Enhancing post-acute mental health outcomes for patients with psychosis in Malawi through nurse-delivered community-based rehabilitation: The ENHANCE Pilot Trial

通过护士提供的社区康复来改善马拉维精神病患者的急性后心理健康结果：ENHANCE 试点试验

• 批准号: 10673841
• 负责人: Kazione Kulisewa
• 金额: $ 21.52万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10673841
• 关键词: Acute; Address; Admission activity; Ambulatory Care; Caregivers; Caring; Chronic; Collaborations; Communities; Conflict (Psychology); Country; Disabled Persons; Effectiveness; Enrollment; Family; Family member; Goals; Home; Human Resources; Individual; Inpatients; Interview; Malawi; Manuals; Medical; Medication Management; Mental Health; Mental Health Services; Modeling; Morbidity - disease rate; Nurses; Outpatients; Patient-Focused Outcomes; Patients; Persons; Pilot Projects; Policies; Population; Positioning Attribute; Process; Productivity; Psychiatric Hospitals; Psychiatric therapeutic procedure; Psychoses; Psychotic Disorders; Public Sector; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation therapy; Relapse; Religion; Research; Resource-limited setting; Risk Factors; Role; Services; Severities; South Africa; Symptoms; Time; Work; acceptability and feasibility; community based care; community based treatment; community-level factor; disability; emerging adult; empowerment; evidence base; experience; family burden; improved; improved outcome; low and middle-income countries; medical specialties; medication compliance; member; mortality; person centered; pilot test; pilot trial; programs; reduce symptoms; relapse prevention; scale up; social inclusion; social stigma; treatment as usual

ABSTRACT Psychosis exacts a heavy morbidity and mortality toll worldwide, but especially in low- and middle- income countries (LMICs). Psychotic disorders are one of the most common presenting complaints for individuals admitted to specialty mental health care in many LMICs. Psychotic disorders typically have onset in early adulthood and a chronic course, meaning patients suffer from many years of poor functionality, disability, and lost productivity. Indeed, psychotic disorders remain among the 15 leading causes of disability globally. Despite the significant toll of psychosis in LMICs, treatment options are extremely limited and focus heavily on acute, time-limited inpatient stabilization. This focus fails to consider the demonstrated need for long-term post-acute outpatient treatment and community-based rehabilitation to improve outcomes. Contextual community factors such as reliable continued access to mental health care, stigma and its negative impact on medication adherence, inadequate support, and family conflict are key risk factors for subsequent relapse upon discharge into the community. Community-based rehabilitation (CBR) is ideally positioned to address the need for post-acute community-based care for people with psychosis in low-resource settings. CBR is a general evidence- based approach for the long-term treatment and support of individuals with a broad range of disabilities. CBR is particularly well suited for adaptation to address the needs of those with psychosis. CBR aims to improve the quality of life of individuals living with disability by encouraging understanding of illness, addressing functional goals, and encouraging social inclusion within their families and communities. CBR enables a person-focused emphasis on recovery rather than symptom reduction. Traditionally, most inpatient and outpatient psychiatric care for people with psychosis focuses on medication management to reduce negative symptoms. Yet emerging work underscores that a focus on recovery through strengthening understanding, connection, empowerment, and hope is paramount to optimize long-term quality of life for individuals with psychosis. Due to its delivery in the home, integration of family members, and focus on functional goals and social inclusion, CBR is ideally suited to embed this recovery orientation. Accordingly, we propose to adapt the CBR model to bring a recovery-focused approach to addressing the needs of community-dwelling individuals with psychosis in Malawi. We will conduct formative research with key stakeholders to guide the adaptation of the CBR model and complete a pilot randomized controlled trial to evaluate the feasibility, acceptability, fidelity, and preliminary effectiveness of the adapted CBR treatment model. This work will provide a critical advance toward establishing the evidence base for community-based treatment models for people living with psychosis outside of the context of acute inpatient stabilization so as to enhance rehabilitation, functioning, quality of life, and recovery.

抽象的 精神病肯定在全球范围内严重发病和死亡率，但尤其是在中间和中间 收入国家（LMIC）。精神病是最常见的表达投诉之一 在许多LMIC中接受专业心理保健的个人。精神病疾病通常发作 成年早期和慢性病程，这意味着患者的功能不佳，残疾， 并失去生产力。确实，精神病仍然是全球残疾的15种主要原因之一。 尽管LMICS精神病造成了重大损失，但治疗方案非常有限，并且 重点关注急性，时间限制的住院稳定。这个重点未能考虑已证明的 需要长期急性门诊治疗和基于社区的康复以改善预后。 上下文社区因素，例如可靠的继续获得心理保健，污名及其负面的因素 对药物依从性，支持不足和家庭冲突的影响是随后的关键风险因素 出院后复发。 基于社区的康复（CBR）是理想的定位，可以满足急性后的需求 在低资源环境中为精神病患者提供基于社区的护理。 CBR是一般证据 - 基于长期治疗和支持广泛残疾的人的方法。 CBR 特别适合适应精神病患者的需求。 CBR旨在改善 通过鼓励对疾病的理解，解决功能的人的生活质量 目标，并鼓励其家庭和社区中的社会包容性。 CBR使以人为中心的重点是恢复而不是减轻症状。传统上， 对于患有精神病患者的大多数住院和门诊精神病护理都集中在药物管理上 减少负面症状。然而，新兴的工作强调了通过加强而着重于恢复 理解，联系，授权和希望对于优化长期生活质量至关重要 患有精神病的人。由于其在家中的交付，家庭成员的整合，并专注于 功能目标和社会包容性，CBR非常适合嵌入这种恢复方向。 因此，我们建议调整CBR模型以将以恢复为中心的方法带入 满足马拉维社区居民精神病的需求。我们将进行 与主要利益相关者的形成性研究，以指导CBR模型的适应并完成飞行员 随机对照试验以评估可行性，可接受性，忠诚度和初步效果 改编的CBR治疗模型。这项工作将为建立证据基础提供关键的进步 用于基于社区的治疗模型，适合在急性住院的背景下患有精神病患者 稳定以增强康复，功能，生活质量和恢复。