EFFECTIVENESS OF INVOLUNTARY OUTPATIENT COMMITMENT

非自愿门诊承诺的有效性

• 批准号: 2247961
• 负责人: MARVIN S SWARTZ
• 金额: $ 59.38万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1992
• 资助国家: 美国
• 起止时间: 1992-06-01 至 1997-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2247961
• 关键词: African American; clinical trials; community mental health services; family; functional ability; health care model; health care service evaluation; health care service utilization; health related legal; hospital length of stay; hospital utilization; human subject; human therapy evaluation; interview; mental disorder diagnosis; mental health facility; outpatient care; patient care management; posthospitalization care; psychological tests; psychosis; quality of life; rural area; social support network; substance abuse related disorder; therapy compliance; violence

Non-compliance with treatment continues to be a major cause of relapse, rehospitalization, decreased functioning and other poor outcomes among the seriously mentally ill. Efforts to identify causes of and remedies for non-compliance have stimulated a wide range of clinical investigative efforts. One promising approach to reducing non-compliance is court- mandated outpatient treatment referred to as involuntary outpatient commitment (OPC). All states have made provisions for outpatient commitment in the belief that OPC will improve compliance and treatment outcomes. In practice, OPC may serve as a stimulus to mobilize resources for more aggressive treatment efforts. A number of studies have demonstrated that OPC reduces rates of rehospitalization and improves other outcomes; but findings are mixed, due in part to variability in service provision. No studies have examined the extent to which OPC affects compliance and treatment outcomes when essential services are consistently measured nor have studies controlled for selection effects and other important confounds. The proposed study examines the effects of OPC on compliance and treatment outcomes net of service system mobilization in a randomized clinical trial of OPC combined with community-based case management and will seek to eliminate previous sources of bias in studies of OPC. Involuntarily admitted patients meeting criteria for severe and persistent mental illness and legal criteria for OPC will be randomly assigned to one of two treatment conditions: OPC plus case management or case management alone. Both groups will include similar proportions of black and rural patients. Outcomes of primary interest are: rehospitalization and length of stay, and time until rehospitalization. Other outcomes include psychiatric symptoms, functioning, quality of life, family burden, dangerousness, arrests and jail time. In addition to the specific program announcements, Effectiveness and Outcomes of Mental Health Services and Research on Mental Health Services in Rural Areas, this study addresses the program priorities of the Public-Academic Liaison Initiative and is responsive to the Legal Issues Section of the Service Systems Research Panel Report developed for the NIMH National Plan of Research to Improve Care for Severe Mental Disorders.

与治疗的不合规仍然是复发的主要原因， 重新寄养，功能降低和其他差的结果 严重的精神病。 努力确定和补救的原因 违规刺激了广泛的临床研究 努力。 减少违规的一种有希望的方法是法院 - 授权门诊治疗被称为非自愿门诊 承诺（OPC）。 所有州都为门诊病人做出了规定 相信OPC将改善合规性和治疗的承诺 结果。 实际上，OPC可能是动员资源的刺激 进行更积极的治疗工作。 许多研究有 证明OPC降低了重新住院的速度并提高了其他 结果；但是发现混合在一起，部分原因是服务的可变性 条款。 没有研究检查OPC影响的程度 当基本服务始终如一时，合规性和治疗结果 衡量的研究也没有控制选择效应和其他 重要的混杂。 拟议的研究检查了OPC对 服务系统动员的合规性和治疗结果 OPC的随机临床试验与社区案例相结合 管理层并将寻求消除研究中以前的偏见来源 OPC 不由自主地允许符合严重和严重标准的患者 OPC的持续精神疾病和法律标准将是随机的 分配给两个治疗条件之一：OPC加案件管理或 仅病例管理。 两组将包括类似的比例 黑人和农村患者。 主要兴趣的结果是： 重新搬迁和住宿时间，以及时间重新搬迁。 其他结果包括精神症状，功能，生活质量， 家庭负担，危险，逮捕和入狱时间。 除了 精神健康的特定计划公告，有效性和成果 这项研究 解决公共学术联络计划的计划优先事项 并响应服务系统的法律问题部分 研究小组报告为NIMH国家研究计划开发了 改善严重精神障碍的护理。