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首页> 外文期刊>Psychological medicine >Randomized and non-randomized evidence for the effect of compulsory community and involuntary out-patient treatment on health service use: systematic review and meta-analysis.
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Randomized and non-randomized evidence for the effect of compulsory community and involuntary out-patient treatment on health service use: systematic review and meta-analysis.

机译：强制性社区和非自愿门诊治疗对卫生服务使用的影响的随机和非随机证据：系统评价和荟萃分析。

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BACKGROUND: There is limited randomized controlled trial (RCT) evidence for compulsory community treatment. Other study methods may clarify their effectiveness. We reviewed RCT and non-RCT evidence for the effect of compulsory community treatment on hospital admissions, bed-days, compliance and out-patient contacts. METHOD: A systematic review of RCTs, controlled before-and-after (CBA) studies, and interrupted time series (ITS) analyses. Meta-analysis of RCTs. RESULTS: Eight papers covering five studies (two RCTs and three CBAs) met inclusion criteria (total n=1108). There was no statistical difference in 12-month admission rates between subjects on involuntary out-patient treatment and controls. Survival analyses of time to admission were equivocal. All five studies reported decreases in the number of bed-days following involuntary out-patient treatment but this only reached statistical significance in one situation; patients receiving the intervention were less likely to have admissions of over 100 days. There was no difference in treatment adherence between the intervention and control groups in either RCT or two of the CBA studies. However, the third CBA study reported a statistically significant increase of nearly five visits in the mean number of overall contacts in the involuntary out-patient treatment group. CONCLUSIONS: The evidence for involuntary out-patient treatment in reducing either admissions or bed-days is very limited. It therefore cannot be seen as a less restrictive alternative to admission. Other effects are uncertain. Evaluation of a wide range of outcomes should be included if this type of legislation is introduced.
机译：背景：强制性社区治疗的随机对照试验（RCT）证据有限。其他研究方法可能会阐明其有效性。我们回顾了RCT和非RCT证据，说明强制性社区治疗对入院，就诊日，依从性和门诊患者的影响。方法：对RCT进行系统回顾，进行前后对照（CBA）研究和中断时间序列（ITS）分析。随机对照试验的荟萃分析。结果：八篇论文涵盖五项研究（两项RCT和三个CBA）符合纳入标准（总n = 1108）。非自愿门诊治疗的受试者与对照组之间的12个月入院率无统计学差异。入院时间的生存分析是模棱两可的。所有五项研究均报告说，非自愿门诊治疗后的卧床天数减少了，但这仅在一种情况下达到了统计意义。接受干预的患者入院100天的可能性较小。在RCT或两项CBA研究中，干预组和对照组之间在治疗依从性方面没有差异。但是，第三项CBA研究报告说，非自愿门诊治疗组中，平均五次就诊次数在统计学上显着增加。结论：减少门诊或卧床时间的非自愿门诊治疗的证据非常有限。因此，它不能被视为对入学限制较小的替代方案。其他影响尚不确定。如果采用此类立法，则应包括对广泛结果的评估。

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