Use of leverage to improve adherence to psychiatric treatment in the community
Use of leverage to improve adherence to psychiatric treatment in the community
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DOI：
10.1176/appi.ps.56.1.37
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发表时间：
2005-01-01
影响因子：
3.8
通讯作者：
McNiel, DE
中科院分区：
文献类型：
--
作者：
Monahan, J;Redlich, AD;McNiel, DE
目的：各种各样的工具被用来作为杠杆，以提高社区精神病治疗的依从性。这项研究是第一次获得这些工具在公共精神卫生系统中使用频率的数据。病人的一生经历的四种具体形式的储蓄-钱（代表收款人或钱处理），住房，刑事司法，门诊承诺进行了评估。采用逻辑回归分析研究临床和人口统计学特征与接受不同类型杠杆之间的关联。研究方法：在美国不同地区的五个州的五个地点的每一个约200名成人门诊患者进行了90分钟的访谈。结果：经历过至少一种杠杆形式的患者比例在各研究中心之间从44%到59%不等。一个相当一致的画面出现在杠杆使用更频繁的年轻患者和那些更严重的，致残的，和持久的精神病理学;一个模式的多次住院;和密集的门诊服务使用。使用金钱作为杠杆的患者占7%至19%;门诊承诺，12%至20%;刑事制裁，15%至30%;住房，23%至40%。结论：关于现行政策的争论只强调一种形式的杠杆作用，门诊承诺，这是一个过于狭窄的焦点。在为传统的公共部门患者服务时，利用治疗依从性的尝试无处不在。研究与杠杆使用相关的结果对于理解精神病治疗系统的有效性至关重要。
Objectives: A variety of tools are being used as leverage to improve adherence to psychiatric treatment in the community. This study is the first to obtain data on the frequency with which these tools are used in the public mental health system. Patients' lifetime experience of four specific forms of leverage-money (representative payee or money handler), housing, criminal justice, and outpatient commitment-was assessed. Logistic regression was used to examine associations between clinical and demographic characteristics and receipt of different types of leverage. Methods: Ninety-minute interviews were conducted with approximately 200 adult outpatients at each of five sites in five states in different regions of the United States. Results: The percentage of patients who experienced at least one form of leverage varied from 44 to 59 percent across sites. A fairly consistent picture emerged in which leverage was used significantly more frequently for younger patients and those with more severe, disabling, and longer lasting psychopathology; a pattern of multiple hospital readmissions; and intensive outpatient service use. Use of money as leverage ranged from 7 to 19 percent of patients; outpatient commitment, 12 to 20 percent; criminal sanction, 15 to 30 percent; and housing, 23 to 40 percent. Conclusions: Debates on current policy emphasize only one form of leverage, outpatient commitment, which is much too narrow a focus. Attempts to leverage treatment adherence are ubiquitous in serving traditional public-sector patients. Research on the outcomes associated with the use of leverage is critical to understanding the effectiveness of the psychiatric treatment system.