Prediction of engagement of sevices following a hospital treatment among patients with psychotic disorders

点击翻译按钮获取中文摘要

Psychotherapy for psychosis is recommended in evidence based practice guidelines for the routine care of schizophrenia and related disorders. However, only a very small rate of patients with these disorders is actually treated with psychotherapeutic intervention. Pharmacotherapy wich is also recommended with the highest degree of recommendation is much more widespread, but the adherence of patients to medication in the course of the long term treatment is low. The aim of this study is to contribute to the identification of reasons of low service-usage from the perspective of service-users. Inpatients with psychotic disorders will be asked to participate in interviews and to fill in self-reports at discharge from hospital. Four weeks after discharge they will be asked about service engagement and medication adherence. The theoretical framework for the study is the Health Behavior Model from Ronald Anderson which proposes predisposing characteristics, enabling resources and need as determinants for service-usage. In studies investigating service-usage and medication-adherence some variables were predictive and are checked in this investigation by standardized measurements: The therapeutic relationship, insight of illness, self-stigmatization, attitude to psychotherapy, psychopathology and subjective well-being under neuroleptics. Sex, years of education and type of health insurance were asked per interview. In non-standardized questions subjective causes for low service-engagement and medication-adherence are asked. In the telephone interview patients who intended to begin psychotherapy or maintain pharmacotherapy but did not, will be asked about the causes for low service usage and discontinuation of medication.Regression analyses with blockwise entry of the groups of independent variables are planned. Logistic regression will be used for dichotomous dependent variables. According to standard rules of thumb a sample of 122 patients is sufficient for checking the influence of seven independent and two control variables. The results of this investigation will help improving inpatient treatment and overcome the interface problem between inpatient an ambulatory treatment. Further, the results will stipulate a dialogue with colleagues responsible for outpatient care. In a following study it is planned to analyse the low provision rate of psychotherapy for patients with psychotic disorders from the perspective of medical professionals working in outpatient care. The results can mainly be generalized for other group of patients with diminished intrinsic change motivation and extended efforts in ambulatory care.