What Do Consumers Say They Want and Need During a Psychiatric Emergency?
What Do Consumers Say They Want and Need During a Psychiatric Emergency?
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消费者在精神紧急情况下表示他们想要和需要什么？
DOI：
10.1097/00131746-200301000-00005
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发表时间：
2003
影响因子：
1.9
通讯作者：
R. Ross
中科院分区：
文献类型：
--
作者：
M. Allen;D. Carpenter;J. L. Sheets;S. Miccio;R. Ross
对于消费者、他们的家庭和社区以及他们所依赖的医疗保健提供者来说，行为紧急情况是一个普遍而严重的问题。近年来，对行为和精神病紧急情况的管理的严重关切，特别是滥用和过度使用物理和化学限制和隔离，已成为精神卫生专业人员和政策制定者以及公众，媒体和患者倡导组织关注的焦点。政策领导人和临床医生正在寻找方法，在难以进行研究的领域平衡消费者的权利与安全和良好护理的考虑。一项针对精神病和行为紧急情况治疗专家的心理健康专业人员的调查发现，消费者的意见以及患者和临床医生之间的合作在尽可能实现最佳短期，特别是最佳长期结果方面非常重要。本文所述的消费者观点调查是为了更好地了解消费者的体验和偏好。作者描述了四个紧急服务论坛在2002年进行，其中涉及到59个消费者。每个论坛都包括一份书面消费者调查以及一个研讨会，以制定和优先考虑改善精神病紧急护理的建议。作者介绍了消费者调查的结果，并总结了研讨会的主要建议。在调查和研讨会中，消费者一再强调让工作人员尊重他们、与他们交谈、倾听他们并让他们参与治疗决策的重要性。消费者小组的建议与为《行为紧急情况治疗专家共识指南》接受调查的紧急精神病学专家的建议在许多重要领域达成了一致。这些措施包括口头干预的可取性，使用协作方法，并使用口服药物的指导下，个人消费者的问题，用药经验，和喜好。大多数消费者小组报告了在综合医院急诊室的不良经历，事实上，他们呼吁发展专门的精神病急诊服务，例如专家共识指南中建议的服务。五分之一的消费者小组将他们的紧急联系归因于缺乏更常规的心理健康护理。消费者显然不会断然拒绝药物。几乎一半的人表示他们想要药物，同样数量的人表示从药物中获益，尽管许多人抱怨被迫服药和不必要的副作用。消费者小组更喜欢苯二氮卓类药物，氟哌啶醇是最不喜欢的选择。在改善精神科急诊护理的关键建议中，消费者小组强调开发传统急诊室服务的替代方案、增加使用预先指示、提供更舒适的等待和治疗物理环境、增加使用同伴支持服务、改善急诊人员培训以促进更加人性化和以人为本的方法、加强从业者和患者之间的合作、并改善出院计划和出院后随访。这些研究结果的影响，以改善精神科急诊。
Behavioral emergencies are a common and serious problem for consumers, their families and communities, and the healthcare providers on whom they rely for help. In recent years, serious concerns about the management of behavioral and psychiatric emergencies—in particular, the misapplication and overuse of physical and chemical restraints and seclusion—have become a focus of attention for mental health professionals and policy makers as well as for the lay public, the media, and patient advocacy organizations. Policy leaders and clinicians are searching for ways to balance the rights of consumers with considerations of safety and good care in an area in which it is difficult to conduct research. A survey of mental health professionals who are experts on the treatment of psychiatric and behavioral emergencies identified consumer input and collaboration between patient and clinician whenever possible as being extremely important in achieving the best short-term and particularly the best long-term outcomes for patients. The survey of consumer perspectives described in this article was undertaken in response to the need to better understand consumer experiences and preferences. The authors describe four emergency services forums conducted in 2002, which involved a total of 59 consumers. Each forum involved a written consumer survey as well as a workshop to develop and prioritize recommendations for improving psychiatric emergency care. The authors present the results of the consumer survey and summarize the top recommendations from the workshops. In both the survey and the workshops, the consumers repeatedly stressed the importance of having staff treat them with respect, talk to them, listen to them, and involve them in treatment decisions. There were a number of important areas of agreement between the recommendations of the consumer panel and those of the experts in emergency psychiatry surveyed for the Expert Consensus Guidelines on the Treatment of Behavioral Emergencies. These include the desirability of verbal interventions, the use of a collaborative approach, and the use of oral medications guided by the individual consumer’s problems, medication experiences, and preferences. The majority of the consumer panel reported adverse experiences with general hospital emergency rooms and, in fact, called for the development of specialized psychiatric emergency services such as those recommended in the Expert Consensus Guidelines. One-fifth of the consumer panel attributed their emergency contact to lack of access to more routine mental health care. The consumers clearly do not reject medications categorically. Almost half indicated that they wanted medications and a similar number indicated benefit from medications, although many complained of forced administration and unwanted side effects. The consumer panel preferred benzodiazepines and ranked haloperidol as a least preferred option. Among their key recommendations for improving psychiatric emergency care, the consumer panel stressed the development of alternatives to traditional emergency room services, the increased use of advance directives, more comfortable physical environments for waiting and treatment, increased use of peer support services, improved training of emergency staff to foster a more humanistic and person-centered approach, increased collaboration between practitioners and patients, and improved discharge planning and post-discharge follow-up. The implications of these findings for improving psychiatric emergency care are considered.
影响因子：
--
作者：
Renn,BrennaN;Areán,PatriciaA
通讯作者：
Areán,PatriciaA
影响因子：
158.5
作者：
Shekelle, PG;Kahan, JP;Park, RE
通讯作者：
Park, RE