Implementing patient-centered decision support for mental health

实施以患者为中心的心理健康决策支持

• 批准号: 8584127
• 负责人: Alexander S. Young
• 金额: $ 23.1万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-09 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8584127
• 关键词: Adverse effects; Affect; Area; Attention; Behavior; Cardiovascular Diseases; Caring; Characteristics; Clinic; Clinical; Cognitive; Communities; Decision Making; Education; Enrollment; Evaluation; Evidence based practice; Evidence based treatment; Family; Feasibility Studies; Gambling; Goals; Guidelines; Health Services Accessibility; Healthcare; Hybrids; Individual; Intervention; Lead; Learning; Marketing; Measures; Medical Records; Medical center; Mental Health; Methods; Obesity; Outcome; Overweight; Participant; Patient Education; Patient Preferences; Patient-Centered Care; Patients; Pharmaceutical Preparations; Planning Theory; Population; Premature Mortality; Psychiatrist; Research; Research Personnel; Respondent; Role; Schizophrenia; Services; Specific qualifier value; Supported Employment; System; Time; Training; Treatment Effectiveness; Visit; Weight; Weight maintenance regimen; Work; alternative treatment; base; computerized; design; disability; evidence base; implementation research; improved; innovation; meetings; patient oriented; point of care; preference; programs; prospective; psychosocial; public health relevance; response; satisfaction; severe mental illness; social; treatment program

DESCRIPTION (provided by applicant): Background/Rationale: It is important that patients with serious mental illness have access to treatments that meet their preferences, and make informed choices among alternative treatments. Too often, preferences are not being routinely elicited from patients, nor used to guide which treatments are made available. Schizophrenia is a serious mental illness that is common and can produce substantial disability when poorly treated. National treatment guidelines specify that patients with schizophrenia should receive evidence-based psychosocial treatments that improve outcomes. For example, obesity is a pressing problem in this population, a side-effect of commonly used medications, and a cause of cardiovascular disease and premature mortality. There are multiple, different psychosocial treatments for weight management that can lead to reduced weight. None are widely used. If patient preferences were routinely assessed, then clinicians and managers would know when to make alternative treatments available, and for which patients. Objectives: This project implements and evaluates a method for routinely assessing the treatment preferences of patients with schizophrenia. The objectives are to: 1) develop a computerized, kiosk-based system that delivers patient education regarding treatment options for weight, uses conjoint analysis to elicit patient preferences, and meets the cognitive needs of individuals with schizophrenia; 2) study the feasibility and acceptability of implementing this method at a mental health clinic; and, 3) evaluate the extent to which this method predicts use of an evidence-based weight service, and satisfaction with the service at three months. Methods: This is a prospective evaluation of preferences, treatment use, and satisfaction in patients with schizophrenia. 94 patients are enrolled who are overweight and receiving treatment at a busy, urban mental health clinic. These participants use a kiosk system that provides them with education about treatment options, and assesses their preferences regarding alternative treatments for overweight. They are then offered a weekly, intensive, evidence-based psychosocial treatment for weight. Research assessments occur at baseline and 3 months. Treatment preferences are analyzed to determine how they relate to use of weight treatment, and satisfaction with treatment. Significance: People with serious mental illness could benefit from access to effective psychosocial treatments. Implementing these treatments would be facilitated by routinely collecting information regarding individual patients' preferences. If the assessment method in this study is found to be feasible, acceptable, and accurate, it could be used to support implementation of improved care at clinics, medical centers, and community-based programs.

描述（由申请人提供）：背景/理由：重要的是，患有严重精神疾病的患者能够获得符合其偏好的治疗方法，并在替代治疗中做出明智的选择。常常不会从患者那里引起偏好，也不会用于指导哪些治疗可用。精神分裂症是一种严重的精神疾病，很常见，治疗不佳时会产生大量的残疾。国家治疗指南指出，精神分裂症患者应接受基于证据的社会心理治疗，以改善预后。例如，肥胖是该人群中的一个紧迫问题，常用药物的副作用以及心血管疾病和过早死亡的原因。体重管理有多种不同的社会心理治疗，可以减少体重。没有广泛使用。如果常规评估患者的偏好，那么临床医生和经理将知道何时可以提供替代性治疗以及为哪些患者进行。 目标：该项目实施并评估一种常规评估精神分裂症患者治疗偏好的方法。目的是：1）开发一个基于售货亭的系统，该系统对体重的治疗选择，使用联合分析来引起患者的偏好，并满足精神分裂症患者的认知需求； 2）研究在心理健康诊所实施此方法的可行性和可接受性； 3）评估该方法预测使用基于证据的体重服务的程度，并在三个月后对服务满意。 方法：这是对精神分裂症患者偏好，治疗使用和满意度的前瞻性评估。在繁忙的城市心理健康诊所中，有94名患者超重并接受治疗。这些参与者使用售货亭系统，为他们提供有关治疗选择的教育，并评估他们对超重替代治疗的偏好。然后，为他们提供每周，密集的，基于证据的心理心理治疗的体重。研究评估在基线和3个月时进行。分析治疗偏好，以确定它们与体重治疗的使用和对治疗的满意度的关系。 意义：患有严重精神疾病的人可以从获得有效的社会心理治疗中受益。实施这些治疗方法将通过常规收集有关患者偏好的信息来促进。如果发现本研究中的评估方法是可行的，可接受和准确的，则可以用来支持在诊所，医疗中心和基于社区的计划中的改进护理的实施。