摘要
背景 在过去的6年里,中国开展了世界上最大规模的重性精神病社区管理治疗项目(简称686项目),但项目实施的效果并未得到详细的评估。目的 对参与该项目的精神分裂症患者的临床有效者与临床无效者的特征进行比较。方法 从该项目的全国登记系统电子数据库中,提取2011年在四川省绵阳市(农村人口占60%)参加该项目的精神分裂症患者的资料,共3090份。根据精神科医生2011年的末次评估,将患者的疗效为"治愈"或"好转"者归为有效组(n=1866),将"无变化"或"加重"者归为无效组(n=1224),比较两组之间的社会人口学特征和治疗特点。收集的资料包括性别、年龄、民族、职业、文化程度、家庭经济状况、婚姻状况、精神疾病家族史、患病时间、参加686项目的时间以及治疗依从性等。结果 单因素分析结果显示,除性别、民族和精神疾病家族史外,其他因素的组间差异均有统计学意义。年龄小、病程短、受教育时间长、家庭经济状况好、治疗依从性好、参与686项目时间短的患者疗效更好。Logistic回归分析结果显示,服药依从性差、家庭贫困以及参加686项目时间长等因素更多见于疗效"无变化"或"加重"的患者。结论 治疗依从性差和家庭贫困严重地影响了686项目的效果。想方设法提高精神疾病患者的治疗依从性,向患者家庭提供基本的经济支持,将有助于提高该项目的成效。
Background: Over the last six years China has developed the largest community-based service network for persons with serious mental illness in the world (the ‘686 Project’) but the effectiveness of this program has not been assessed in detail. Aim: Compare the characteristics of patients with schizophrenia enrolled in the program whose clinical status has improved with the characteristics of patients whose clinical status has not improved. Methods: The records of 3090 patients with schizophrenia in Mianyang Municipality, Sichuan (a community with 60% rural residents) who participated in the 686 Project at any time during 2011 were extracted from the national electronic registry system for the project and the demographic and treatment characteristics of individuals rated by treating clinicians as ‘recovered’ or ‘improved’ at the time of their last evaluation in 2011 (n=1866) were compared to those of patients rated as ‘unchanged’ or ‘worsened’ (n=1224). The factors considered included gender, age, ethnicity, occupation, education, family economic status, marital status, family history of mental illness, duration of illness, time of enrolled in the 686 Program, and adherence to medication. Results: In the univariate analysis there were significant differences between the two groups in all variables considered except for gender, ethnicity, and family history of mental illness. The recorded treatment outcome was better in patients who were younger, who had a shorter duration of illness, who were more educated, who came from better-off families, who were more adherent to treatment and who had participated in the program for a shorter period of time. Logistic regression analysis found that patients classified as unchanged or worsened were more likely to be non-adherent to drug treatment, to come from families living below the local poverty line, and to be enrolled in the 686 Program for a longer period of time. Conclusion: Poor treatment adherence and poverty seriously limit the effectiveness of the
出处
《上海精神医学》
2012年第03X期131-139,共9页
Shanghai Archives of Psychiatry
基金
supported by funds from the 'National Project on Management and Treatment of Severe Mental Illness'
the 'National Fund for Equalizing Public Health Services'
