Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review.
Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review.
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DOI：
10.4088/jcp.12r07757
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发表时间：
2013-06
期刊：
影响因子：
--
通讯作者：
Otto MW
中科院分区：
文献类型：
--
作者：
McHugh RK;Whitton SW;Peckham AD;Welge JA;Otto MW
循证实践模式强调在治疗选择和实施中考虑治疗效果/有效性、临床专业知识和患者偏好。然而，患者对精神病治疗的偏好尚未得到充分研究。这项荟萃分析综述的目的是估计相对于精神疾病药物治疗，更喜欢心理治疗的患者比例。使用PubMed、PsycINFO和科克伦协作图书馆进行文献检索，检索到2011年8月，以英文撰写的评估患者对精神疾病治疗偏好的研究。纳入了评估首选治疗类型的研究，包括至少一种心理治疗和一种药物治疗。在最初识别的641篇文章中，34篇符合纳入标准。作者提取了相关数据，包括报告偏好心理和药物治疗的参与者比例。在所有研究中，倾向于心理治疗的比例为0.75（95% CI：0.69至0.80），显著高于同等偏好（即，高于0.50，p < .001）。敏感性分析表明，年轻患者（p <0.05）和女性患者（p <0.01）更倾向于选择心理治疗。心理治疗的偏好在寻求治疗的样本和接受治疗的样本中都是一贯明显的（ps <0.05），但在接受治疗的样本中更强。不同环境下患者偏好的汇总产生了相对于药物治疗的三倍偏好。鉴于这些治疗抑郁症和焦虑症的疗效相似，需要改善循证心理治疗的可及性，以将更多患者与他们首选的治疗联系起来。
Models of evidence-based practice emphasize the consideration of treatment efficacy/effectiveness, clinical expertise, and patient preference in treatment selection and implementation. However, patient preference for psychiatric treatment has been understudied. The aim of this meta-analytic review was to provide an estimate of the proportion of patients preferring psychological treatment relative to medication for psychiatric disorders. A literature search was conducted using PubMed, PsycINFO, and the Cochrane Collaboration Library through August, 2011 for studies written in English that assessed patient preferences for the treatment of psychiatric disorders. Studies assessing the preferred type of treatment including at least one psychological treatment and one pharmacological treatment were included. Of the 641 articles initially identified, 34 met criteria for inclusion. Authors extracted relevant data including the proportion of participants reporting preference for psychological and pharmacological treatment. Across studies, the proportion preferring psychological treatment was 0.75 (95% CI: 0.69 to 0.80), which was significantly higher than equivalent preference (i.e., higher than 0.50, p < .001). Sensitivity analyses suggested that younger patients (p < .05) and women (p < .01) were significantly more like to choose psychological treatment. A preference for psychological treatment was consistently evident in both treatment-seeking and unselected samples (ps < .05), but was somewhat stronger for the unselected samples. Aggregation of patient preferences across diverse settings yielded a significant three-fold preference for psychological treatment relative to medication. Given the similar efficacy of these treatments for depression and anxiety, improving access to evidence-based psychological treatment is needed to connect more patients to their preferred treatment.