[精神病学中的非自愿拘留和隔离措施：我们现在处于什么情况？卢瓦尔河谷地区中心2012 - 2017年研究]
[Involuntary detention and seclusion measures in psychiatry: Where are we now? A regional Centre-Val de Loire 2012-2017 study].
作者信息
Laurent O, Godillon L, Biotteau M, Baron S, Grammatico-Guillon L, Laurent E
机构信息
Département d'information médicale (DIM), CH George-Sand, 77, rue Louis-Mallet, 18024 Bourges cedex, France; Laboratoire de santé publique, faculté de médecine, université de Tours, 10, boulevard Tonnellé, 37000 Tours, France.
Laboratoire de santé publique, faculté de médecine, université de Tours, 10, boulevard Tonnellé, 37000 Tours, France; Épidémiologie des données cliniques en Centre-Val de Loire (EpiDcliC), CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours, France.
出版信息
Rev Epidemiol Sante Publique. 2020 Jun;68(3):155-161. doi: 10.1016/j.respe.2020.02.001. Epub 2020 Apr 17.
BACKGROUND
The French legal framework in psychiatry for involuntary detention (ID) and seclusion measures was modified in 2011 and 2016, respectively. This study aimed to describe the evolution of ID and seclusion measures in the Centre-Val de Loire region (CVL France) between 2012 and 2017, using the psychiatric hospital discharge database.
METHODS
A cross-sectional study was conducted, including adult patients (≥ 18 years old) from CVL hospitalized in psychiatry or included in a care program (outpatient care) between 2012 and 2017. Hospital stays for each patient were identified by an anonymized number.
RESULTS
In 2017 in CVL, 13,942 patients were hospitalised for psychiatric reasons, with 2378 in ID (17%), a proportion that has remained stable since 2012. Among them, 3% were in care due to imminent danger (+ 54% since 2013, stabilisation since 2016), and 11% were hospitalized following a third party request (-13%). However, regarding location results varied from one department to the next. Seclusion measures involved 10% of full-time patients (stable), 27% of ID patients and 3% of those under voluntary care (stable). One quarter of the secluded patients were in voluntary care. Mean seclusion duration was 12 days, consecutive or not, and somewhat less for patients in voluntary care alone (10 days).
CONCLUSION
The region wide ID rate and average duration of seclusion were lower than the nationwide rate (24% in full-time ID in 2015; 15 days of seclusion/patient), whereas the number of imminent danger procedures increased, as did the persistence of seclusion measures for patients in voluntary care (recommended only as a last resort and/or for ID patients). These results should lead to renewed assessment of care center practices. The French psychiatric hospital discharge database has several limitations, including lack of financial incentive and highly complex structuration. However, since 2018 new data regarding seclusion and restraint measures have been added to the existing registry, and they should facilitate more accurate analyses, particularly as concerns restraint.
背景
法国精神病学中关于非自愿住院（ID）和隔离措施的法律框架分别于2011年和2016年进行了修订。本研究旨在利用精神病医院出院数据库描述2012年至2017年期间法国卢瓦尔河谷中心地区（CVL）ID和隔离措施的演变情况。
方法
进行了一项横断面研究，纳入2012年至2017年期间在CVL因精神疾病住院或纳入护理项目（门诊护理）的成年患者（≥18岁）。通过匿名编号识别每位患者的住院情况。
结果
2017年在CVL，有13942名患者因精神疾病住院，其中2378名接受非自愿住院治疗（占17%），这一比例自2012年以来一直保持稳定。其中，3%的患者因迫在眉睫的危险而接受治疗（自2013年以来增加了54%，自2016年以来趋于稳定），11%的患者应第三方要求住院治疗（下降了13%）。然而，各部门的住院地点结果有所不同。隔离措施涉及10%的全日制患者（稳定）、27%的非自愿住院患者和3%的自愿护理患者（稳定）。四分之一的被隔离患者接受自愿护理。平均隔离时间为1天，连续或不连续，仅接受自愿护理的患者隔离时间略短（10天）。
结论
该地区的非自愿住院率和平均隔离时间低于全国水平（2015年全日制非自愿住院率为24%；每位患者隔离15天），而因迫在眉睫的危险而进行的治疗程序数量增加，自愿护理患者的隔离措施持续时间也增加（仅建议作为最后手段和/或针对非自愿住院患者）。这些结果应促使对护理中心的做法进行重新评估。法国精神病医院出院数据库有几个局限性，包括缺乏经济激励和结构高度复杂。然而，自2018年以来，关于隔离和约束措施的新数据已被添加到现有登记册中，它们应有助于进行更准确的分析，特别是在约束方面。
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