个案管理对社区精神分裂症的疗效及卫生经济学分析
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中山市科学事业费项目(2015B1034)


Effects of case management on community schizophrenia and health economic analysis
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    摘要:

    目的 分析个案管理对社区精神分裂症患者效果及卫生经济学影响。方法 2015 年3— 6 月选取中山市南朗及东升镇接受个案管理服务的50 例精神分裂症患者为个案组,依据经济及人口匹 配原则从民众镇随机抽取50 例精神分裂症患者为对照组,对照组患者接受国家要求的基础管理服务, 对两组患者随访2 年,采用阳性与阴性症状量表(PANSS)和自编成本调查表在入组时、1 年后和2 年后分 别评估两组患者的疾病症状和成本费用,并统计两组患者的住院人数和住院时间。结果 经重复测量 方差分析,两组患者在PANSS 评分、直接成本、间接成本和总成本的组间效应、时间效应和交互效应均 具有统计学意义(P< 0.05);在入组1 年和2 年时以上各指标组间差异均有统计学意义,个案组均低于对 照组(P< 0.05)。第2 年度时,个案组住院时间明显低于对照组,差异有统计学意义(P< 0.05)。两组患 者住院率差异无统计学意义。结论 个案管理可以改善社区精神分裂症患者的症状,缩短住院时间, 降低直接和间接经济成本。

    Abstract:

    Objective To evaluate the effectiveness of case management on the schizophrenia patients in community and its health economic effects. Methods From March to June 2015, 50 patients with schizophrenia in Nanlang and Dongsheng town were recruited into case management group. According to the principle of economic and population matching, another 50 patients with schizophrenia in Minzhong town were randomly selected into control group and given basic management services required by the state. The patients of two groups have been followed up for 2 years. All patients were evaluated with the Positive and Negative Symptoms Scale( PANSS) and a self-designed questionnaire on admission, 1 and 2 years after admission for patients' symptoms and the cost of treatment. The number of inpatients and the time of hospitalization of were compared between the two groups. Results It is shown in the repeated measurement of variance analysis that the intergroup effect, time effect and interaction effect of the two groups were statistically significant in PANSS score, direct cost, indirect cost and total cost( P<0.05). There were statistically difference in each indicators at the time of 1 and 2 years after adimssion( P < 0.05). The direct cost, indirect cost and total cost of case management were lower than that of the control group. In the second year, the hospitalization time of the case management group was significantly lower than that of the control group, with statistical significance( P<0.05). There was no difference in hospitalization rate between the two groups. Conclusions Case management can improve the symptoms of schizophrenia patients in community, reduce the length of hospital stay, and reduce the direct and indirect economic cost.

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林振东 周强 黄海锋 李维娜 黄妙妃 孙宝川 周家凤.个案管理对社区精神分裂症的疗效及卫生经济学分析[J].神经疾病与精神卫生,2018,18(4):
DOI :10.3969/j. issn.1009-6574.2018.04.005.

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  • 在线发布日期: 2018-08-21