Velligan Dawn I, Fredrick Megan M, Sierra Cynthia, Hillner Kiley, Kliewer John, Roberts David L, Mintz Jim
Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
Patient Prefer Adherence. 2017 May 12;11:919-928. doi: 10.2147/PPA.S132339. eCollection 2017.
As many as 40% of those with serious mental illness (SMI) do not attend any outpatient visits in the 30 days following discharge. We examined engagement-focused care (EFC) versus treatment as usual in a university-based transitional care clinic (TCC) with a 90-day program serving individuals with SMI discharged from hospitals and emergency rooms. EFC included a unique group intake process (access group) designed to get individuals into care rapidly and a shared decision-making coach.
Assessments of quality of life, symptomatology, and shared decision-making preferences were conducted at baseline, at 3 months corresponding to the end of TCC treatment and 6 months after TCC discharge. Communication among the patients and providers was assessed at each visit as was service utilization during and after TCC.
Subjective quality of life improved in EFC. Prescribers and patients saw communication more similarly as time went on. Ninety-one percent of patients wanted at least some say in decisions about their treatment.
SDM coaching and improved access improve quality of life. Most people want a say in treatment decisions.
多达40%的严重精神疾病（SMI）患者在出院后的30天内未进行任何门诊就诊。我们在一家大学附属的过渡性护理诊所（TCC）对以参与为重点的护理（EFC）与常规治疗进行了比较，该诊所开展了一项为期90天的项目，服务于从医院和急诊室出院的SMI患者。EFC包括一个独特的群体接纳流程（准入组），旨在使患者迅速获得护理，以及一名共同决策教练。
在基线、TCC治疗结束对应的3个月以及TCC出院后的6个月，对生活质量、症状学和共同决策偏好进行评估。每次就诊时评估患者与医护人员之间的沟通情况，以及TCC期间及之后的服务利用情况。
EFC组的主观生活质量有所改善。随着时间的推移，开处方者和患者对沟通的看法越来越相似。91%的患者希望在治疗决策中至少有一定的发言权。
共同决策指导和更好的准入改善了生活质量。大多数人希望在治疗决策中有发言权。
