Thornicroft G
Psychiatric Research in Service Measurement (PRISM), Institute of Psychiatry, De Crespigny Park, Londres, Angleterre.
Rev Epidemiol Sante Publique. 1993;41(4):292-7.
In Britain, we are in the process of closing the majority of the old psychiatric hospitals. In 1954, there were 148,000 psychiatric beds, and in 1990 about 50,000 still remained. At Friern Hospital, in North London, a research team has studied 1,000 long-term in-patients who have been discharged from hospital. This paper sets out the results for the first 350 of these patients, discharged from Friern and Claybury hospitals between 1985 and 1990, comparing before and after discharge. In the first year after discharge 16% were readmitted to hospital. We used the following scales to measure the function of these patients: Present State Examination, Social Behaviour Schedule, Physical Health Index, Social Network Scale, Patient Attitude Questionnaire. One year after discharged, the majority of these measures showed no change. However, significant changes (p < 0.01) were noted for: the attitude of patients (who preferred their new way of life in the community), the costs of care (which were initially reduced by 5% for patients discharged from hospital), and for the improved quality of accommodation (which allowed more choice for patients). These first results suggest that care in the community is no worse, in many respects is better, and is no more expensive than hospital care.
在英国，我们正在关闭大多数旧的精神病医院。1954年，有14.8万张精神病床位，到1990年仍有约5万张。在伦敦北部的弗里恩医院，一个研究团队对1000名已出院的长期住院患者进行了研究。本文阐述了其中前350名患者的研究结果，这些患者于1985年至1990年间从弗里恩医院和克莱伯里医院出院，并对出院前后的情况进行了比较。出院后的第一年，16%的患者再次入院。我们使用了以下量表来衡量这些患者的功能：《现况检查》《社会行为量表》《身体健康指数》《社会网络量表》《患者态度问卷》。出院一年后，这些测量指标中的大多数没有变化。然而，出现了显著变化（p < 0.01）的方面有：患者的态度（他们更喜欢社区中的新生活方式）、护理成本（出院患者的护理成本最初降低了5%）以及居住质量的提高（这让患者有了更多选择）。这些初步结果表明，社区护理并不比医院护理差，在很多方面更好，而且成本也并不更高。
