Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Consultations de Chauderon, Chauderon 18, 1003, Lausanne, Switzerland.
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Adm Policy Ment Health. 2022 Sep;49(5):798-809. doi: 10.1007/s10488-022-01198-y. Epub 2022 May 16.
An Intensive Case Management (ICM) intervention has been developed in Lausanne, Switzerland. It aims to promote access to care for people with severe mental disorders who have difficulties to engage with mental health services because of the severity of their disorders and/or their marginality. ICM embrace components of assertive community treatment and critical time intervention. It is time limited and focused on critical phases of recovery. The goal of this study was to examine the heterogeneity of service use patterns of people who required ICM interventions and identify differences in patterns of duration and timing of the intervention. Records of 471 patients from the Department of Psychiatry of Lausanne University Hospital for whom the ICM team intervention was requested were analysed over a 6 year period with discrete sequential-state analysis. Trajectories could be split between six meaningful clusters including service light use and critical time intervention (58.0%), transition to long-term regular ambulatory-care (11.3%), partial transition to ambulatory care (14.4%), alternative to hospitalization (10.4%), continued ICM (4.9%) and long hospital stays (1.1%). Diagnoses of substance abuse were overrepresented among heavy users and diagnoses of schizophrenia were the most frequent diagnostic overall. Profiles of service use for ICM patients were very diverse. Long term interventions were frequently not necessary. A time-limited intervention was likely sufficient to stabilize the situation and/or engage the patient in care. A small number of situations required a sustained and long-term investment and did not always allowed for a reduction in the need for hospitalization. A general reflection on alternatives to hospitalization must be pursued, in particular for these patients.
在瑞士洛桑开发了一种强化病例管理（ICM）干预措施。其目的是促进严重精神障碍患者获得治疗，这些患者由于疾病的严重程度和/或边缘化而难以接受精神卫生服务。ICM 包含了主张治疗和关键时期干预的内容。它是限时的，专注于恢复的关键阶段。本研究的目的是检查需要 ICM 干预的患者的服务使用模式的异质性，并确定干预的持续时间和时间安排的差异。在 6 年的时间里，对洛桑大学医院精神病学部的 471 名患者的记录进行了分析，这些患者的 ICM 团队干预请求被离散序列状态分析所分析。轨迹可以分为六个有意义的集群，包括服务轻度使用和关键时期干预（58.0%）、过渡到长期常规门诊护理（11.3%）、部分过渡到门诊护理（14.4%）、替代住院治疗（10.4%）、持续 ICM（4.9%）和长期住院（1.1%）。重度使用者中药物滥用的诊断更为常见，总体而言，精神分裂症的诊断最为常见。ICM 患者的服务使用模式非常多样化。长期干预通常不是必要的。限时干预可能足以稳定病情和/或使患者接受治疗。少数情况需要持续和长期的投入，并不总是能够减少住院的需求。必须继续对替代住院治疗的方案进行全面的思考，特别是对于这些患者。
