The Effectiveness of a Patient-Centred Assessment with a Solution-Focused Approach (DIALOG plus ) for Patients with Psychosis: A Pragmatic Cluster-Randomised Controlled Trial in Community Care
The Effectiveness of a Patient-Centred Assessment with a Solution-Focused Approach (DIALOG plus ) for Patients with Psychosis: A Pragmatic Cluster-Randomised Controlled Trial in Community Care
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DOI：
10.1159/000430991
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发表时间：
2015-01-01
影响因子：
22.8
通讯作者：
McCabe, Rosemarie
中科院分区：
文献类型：
--
作者：
Priebe, Stefan;Kelley, Lauren;McCabe, Rosemarie
背景：Dialog+被开发为一种计算机中介干预，包括对患者担忧的结构化评估和以解决方案为重点的方法来启动变化。这项研究测试了DIALOG+在精神病患者社区治疗中的有效性。方法：这是一项务实、探索性、平行组、整群随机对照试验。社区团队中的临床医生-以及在他们护理下的精神病患者-被随机分配到每月一次的DIALOG+，为期6个月或积极控制。在3、6和12个月后，采用盲法评估者评估一次结果(主观生活质量，SQOL)和二次结果，并使用混合效应模型进行分析。结果：共有49名临床医生和179名患者被随机分组。DIALOG+的实施情况各不相同，前3个月平均为1.8次(SD=1.6)，随后3个月平均为1.1次(SD=1.2)。DIALOG+ARM组患者术后3、6、12个月的生活质量较好(P值分别为0.035、0.058、0.014；Cohen‘s d=0.29~0.34)。他们在3个月和6个月时的未满足需求也明显减少，所有时间点的一般精神病理症状都较少，12个月时客观社会结果更好，其他结果没有显著差异。干预组的总体护理成本较低。结论：尽管实施不同，DIALOG+对社区精神病患者来说是一种有益的干预措施。作为一种不昂贵且可能节省成本的通用干预措施，DIALOG+可能会被广泛使用，并可能提高社区治疗的有效性。进一步的试验应该在不同的患者群体和背景下测试DIALOG+。(C)2015年S.Karger AG，巴塞尔
Background: DIALOG+ was developed as a computer-mediated intervention, consisting of a structured assessment of patients' concerns combined with a solution-focused approach to initiate change. This study tested the effectiveness of DIALOG+ in the community treatment of patients with psychosis. Method: This was a pragmatic, exploratory, parallel-group, cluster-randomised controlled trial. Clinicians within community teams - along with patients with psychosis under their care - were randomised to use DIALOG+ once per month for 6 months or an active control. The primary outcome (subjective quality of life, SQOL) and secondary outcomes were assessed after 3, 6 and 12 months by blinded assessors and analysed using mixed-effect models. Results: A total of 49 clinicians and 179 patients were randomised. Implementation of DIALOG+ was variable, with an average of 1.8 sessions (SD = 1.6) in the first 3 months and 1.1 (SD = 1.2) in the following 3 months. Patients in the DIALOG+ arm had better SQOL at 3, 6 and 12 months (p = 0.035, 0.058 and 0.014, respectively; Cohen's d = 0.29-0.34). They also had significantly fewer unmet needs at 3 and 6 months, fewer general psychopathological symptoms at all time points and better objective social outcomes at 12 months, with no significant differences in other outcomes. Overall care costs were lower in the intervention group. Conclusion: Despite variable implementation, DIALOG+ is a beneficial intervention for community patients with psychosis. As a non-expensive and potentially cost-saving, generic intervention, DIALOG+ may be widely used and may improve the effectiveness of community treatment. Further trials should test DIALOG+ in different patient groups and contexts. (C) 2015 S. Karger AG, Basel