Stulz N, Kawohl W, Jäger M, Mötteli S, Schnyder U, Hepp U
Integrated Psychiatric Services Winterthur-Zurcher Unterland, P.O. Box 144, CH-8408Winterthur, Switzerland.
Psychiatric Services Aargau, P.O. Box 432, CH-5201Brugg, Switzerland.
Eur Psychiatry. 2020 Oct 13;63(1):e94. doi: 10.1192/j.eurpsy.2020.91.
In line with previous findings, in a recent randomized controlled trial (RCT), we found that home treatment (HT) for acute mental health care can reduce (substitute) hospital use among severely ill patients in crises. This study examined whether the findings of the RCT generalize to HT services provided under routine care conditions.
We compared patients who received HT during the RCT study phase with patients who received the same HT service after it had become part of routine mental health services in the same catchment area. Sociodemographic and clinical characteristics as well as service use (HT and hospital bed days) were compared between the RCT and the subsequent routine care study period.
Compared to patients who received HT during the RCT, routine care HT patients were more often living with others, less often admitted compulsorily, more often diagnosed with anxiety and stress-related disorders (ICD-10 F4) and less often diagnosed with schizophrenia spectrum disorders (F2). When compared to patients who were exclusively treated on hospital wards, involvement of the HT team in patients' care was associated with a clear-cut reduction of hospital bed days both during the RCT and under routine care conditions. However, unlike during the RCT study period, involvement of HT was associated with longer overall treatment episodes (inpatient + HT days) under routine care conditions.
HT seems to reduce the use of hospital bed days even under routine care conditions but is at risk of producing longer overall acute treatment episodes.
与之前的研究结果一致，在最近一项随机对照试验（RCT）中，我们发现急性精神卫生保健的居家治疗（HT）可减少（替代）处于危机中的重症患者的住院次数。本研究探讨了RCT的研究结果是否适用于常规护理条件下提供的HT服务。
我们将在RCT研究阶段接受HT的患者与在同一集水区该HT服务成为常规精神卫生服务一部分后接受相同HT服务的患者进行了比较。比较了RCT阶段与后续常规护理研究阶段患者的社会人口学和临床特征以及服务使用情况（HT和住院天数）。
与在RCT期间接受HT的患者相比，常规护理HT患者更常与他人同住，强制入院的情况较少，更常被诊断为焦虑和应激相关障碍（国际疾病分类第十版F4），而被诊断为精神分裂症谱系障碍（F2）的情况较少。与仅在医院病房接受治疗的患者相比，HT团队参与患者护理在RCT期间和常规护理条件下均与住院天数的明显减少相关。然而，与RCT研究阶段不同，在常规护理条件下，HT的参与与更长的总体治疗疗程（住院+HT天数）相关。
即使在常规护理条件下，HT似乎也能减少住院天数，但存在导致总体急性治疗疗程延长的风险。
