女性慢性精神分裂症患者的社区康复与住院治疗的疗效、复发率及成本费用的差异比较

Differences of curative efficacy, relapse rate and cost between female patients with chronic schizophrenia under community-based rehabilitation and inpatient care

目的:探讨社区康复疗法和住院治疗对女性精神分裂症患者的治疗效果、社会功能、复发率及成本费用的影响。方法:将2001-09/2002-09德州市第二人民医院精神科就诊81例女性慢性精神分裂症患者随机分为住院治疗组(n=40)和社区康复组(n=41)。住院治疗组实行封闭式住院管理,以药物治疗为主,辅以工娱疗法和心理治疗。社区康复组均予建立家庭病床,实行开放式管理,至少每周上门巡诊1次,给予心理辅导;平时通过电话指导康复干预措施,包括药物治疗、参加适度劳动和社交活动。两组疗程均为1～3个月,随访半年。在疗程结束时用简明精神病量表减分率评定疗效(减分率≥80%为痊愈,≥60%为显著进步,≥30%为进步,<30%为无效);在治疗前后和半年后随访分别用社会功能缺陷筛查量表评定社会功能(10个项目,每项评分为0～2分,以总分≥2分为有社会功能缺陷);根据患者缓解半年后症状是否再度出现,或原残留症状有否加重需要调整药物或剂量等判别有无复发情况;用直接费用核算法分析治疗成本与费用。结果:住院治疗组平均疗程为51d,社区康复组平均疗程为50d。住院治疗组脱落2例,社区康复组脱落3例,两组各有38例患者进入结果分析。①两组治疗效果比较:两组有效率无显著性差异犤89%(34/38)和92%(35/38)犦;半年后随访住院治疗组简明精神病量表评分由42.80±3.79降为12.84±5.36,社区康复组由43.08±3.66降为12.92±4.98,两组间治疗前后差异均无显著性。②两组患者社会功能缺陷筛查量表评分比较:社区康复组治疗后明显好于住院治疗组(1.61±4.56和3.64±4.05;t=2.05,P<0.05)。③两组复发率比较:住院治疗组高于社区康复组犤38%(10/26)和14%(4/28);(χ2=4.44,P<0.05犦。④两组直接成本与费用比较:住院治疗组每位患者平均需支付2408元(包括住院诊疗费、床位费、护理费、检查处置费、治疗费和药费等),社区康复组每位患者平均支付722元(包括巡视费、监护费、检查治疗费和药费等),住院治疗组的成本与费用是社区康复组的3.34倍。结论:社区康复治疗和住院治疗女性慢性精神分裂症患者的疗效相当,但相对于住院治疗,社区康复疗法更能降低复发率,提高患者社会功能,减轻患者经济负担。

AIM： To investigate the influence of community rehabilitation therapy and inpatient care on the effect, social function, relapse rate and cost in female patients with chronic schizophrenia. METHODS： Eighty-one female patients with chronic schizophrenia, who were treated in the Department of Psychiatry, Dezhou Second People＇s Hospital from September 2001 to September 2002, were randomly divided into inpatient care group （n=40） and community-based rehabilitation group （n=41）. The inpatient care group accepted closed hospital management, with drug therapy mainly, assistant with occupational-recreational therapy and psychotherapy. The community-based rehabilitation group was treated in home bed, accepted opening management, followed up once a week at least, the patients were also given psychological education; In normal time, the measures of rehabilitative interventions, including drug therapy, appropriated labor and social activities, were given on telephone. The therapeutic course was 1 to 3 months in both groups, and all the patients were followed up for half a year. At the end of treatment, the curative effect was assessed with the decreasing rate of the score of mini-mental state examination （the decreasing rate of score ≥ 80% was taken as cured, ≥ 60% as significantly improved, ≥ 30% as improved, 〈 30% as invalid）. Before and after treatment and after half-a-year follow-up, their social function was assessed with the social disability screening schedule （including 10 items, each item was rated from 0 to 2, the total score ≥ 2 was taken as social disability）; The relapse was assessed by the recurrent symptoms after six months, or the dose need add to treat the aggravated symptoms; The cost and charge were analyzed with the direct cost calculation. RESULTS： The average therapeutic course in the inpatient care group was 51 days, and that in the commnuity-based rehabilitation group was 50 days. Two and 3 cases in the inpatient care group and community-based rehabilitation group lost, and 38 cases in each group respectively were involved in the analysis of results. ① Comparison of the therapeutic effects： the valid rate was insignificantly different before the two groups [89% （34/38）, 92% （35/38）]; After half-a-year follow-up, the score of minimental state examination decreased from 42.80±3.79 to 12.84±5.36 in the inpatient care group, and from 43.08±3.66 to 12.92±4.98 in the communitybased rehabilitation group, and there were insignificant differences between the two groups before and after treatment. ② Comparison of the score of social disability screening schedule： After treatment, it was obviously better in the inpatient care group than in the community-based rehabilitation group （1.61±4.56, 3.64±4.05; t=2.05, P 〈 0.05）. ③ Comparison of relapse rate： It was higher in the inpatient care group than in the community-based rehabilitation group [38% （10/26） vs 14% （4/28）, （ X^2=4.44, P 〈 0.05]. ④ Comparison of direct cost and charge： In the inpatient care group, the average pay （including pays of inpatient diagnosis and treatment, bed, nursing, examination and disposal, treatment and medicine） for each patient was 2 408 yuan. In the community-based rehabilitation group, the average pay （including pays of Inspection, monitoring, examination and treatment and medicine） for each patient was 722 yuan. The cost and charge in the inpatient care group was 3.34 times as much as that in the community-based rehabilitation group. CONCLUSION： The therapeutic effects in the female patients with chronic schizophrenia under community-based rehabilitation and inpatient care are comparative. Compared with inpatient care, community-based rehabilitation treatment can lower the relapse rate, better the social function and lighter the economic burden of the patients.