Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
Division of Psychiatry, University College London, London, UK.
Lancet. 2018 Aug 4;392(10145):409-418. doi: 10.1016/S0140-6736(18)31470-3.
High resource expenditure on acute care is a challenge for mental health services aiming to focus on supporting recovery, and relapse after an acute crisis episode is common. Some evidence supports self-management interventions to prevent such relapses, but their effect on readmissions to acute care following a crisis is untested. We tested whether a self-management intervention facilitated by peer support workers could reduce rates of readmission to acute care for people discharged from crisis resolution teams, which provide intensive home treatment following a crisis.
We did a randomised controlled superiority trial recruiting participants from six crisis resolution teams in England. Eligible participants had been on crisis resolution team caseloads for at least a week, and had capacity to give informed consent. Participants were randomly assigned to intervention and control groups by an unmasked data manager. Those collecting and analysing data were masked to allocation, but participants were not. Participants in the intervention group were offered up to ten sessions with a peer support worker who supported them in completing a personal recovery workbook, including formulation of personal recovery goals and crisis plans. The control group received the personal recovery workbook by post. The primary outcome was readmission to acute care within 1 year. This trial is registered with ISRCTN, number 01027104.
221 participants were assigned to the intervention group versus 220 to the control group; primary outcome data were obtained for 218 versus 216. 64 (29%) of 218 participants in the intervention versus 83 (38%) of 216 in the control group were readmitted to acute care within 1 year (odds ratio 0·66, 95% CI 0·43-0·99; p=0·0438). 71 serious adverse events were identified in the trial (29 in the treatment group; 42 in the control group).
Our findings suggest that peer-delivered self-management reduces readmission to acute care, although admission rates were lower than anticipated and confidence intervals were relatively wide. The complexity of the study intervention limits interpretability, but assessment is warranted of whether implementing this intervention in routine settings reduces acute care readmission.
National Institute for Health Research.
精神卫生服务旨在专注于支持康复，但急性护理的高资源支出是一个挑战，急性危机发作后的复发很常见。 一些证据支持自我管理干预措施来预防这种复发，但它们对危机后急性护理再入院的影响尚未得到检验。 我们测试了由同伴支持工作者提供的自我管理干预是否可以降低从危机解决小组出院的人的急性护理再入院率，这些小组在危机后提供强化家庭治疗。
我们进行了一项随机对照优势试验，从英格兰的六个危机解决小组招募参与者。 符合条件的参与者在危机解决小组的病例数中至少一周，并有能力给予知情同意。 参与者通过未蒙面的数据管理员随机分配到干预组和对照组。 收集和分析数据的人员对分配情况进行了屏蔽，但参与者没有。 干预组的参与者最多可与同伴支持工作者进行十次会议，支持他们完成个人康复工作簿，包括制定个人康复目标和危机计划。 对照组通过邮寄收到个人康复工作簿。 主要结局是在 1 年内再次入院到急性护理。 该试验在 ISRCTN 注册，编号为 01027104。
221 名参与者被分配到干预组，220 名参与者被分配到对照组；主要结局数据可用于 218 名参与者和 216 名参与者。 干预组的 218 名参与者中，有 64 名（29%）在 1 年内再次入院到急性护理，对照组的 216 名参与者中有 83 名（38%）（比值比 0.66，95%CI 0.43-0.99；p=0.0438）。 试验中确定了 71 例严重不良事件（治疗组 29 例；对照组 42 例）。
我们的研究结果表明，同伴提供的自我管理可降低急性护理再入院率，尽管入院率低于预期，置信区间相对较宽。 研究干预措施的复杂性限制了其可解释性，但需要评估在常规环境中实施此干预措施是否可以降低急性护理再入院率。
英国国家卫生研究院。
