使用线性混合模型和回归模型进行分析。
对PAM - 13无显著影响（估计平均差（emd）-0.41，95%置信区间（CI）：-7.49 - 6.67），对RAS（emd 0.02，CI：-0.27 - 0.31）或BASIS - 32（0.09，CI：-0.28 - 0.45）也无显著影响。一项探索性事后分析显示，SRIT对PAM得分低于≤47的患者有影响（p = 0.049）。
12个月后两组无差异，但两组均维持了基线水平。
可推荐使用SRIT合同，因为它支持自决权，促进服务使用者参与自身治疗的决策，且未显示出任何不良反应迹象。
