A comparison of assertive community treatment and intensive case management for patients in rural areas.
A comparison of assertive community treatment and intensive case management for patients in rural areas.
复制标题
对农村地区患者的积极社区治疗和强化病例管理的比较。
DOI：
10.1176/ps.2007.58.1.121
复制
发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Morrissey,JosephP
中科院分区：
文献类型：
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作者：
Meyer,PiperS;Morrissey,JosephP
目的回顾农村社区服务有效性的证据，特别是积极的社区治疗和强化的病例管理。农村重度精神病患者的服务面临着人口密度低、服务有限、专业人员短缺等问题。方法通过全面的文献检索，确定了6篇关于农村社区治疗的研究，其中只有2篇是对照研究，4篇农村强化病例管理研究，只有1篇是对照研究。自信的社区治疗似乎非常适合缺乏服务的地区，因为它的自给自足的多学科治疗团队方法。然而，农村项目被迫对自信的社区治疗模式进行了几次调整，包括更小的团队、更全面的工作人员和更不密集的服务。没有公布的证据表明，这些适应能够产生与完全忠诚的团队相同的结果。一些人认为，在农村环境中，强化病例管理可能是自信的社区治疗的替代方案，因为强化病例管理强调个体病例工作量、较少的工作人员、较少的接触和中介服务。结论证据表明，强化病例管理计划只有在治疗和支持服务供应充足的社区环境中才有效。为了为这些模式的有效性建立证据基础，需要将更多的注意力放在评估当前农村地区自信的社区治疗和密集的病例管理传播浪潮上。
ObjectiveThis article reviews the evidence for the effectiveness of com-munity-based services for rural areas, specifically assertive community treatment and intensive case management. Service delivery to persons with severe mental illness in rural areas is challenged by low population densities, limited services, and shortages of professionals.MethodsA comprehensive literature search identified six studies of rural assertive community treatment, only two of which were controlled studies, and four rural intensive case management studies, only one of which was a controlled study. Assertive community treatment would seem ideally suited to areas lacking services because of its self-contained multidisciplinary treatment team approach. However, rural programs have been forced to make several adaptations to the assertive community treatment model, including smaller teams, less comprehensive staff, and less intensive services. There is no published evidence that these adaptations are able to produce the same results as full-fidelity teams. Some believe that intensive case management may be an alternative to assertive community treatment in rural settings because intensive case management emphasizes individual caseloads, fewer staff, less intensive contacts, and brokered services.ConclusionsThe evidence suggests that intensive case management programs are effective only in community settings where there is an ample supply of treatment and support services. To build the evidence base for the effectiveness of these models, much more attention needs to be focused on evaluating the current wave of assertive community treatment and intensive case management dissemination in rural areas.(Psychiatric Services 58: 121–127, 2007)