Simpson Paul L, Settumba Stella, Adily Armita, Ton Bianca, Butler Tony
School of Population Health, University of New South Wales, Sydney, NSW, Australia.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
Front Psychiatry. 2021 Oct 22;12:760904. doi: 10.3389/fpsyt.2021.760904. eCollection 2021.
Early treatment (considered as early contact with community mental health services) and treatment retention are associated with reduced reoffending among those with a previous diagnosis of psychosis, yet the attributes of care required to best achieve this is largely unexplored for people with psychosis leaving prison. This study sought consensus from a sample of experts and consumers regarding the attributes of an "optimal model of care" for those with a prior episode of psychosis leaving prison in New South Wales, Australia. A Delphi method was used, which involved establishing a consensus from a panel of 25 experts and consumers. Following three meetings, 34 model of care attributes and 168 attribute levels were generated for two rounds of online scoring. All attributes and levels were included in the final model if they scored "very important" or "extremely important;" or if the attribute was agreed on by 70% or more of participants. The participant retention rate across scoring rounds was 96% for Round 1 and 84% for Round 2, where consensus was reached. Two "member checking" procedures were undertaken to enhance the integrity of findings: a model "stress test" and an online consumer poll. Thirty-two attributes and 72 attribute levels were included in the final model across four components: pre-release care planning and coordination; treatments in community; diversion from prison; and evaluation. Member checking endorsed a person-centered approach with carers and peer-support central to care. Participants agreed that an optimal model of care should involve a specialized team who works independent of community health service teams to directly deliver certain treatments and services while helping consumers to access external social an economic supports and services.
早期治疗（定义为尽早与社区心理健康服务机构接触）以及治疗依从性与降低曾被诊断为精神病患者的再犯罪率相关，但对于刚出狱的精神病患者而言，能最佳实现这一目标所需的护理属性在很大程度上尚未得到探索。本研究旨在就澳大利亚新南威尔士州刚出狱的曾有过精神病发作经历的患者的“最佳护理模式”属性，向专家和消费者样本征求意见。采用了德尔菲法，即从由25名专家和消费者组成的小组中达成共识。经过三次会议，针对两轮在线评分生成了34项护理模式属性和168个属性级别。如果所有属性和级别得分“非常重要”或“极其重要”；或者如果70%或更多参与者认可该属性，则将其纳入最终模型。在达成共识的评分轮次中，第一轮参与者保留率为96%，第二轮为84%。为提高研究结果的完整性，进行了两项“成员核查”程序：模型“压力测试”和在线消费者民意调查。最终模型涵盖四个组成部分中的32项属性和72个属性级别：释放前护理规划与协调；社区治疗；监狱分流；以及评估。成员核查认可了一种以患者为中心的方法，其中护理人员和同伴支持是护理的核心。参与者一致认为，最佳护理模式应包括一个专门团队，该团队独立于社区卫生服务团队开展工作，直接提供某些治疗和服务，同时帮助消费者获得外部社会和经济支持与服务。
