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Trends in the use of coercive measures in Finnish psychiatric hospitals: a register analysis of the past two decades

机译：芬兰精神病医院使用强制措施的趋势：过去二十年的记录分析

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Coercive measures is a topic that has long been discussed in the field of psychiatry. Despite global reports of reductions in the use of restraint episodes due to new regulations, it is still questionable if practices have really changed over time. For this study, we examined the rates of coercive measures in the inpatient population of psychiatric care providers across Finland to identify changing trends as well as variations in such trends by region. In this nationwide registry analysis, we extracted patient data from the national database (The Finnish National Care Register for Health Care) over a 20-year period. We included adult patients admitted to psychiatric units (care providers) and focused on patients who had faced coercive measures (seclusion, limb restraints, forced injection and physical restraints) during their hospital stay. Multilevel logistical models (a polynomial model of quadratic form) were used to examine trends in prevalence of any coercive measures as well as the other four specified coercive measures over time, and to investigate variation in such trends among care providers and regions. Between 1995 and 2014, the dataset contained 226,948 inpatients who had been admitted during the 20-year time frame (505,169 treatment periods). The overall prevalence of coercive treatment on inpatients was 9.8%, with a small decrease during 2011–2014. The overall prevalence of seclusion, limb restraints, forced injection and physical restraints on inpatients was 6.9, 3.8, 2.6 and 0.8%, respectively. Only the use of limb restraints showed a downward trend over time. Geographic and care provider variations in specific coercive measures used were also observed. Despite the decreasing national level of coercive measures used in Finnish psychiatric hospitals, the overall reduction has been small during the last two decades. These results have implications on the future development of structured guidelines and interventions for preventing and more effectively managing challenging situations. Clinical guidelines and staff education related to the use of coercive measures should be critically assessed to ensure that the staff members working with vulnerable patient populations in psychiatric hospitals are ethically competent.
机译：强制措施是精神病学领域中长期讨论的话题。尽管全球都有报道称由于新法规而减少了约束事件的使用，但实践是否真的随着时间的推移而改变仍然令人怀疑。在本研究中，我们检查了芬兰精神病医疗服务提供者住院人群中强制性措施的比率，以发现变化趋势以及各地区这种趋势的变化。在这项全国性的注册表分析中，我们在20年的时间里从国家数据库（芬兰国家医疗保健注册簿）中提取了患者数据。我们纳入了入住精神病院（护理提供者）的成年患者，重点关注住院期间面临强制措施（隔离，四肢约束，强制注射和身体约束）的患者。多级逻辑模型（二次形式的多项式模型）用于检查任何强制性措施以及其他四种指定的强制性措施随时间推移的流行趋势，并调查护理提供者和地区之间这种趋势的变化。在1995年至2014年之间，数据集包含226,948名在20年时间范围内（505,169个治疗期）的住院患者。住院患者的强制治疗总体患病率为9.8％，在2011-2014年期间有所下降。住院患者的隐居，肢体约束，强制注射和身体约束的总体患病率分别为6.9％，3.8％，2.6％和0.8％。随着时间的流逝，只有使用四肢约束装置才显示下降趋势。还观察到地域和医疗服务提供者在使用的特定强制措施方面的差异。尽管芬兰精神病医院采用的强制措施的国家水平有所下降，但在过去的二十年中，总体下降幅度很小。这些结果对预防和更有效地管理具有挑战性的情况的结构化指南和干预措施的未来发展具有影响。应严格评估与使用强制措施有关的临床指南和员工教育，以确保在精神病医院中与弱势患者人群打交道的员工具有道德能力。

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