上海精神医学
上海精神醫學
상해정신의학
SHANGHAI ARCHIVES OF PSYCHIATRY
2012年
1期
30-37
,共8页
社区%精神分裂症%再入院%因素分析%前瞻性研究
社區%精神分裂癥%再入院%因素分析%前瞻性研究
사구%정신분렬증%재입원%인소분석%전첨성연구
Community%Schizophrenia%Re-hospitalization%Factor analysis%Prospective study
背景 近年来国内提倡对精神分裂症患者以提供社区防治服务为主,然而评价这种服务模式疗效的相关研究为数不多.目的 对纳入成都市社区防治服务系统的精神分裂症患者,评估其继续接受管理服务的比例以及2年内的再住院比例.方法 对成都市金牛区14个社区和青羊区10个社区建档立卡并曾住院治疗的精神分裂症患者随访2年并进行评估.详细记录患者进入本研究时的人口学资料和临床信息,随访2年中每月评估1次并记录患者是否住院.结果 随访2年内,参与本研究的1 027例患者中有963例(93.8%)坚持接受社区防治服务.受教育程度低、独居的患者相对容易脱落.963例中有174例(18.1%)患者在2年内再次住院.Logistic 回归分析显示与再住院相关的因素为入组时未婚、独居、突出的阳性症状和明显的阴性症状,以及在入组前6个月中治疗药物使用不足.结论 城市居民中94%的精神分裂症患者坚持接受社区防治服务,这一比例相当高.2年内18%的再住院比例要低于其他国家类似服务体系下的数据.独居患者脱落以及再住院的风险高,因此要特别关注这一高危人群.为了明确这一社区防治服务体系的作用,需要全面评估与精神分裂症患者康复相关的各种指标 (包括社会整合功能、生活质量以及再住院),也需要在研究时运用标准化的社区干预方法 、设立对照组,并随访更长时间.
揹景 近年來國內提倡對精神分裂癥患者以提供社區防治服務為主,然而評價這種服務模式療效的相關研究為數不多.目的 對納入成都市社區防治服務繫統的精神分裂癥患者,評估其繼續接受管理服務的比例以及2年內的再住院比例.方法 對成都市金牛區14箇社區和青羊區10箇社區建檔立卡併曾住院治療的精神分裂癥患者隨訪2年併進行評估.詳細記錄患者進入本研究時的人口學資料和臨床信息,隨訪2年中每月評估1次併記錄患者是否住院.結果 隨訪2年內,參與本研究的1 027例患者中有963例(93.8%)堅持接受社區防治服務.受教育程度低、獨居的患者相對容易脫落.963例中有174例(18.1%)患者在2年內再次住院.Logistic 迴歸分析顯示與再住院相關的因素為入組時未婚、獨居、突齣的暘性癥狀和明顯的陰性癥狀,以及在入組前6箇月中治療藥物使用不足.結論 城市居民中94%的精神分裂癥患者堅持接受社區防治服務,這一比例相噹高.2年內18%的再住院比例要低于其他國傢類似服務體繫下的數據.獨居患者脫落以及再住院的風險高,因此要特彆關註這一高危人群.為瞭明確這一社區防治服務體繫的作用,需要全麵評估與精神分裂癥患者康複相關的各種指標 (包括社會整閤功能、生活質量以及再住院),也需要在研究時運用標準化的社區榦預方法 、設立對照組,併隨訪更長時間.
배경 근년래국내제창대정신분렬증환자이제공사구방치복무위주,연이평개저충복무모식료효적상관연구위수불다.목적 대납입성도시사구방치복무계통적정신분렬증환자,평고기계속접수관리복무적비례이급2년내적재주원비례.방법 대성도시금우구14개사구화청양구10개사구건당립잡병증주원치료적정신분렬증환자수방2년병진행평고.상세기록환자진입본연구시적인구학자료화림상신식,수방2년중매월평고1차병기록환자시부주원.결과 수방2년내,삼여본연구적1 027례환자중유963례(93.8%)견지접수사구방치복무.수교육정도저、독거적환자상대용역탈락.963례중유174례(18.1%)환자재2년내재차주원.Logistic 회귀분석현시여재주원상관적인소위입조시미혼、독거、돌출적양성증상화명현적음성증상,이급재입조전6개월중치료약물사용불족.결론 성시거민중94%적정신분렬증환자견지접수사구방치복무,저일비례상당고.2년내18%적재주원비례요저우기타국가유사복무체계하적수거.독거환자탈락이급재주원적풍험고,인차요특별관주저일고위인군.위료명학저일사구방치복무체계적작용,수요전면평고여정신분렬증환자강복상관적각충지표 (포괄사회정합공능、생활질량이급재주원),야수요재연구시운용표준화적사구간예방법 、설립대조조,병수방경장시간.
Background: China has recently introduced a community-based service network for managing individuals with schizophrenia but there has been relatively little formal evaluation of the effectiveness of this approach.Objective: Assess the retention rate and the two-year re-hospitalization rate of patients who are enrolled in the community management network in Chengdu, China.Methods: Patients with a confirmed diagnosis of schizophrenia who had at least one prior hospitalization and who were enrolled in the service network at the community health clinics in 14 communities in the Jinniu District of Chengdu and 10 communities in the Qingyang District of Chengdu participated in the two-year prospective follow-up assessment. Detailed demographic and clinical information was obtained at the time of intake into the follow-up program and their hospitalization status was recorded during monthly evaluations over the subsequent two years. Results: Of the 1 027 participating patients, 963 (93.8%) remained in the program for the entire two-year period. Patients with a lower level of education and those who did not live with family members were more likely to drop-out of the network. Among the 963 patients who completed the follow-up 174 (18.1%) were re-hospitalized over the two-year period. Multivariate logistic regression identified factors related to re-hospitalization: not married or not living with family members, having more prominent positive and negative symptoms at the time of intake, and using medication less in the six months prior to intake.Conclusion: The 94% two-year retention of patients in this urban community management network for individuals with schizophrenia was excellent and the two-year re-hospitalization rate of 18% is better than that reported in most similar programs in other countries. Patients not living with family members were at higher risk for dropping out of the network and for re-hospitalization so this is a high-risk group that deserves special attention. Standardization of the community interventions and longer follow-up studies with control communities that consider the full range of factors relevant to the well-being of patients with schizophrenia (i.e., social integration, quality of life and re-hospitalization) are needed to definitively demonstrate the effectiveness of this community service network.
