Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC), U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Forster, Hostetter, Billera, Brenner); Department of Psychiatry (Matarazzo), and Department of Physical Medicine and Rehabilitation (Forster, Brenner), University of Colorado School of Medicine, Aurora; South Central MIRECC, VA, Houston, and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Adler); Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, and Department of Psychiatry, Oregon Health and Science University, Portland (Ganzini); MIRECC, Veterans Integrated Service Network 4, VA, Philadelphia, and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin).
Psychiatr Serv. 2019 Dec 1;70(12):1094-1100. doi: 10.1176/appi.ps.201900002. Epub 2019 Aug 27.
The risk of suicide is elevated in the days and weeks after discharge from a psychiatric hospitalization, and lack of treatment engagement posthospitalization is also associated with suicide. The authors sought to determine whether the Home-Based Mental Health Evaluation [HOME] Program is efficacious in helping patients engage in care after psychiatric hospitalization.
This study was a nonrandomized, controlled, two-arm (HOME Program versus enhanced care as usual [E-CARE]) trial that took place at four Department of Veterans Affairs medical centers. Participants (N=302) were patients admitted to a psychiatric inpatient unit. The HOME Program consists of phone- and home-based contacts that include suicide risk assessment, safety planning, and problem-solving around barriers to care. The primary outcome was treatment engagement, as documented in the electronic medical record.
Veterans in the HOME Program group were 1.33 (95% confidence interval [CI]=1.29-1.37) times more likely to engage in treatment, compared with veterans in the E-CARE group (p<0.001). HOME Program participants were estimated to have attended 55% more individual appointments (95% CI=12%-113%, p=0.02), compared with those in the E-CARE group. The adjusted difference in median time to treatment engagement was 15 days (95% CI=3.5-27.0) such that HOME Program participants engaged in treatment more quickly than participants at the E-CARE sites.
Findings suggest that participation in the HOME Program can help individuals at high risk of suicide engage in care after psychiatric hospitalization.
在精神科住院后的几天和几周内，自杀风险会升高，而住院后缺乏治疗参与也与自杀有关。作者试图确定家庭心理健康评估[HOME]计划是否有助于帮助患者在精神科住院后参与治疗。
本研究是一项非随机、对照、双臂（HOME 计划与增强的常规护理[E-CARE]）试验，在四家退伍军人事务部医疗中心进行。参与者（N=302）为入住精神科住院病房的患者。HOME 计划包括电话和家庭访问，包括自杀风险评估、安全计划和解决护理障碍。主要结果是治疗参与情况，记录在电子病历中。
与接受 E-CARE 护理的退伍军人相比，接受 HOME 计划护理的退伍军人更有可能接受治疗，其可能性是后者的 1.33 倍（95%置信区间[CI]=1.29-1.37，p<0.001）。与接受 E-CARE 护理的退伍军人相比，HOME 计划组的参与者预计会多参加 55%的个人预约（95%CI=12%-113%，p=0.02）。调整后 HOME 计划组和 E-CARE 组之间治疗参与中位数时间的差异为 15 天（95%CI=3.5-27.0），表明 HOME 计划组比 E-CARE 组的参与者更快地开始接受治疗。
研究结果表明，参与 HOME 计划可以帮助高自杀风险的个体在精神科住院后参与治疗。
