Kent S, Yellowlees P
South Australian Mental Health Services, Adelaide.
Hosp Community Psychiatry. 1994 Apr;45(4):347-50. doi: 10.1176/ps.45.4.347.
The authors attempted to identify factors that commonly contributed to the decision to rehospitalize patients who made heavy use of mental health services.
The case notes of 50 patients with frequent readmissions to the South Australian Mental Health Services over a three-year period were examined to identify which of 15 factors most frequently contributed to hospital readmission.
Lack of insight or denial of illness was cited in 62.2 percent of the patients' 442 total admissions, followed by relationship problems (61.1 percent), suicidal ideation (44.8 percent), and noncompliance with medication (43.2 percent). When the 15 factors were combined into four major categories, social factors were found to contribute to 38.9 percent of admissions, followed by factors related to psychiatric and physical illness (31.1 percent), dangerousness to self or others (20.3 percent), and substance abuse (9.7 percent).
The substantial contribution of social factors to the readmission of patients to acute mental health services is strong evidence that the mental health system must provide appropriate targeted resources and assertive, continuous case management to avoid social crises. Issues surrounding drug and alcohol abuse among heavy users of services must be actively addressed.
作者试图确定那些常常促使大量使用心理健康服务的患者再次住院的因素。
对南澳大利亚心理健康服务机构在三年期间频繁再次入院的50名患者的病历进行检查，以确定15个因素中哪些因素最常导致再次入院。
在患者总计442次入院中，62.2%的情况被认为是缺乏洞察力或否认病情，其次是关系问题（61.1%）、自杀意念（44.8%）和不遵医嘱服药（43.2%）。当将这15个因素合并为四大类时，发现社会因素导致38.9%的入院情况，其次是与精神疾病和身体疾病相关的因素（31.1%）、对自己或他人的危险性（20.3%）以及药物滥用（9.7%）。
社会因素对急性心理健康服务患者再次入院有重大影响，这有力地证明心理健康系统必须提供适当的针对性资源以及积极、持续的个案管理，以避免社会危机。必须积极解决服务大量使用者中围绕药物和酒精滥用的问题。
