EFFECTIVENESS OF INVOLUNTARY OUTPATIENT COMMITMENT

非自愿门诊承诺的有效性

基本信息

批准号：
6042241
负责人：
MARVIN S SWARTZ
金额：
$ 19.63万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
1992
资助国家：
美国
起止时间：
1992-06-01 至 2002-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/6042241
关键词：
behavioral /social science research tag clinical research clinical trials community mental health services functional ability health care model health care service evaluation health related legal health services research tag hospital length of stay hospital utilization human subject human therapy evaluation mental disorder diagnosis mental health facility outcomes research outpatient care posthospitalization care psychological tests psychosis rural area social support network substance abuse related disorder therapy compliance

behavioral /social science research tag clinical research clinical trials community mental health services functional ability health care model health care service evaluation health related legal health services research tag hospital length of stay hospital utilization human subject human therapy evaluation mental disorder diagnosis mental health facility outcomes research outpatient care posthospitalization care psychological tests psychosis rural area social support network substance abuse related disorder therapy compliance

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项目摘要

This competing continuation extends the Duke Mental Health Study the first randomized controlled trial (RCT) of the effectiveness of involuntary outpatient commitment (OPC) in reducing rehospitalization and improving outcomes among persons with severe mental illnesses (SMI). OPC is a promising, but controversial legal intervention designed to benefit SMI individuals who need ongoing psychiatric care and support to prevent dangerous relapse and recidivism, but who are SMI individuals who need ongoing psychiatric care and support to prevent dangerous relapse and recidivism, but who are reluctant or have difficulty seeking and following through with community-based treatment. Thirty-eight states and the District of Columbia have explicit OPC statutes. Still, key information is lacking on the advantages and drawbacks of OPC how it exerts its effects, for how long, and for which clinical subgroups. Are the coercive aspects of court-ordered treatment in the community worth the potential benefits to SMI consumers, those who care for them, and to society in general? In the RCT recently completed, involuntarily hospitalized patients awaiting OPC were randomly assigned to continue under OPC upon discharge, or be released from their court order and receive voluntary case management services. Analyses of one-year follow-up data demonstrate that subjects who received sustained periods of OPC and frequent outpatient services had significantly reduced hospitalizations and violent behavior. However, we have yet to (and propose to) examine other key outcomes (symptoms, functioning, substance abuse, homelessness, arrests, family/caregiver strain), and key intervening variables (treatment intensity, medication adherence). Mechanisms underlying OPC must also be examined as well as long-term outcomes post-OPC. Assessment of stakeholders' utilities for this controversial intervention is also needed in order to develop OPC practice guidelines. The goal of this competing continuation application is to address the priorities outlined in the NIMH National Advisory Mental Health Council's Clinical Treatment and Services Workgroup Report. "Bridging Science and Service." We propose to: (1) Extend existing research on OPC's effectiveness by completing ongoing RCT analyses; (2) Gather data about consumers' and other stakeholders' preferences and attitudes regarding OPC; (3) Synthesize all available evidence on OPC effectiveness and utilities for an expert consensus panel charged with developing OPC practice guidelines; and (4) Assess strategies for guideline implementation and design practice improvement research.

这种竞争性的延续扩展了杜克心理健康研究的第一个随机对照试验（RCT），即非自愿门诊承诺（OPC）在减少重新住院和改善严重精神疾病（SMI）的结果方面的有效性。 OPC是一种有前途但有争议的法律干预措施，旨在使需要持续的精神科护理和支持以防止危险复发和累犯的SMI个人受益，但是他们是需要持续的精神科护理和支持以防止危险复发和累犯的SMI个人，但他们不愿意或难以寻求或遵循社区基于社区的治疗。 38个州和哥伦比亚特区有明确的OPC法规。尽管如此，关键信息仍缺乏OPC的优势和缺点，其效果如何持续多长时间以及在哪些临床子组中。社区中法院命令的待遇的强制性方面是否值得对SMI消费者，关心他们和整个社会的潜在利益？在最近完成的RCT中，等待OPC的非自愿住院的患者被随机分配在OPC下，或从法院命令中释放并获得自愿案件管理服务。对一年的随访数据的分析表明，接受OPC持续和频繁门诊服务的受试者大大减少了住院和暴力行为。但是，我们尚未（并提议）检查其他关键结果（症状，功能，滥用药物，无家可归，逮捕，家庭/照顾者株）和关键的中间变量（治疗强度，药物依从性）。还必须检查OPC的机制以及OPC后的长期结果。为了制定OPC实践指南，还需要对利益相关者公用事业进行这种有争议的干预措施的评估。该竞争性延续申请的目的是解决NIMH国家咨询心理健康委员会的临床治疗和服务工作组报告中概述的优先事项。 “桥接科学和服务。”我们建议：（1）通过完成正在进行的RCT分析来扩展对OPC有效性的现有研究；（2）收集有关消费者和其他利益相关者对OPC的偏好和态度的数据；（3）综合有关OPC有效性和公用事业的所有可用证据，以制定OPC实践指南的专家共识小组；（4）评估指南实施和设计实践改进研究的策略。