Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott).
Psychiatr Serv. 2021 Jun;72(6):691-703. doi: 10.1176/appi.ps.202000145. Epub 2021 Mar 26.
An ongoing need exists for innovation in service delivery to ensure that mental health services deliver high-quality treatment and prevention in the population. This Special Article proposes the adoption of "staged care" as a population health-oriented service delivery model for packages of specialized services delivered largely in ambulatory care settings for individuals with common affective disorders. Staged care integrates measures of clinical need alongside clinical stage and personal choice to select hierarchically arranged service packages for individuals. Packages then vary according to the intensity, duration, and mix of treatment options. This Special Article describes five levels of care in staged care: self- or family-directed monitoring and management, low-intensity services, moderate-intensity services, high-intensity services, and acute and specialist community mental health services. The care environment, treatment team, and length of treatment are also described, and provisional criteria are specified for assigning individuals to different care levels on the basis of current clinical need and clinical stage. Staged care is presented as a model that guides treatment selection and health service delivery to ensure that the high-quality care aims of "right care first time" and prevention are achieved and optimal use of available resources is considered.
持续需要在服务提供方面进行创新，以确保精神卫生服务在人群中提供高质量的治疗和预防。这篇特稿建议采用“分级护理”作为一种面向人群健康的服务提供模式，为常见情感障碍患者提供专门服务包，主要在门诊环境中提供。分级护理将临床需求的衡量标准与临床阶段和个人选择相结合，为个人选择分层排列的服务包。然后，根据治疗选择的强度、持续时间和组合，对套餐进行调整。这篇特稿描述了分级护理中的五个护理级别：自我或家庭指导监测和管理、低强度服务、中强度服务、高强度服务以及急性和专科社区精神卫生服务。还描述了护理环境、治疗团队和治疗时间，并根据当前的临床需求和临床阶段，为将个人分配到不同的护理级别制定了临时标准。分级护理旨在指导治疗选择和卫生服务提供，以确保实现“首次正确治疗”和预防的高质量护理目标，并考虑到可用资源的最佳利用。
