Swartz M S, Burns B J, Hiday V A, George L K, Swanson J, Wagner H R
Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA.
Psychiatr Serv. 1995 Apr;46(4):381-5. doi: 10.1176/ps.46.4.381.
Involuntary outpatient commitment has been used as a method of improving tenure in community programs for individuals with severe and persistent mental illness. This paper reviews literature on research about involuntary outpatient commitment and suggests questions and methods for future research.
Literature describing research studies of involuntary outpatient commitment, located by searching MEDLINE and following up references cited in relevant articles, was reviewed with attention to patient characteristics and diagnostic, treatment, and outcomes measures.
Involuntary outpatient commitment appears to provide limited but improved outcomes in rates of rehospitalization and lengths of hospital stay. Variability in community treatment makes interpretation of other types of outcome difficult. Few studies specifically identify results among patients with severe and persistent mental illness.
No studies have examined the extent to which outpatient commitment affects compliance and treatment when essential community services such as case management are consistently and aggressively provided, nor have studies controlled for potentially confounding factors such as treatment and nontreatment effects, including informal coercion. A randomized trial of involuntary outpatient commitment should be useful in evaluating the effectiveness of this type of intervention.
非自愿门诊治疗已被用作一种改善患有严重和持续性精神疾病的个体在社区项目中留治率的方法。本文回顾了关于非自愿门诊治疗的研究文献，并提出了未来研究的问题和方法。
通过检索MEDLINE并追踪相关文章中引用的参考文献，查找描述非自愿门诊治疗研究的文献，并对患者特征以及诊断、治疗和结局指标进行了综述。
非自愿门诊治疗似乎在再住院率和住院时间方面提供了有限但有所改善的结果。社区治疗的差异使得对其他类型结局的解读变得困难。很少有研究专门确定严重和持续性精神疾病患者的结果。
尚无研究考察在持续且积极提供诸如个案管理等基本社区服务时，门诊治疗对依从性和治疗的影响程度，也没有研究控制潜在的混杂因素，如治疗和非治疗效果，包括非正式强制手段。非自愿门诊治疗的随机试验对于评估此类干预措施的有效性应是有用的。
