对患有长期精神疾病且已接受治疗的人群的社区精神护理评估。

An evaluation of community-based psychiatric care for people with treated long-term mental illness.

作者信息

Wilkinson G, Piccinelli M, Falloon I, Krekorian H, McLees S

机构信息

University of Liverpool, Royal Liverpool University Hospital.

出版信息

Br J Psychiatry. 1995 Jul;167(1):26-37; discussion 38-40. doi: 10.1192/bjp.167.1.26.

DOI:10.1192/bjp.167.1.26

PMID:7551605

Abstract

BACKGROUND

We evaluated integrated, multidisciplinary, community-based care for a cohort of people with treated long-term mental illness over two years in a field trial set in a semi-rural setting. The aim was to organise local psychiatric services on an extramural basis with general practitioner teams as the key element.

METHOD

Trained research workers used a structured interview to collect standardised base-line and three-monthly socio-demographic, clinical, social, family adjustment and burden, and treatment measures from patients, informants, and key-workers. Analysis included descriptive statistics and, for longitudinal data, analysis of best-fitted straight lines.

RESULTS

We studied 34 patients (14 with schizophrenia, 11 with major affective disorders, and 9 with minor (non-major) affective disorders and anxiety disorders) who had a mean of 12 years continuous illness. At baseline, they were mainly characterised by research workers as mildly ill with fair social adaptive functioning, and by lay informants as having moderate target symptom severity and disturbance of social performance. Over two years, there were statistically significant, slight improvements in clinical global impressions ratings by research workers, and in informants ratings of target symptoms and social performance. Most patients continued to receive prescriptions for psychotropic drugs throughout follow-up, and they had a mean of 47 therapeutic contacts, mainly from nurses. Two patients were admitted to psychiatric hospital. There were few differences between patients in different diagnostic groups.

CONCLUSIONS

Integrated, multidisciplinary, community-based psychiatric care for people with treated long-term mental illness is feasible in a semi-rural setting: patients receiving pharmacotherapy and regular psychosocial treatments remained relatively stable on clinical and social measures over two years. The unique way in which the service was monitored, by making regular, systematic assessments of patients and carers, serves as an example for other services.

摘要

背景

在一个半农村地区进行的一项现场试验中，我们对一组接受过长期治疗的精神疾病患者进行了为期两年的综合、多学科、基于社区的护理评估。目的是以全科医生团队为关键要素，在院外组织当地的精神科服务。

方法

训练有素的研究人员采用结构化访谈，从患者、 informant 和关键工作人员那里收集标准化的基线以及每三个月一次的社会人口统计学、临床、社会、家庭适应与负担以及治疗措施。分析包括描述性统计，对于纵向数据，采用最佳拟合直线分析。

结果

我们研究了 34 名患者（14 名精神分裂症患者、11 名重度情感障碍患者以及 9 名轻度（非重度）情感障碍和焦虑症患者），他们平均患病 12 年。在基线时，研究人员主要将他们描述为病情较轻且社会适应功能良好，而外行 informant 则认为他们的目标症状严重程度中等且社会功能受到干扰。在两年时间里，研究人员对临床总体印象评分、informant 对目标症状和社会功能的评分有统计学上显著的轻微改善。大多数患者在整个随访期间继续接受精神药物处方，他们平均有 47 次治疗接触，主要来自护士。两名患者被收治到精神病院。不同诊断组的患者之间差异不大。