Sytema S, Micciolo R, Tansella M
Afdeling Sociale Psychiatrie, Rijksuniversiteit Groningen, The Netherlands.
Psychol Med. 1997 Nov;27(6):1355-62. doi: 10.1017/s0033291797005539.
It is widely believed that for the severely mentally ill continuity of care is essential to ensure a better outcome and prevent long-term hospitalization. However, not much progress has been made in the operationalization and measurement of this concept. We used two indicators to compare continuity of care of schizophrenic patients in two kinds of mental health systems. One is a community mental health system without the back-up of a mental hospital (South-Verona, Italy). The other is an institution-based system in which mental hospitals are still predominant (Groningen, The Netherlands).
The first indicator of continuity of care, readiness of aftercare, is the time from discharge from hospital to the first day- or out-patient contact. Survival analysis was applied to correct for censored observations. The second indicator, flexibility of care, is the use of combinations of in-, day- and out-patient care during 2-year follow-up.
More patients in South-Verona received community care within 2 weeks after discharge (71.5%), than in the Groningen register area (54.6%). The survival functions differed significantly. Cox regression analysis revealed that in both systems a contact before admission, the time between this contact and admission and the duration of the admission are predictors for aftercare. A higher percentage of patients made multiple service use (combinations of in-, day- and out-patient care) in South-Verona than in Groningen (62 v. 45%).
Both indicators showed a higher continuity of care in the South-Verona system.
人们普遍认为，对于重症精神病患者而言，持续的护理对于确保更好的治疗效果和防止长期住院至关重要。然而，在这一概念的实施和衡量方面进展甚微。我们使用两个指标来比较两种精神卫生系统中精神分裂症患者的护理连续性。一种是没有精神病院作为后盾的社区精神卫生系统（意大利南维罗纳）。另一种是以机构为基础的系统，其中精神病院仍然占主导地位（荷兰格罗宁根）。
护理连续性的第一个指标，即后续护理准备情况，是从出院到首次门诊或日间门诊接触的时间。采用生存分析来校正删失观察值。第二个指标，护理灵活性，是指在2年随访期间综合使用住院、日间和门诊护理的情况。
南维罗纳地区更多患者在出院后2周内接受了社区护理（71.5%），高于格罗宁根登记地区（54.6%）。生存函数有显著差异。Cox回归分析显示，在这两种系统中，入院前的接触、此次接触与入院之间的时间以及住院时间都是后续护理的预测因素。南维罗纳地区使用多种服务（综合使用住院、日间和门诊护理）的患者比例高于格罗宁根（62%对45%）。
两个指标均显示南维罗纳系统的护理连续性更高。
