首发精神分裂症患者社区个案管理的卫生经济学研究

Health economics study on community case management of the first episode schizophrenia patients

目的探讨社区个案管理对首发精神分裂症患者康复的卫生经济学价值,为改善精神分裂症患者预后和生活质量、降低康复成本提供依据。方法选择衢州市第三医院和湖北科技学院附属第二医院精神科2013年1-12月出院的320例首发精神分裂症患者为研究对象,随机分为个案管理组和对照组,每组160例。患者临床痊愈出院后,对照组门诊随诊,个案管理组给予社区个案管理,时间2年。用阳性与阴性症状量表(PANSS)、个人和社会功能量表(PSP)、精神分裂症生活质量量表(SQLS-R4)和疾病家庭负担量表(FBS)分别评定患者病情、社会功能、生活质量和疾病家庭负担的变化,并进行康复成本-效益分析。用SPSS 18.0软件对数据进行χ2检验和t检验。结果个案管理组各评分时段(出院12、18、24个月),PANSS、SQLS-R4和FBS总分减分幅度均明显大于对照组,PSP增分幅度明显大于对照组,差异均有统计学意义(P<0.01),各时段累计总成本(出院6个月除外)明显低于对照组,差异均有统计学意义(P<0.01),总效益和效益/成本比值均明显大于对照组,差异均有统计学意义(P<0.01)。结论社区个案管理有助于提高首发精神分裂症患者康复效益,降低康复成本,极大地提高卫生资源利用效益,比门诊随诊具有更好的卫生经济学价值。

Objective To explore the health economic value of community case management on rehabilitation of the first episode schizophrenia patients, and to provide the basis for improving the health management of schizophrenia patients. Methods All 320 first episode schizophrenia inpatients from the psychology department of the third hospital in Quzhou City and the psychology department of the second affiliated hospital of Hubei technical and scientific college were divided into management group（160cases） and control group（160 cases）. After discharge, the patients of management group had received an intervention by community case management, and the patients in the control group had received a service from outpatient clinic for two years. The positive and negative syndrome scale（PANSS）, the personal and social performance scale（PSP）, the schizophrenia quality of life scale revision 4（SQLS-R4） and the family burden scale of disease（FBS） were used to evaluate the state of patients＇ illness, the social function and the change of life quality and family burden, respectively. And the recovery cost-effectiveness analysis was performed. χ2test and t test were used to analyze the data with SPSS 18.0 software. Results In 12, 18 and 24 months after discharge, the decrease ranges of total scores of PANSS, SQLS-R4 and FBS in management group and the increase range of the score of PSP were significantly higher than those in the control group（P〈0.01）; the total cost in management group for 12,18 and24 months after discharge was significantly lower than that in control group（P 〈0.01）; the total effectiveness and ratio of effectiveness to cost were significantly higher than those in control group（P〈0.01）. Conclusion The community case management can contribute to improving the effectiveness of rehabilitation for the first episode schizophrenia patients, reducing the rehabilitation cost and enhancing the utilization effectiveness of health resources. The health economic value of community case management is better than that of outpatient clinic.