Assessing the efficacy of a modified assertive community-based treatment programme in a developing country
Assessing the efficacy of a modified assertive community-based treatment programme in a developing country
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DOI：
10.1186/1471-244x-10-73
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发表时间：
2010-09-15
期刊：
影响因子：
4.4
通讯作者：
Oosthuizen, Piet P.
中科院分区：
文献类型：
--
作者：
Botha, Ulla A.;Koen, Liezl;Oosthuizen, Piet P.
背景资料：最近发表的一些在发达国家进行的随机对照试验报告称，与标准护理模式相比，自信干预没有优势。一种可能的解释是，所谓的“标准护理”近年来变得更加全面，在其工作方式中纳入了自信模式的一些突出方面。我们的研究代表了第一个随机对照试验评估的效果，修改后的自信心治疗服务的再入院率和其他措施的结果，在一个发展中countries.Methods：高频率的服务用户被随机分为干预组（n = 34）和对照组（n = 26）。对照组接受标准社区护理，活动组接受基于国际自信社区治疗模式修改版的自信干预。在基线和12个月时进行研究访视，在访视1时收集人口统计学和疾病信息，并在研究结束时记录再入院率。结果：在12个月的随访中，接受肯定干预的受试者总PANSS（p = 0.02）、阳性（p < 0.01）和一般精神病理学（p = 0.01）分量表得分显著降低。平均SOFAS评分也显着较高（p = 0.02）和精神病入院的平均人数显着降低（p < 0.01）在干预group.Conclusions：我们的研究结果表明，在发展中国家的设置，标准的社区精神服务往往是资源不足的自信干预可以产生显着的成果。此外，这些干预措施不需要像国际第一世界模式那样昂贵和全面，以减少住院天数，改善严重精神疾病患者的精神病理学和整体功能水平。
Background: A number of recently published randomized controlled trials conducted in developed countries have reported no advantage for assertive interventions over standard care models. One possible explanation could be that so-called "standard care" has become more comprehensive in recent years, incorporating some of the salient aspects of assertive models in its modus operandi. Our study represents the first randomised controlled trial assessing the effect of a modified assertive treatment service on readmission rates and other measures of outcome in a developing country.Methods: High frequency service users were randomized into an intervention (n = 34) and a control (n = 26) group. The control group received standard community care and the active group an assertive intervention based on a modified version of the international model of assertive community treatment. Study visits were conducted at baseline and 12 months with demographic and illness information collected at visit 1 and readmission rates documented at study end. Symptomatology and functioning were measured at both visits using the PANSS, CDSS, ESRS, WHO-QOL and SOFAS.Results: At 12 month follow-up subjects receiving the assertive intervention had significantly lower total PANSS (p = 0.02) as well as positive (p < 0.01) and general psychopathology (p = 0.01) subscales' scores. The mean SOFAS score was also significantly higher (p = 0.02) and the mean number of psychiatric admissions significantly lower (p < 0.01) in the intervention group.Conclusions: Our results indicate that assertive interventions in a developing setting where standard community mental services are often under resourced can produce significant outcomes. Furthermore, these interventions need not be as expensive and comprehensive as international, first-world models in order to reduce inpatient days, improve psychopathology and overall levels of functioning in patients with severe mental illness.