Williams Ryan, Farquharson Lorna, Rhodes Ellen, Dang Mary, Fitzpatrick Naomi, Quirk Alan, Baldwin David S, Crawford Mike J
College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
Department of Brain Sciences, Imperial College London, UK.
Personal Ment Health. 2020 Nov;14(4):336-349. doi: 10.1002/pmh.1484. Epub 2020 May 19.
Concerns have been raised about the quality of inpatient care received by patients with a diagnosis of personality disorder.
The aim of this study was to examine the quality of care received by inpatients with an anxiety or depressive disorder, comparing subgroups with or without a co-morbid personality disorder.
We used a retrospective case-note review of 3 795 patients admitted to inpatient psychiatric wards in England, utilizing data from the National Clinical Audit of Anxiety and Depression. Data were gathered on all acute admissions with an anxiety or depressive disorder over a 6-month period, for a number of measures reflecting quality of care derived from national standards. Association of coexisting personality disorder with quality of care was investigated using multivariable regression analyses.
Four hundred sixteen (11.0%) of the patients had a co-co-morbid diagnosis of personality disorder. Patients with personality disorder were less likely to have been asked about prior responses to treatment in their initial assessment (odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.50 to 0.89, p = 0.007). They were less likely to receive adequate notice in advance of their discharge (OR = 0.87, 95% CI 0.65 to 0.98, p = 0.046). They were more likely to be prescribed medication at the point of discharge (OR = 1.52, 95% CI 1.02 to 2.09, p = 0.012) and less likely to have been provided with information about the medicines they were taking (OR = 0.86, 95% CI 0.69 to 0.94, p = 0.048). In addition, the carers of patients with co-morbid personality disorder were less likely to have been provided with information about available support services (OR = 0.73, 95% CI 0.51 to 0.93, p = 0.045).
We found evidence of poorer quality of care for patients with co-morbid personality disorder who were admitted to psychiatric hospital for treatment of anxiety or depressive disorders, highlighting the need for improved clinical care in this patient group.
对于被诊断患有精神障碍的患者所接受的住院护理质量，人们已提出担忧。
本研究旨在调查患有焦虑或抑郁障碍的住院患者所接受的护理质量，比较伴有或不伴有共病性精神障碍的亚组情况。
我们对英格兰住院精神科病房收治的3795例患者进行了回顾性病历审查，利用来自焦虑和抑郁国家临床审计的数据。收集了6个月期间所有因焦虑或抑郁障碍急性入院患者的数据，涉及多项反映源自国家标准的护理质量的指标。使用多变量回归分析研究共存的精神障碍与护理质量之间的关联。
416例（11.0%）患者有共病性精神障碍诊断。患有精神障碍的患者在初始评估中被询问既往治疗反应的可能性较小（比值比（OR）=0.67，95%置信区间（CI）0.50至0.89，p=0.007）。他们在出院前得到充分通知的可能性较小（OR=0.87，95%CI 0.65至0.98，p=0.046）。他们在出院时更有可能被开具药物（OR=1.52，95%CI 1.02至2.09，p=0.012），而获得所服用药物信息的可能性较小（OR=0.86，95%CI 0.69至0.94，p=0.048）。此外，患有共病性精神障碍患者的护理人员获得可用支持服务信息的可能性较小（OR=0.73，95%CI 0.51至0.93，p=0.045）。
我们发现，因焦虑或抑郁障碍入住精神病院治疗的共病性精神障碍患者的护理质量较差，这凸显了改善该患者群体临床护理的必要性。
