Effectiveness of a housing support team intervention with a recovery-oriented approach on hospital and emergency department use by homeless people with severe mental illness: a randomised controlled trial.
Effectiveness of a housing support team intervention with a recovery-oriented approach on hospital and emergency department use by homeless people with severe mental illness: a randomised controlled trial.
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DOI：
10.1017/s2045796020000785
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发表时间：
2020-09-30
影响因子：
8.1
通讯作者：
Auquier P
中科院分区：
文献类型：
--
作者：
Tinland A;Loubière S;Boucekine M;Boyer L;Fond G;Girard V;Auquier P
许多患有严重精神疾病的无家可归者是医疗服务和社会服务的高使用者，但却没有减少这一弱势群体日益扩大的健康不平等。这项研究旨在确定为患有严重精神障碍的无家可归者提供独立住房和精神健康支持团队并采用面向康复的方法(住房优先(HF)计划)是否改善了医院和急诊科的使用情况。我们在四个法国城市进行了随机对照试验：里尔、马赛、巴黎和图卢兹。如果参与者年满18岁或以上，绝对无家可归或住房危险，被诊断为精神分裂症(SCZ)或双相情感障碍(BD)，并被要求有高水平的需求(中至重度残疾和过去5年内住院或合并酒精或药物使用障碍)，则符合条件。参与者被随机分配(1：1)立即获得独立住房和来自果断社区治疗小组(社会工作者、护士、医生、精神病学家和同伴工作者)(HF组)或照常治疗(TAU组)的支持，即先前存在的专门针对无家可归者的方案和服务。参与者和面试官被揭开了任务的面具。主要结果是24个月时急诊科就诊次数、住院人数和住院天数。次要结果是康复(恢复评估量表)、生活质量(SQOL和SF36)、精神健康症状、成瘾问题、稳定居住天数和从社会角度来看的成本节约。进行意向处理分析。符合条件的患者被随机分配到HF组(n=353)或TAU组(n=350)。住院次数(相对危险度(95%CI)，0.96(0.76-1.21))和急诊就诊次数(0.89(0.66-1.21))差异无统计学意义。HF和TAU的住院天数显著减少(0.62(0.48~0.80))。HF组的住房稳定性较高(斜率差116(103~128))，S生活质量量表各维度(心理幸福感和自主性)得分也较高。在躯体综合评分SF36、心理健康症状和酒精或物质依赖率方面，两组没有差异。每名患者24个月的平均费用差异为217欧元，而心力衰竭组的费用为217欧元。HF与节省医疗费用(RR 0.62(0.48-0.78))和居住费用(0.07(0.05-0.11))有关。立即获得独立住房和精神健康团队的支持，导致患有SCZ或BP障碍的无家可归者住院天数减少，住房稳定性提高，并节省了成本。
Many people who are homeless with severe mental illnesses are high users of healthcare services and social services, without reducing widen health inequalities in this vulnerable population. This study aimed to determine whether independent housing with mental health support teams with a recovery-oriented approach (Housing First (HF) program) for people who are homeless with severe mental disorders improves hospital and emergency department use. We did a randomised controlled trial in four French cities: Lille, Marseille, Paris and Toulouse. Participants were eligible if they were 18 years or older, being absolutely homeless or precariously housed, with a diagnosis of schizophrenia (SCZ) or bipolar disorder (BD) and were required to have a high level of needs (moderate-to-severe disability and past hospitalisations over the last 5 years or comorbid alcohol or substance use disorder). Participants were randomly assigned (1:1) to immediate access to independent housing and support from the Assertive Community Treatment team (social worker, nurse, doctor, psychiatrist and peer worker) (HF group) or treatment as usual (TAU group) namely pre-existing dedicated homeless-targeted programs and services. Participants and interviewers were unmasked to assignment. The primary outcomes were the number of emergency department (ED) visits, hospitalisation admissions and inpatient days at 24 months. Secondary outcomes were recovery (Recovery Assessment Scale), quality of life (SQOL and SF36), mental health symptoms, addiction issues, stably housed days and cost savings from a societal perspective. Intention-to-treat analysis was performed. Eligible patients were randomly assigned to the HF group (n = 353) or TAU group (n = 350). No differences were found in the number of hospital admissions (relative risk (95% CI), 0.96 (0.76–1.21)) or ED visits (0.89 (0.66–1.21)). Significantly less inpatient days were found for HF v. TAU (0.62 (0.48–0.80)). The HF group exhibited higher housing stability (difference in slope, 116 (103–128)) and higher scores for sub-dimensions of S-QOL scale (psychological well-being and autonomy). No differences were found for physical composite score SF36, mental health symptoms and rates of alcohol or substance dependence. Mean difference in costs was €-217 per patient over 24 months in favour of the HF group. HF was associated with cost savings in healthcare costs (RR 0.62(0.48–0.78)) and residential costs (0.07 (0.05–0.11)). An immediate access to independent housing and support from a mental health team resulted in decreased inpatient days, higher housing stability and cost savings in homeless persons with SCZ or BP disorders.