Data_Sheet_1_The association between the admission to wards with open- vs. closed-door policy and the use of coercive measures.PDF

IntroductionPsychiatric treatment on a ward with open-door policy is associated with reduced numbers of coercive measures. The effect of the door policy of previous stays, however, has not been investigated.
MethodsThe data set consisted of 22,172 stays by adult inpatients in a psychiatric university hospital between 2010 and 2019. Pairs of consecutive stays were built. The outcome variable was the occurrence of coercive measures during the second stay.
ResultsCompared to treatments on wards with a closed-door policy at both stays, treatments on wards with an open-door policy at the second stay had smaller odds for coercive measures (OR ranging between 0.09 and 0.33, p < 0.01). In addition, coercive measures were more frequent in treatment histories where patients previously treated on a closed ward were admitted to a ward with an open-door policy and subsequently transferred to a ward with a closed-door policy at the second stay (OR=2.97, p = 0.046).
DiscussionTreatment under open-door policy is associated with fewer coercive measures, even in patients with previous experience of closed-door settings. The group of patients who were admitted to a ward with an open-door, then transmitted to a ward with a closed-door policy seem to be prone to experience coercive measures. Clinical strategies to keep these patients in treatment in an open-door setting could further reduce coercive measures.

**引言** 精神科开放病房政策（open-door policy）下的治疗模式与约束性措施（coercive measures）使用量减少存在关联。然而，既往住院期间的病房政策对后续治疗的影响尚未得到研究。
**方法** 本数据集涵盖2010年至2019年间某精神科大学附属医院的22172例次成年住院患者住院疗程。研究构建了连续两次住院的配对样本，结局变量为第二次住院期间约束性措施的发生情况。
**结果** 与两次住院均接受封闭病房政策（closed-door policy）治疗的患者相比，第二次住院时采用开放病房政策的患者发生约束性措施的比值比（odds ratio, OR）更低（OR范围为0.09~0.33，p<0.01）。此外，若患者既往接受封闭病房治疗，首次入院时入住开放病房，但第二次住院时转入封闭病房，则其约束性措施的发生频率显著更高（OR=2.97，p=0.046）。
**讨论** 即便既往有封闭病房治疗经历的患者，开放病房政策下的治疗模式仍与约束性措施使用量减少相关。而那些先入住开放病房、随后转至封闭病房的患者群体，似乎更容易出现约束性措施相关事件。临床中可通过制定策略维持该类患者在开放病房环境下接受治疗，以进一步降低约束性措施的使用。