Universitäre Psychiatrische Kliniken Basel, Universität Basel, 27, Wilhelm Klein-Strasse, 4012 Basel, Switzerland.
Universitäre Psychiatrische Kliniken Basel, Universität Basel, 27, Wilhelm Klein-Strasse, 4012 Basel, Switzerland.
Eur Psychiatry. 2018 Feb;48:51-57. doi: 10.1016/j.eurpsy.2017.09.008. Epub 2018 Jan 10.
Psychiatric inpatient treatment is increasingly performed in settings with locked doors. However, locked wards have well-known disadvantages and are ethically problematic. In addition, recent data challenges the hypothesis that locked wards provide improved safety over open-door settings regarding suicide, absconding and aggression. Furthermore, there is evidence that the introduction of an open-door policy may lead to short-term reductions in involuntary measures. The aim of this study was to assess if the introduction of an open-door policy is associated with a long-term reduction of the frequency of seclusion and forced medication.
In this 6-year, hospital-wide, longitudinal, observational study, we examined the frequency of seclusion and forced medication in 17,359 inpatient cases admitted to the Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken (UPK) Basel, University of Basel, Switzerland. In an approach to enable a less restrictive policy, six previously closed psychiatric wards were permanently opened beginning from August 2011. During this process, a systematic change towards a more patient-centered and recovery-oriented care was applied. Statistical analysis consisted of generalized estimating equations (GEE) models.
In multivariate analyses controlling for potential confounders, the implementation of an open-door policy was associated with a continuous reduction of seclusion (from 8.2 to 3.5%; η=0.82; odds ratio: 0.88) and forced medication (from 2.4 to 1.2%; η=0.70; odds ratio: 0.90).
This underlines the potential of the introduction of an open-door policy to attain a long-term reduction in involuntary measures.
精神科住院治疗越来越多地在设有锁定门的环境中进行。然而，锁定病房有众所周知的缺点，并且在道德上存在问题。此外，最近的数据对锁定病房在自杀、擅自离院和攻击方面提供优于开放式病房的安全性的假设提出了挑战。此外，有证据表明，开放式病房政策的引入可能会导致非自愿措施的短期减少。本研究旨在评估开放式病房政策的引入是否与禁闭和强制药物治疗频率的长期减少相关。
在这项为期 6 年的、全院范围的、纵向、观察性研究中，我们检查了瑞士巴塞尔大学（University of Basel）的成人精神病学系（UPK）收治的 17359 例住院患者的禁闭和强制药物治疗的频率。为了实现更宽松的政策，从 2011 年 8 月开始，六个以前关闭的精神病病房永久开放。在此过程中，系统地向以患者为中心和以康复为导向的护理方式转变。统计分析包括广义估计方程（GEE）模型。
在控制潜在混杂因素的多变量分析中，开放式病房政策的实施与禁闭（从 8.2%降至 3.5%；η=0.82；优势比：0.88）和强制药物治疗（从 2.4%降至 1.2%；η=0.70；优势比：0.90）的持续减少相关。
这强调了引入开放式病房政策以实现非自愿措施长期减少的潜力。
