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[德国、奥地利和瑞士针对精神障碍患者的危机解决团队、居家治疗及积极外展服务效果的证据——一项系统综述]

[Evidence on the effects of crisis resolution teams, home treatment and assertive outreach for people with mental disorders in Germany, Austria and Switzerland - a systematic review].

作者信息

Bechdolf Andreas, Bühling-Schindowski Felix, Nikolaidis Konstantinos, Kleinschmidt Martin, Weinmann Stefan, Baumgardt Johanna

机构信息

Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland.

Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln, Köln, Deutschland.

出版信息

Nervenarzt. 2022 May;93(5):488-498. doi: 10.1007/s00115-021-01143-8. Epub 2021 Jun 10.


DOI:10.1007/s00115-021-01143-8
PMID:34114073
Abstract

BACKGROUND: Based on international randomized controlled trials (RCT) the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) recommends acute treatment in the domestic environment (AHU) and intensive outreach treatment (IAB) with the highest level of evidence; however, due to large differences in national healthcare systems the transference of results from international studies to the healthcare systems in Germany, Austria and Switzerland could be limited. OBJECTIVE: Evaluation of studies on outreach psychiatric treatment forms in Germany, Austria and Switzerland and discussion of the results in the light of international evidence. MATERIAL AND METHODS: A systematic literature search for clinical trials on outreach community treatment from Germany, Austria and Switzerland was conducted in the PubMed database. RESULTS: A total of 19 publications were identified which could be assigned to 5 publications on 4 studies with 2857 patients on AHU and 14 publications on 10 studies with 3207 patients on IAB. The studies on AHU showed this treatment form to be superior regarding the duration of inpatient stay and healthcare costs. The studies on IAB showed more positive outcomes in comparison to controls regarding symptoms, severity of illness, substance abuse, functioning level, remission, satisfaction with treatment, quality of life, healthcare costs, work and housing situations. CONCLUSION: The studies from Germany, Austria, and Switzerland suggest that outreach community treatment is superior regarding several outcome parameters. Thus, there are no indications suggesting that international evidence could not be valid for these countries. Additionally, with one RCT for AHU and one for IAB the requirements for an evidence level of 1b for outreach community treatment in the healthcare systems in question are fulfilled.

摘要

背景:基于国际随机对照试验(RCT),德国精神病学、心理治疗与身心医学协会(DGPPN)推荐在家庭环境中进行急性治疗(AHU)以及进行最高证据水平的强化外展治疗(IAB);然而,由于各国医疗保健系统存在巨大差异,国际研究结果向德国、奥地利和瑞士医疗保健系统的转化可能受到限制。 目的:评估德国、奥地利和瑞士关于外展精神科治疗形式的研究,并根据国际证据对结果进行讨论。 材料与方法:在PubMed数据库中对德国、奥地利和瑞士关于外展社区治疗的临床试验进行系统的文献检索。 结果:共识别出19篇出版物,可将其归为4项研究的5篇出版物,涉及2857例接受AHU治疗的患者,以及10项研究的14篇出版物,涉及3207例接受IAB治疗的患者。关于AHU的研究表明,这种治疗形式在住院时间和医疗费用方面更具优势。关于IAB的研究表明,与对照组相比,在症状、疾病严重程度、药物滥用、功能水平、缓解情况、治疗满意度、生活质量、医疗费用、工作和住房状况等方面有更积极的结果。 结论:来自德国、奥地利和瑞士的研究表明,外展社区治疗在几个结果参数方面更具优势。因此,没有迹象表明国际证据对这些国家无效。此外,有一项关于AHU的RCT和一项关于IAB的RCT,满足了相关医疗保健系统中外展社区治疗证据水平为1b的要求。

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引用本文的文献

[1]
Efficacy of home-based and inpatient treatment for children and adolescents in psychiatric crisis: A systematic review protocol.

PLoS One. 2025-3-10

[2]
[A comparison of direct admissions to inpatient-equivalent home treatment with transfers from psychiatric wards].

Psychiatr Prax. 2025-4

[3]
Utilization of Psychiatric Hospital Services Following Intensive Home Treatment: A Nonrandomized Clinical Trial.

JAMA Netw Open. 2024-11-4

[4]
Work-related participation impairments and support needs of patients in a Swiss psychiatric university hospital.

Front Psychiatry. 2024-1-4

本文引用的文献

[1]
Implementation, efficacy, costs and processes of inpatient equivalent home-treatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial.

BMC Psychiatry. 2021-3-30

[2]
Intensive case management for severe mental illness.

Cochrane Database Syst Rev. 2017-1-6

[3]
[Cost evaluation of a model for integrated care of seriously mentally ill patients].

Gesundheitswesen. 2014-2

[4]
Prophylactic platelet transfusion for prevention of bleeding in patients with haematological disorders after chemotherapy and stem cell transplantation.

Cochrane Database Syst Rev. 2012-5-16

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