重度の精神疾患における身体健康検査の普及:体系的レビュー
Elizabeth Emsley1, Sarah Sullivan2, Elizabeth Rose-Innes3
1University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, United Kingdom elizabeth.emsley@bristol.ac.uk.
まとめ
重度の精神疾患 (SMI) の人の身体的健康診断を改善するための介入は,限られた証拠を示しています. ケースマネジメントのアプローチは有望に見えますが,より高い品質の研究が普及を促す必要があります.
科学分野:
- 公衆衛生
- メンタルヘルスサービス研究
- 医療サービス研究
背景:
- 重度の精神疾患 (SMI) の個人は,主に予防可能な身体的健康状態のために,早死のリスクが高くなります.
- この集団における身体健康管理の重要な戦略である身体健康検査の実施は一貫していない.
研究 の 目的:
- SMI患者の身体健康評価へのアクセスと利用を向上させるための介入に関する証拠を体系的に検討し評価する.
主な方法:
- 2000年以降の研究をMEDLINE,CINAHL,PsycInfoで検索することで,体系的なレビューが行われました.
- ランダム化比較試験と非ランダム化比較試験を含む,SMI患者における身体健康チェックの利用率を増やすための介入を評価した研究が含まれています.
- バイアスのリスクは,Cochrane RoB 2とROBINS- Iツールを使用して評価され,データは効果方向グラフで合成されました.
主要な成果:
- 特定された4437件のうち,12件が適格性基準を満たした. 介入にはケース管理,金銭的インセンティブ,サービス変更,招待が含まれていました.
- 2つのランダム化制御試験は,症例管理のポジティブな効果を示したが,そのうちの1つは高いバイアスの懸念を示した.
- 主にランダム化されていない研究からの他の介入は,中等から重大なバイアスのリスクを持つ混合またはポジティブな結果をもたらしました.
結論:
- 効果的な介入に関する確固たるデータは 極めて不足しています
- 症例管理のアプローチは,SMI患者における身体健康チェックの利用率を改善する可能性を示しています.
- 効果的な戦略を開発し検証するには,さらに質の高い研究が不可欠です.
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