Hoult J, Rosen A, Reynolds I
Soc Sci Med. 1984;18(11):1005-10. doi: 10.1016/0277-9536(84)90272-7.
One hundred and twenty patients presenting for admission to a state psychiatric hospital were randomly allocated into two groups. Control patients received standard hospital care and after-care. Experimental patients were not admitted if this could be avoided; instead they and their relatives were provided with comprehensive community treatment and a 24-hour crisis service. Patients with a primary diagnosis of alcohol or drug dependence, organic brain disorder or mental retardation were excluded. Most patients were suffering from psychotic disorders--more than half specifically from schizophrenia. During the 12 months study period 96% of the control patients were admitted--51% more than once. Of the experimental patients 60% were not admitted at all and only 8% were admitted more than once. Control patients spent an average of 53.5 days in psychiatric hospital, experimental patients spent an average of 8.4 days. Community treatment did not increase the burden upon the community, was considered to be significantly more satisfactory and helpful by patients and their relatives, achieved a clinically superior outcome, and cost less than standard care and after-care. The ingredients differentiating comprehensive community-based care from prevailing methods of psychiatric care are discussed.
120名前往一家州立精神病院住院的患者被随机分为两组。对照组患者接受标准的住院治疗和后续护理。如果可以避免，试验组患者则不入院；相反，他们及其亲属会获得全面的社区治疗和24小时危机服务。初步诊断为酒精或药物依赖、器质性脑障碍或智力障碍的患者被排除在外。大多数患者患有精神障碍——超过一半的患者具体患有精神分裂症。在为期12个月的研究期间，96%的对照组患者入院——其中51%不止一次入院。试验组患者中，60%根本未入院，只有8%不止一次入院。对照组患者平均在精神病院住院53.5天，试验组患者平均住院8.4天。社区治疗并未增加社区负担，患者及其亲属认为其明显更令人满意且更有帮助，取得了临床上更好的效果，且成本低于标准护理和后续护理。文中讨论了将基于社区的全面护理与现行精神病护理方法区分开来的要素。
