摘要
目的:探讨社区管理防治精神分裂症患者疗效的影响,以及对患者经济因素的影响。方法:纳入2003-05/2004-06恩施市社区精神分裂症患者160例,随机分为社区观察组和对照组,每组80例,采用前瞻性对照观察,随访1年。社区观察组:均登记建卡纳入防治康复网络,制订康复方案,并成立社区治疗小组。具体措施有:①药物康复:给予肌注长效制剂或口服维持剂量的抗精神病药物,用药剂量折合成氯丙嗪效价为(238±9.67)mg/d。②实施家庭干预:对康复对象及家庭成员予以现场指导,包括集体家庭教育和个别家庭治疗。③职业康复:强调治疗的最终目的是恢复技能,重返社会。④进行追踪随访对患者每月的临床症状、用药情况、医疗费用支出、家庭经济收入等情况记录。对照组:发作期去医院治疗。患者住院期间接受常规药物治疗,药物治疗剂量折合成氯丙嗪效价为(242±10.53)mg/d。采用简明精神病评定量表、社会功能缺陷筛选量表进行疗效评定,分别于治疗前、中(6个月)、后(12个月)各评定1次。进行正态性检验、方差分析、χ2检验,比较1年前后临床症状变化、医疗费用及其他经济损失情况。结果:①1年末,社区观察组的简明精神病评定量表、社会功能缺陷筛选量表评分较入组前及对照组同期明显降低(25.01±12.17,32.42±13.69,31.69±12.33;3.61±2.17,7.41±3.12,10.31±2.49;t=2.12~7.93,P<0.05~0.01);且6个月末社区观察组社会功能缺陷筛选量表总分明显低于对照组(5.41±2.05,9.31±4.16,t=3.76,P<0.01)。②社区观察组患者药物治疗规则率由25例(31.0%)提高到73例(91.0%),而对照组药物治疗规则率仅维持在26例(33%)。社区观察组复发2例(3%),对照组复发14例(18%),两组比较差异有显著性意义(t=3.16,P<0.05)。③社区观察组患者的缺勤天数比对照组患者平均下降7.7d/个月,折合23l元/个月;患者家属缺勤天数平均下降2.3d/个月,折合59元/个月,平均每人减少间接费用290元/个月。对照组1年中有23人次住院治疗,合计住院费57271.70元,社区观察组无住院治疗人次,治疗费用显著低于对照组(t=2.86,P<0.01)。结论:精神分裂症患者经社区管理和规范防治,可改善临床症状,降低复发率,减少医疗费用支出,有利于患者的社会康复。
AIM:To investigate the influence of community managed prevention and treatment on the effect and economic factors of patients with schizophrenia.METHODS:From May 2003 to June 2004,totally 160 patients with schizophrenia in the community of Enshi city were randomly divided into observational group(n=80)and control group(n=80).They were followed up for 1 year by prospective control observation.Community observational group:the patients were registered to create cards,and involved in the rehabilitative network of prevention and treatment,rehabilitative program was worked out,the community treatment group was also founded.Concrete measures:①Drug rehabilitation:The patients were treated with intramuscular injection of uhralente agent or oral antipsychotic drugs,and the dosage equal to(238:t-9.67)mg per day(chloropromazine).②family interventions:Instructions were given to the subjects and their family members on the spot,including grouped and individual family treatments.③Occupational rehabilitation:It was emphasized that the final purpose of treatment was the recovery of skills and return to society.④The monthly clinical symptoms,medication,medical cost and family income of the patients were traced and recorded.Control group:The patients went to the hospital at exacerbation,and they were treated with routine drug treatment,the dosage equal to(242±10.53)mg per day(chloropromazine).The curative effect was evaluated with brief psychiatric rating scale(BPRS)and social disability screening schedule(SDSS)before,during(6 months)and after treatment(12 months)respectively.The test of normality,analysis of variance and chi-square test were used to compare the changes of clinical symptoms,medical care and other economic loss before and after 1-year treatment.RESULTS:①At the end of 1-year treatment,the scores of BPRS and SDSS in the community observational group were obviously lower than those before treatment and those in the control group at the same period(25.01±12.17,32.42±13.69,31.69±12.33;3.61±2.17,7.41±3.12,10.31±2.49,t=2.12-7.93,P〈0.05-0.01),and the total score of SDSS at the end of the 6^th month was obviously lower in the community observational group than in the control group(5.41±2.05,9.31±4.16,t=3.76,P〈0.01).②The regular rate of drug treatment in the community observational group was increased from 25 cases(31.0%)to 73 cases(91.0%),and that in the control group was only maintained at 26 cases(33%).It reoccurred in 2 cases(3%)in the community observational group,which was significantly different from that in the control group(14 cases,18%)(t=3.16,P〈0.05).③Compared with the control group,the absent days of patients in the community observational group was averagely decreased by 7.7 days per month,and equal to 231 yuan per month;and those of relatives was averagely decreased by 2.3 days per month,and equal to 59 yuan per month;the indirect cost for each person was averagely reduced by 290 yuan per month.In the control group,23 cases were hospitalized within one years,the total cost of hospitalization was 57271.70 yuan,no one hospitalized in the community observational group,the cost of treatment was significantly lower than that in the control group(t=2.86,P〈0.01).CONCLUSION:The community management and regular prevention and treatment can ameliorate the clinical symptom,reduce reoccurrence rate and medical cost of patients with schizophrenia,it is also good for the social rehabilitation of the patients.
出处
《中国临床康复》
CSCD
北大核心
2005年第28期24-26,共3页
Chinese Journal of Clinical Rehabilitation
基金
湖北省教育厅自然科学研究资助计划项目:鄂教科犤2004犦5号项目编号:2004D002
