医患共同决策诊疗模式对精神分裂症患者治疗依从性的影响

Influences of shared decision making on schizophrenic treat-ment compliance

目的：探讨医患共同决策诊疗模式的实施对精神分裂症患者治疗依从性的影响。方法将46例精神分裂症患者随机分为两组，每组23例，均接受常规抗精神病药物治疗及护理，研究组在治疗全过程中与患者共同决策治疗方案，对照组予以一般健康教育，观察住院全程，出院后随访1 a 。采用简明精神病评定量表、大体功能评定量表评定临床疗效，自拟治疗依从性调查表评定治疗依从性，统计再住院率。结果出院时、随访6个月及随访1 a ，两组简明精神病评定量表评分均显著低于入院时（P ＜0．05或0．01），大体功能评定量表评分均显著高于入院时（P＜0．01），随访6个月及随访1 a 两组比较差异有显著性（P＜0．01）。研究组治疗依从性显著优于对照组（P＜0．01），再住院率显著低于对照组（P＜0．01）。结论医患共同决策模式的实施能提高精神分裂症患者的治疗依从性和临床疗效，改善社会功能，降低复发率。

Objective To explore the effect of shared decision‐making （SDM ） on schizophrenic treatment compliance .Methods Forty‐six schizophrenics were randomly divided into two groups of 23 ones each , both groups received routine antipsychotic treatment and nursing ,research group made treatment protocol‐sa together with patients during treatment whole course ,control group received general health education , hospitalization whole course was observed ,and were followed up for 1 year after discharge .Efficacies were assessed with the Brief Psychiatric Rating Scale （BPRS） and Global Assessment Scale （GAS） ,treatment compliances with the self‐made treatment compliance questionnaire , re‐hospitalization rate after relapse during 1 year follow‐up was added up .Results The BPRS scores of both groups on discharge and in the 6th and 12th month follow‐up lowered more significantly （P〈 0 .05 or 0 .01） and the GAS heightened （P〈0 .01） compared with those on admission ,there were significantly difference between two groups in the 6th and 12th month follow‐up （P 〈 0 .01） .Treatment compliance was better （ P 〈 0 .01） and re‐hospitalization rate lower （P 〈 0 .01） in research than in control group .Conclusion Shared decision‐making could effectively boost schizophrenic compliance and efficacy ,improve social functioning ,and reduce relapse rate .