Psychiatry Department, University Hospital of Saint Etienne, Saint Etienne, France.
Rehabilitation Department (CRR and CL3R), Le Vinatier Hospital, 4 rue Jean Sarrazin, 69008, Lyon, France.
Psychiatr Q. 2019 Mar;90(1):89-100. doi: 10.1007/s11126-018-9603-6.
World Health Organization recommends the implementation of alternatives to full-time hospitalizations. Psychiatric home-care has known a worldwide development in the last 20 years. The psychiatric mobile team for social and medico-social institutions in Saint-Etienne, France, (Equipe mobile d'intervention en établissements Sociaux et Médico-sociaux, ESMS) aims to support professionals from medico-social housing institutions (MSHI) in order to maintain people in housing. The objective of the study was to evaluate the efficiency of home-based interventions to reduce hospitalizations and improve collaboration between psychiatric hospital facilities and MSHI. We used a pre-post study design. A same cohort of patients living in a MSHI one year before intervention and one year after implementation of the ESMS was studied. Hospitalizations were compared between the two periods. A survey was conducted for qualitative evaluation among professionals in MHSI. Sixty-three patients were included. Most patients suffered from psychotic disorders (71%). We found a significant decrease in the mean number of admissions per year from 2,06 to 1,48 (Wilcoxon signed rank test; df64; p = 0,01). Mobile-team interventions included answering phone calls, home visits, coordination meetings, or clinical interviews with patients in inpatient and outpatient services, with an average of 9,3 interventions per patient (SD = 11,4). ESMS was evaluated as "essential" for 73% of 11 professionals from MSHI who answered the questionnaire in May 2017. Assertive Community Treatment and Crisis Resolution Teams are the most studied home-care models in psychiatry. Our results tend to show the efficiency of mobile-team interventions in MSHI, to enhance partnerships.
世界卫生组织建议实施替代全日制住院治疗的方案。在过去的 20 年中，精神科家庭护理在全球范围内得到了发展。法国圣艾蒂安的社会和医社机构精神科移动团队（Equipe mobile d'intervention en établissements Sociaux et Médico-sociaux，ESMS）旨在为医社住房机构的专业人员提供支持，以维持人们的住房。该研究的目的是评估基于家庭的干预措施的效率，以减少住院治疗，并改善精神病院设施和医社住房机构之间的合作。我们使用了前后研究设计。在干预实施前一年和实施后一年，对居住在医社住房机构中的同一组患者进行了研究。比较了两个时期的住院情况。还对医社住房机构的专业人员进行了定性评估调查。共纳入 63 名患者。大多数患者患有精神障碍（71%）。我们发现每年的平均住院人数从 2.06 人减少到 1.48 人（Wilcoxon 符号秩检验；df64；p=0.01）。移动团队干预包括接听电话、家访、协调会议或在住院和门诊服务中与患者进行临床访谈，平均每个患者有 9.3 次干预（SD=11.4）。在 2017 年 5 月回答问卷的 11 名医社住房机构专业人员中，有 73%认为 ESMS“必不可少”。社区强化治疗和危机解决小组是精神病学中研究最多的家庭护理模式。我们的结果表明，移动团队干预在医社住房机构中具有提高合作关系的效率。
