背景:精神分裂症是一种以妄想为特征的慢性精神疾病,幻觉,以及重要的功能和社会残疾。标记为“过渡性”的干预措施增加了住院期间准备出院的护理计划。它们还包括出院后开发的干预措施,以支持患有严重精神疾病的人从医院过渡到社区。过渡性出院干预措施可以通过协调卫生系统的不同级别来预测患者出院后的未来需求,从而可以有效地保证社区护理的连续性。这是通过提供治疗关系来实现的,这种关系在整个出院和社区重返社会过程中提供了安全网,以改善使用者的总体状况,功能水平,利用卫生资源,和对护理的满意度。
目的:评估过渡性出院干预对精神分裂症患者的影响。
方法:在2022年12月7日,我们搜索了Cochrane精神分裂症小组的基于研究的试验登记册,基于中央,MEDLINE,Embase,PubMed,CINAHL,ClinicalTrials.gov,ISRCTN,PsycINFO,世卫组织ICTRP。
方法:随机对照试验(RCTs)评估过渡性出院干预对精神分裂症患者和精神分裂症相关疾病患者的影响。合格的干预措施包括三个关键要素:出院前计划,协调护理和后续行动,和出院后支持。
方法:我们使用标准Cochrane方法。这项审查的结果包括全球状况(复发),服务使用(住院),一般功能,满意的护理,不良反应/事件,生活质量,和直接成本。对于二元结果,我们计算了风险比(RR)及其95%置信区间(CI)。对于连续的结果,我们计算了平均差(MD)或标准化平均差(SMD)及其95%CI。我们使用等级来评估证据的确定性。
结果:我们发现了12项研究,其中有1748名参与者将过渡出院干预措施与常规护理进行了比较。均为平行组RCT。没有研究评估全球状态(复发)或报告有关不良事件/影响的数据。所有研究都有很高的偏倚风险,主要是由于对分配隐瞒的严重担忧,偏离预期的干预措施,衡量结果,缺少结果数据。在短期和长期随访中,过渡性出院干预措施在服务使用(住院)方面可能几乎没有差异,但证据非常不确定(RR1.18,95%CI0.55至2.50;I2=54%;4项研究,462名参与者;非常低的确定性证据)。过渡性出院干预可能会增加出院后的功能水平(一般功能的临床重要变化)(SMD0.95,95%CI-0.06至1.97;I²=95%;4项研究,437名参与者;确定性非常低的证据),并且可能会增加对干预措施感到满意的参与者比例(满意度的临床重要变化)(RR1.96,95%CI1.37至2.80;1项研究,76名参与者;非常低的确定性证据),但是对于这两种结果,证据都非常不确定。与常规治疗相比,过渡性出院干预可能对生活质量几乎没有影响(SMD0.24,95%CI-0.30至0.78;I²=90%;4项研究,748名参与者;非常低的确定性证据),但是我们非常不确定。对于直接成本,一项有124名参与者的研究未报告全部细节,因此结果尚无定论.
结论:目前尚无明确的证据支持或反对对精神分裂症患者实施过渡性出院干预措施。过渡性出院干预措施可以提高患者满意度和功能,但是这个证据也很不确定。为了将来的研究,提高这些试验的实施和报告质量非常重要,包括使用经过验证的工具来衡量他们的结果。
Schizophrenia is a chronic mental illness characterized by delusions, hallucinations, and important functional and social disability. Interventions labeled as \'transitional\' add to care plans made during the hospital stay in preparation for discharge. They also include interventions developed after discharge to support people with serious mental illness as they make the transition from the hospital to the community. Transitional discharge interventions may anticipate the future needs of the patient after discharge by co-ordinating the different levels of the health system that can effectively guarantee continuity of care in the community. This occurs through the provision of therapeutic relationships which give a safety net throughout the discharge and community reintegration processes to improve the general condition of users, level of functioning, use of health resources, and satisfaction with care.
To assess the effects of transitional discharge interventions for people with schizophrenia.
On 7 December 2022, we searched the Cochrane Schizophrenia Group\'s Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, PubMed, CINAHL, ClinicalTrials.gov, ISRCTN, PsycINFO, and WHO ICTRP.
Randomized controlled trials (RCTs) evaluating the effects of transitional discharge interventions in people with schizophrenia and schizophrenia-related disorders. Eligible interventions included three key elements: predischarge planning, co-ordination of care and follow-up, and postdischarge support.
We used standard Cochrane methods. Outcomes of this review included global state (relapse), service use (hospitalization), general functioning, satisfaction with care, adverse effects/events, quality of life, and direct costs. For binary outcomes, we calculated risk ratios (RRs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated the mean difference (MD) or standardized mean difference (SMD) and their 95% CIs. We used GRADE to assess certainty of evidence.
We found 12 studies with 1748 participants comparing transitional discharge interventions to usual care. All were parallel-group RCTs. No studies assessed global state (relapse) or reported data about adverse events/effects. All studies had a high risk of bias, mainly due to serious concerns about allocation concealment, deviations from intended interventions, measurement of the outcomes, and missing outcome data. Transitional discharge interventions may make little to no difference in service use (hospitalization) at short- and long-term follow-ups, but the evidence is very uncertain (RR 1.18, 95% CI 0.55 to 2.50; I2 = 54%; 4 studies, 462 participants; very low-certainty evidence). Transitional discharge intervention may increase the levels of functioning after discharge (clinically important change in general functioning) (SMD 0.95, 95% CI -0.06 to 1.97; I² = 95%; 4 studies, 437 participants; very low-certainty evidence) and may increase the proportion of participants who are satisfied with the intervention (clinically important change in satisfaction) (RR 1.96, 95% CI 1.37 to 2.80; 1 study, 76 participants; very low-certainty evidence), but for both outcomes the evidence is very uncertain. Transitional discharge intervention may make little to no difference in quality of life compared to treatment as usual (SMD 0.24, 95% CI -0.30 to 0.78; I² = 90%; 4 studies, 748 participants; very low-certainty evidence), but we are very uncertain. For direct costs, one study with 124 participants did not report full details and thus the results were inconclusive.
There is currently no clear evidence for or against implementing transitional discharge interventions for people with schizophrenia. Transitional discharge interventions may improve patient satisfaction and functionality, but this evidence is also very uncertain. For future research, it is important to improve the quality of the conduct and reporting of these trials, including using validated tools for measuring their outcomes.