Анализ эффективности стационарозамещающих форм помощи в структуре психоневрологического диспансера

Abstract

Introduction : reorganization of a Moscow psychiatric service is underway. The main object of this renovation is switching from inpatient to outpatient service. Despite the fact, that many researches were made concerning this process, articles focused on an ambulatory psychiatry center are rare. Objective : to evaluate the efficiency of outpatient departments. To find out the most effective pharmacological ways to deal with patients who often hospitalize to psychiatric hospitals and see whether it is affective to treat them in the outpatient departments. Material and methods : a statistical and clinical analysis of medical documents of adult patients who received psychiatric help in an outpatient psychiatry clinic and statistic data of the Gannushkins clinic. Results : the efficiency of an outpatient hospital department and assertive care department was measured. Nosological differences were shown: Patients with schizophrenia (F20.001/2/3) and personality change due to known physiological condition (F00-09) prevailed in the assertive care department. Significantly more patients with neurotic (F40-F48), neurosis-like (F21.3), schizoaffective disorder (F25) and affective (F30-F39) disorders were treated in the outpatient hospital department. Dissimilarities in psychopharmacotherapy were also found, especially significant was the fact that anti-dementia medications were used 3 times more often in the assertive care department. Result of complex work (medical and psychosocial) were shown. Reduction in the number of hospitalization sin the inpatient hospital hospital and the average duration of treatment there were proved. Also, attention was paid to the group of especially often hospitalized patients, among which 74%suffered from paranoid schizophrenia. The main causes of repeated hospitalizations have been identified: lack of compliance (37%), treatment resistance (30%), alcohol and drug use (22%). It was revealed that patients who used long-acting injectable antipsychotics were hospitalized more often and spent more time in the inpatient department. Those who received mood stabilizers spent less time in the hospital compared with those who did not receive this type of therapy. It is shown that treatment in the outpatient hospital department and assertive care department reduces the frequency and duration of treatment in the inpatient department.