精神病患者 (OCTET) 的社区治疗订单:一个随机对照试验
Tom Burns1, Jorun Rugkåsa, Andrew Molodynski
1Department of Psychiatry, University of Oxford, Oxford, UK. tom.burns@psych.ox.ac.uk
Lancet (London, England)
|March 30, 2013
概括
与第17节假期相比,社区治疗命令 (CTO) 并没有减少精神病患者的再入院. 这项研究没有发现强制监督改善治疗结果的证据,尽管治疗时间较长.
科学领域:
- 精神病学是一个精神病学.
- 心理健康服务研究 心理健康服务研究
- 临床试验方法论 临床试验方法论
背景情况:
- 精神卫生服务的非制度化导致了国际上越来越多地在医院之外使用强制监督.
- 社区治疗命令 (CTO) 于2008年在英格兰和威尔士引入,作为一种强制性门诊护理形式.
- 与现有的假期条款相比,CTOs在减少再入院的有效性仍然没有得到证实.
研究的目的:
- 评估社区治疗命令 (CTO) 是否降低精神病患者的再入院率.
- 为了比较CTO与第17节假期在12个月内预防再入院的有效性.
- 评估不同长度的强制监督是否会影响临床接触等同时的再接收率.
主要方法:
- 一项非盲目,并行臂随机对照试验 (OCTET) 涉及333名被诊断患有精神病的患者.
- 患者被随机分配 (1:1) 到CTO或第17节假期,按性别,诊断和疾病持续时间分层.
- 主要结局是12个月内入院,分析使用LOG-双项回归的治疗意图原则.
主要成果:
- 在CTO组 (36%) 和第17节休假组 (36%) 之间,12个月再接收率没有显著差异.
- 强制性门诊治疗的中位持续时间对于CTO (183天) 与第17节假期 (8天) 相比显著更长.
- 再入院的调整后相对风险为1.0 (95% CI 0.75-1.33),表明两组之间没有差异.
结论:
- 通过CTO的强制监督并没有降低精神病患者在协调良好的精神卫生服务中的再接收率.
- 这些发现不支持使用CTO来减少住院病例,尽管对个人自由有重大限制.
- 可能需要进一步的研究来探索替代干预措施,以改善监督门诊心理健康护理的结果.
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