Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm, functional impairment, and educational a
Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm, functional impairment, and educational a
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支持出院服务与住院护理评估 (SITE)：一项随机对照试验，比较重症社区护理服务与照常住院治疗对患有严重精神疾病的青少年的有效性：自残、功能障碍和教育障碍
DOI：
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发表时间：
2020
影响因子：
6.4
通讯作者：
E. Taylor
中科院分区：
文献类型：
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作者：
Dennis Ougrin;R. Corrigall;D. Ståhl;J. Poole;Tobias Zundel;Mandy Wait;V. Slater;P. Reavey;S. Byford;J. Ivens;Maarten Crommelin;D. Hayes;Kerry Middleton;Paul Young;E. Taylor
临床指南建议加强社区护理服务治疗（ICCS）以减少青少年精神病住院护理。我们之前曾报道过，ICCS 的加入导致医院使用量大幅减少，并改善了学校重新融入的情况。本研究的目的是进行一项随机对照试验 (RCT)，将 ICCS 支持的住院患者提前出院与通常住院治疗（照常治疗；TAU）进行比较。在本文中，我们报告了 ICCS 对自残和其他临床和教育结果的影响。 106 名 12-18 岁的住院精神病患者被随机 (1:1) 分配至 ICCS 或 TAU。随机分组后六个月，我们比较了两个治疗组的自残发作次数和严重程度、功能障碍、精神症状的严重程度、临床改善、阅读和数学能力、体重、身高以及心理治疗和药物的使用。在六个月的随访中，两组在大多数指标上没有差异。接受 ICCS 的患者报告多次（五次或以上）自残的可能性显着降低（OR = 0.18，95% CI：0.05-0.64）。与 TAU 相比，ICCS 组入住私人住院病房的患者住院天数平均减少 118.4 天（95% CI：28.2–208.6）。在 TAU 中添加 ICCS 可能会降低多重自残的风险，并可能减少住院时间，尤其是那些接受私人护理的患者。早期出院并接受 ICCS 似乎是标准住院治疗的可行替代方案。
Clinical guidelines recommend intensive community care service treatment (ICCS) to reduce adolescent psychiatric inpatient care. We have previously reported that the addition of ICCS led to a substantial decrease in hospital use and improved school re-integration. The aim of this study is to undertake a randomised controlled trial (RCT) comparing an inpatient admission followed by an early discharge supported by ICCS with usual inpatient admission (treatment as usual; TAU). In this paper, we report the impact of ICCS on self-harm and other clinical and educational outcomes. 106 patients aged 12–18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomisation, we compared the two treatment arms on the number and severity of self-harm episodes, the functional impairment, severity of psychiatric symptoms, clinical improvement, reading and mathematical ability, weight, height and the use of psychological therapy and medication. At six-month follow-up, there were no differences between the two groups on most measures. Patients receiving ICCS were significantly less likely to report multiple episodes (five or more) of self-harm (OR = 0.18, 95% CI: 0.05–0.64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28.2–208.6) fewer days in hospitals if they were in the ICCS group compared to TAU. The addition of ICCS to TAU may lower the risk of multiple self-harm and may reduce the duration of inpatient stay, especially in those patients admitted for private care. Early discharge with ICCS appears to be a viable alternative to standard inpatient treatment.