Clinicians' and clients' perspectives on the impact of assertive community treatment.
Clinicians' and clients' perspectives on the impact of assertive community treatment.
复制标题
临床医生和客户对自信社区治疗影响的看法。
作者：
M. Lang;L. Davidson;P. Bailey;M. Levine
目的
在一个自信的社区治疗计划的客户和他们的临床医生被要求评估客户目前的困难，在13个生活质量领域，以确定是否在任何领域的改善预测住院和监禁减少。
方法
一位同伴顾问采访了45名客户的精神症状，物质使用和滥用，医疗问题，药物依从性，主要支持，社会支持，职业和职业问题，住房，日常生活技能，经济问题和权利，法律的参与，行为问题和治疗参与。客户的临床医生在这些相同的领域对客户进行评级。在方案开始时，对客户在这些领域的困难的评级是基于在接收时和审查客户图表后的综合评级。关于住院和监禁的数据来自医疗和警察记录。Logistic回归分析被用来寻找医院和监狱（简称机构入院）入院率下降的预测因素。
结果
机构招生下降后，计划进入;下降幅度较大的客户承认，在最近几年。根据临床医生和客户的评级和基线评级的比较，客户在所有13个生活质量领域都有显着改善;然而，客户认为自己在药物滥用，药物依从性，主要支持，社会支持，日常生活技能和治疗参与方面的困难比临床医生认为的要小。根据临床医生的评级，药物滥用问题的改善预示着住院人数的下降。根据客户的评级，社会支持和经济问题的改善预计会下降。
结论
这些发现强调了客户的观点在治疗计划中的重要性，并表明临床医生可能会忽视客户所重视的较小的渐进式改善步骤。
OBJECTIVE
Clients in an assertive community treatment program and their clinicians were asked to rate clients' current difficulties in 13 quality-of-life areas to determine whether improvement in any area predicted reductions in hospitalization and incarceration.
METHODS
A peer counselor interviewed 45 clients about psychiatric symptoms, substance use and abuse, medical issues, medication compliance, primary supports, social supports, vocational and occupational issues, housing, daily living skills, economic issues and entitlements, legal involvement, behavioral issues, and treatment involvement. The clients' clinicians rated the clients in these same areas. Ratings of clients' difficulties in these areas at program entry were based on combined ratings made at intake and after a review of clients' charts. Data on hospitalization and incarceration were obtained from medical and police records. Logistic regression analyses were used to seek predictors of declines in admissions to hospitals and jails (referred to as institutional admissions).
RESULTS
Institutional admissions decreased after program entry; decreases were larger among clients admitted in recent years. Clients improved significantly in all 13 quality-of-life areas based on comparisons of both clinicians' and clients' ratings and baseline ratings; however, clients rated themselves as having less difficulty than their clinicians thought they had in the areas of substance abuse, medication compliance, primary supports, social supports, daily living skills, and treatment involvement. Based on clinicians' ratings, improvement in substance abuse issues predicted declines in institutionalized admissions. Based on clients' ratings, improvement in social support and economic issues predicted declines.
CONCLUSIONS
These findings emphasize the importance of clients' perspectives in treatment planning and suggest that clinicians may overlook the smaller incremental steps toward improvement that are valued by clients.
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