Kwok Ka Ho Robin, Yuan Sze Ngar Vanessa, Ougrin Dennis
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, PO 85, De Crespigny Park, London SE5 8AF, UK.
Child Adolesc Ment Health. 2016 Feb;21(1):3-10. doi: 10.1111/camh.12123. Epub 2015 Sep 23.
Intensive community services may provide an alternative to inpatient care but there is little systematic evidence of their efficacy. This article provides a systematic review of randomized controlled trials (RCTs) reporting efficacy of intensive community services versus inpatient care in youth.
Data sources were identified by searching Medline, PsychINFO and EMBASE databases as of December 2014. RCTs comparing intensive community services versus inpatient care in children and adolescents (through age 18) were included.
Six unique RCTs including 569 youth were identified. The RCTs examined the efficacy of specialist outpatient treatment, multisystemic therapy, day patient treatment, intensive home treatment and supported discharge services versus inpatient care. Using intensive community services was associated with clinical improvements similar to inpatient care in most studies. Where differences in clinical outcomes existed, they tended to favour intensive community treatment. Using intensive community services was associated with shorter hospitalizations, lower costs and greater patient satisfaction. There were no independent replications of the results. Few studies investigated the use of intensive community treatment as an alternative to inpatient care in children and adolescents with severe immediate risk to self and others.
Intensive community services appear to be a viable alternative to inpatient care. Independent replication of results achieved by specific intensive community treatment models is a research priority.
强化社区服务可能为住院治疗提供一种替代方案，但几乎没有关于其疗效的系统性证据。本文对报告强化社区服务与青少年住院治疗疗效对比的随机对照试验（RCT）进行了系统综述。
通过检索截至2014年12月的Medline、PsychINFO和EMBASE数据库来确定数据来源。纳入了比较儿童和青少年（至18岁）强化社区服务与住院治疗的随机对照试验。
共识别出6项独特的随机对照试验，涉及569名青少年。这些随机对照试验考察了专科门诊治疗、多系统治疗、日间住院治疗、强化家庭治疗和支持性出院服务与住院治疗相比的疗效。在大多数研究中，使用强化社区服务与类似于住院治疗的临床改善相关。在临床结果存在差异的情况下，这些差异往往有利于强化社区治疗。使用强化社区服务与住院时间缩短、成本降低以及患者满意度提高相关。结果没有独立的重复验证。很少有研究调查在对自己和他人有严重直接风险的儿童和青少年中，使用强化社区治疗替代住院治疗的情况。
强化社区服务似乎是住院治疗的一个可行替代方案。对特定强化社区治疗模式所取得结果的独立重复验证是一项研究重点。
