Hirsch Sophie, Baumgardt Johanna, Bechdolf Andreas, Bühling-Schindowski Felix, Cole Celline, Flammer Erich, Mahler Lieselotte, Muche Rainer, Sauter Dorothea, Vandamme Angelika, Steinert Tilman
Department for Psychiatry and Psychotherapy I, Faculty of Medicine, Ulm University, Ulm, Germany.
Department for Psychiatry and Psychotherapy Biberach, ZfP Südwürttemberg, Biberach, Germany.
Front Psychiatry. 2023 May 11;14:1130727. doi: 10.3389/fpsyt.2023.1130727. eCollection 2023.
The PreVCo study examines whether a structured, operationalized implementation of guidelines to prevent coercion actually leads to fewer coercive measures on psychiatric wards. It is known from the literature that rates of coercive measures differ greatly between hospitals within a country. Studies on that topic also showed large Hawthorne effects. Therefore, it is important to collect valid baseline data for the comparison of similar wards and controlling for observer effects.
Fifty five psychiatric wards in Germany treating voluntary and involuntary patients were randomly allocated to an intervention or a waiting list condition in matched pairs. As part of the randomized controlled trial, they completed a baseline survey. We collected data on admissions, occupied beds, involuntarily admitted cases, main diagnoses, the number and duration of coercive measures, assaults and staffing levels. We applied the PreVCo Rating Tool for each ward. The PreVCo Rating Tool is a fidelity rating, measuring the degree of implementation of 12 guideline-linked recommendations on Likert scales with a range of 0-135 points covering the main elements of the guidelines. Aggregated data on the ward level is provided, with no patient data provided. We performed a Wilcoxon signed-rank-test to compare intervention group and waiting list control group at baseline and to assess the success of randomization.
The participating wards had an average of 19.9% involuntarily admitted cases and a median 19 coercive measures per month (1 coercive measure per occupied bed, 0.5 per admission). The intervention group and waiting list group were not significantly different in these measurements. There were 6.0 assaults per month on average (0.3 assaults per occupied bed and 0.1 per admission). The PreVCo Rating Tool for guideline fidelity varied between 28 and 106 points. The percentage of involuntarily admitted cases showed a correlation with coercive measures per month and bed (Spearman's Rho = 0.56, < 0.01).
Our findings that coercion varies widely within a country and mainly is associated with involuntarily admitted and aggressive patients are in line with the international literature. We believe that we included a sample that covers the scope of mental health care practice in Germany well.: www.isrctn.com, identifier ISRCTN71467851.
PreVCo研究旨在探讨对预防强制手段的指南进行结构化、可操作的实施是否真的能减少精神科病房的强制手段。从文献中可知，一个国家内不同医院的强制手段发生率差异很大。关于该主题的研究还显示出显著的霍桑效应。因此，收集有效的基线数据对于比较相似病房以及控制观察者效应非常重要。
德国55个收治自愿和非自愿患者的精神科病房被随机配对分为干预组或等待名单组。作为随机对照试验的一部分，他们完成了一项基线调查。我们收集了关于入院人数、占用病床数、非自愿入院病例、主要诊断、强制手段的数量和持续时间、攻击行为以及人员配备水平的数据。我们为每个病房应用了PreVCo评级工具。PreVCo评级工具是一种保真度评级，用于衡量12项与指南相关的建议在李克特量表上的实施程度，范围为0 - 135分，涵盖了指南的主要要素。提供的是病房层面的汇总数据，未提供患者数据。我们进行了威尔科克森符号秩检验，以比较干预组和等待名单对照组在基线时的情况，并评估随机化的成功程度。
参与研究的病房平均有19.9%的非自愿入院病例，每月强制手段的中位数为19次（每张占用病床1次强制手段，每次入院0.5次）。在这些测量中，干预组和等待名单组没有显著差异。平均每月有6.0次攻击行为（每张占用病床0.3次攻击行为，每次入院0.1次）。指南保真度的PreVCo评级工具得分在28至106分之间。非自愿入院病例的百分比与每月每张病床的强制手段次数呈正相关（斯皮尔曼等级相关系数=0.56，<0.01）。
我们的研究结果表明，一个国家内强制手段差异很大，且主要与非自愿入院和有攻击行为的患者相关，这与国际文献一致。我们认为我们纳入的样本很好地涵盖了德国精神卫生保健实践的范围。：www.isrctn.com，标识符ISRCTN71467851。
