CAJ | 학술논문

背景在过去的6年里,中国开展了世界上最大规模的重性精神病社区管理治疗项目(简称686项目),但项目实施的效果并未得到详细的评估.目的对参与该项目的精神分裂症患者的临床有效者与临床无效者的特征进行比较.方法从该项目的全国登记系统电子数据库中,提取2011年在四川省绵阳市(农村人口占60%)参加该项目的精神分裂症患者的资料,共3090份.根据精神科医生2011年的末次评估,将患者的疗效为"治愈"或"好转"者归为有效组(n=1866),将 "无变化"或"加重"者归为无效组(n=1224),比较两组之间的社会人口学特征和治疗特点.收集的资料包括性别、年龄、民族、职业、文化程度、家庭经济状况、婚姻状况、精神疾病家族史、患病时间、参加686项目的时间以及治疗依从性等.结果单因素分析结果显示,除性别、民族和精神疾病家族史外,其他因素的组间差异均有统计学意义.年龄小、病程短、受教育时间长、家庭经济状况好、治疗依从性好、参与686项目时间短的患者疗效更好.Logistic回归分析结果显示,服药依从性差、家庭贫困以及参加686项目时间长等因素更多见于疗效"无变化"或"加重"的患者.结论治疗依从性差和家庭贫困严重地影响了686项目的效果.想方设法提高精神疾病患者的治疗依从性,向患者家庭提供基本的经济支持,将有助于提高该项目的成效.
배경 재과거적6년리,중국개전료세계상최대규모적중성정신병사구관리치료항목(간칭686항목),단항목실시적효과병미득도상세적평고.목적 대삼여해항목적정신분렬증환자적림상유효자여림상무효자적특정진행비교.방법 종해항목적전국등기계통전자수거고중,제취2011년재사천성면양시(농촌인구점60%)삼가해항목적정신분렬증환자적자료,공3090빈.근거정신과의생2011년적말차평고,장환자적료효위"치유"혹"호전"자귀위유효조(n=1866),장 "무변화"혹"가중"자귀위무효조(n=1224),비교량조지간적사회인구학특정화치료특점.수집적자료포괄성별、년령、민족、직업、문화정도、가정경제상황、혼인상황、정신질병가족사、환병시간、삼가686항목적시간이급치료의종성등.결과 단인소분석결과현시,제성별、민족화정신질병가족사외,기타인소적조간차이균유통계학의의.년령소、병정단、수교육시간장、가정경제상황호、치료의종성호、삼여686항목시간단적환자료효경호.Logistic회귀분석결과현시,복약의종성차、가정빈곤이급삼가686항목시간장등인소경다견우료효"무변화"혹"가중"적환자.결론 치료의종성차화가정빈곤엄중지영향료686항목적효과.상방설법제고정신질병환자적치료의종성,향환자가정제공기본적경제지지,장유조우제고해항목적성효.
Background: Over the last six years China has developed the largest community-based service network for persons with serious mental illness in the world (the ‘686 Project') but the effectiveness of this program has not been assessed in detail.Aim: Compare the characteristics of patients with schizophrenia enrolled in the program whose clinical status has improved with the characteristics of patients whose clinical status has not improved.Results: In the univariate analysis there were significant differences between the two groups in all variables considered except for gender, ethnicity, and family history of mental illness. The recorded treatment outcome was better in patients who were younger, who had a shorter duration of illness, who were more educated, who came from better-off families, who were more adherent to treatment and who had participated in the program for a shorter period of time. Logistic regression analysis found that patients classified as unchanged or worsened were more likely to be non-adherent to drug treatment, to come from families living below the local poverty line, and to be enrolled in the 686 Program for a longer period of time.Conclusion: Poor treatment adherence and poverty seriously limit the effectiveness of the 686 Program. New approaches to improving adherence and for providing basic financial support to families with a mentally ill member will be needed to enhance the efficacy of the program.