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Yıl:2014; Cilt: 15; Sayı: 3>> Özet
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Anadolu Psikiyatri Dergisi; 2014;15(3):185-191
Döner kapı olgusu: Toplum temelli ruh sağlığı hizmet modeline geçişin psikiyatri servisine yatış üzerine etkisi
E Aydın, A Tabo, KO Karamustafalıoğlu, G Alataş, E Aydın, S Yiğit, GH Erkuş
Üsküdar Üniversitesi, İstanbul
Amaç: Genel anlamda sık yatış olarak tanımlanan “döner kapı olgusu” toplum temelli bakım planlarının etkin sunulması ile aşılabilir. Bu çalışmada, pilot proje olarak açılan Zeytinburnu Toplum Ruh Sağlığı Merkezi’nde (ZTRSM) döner kapı olgusuna uyan hastalar saptanmış ve sosyodemografik özellikleri araştırılmıştır. TRSM’de sunulan hizmetlerin hastaların psikiyatri servisine yatışına etkisinin belirlenmesi hedeflenmiştir. Yöntem: ZTRSM’de izlenen ve döner kapı olgusu ölçütlerine uyan hastalar, kaydedildiği tarihte ve izlenmelerinin 18. ayında ölçeklerle değerlendirilmiş, önce ve sonra uygulanan ölçekler karşılaştırılmıştır. Ayrıca hastaların 18 aylık izlenmeleri süresince gerçekleşen yatış gün ve sayıları, izleme öncesindeki yatış gün ve sayıları ile karşılaştırılmıştır. Bulgular: Döner kapı olgusuna uyan 18 hastanın 18 aylık izlenmesi sonunda yalnız beş yatışının olduğu, aynı hasta grubunun izleme öncesinde 18 ay süresince yatış sayısının 49 olduğu ve aradaki farkın istatistiksel olarak anlamlı olduğu görüldü. Depo tedavi ve klozapin kullanım oranı değişmeden pozitif, negatif, depresif belirtiler ve sosyal işlevsellikte düzelme gerçekleşmiştir. Tartışma: Döner kapı olgusu ölçütlerini karşılayan hastaların yatış sayıları toplum temelli bakım planı temelinde sunulan hizmetler ile azalmıştır. Bu sonuca ulaşmakta; ZTRSM’nin hastaların tedavisinde bütüncül yaklaşım sergilemesinin önemli rolü olduğu düşünülmektedir.
Revolving door phenomenon: the effect of application of community-based mental health services model at acute psychiatric hospitalization
Objective: “Revolving door” phenomenon describes patients with severe mental illness who are frequently admitted to hospital. The availability of better resources in the community, particularly outreach programs may play a significant role in reducing relapse and readmission. In this study, we aimed to give brief information about the effect of Zeytinburnu Community Mental Health Center (ZCMHC) organization on the need of acute psychiatric hospitalization. Methods: In order to evaluate the effect of ZCMHC organization, registered patients were investigated for the number of acute hospitalizations. Patients who met the criteria for revolving door phenomenon were followed at least 18 months and the number of previous hospitalizations was compared within 18 months follow-up period. Results: From 18 patients with a previous hospitalization due to revolving door phenomenon, we recorded only 5 hospitalizations were during our follow-up period, while previous hospitalizations were totally 49 in previous 18 months; this difference was also statistically significant. Improvement has been made in positive, negative and depressive symptoms and social functionality without a change in the ratio of the use of depot treatment and clozapine. Discussion: Patient follow-up with CMHC system may reduce the number of acute hospitalizations. ZCMHC has adopted a holistic approach in the treatment of patients which has an important role to reach this result.

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