Mueser K T, Bond G R, Drake R E, Resnick S G
Department of Psychiatry, Dartmouth Medical School, Hanover, NH, USA.
Schizophr Bull. 1998;24(1):37-74. doi: 10.1093/oxfordjournals.schbul.a033314.
We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.
我们描述了针对重度精神疾病患者的不同社区护理模式，并回顾了有关个案管理的研究文献，包括75项研究的结果。大多数研究是针对积极社区治疗（ACT）或强化个案管理（ICM）模式进行的。对ACT和ICM的对照研究表明，这些模式可减少住院时间并改善住房稳定性，尤其是在高服务使用率的患者中。ACT和ICM似乎对改善症状和生活质量有中等效果。大多数研究表明，ACT和ICM对社会功能、被捕次数和在监狱中度过的时间或职业功能影响不大。关于减少或撤销ACT或ICM服务的研究表明，已取得的成果会有所恶化。关于其他社区护理模式的研究尚无定论。我们根据ACT或ICM团队专业化以解决社会和职业功能以及药物滥用问题的必要性来讨论这些发现的意义。我们为社区护理模式的未来研究提出了方向，包括评估实施的保真度、探索改善的患者预测因素以及评估帮助联盟在调节结果中的作用。
