积极式个案管理对社区精神分裂症复发及卫生经济学影响

发布时间：2018-08-08 14:20

【摘要】：目的积极式个案管理模式(assertive case management,ACM)对社区精神分裂症患者疾病复发及卫生经济学指标的影响。方法 200例社区精神分裂症患者随机分为研究组(入组107例,完成107例)和对照组(入组93例,完成91例),分别接受ACM干预及进行自然观察,随访12个月。采用临床总体印象量表(clinical global impressions scale,CGI)、卫生经济学指标每3个月评估一次,采用药物依从性量表(medication adherence rating scale,MARS)在基线、3、6、12个月时分别进行评估,家庭负担量表(family burden instructing,FBI)在干预前后评估。结果研究组复发率(1.9%)低于对照组(11.0%),差异有统计学意义(P0.01)。经重复测量方差分析,CGI-SI的时间主效应有统计学意义(P0.01)。MARS因子1、因子3的时间主效应和组间主效应均有统计学意义(均P0.05),因子1的交互作用有统计学意义(P0.01),研究组的因子1评分不同时间之间有统计学差异(P0.01)。两组间接成本、总费用的时间主效应有统计学意义(均P0.05),直接成本、总费用的交互效应有统计学意义(P0.05),研究组直接成本、总费用不同时间之间有统计学差异(均P0.05)。两组干预前后FBI各维度的差值比较,研究组干预后对家庭关系影响分较对照组下降更明显(P0.01)。结论 ACM模式能减少社区精神分裂症的复发,改善服药依从性,改善对家庭关系影响,减少治疗成本。
[Abstract]:Objective to study the effect of (assertive case management on disease recurrence and health economics in community schizophrenic patients. Methods 200 patients with schizophrenia in community were randomly divided into study group (107 cases, complete 107 cases) and control group (93 cases, 91 cases). They were treated with ACM intervention and natural observation, and followed up for 12 months. The general impression scale (clinical global impressions) was used, the health economics index was evaluated every 3 months, the drug compliance scale (medication adherence rating scale) was used to evaluate at baseline of 6 cases and 12 months, and the family burden scale (family burden instructing FBI was used to evaluate before and after intervention. Results the recurrence rate in the study group (1.9%) was significantly lower than that in the control group (11.0%) (P0.01). The time main effect of CGI-SI was statistically significant (P0.01). Mars factor 1, factor 3 and inter-group main effect were statistically significant (P0.05), the interaction of factor 1 was statistically significant (P0.01), the study group had significant difference in the time main effect of CGI-SI (P0.01), the time main effect of factor 3 and the main effect between groups were statistically significant (P0.05), and the interaction of factor 1 was statistically significant (P0.01). Factor 1 score had statistical difference between different time (P0.01). The time main effect of indirect cost and total cost were statistically significant (P0.05), direct cost and total cost interaction effect were statistically significant (P0.05), study group direct cost, total cost had statistical difference between different time (P0.05). The difference of FBI between the two groups before and after intervention was significantly lower than that in the control group (P0.01). Conclusion ACM model can reduce the recurrence of schizophrenia, improve drug compliance, improve family relationship and reduce the cost of treatment.
【作者单位】： 上海交通大学医学院附属精神卫生中心;上海市虹口区精神卫生中心;上海市黄浦区精神卫生中心;上海市静安区精神卫生中心;上海市杨浦区精神卫生中心;上海市普陀区精神卫生中心;
【基金】：上海市公共卫生优秀学科带头人培养计划(编号:GWDTR201227) 国家自然科学基金(编号:81171272)
【分类号】：R749.3

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