【摘要】：目的積極式個案管理模式(assertive case management,ACM)對社區(qū)精神分裂癥患者疾病復發(fā)及衛(wèi)生經(jīng)濟學指標的影響。方法 200例社區(qū)精神分裂癥患者隨機分為研究組(入組107例,完成107例)和對照組(入組93例,完成91例),分別接受ACM干預及進行自然觀察,隨訪12個月。采用臨床總體印象量表(clinical global impressions scale,CGI)、衛(wèi)生經(jīng)濟學指標每3個月評估一次,采用藥物依從性量表(medication adherence rating scale,MARS)在基線、3、6、12個月時分別進行評估,家庭負擔量表(family burden instructing,FBI)在干預前后評估。結果研究組復發(fā)率(1.9%)低于對照組(11.0%),差異有統(tǒng)計學意義(P0.01)。經(jīng)重復測量方差分析,CGI-SI的時間主效應有統(tǒng)計學意義(P0.01)。MARS因子1、因子3的時間主效應和組間主效應均有統(tǒng)計學意義(均P0.05),因子1的交互作用有統(tǒng)計學意義(P0.01),研究組的因子1評分不同時間之間有統(tǒng)計學差異(P0.01)。兩組間接成本、總費用的時間主效應有統(tǒng)計學意義(均P0.05),直接成本、總費用的交互效應有統(tǒng)計學意義(P0.05),研究組直接成本、總費用不同時間之間有統(tǒng)計學差異(均P0.05)。兩組干預前后FBI各維度的差值比較,研究組干預后對家庭關系影響分較對照組下降更明顯(P0.01)。結論 ACM模式能減少社區(qū)精神分裂癥的復發(fā),改善服藥依從性,改善對家庭關系影響,減少治療成本。
[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.
【作者單位】： 上海交通大學醫(yī)學院附屬精神衛(wèi)生中心;上海市虹口區(qū)精神衛(wèi)生中心;上海市黃浦區(qū)精神衛(wèi)生中心;上海市靜安區(qū)精神衛(wèi)生中心;上海市楊浦區(qū)精神衛(wèi)生中心;上海市普陀區(qū)精神衛(wèi)生中心;
【基金】：上海市公共衛(wèi)生優(yōu)秀學科帶頭人培養(yǎng)計劃(編號:GWDTR201227) 國家自然科學基金(編號:81171272)
【分類號】：R749.3

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