Psychiatric advance directives and reduction of coercive crisis interventions.
Psychiatric advance directives and reduction of coercive crisis interventions.
复制标题
精神病学预先指示和减少强制性危机干预。
DOI：
10.1080/09638230802052195
复制
发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Gilbert,AllisonR
中科院分区：
文献类型：
--
作者：
Swanson,JeffreyW;Swartz,MarvinS;Elbogen,EricB;VANDorn,RichardA;Wagner,HRyan;Moser,LornaA;Wilder,Christine;Gilbert,AllisonR
背景：精神病学先行指令旨在使丧失决策能力的患者能够自主治疗，从而减少在精神健康危机期间对强制干预的需要，如警察接送、非自愿承诺、隔离和限制以及非自愿药物治疗；目的：本研究调查了促进精神病学先行指令(F-PAD)的完成是否与减少强制危机干预的频率有关。方法：前瞻性地比较了PAD患者(n=147)和非患者(n=92)的强制干预频率，并在6、12和24个月进行了跟踪评估。采用重复测量多元回归分析评估PADS的疗效。控制相关协变量的模型包括最初选择PAD的倾向分数、强制性干预的基线历史、并发的全球功能和具有决策能力的危机发作。结果：F-PAD的完成与较低的强制干预几率相关(调整后的OR=0.50；95%CI=0.26-0.96；P<；0.05)。结论：PADS可能是一种有效的工具，可以减少围绕丧失能力的心理健康危机的强制性干预。更少的胁迫应该会给患有严重精神疾病的人带来更大的自主权和自我决定力。
Background:Psychiatric advance directives are intended to enable self-determined treatment for patients who lose decisional capacity, and thus reduce the need for coercive interventions such as police transport, involuntary commitment, seclusion and restraints, and involuntary medications during mental health crises; whether PADs can help prevent the use of these interventions in practice is unknown.Aims:This study examined whether completion of a Facilitated Psychiatric Advance Directive (F-PAD) was associated with reduced frequency of coercive crisis interventions.Method:The study prospectively compared a sample of PAD completers (n= 147) to non-completers (n= 92) on the frequency of any coercive interventions, with follow-up assessments at 6, 12, and 24 months. Repeated-measures multiple regression analysis was used to estimate the effect of PADs. Models controlled for relevant covariates including a propensity score for initial selection to PADs, baseline history of coercive interventions, concurrent global functioning and crisis episodes with decisional incapacity.Results:F-PAD completion was associated with lower odds of coercive interventions (adjusted OR = 0.50; 95% CI = 0.26–0.96;p< 0.05).Conclusions:PADs may be an effective tool for reducing coercive interventions around incapacitating mental health crises. Less coercion should lead to greater autonomy and self-determination for people with severe mental illness.