EFFECTIVENESS OF INVOLUNTARY OUTPATIENT COMMITMENT

非自愿门诊承诺的有效性

• 批准号: 2247961
• 负责人: MARVIN S SWARTZ
• 金额: $ 59.38万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1992
• 资助国家: 美国
• 起止时间: 1992-06-01 至 1997-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2247961
• 关键词: African American; clinical trials; community mental health services; family; functional ability; health care model; health care service evaluation; health care service utilization; health related legal; hospital length of stay; hospital utilization; human subject; human therapy evaluation; interview; mental disorder diagnosis; mental health facility; outpatient care; patient care management; posthospitalization care; psychological tests; psychosis; quality of life; rural area; social support network; substance abuse related disorder; therapy compliance; violence

Non-compliance with treatment continues to be a major cause of relapse, rehospitalization, decreased functioning and other poor outcomes among the seriously mentally ill. Efforts to identify causes of and remedies for non-compliance have stimulated a wide range of clinical investigative efforts. One promising approach to reducing non-compliance is court- mandated outpatient treatment referred to as involuntary outpatient commitment (OPC). All states have made provisions for outpatient commitment in the belief that OPC will improve compliance and treatment outcomes. In practice, OPC may serve as a stimulus to mobilize resources for more aggressive treatment efforts. A number of studies have demonstrated that OPC reduces rates of rehospitalization and improves other outcomes; but findings are mixed, due in part to variability in service provision. No studies have examined the extent to which OPC affects compliance and treatment outcomes when essential services are consistently measured nor have studies controlled for selection effects and other important confounds. The proposed study examines the effects of OPC on compliance and treatment outcomes net of service system mobilization in a randomized clinical trial of OPC combined with community-based case management and will seek to eliminate previous sources of bias in studies of OPC. Involuntarily admitted patients meeting criteria for severe and persistent mental illness and legal criteria for OPC will be randomly assigned to one of two treatment conditions: OPC plus case management or case management alone. Both groups will include similar proportions of black and rural patients. Outcomes of primary interest are: rehospitalization and length of stay, and time until rehospitalization. Other outcomes include psychiatric symptoms, functioning, quality of life, family burden, dangerousness, arrests and jail time. In addition to the specific program announcements, Effectiveness and Outcomes of Mental Health Services and Research on Mental Health Services in Rural Areas, this study addresses the program priorities of the Public-Academic Liaison Initiative and is responsive to the Legal Issues Section of the Service Systems Research Panel Report developed for the NIMH National Plan of Research to Improve Care for Severe Mental Disorders.

不遵守治疗仍然是复发的一个主要原因， 再住院、功能下降和其他不良结局， 严重的精神病 努力查明儿童遭受暴力的原因和补救办法 不依从刺激了广泛的临床研究 努力 减少不遵守的一个有希望的方法是法院- 强制门诊治疗，称为非自愿门诊 承诺（OPC）。 所有的州都为门诊病人提供了 承诺，相信OPC将改善依从性和治疗 结果。 在实践中，OPC可作为调动资源的一种激励手段 进行更积极的治疗 多项研究 证明OPC降低了再住院率，并改善了其他 结果;但结果好坏参半，部分原因是服务的可变性 款规定而 没有研究检查OPC影响 当基本服务得到一致的支持时， 也没有研究控制选择效应和其他 重要的困惑。 拟议的研究探讨了OPC对 在一个不包括服务系统动员的 OPC结合社区病例的随机临床试验 管理，并将寻求消除以前的偏见来源的研究 OPC的。 符合重度和重度非自愿入院标准的患者 持续性精神疾病和OPC的法律的标准将随机 分配到两种治疗条件之一：OPC加病例管理或 单独管理案件。 这两组将包括类似比例的 黑人和农村病人 主要关注的结果是： 再住院和住院时间，以及再住院的时间。 其他结果包括精神症状，功能，生活质量， 家庭负担，犯罪，逮捕和监禁时间。 除了有 具体的计划公告，心理健康的有效性和结果 农村心理卫生服务研究 解决了公众-学术联络倡议的计划优先事项 并对服务系统的法律的问题部分作出回应 为NIMH国家研究计划编写的研究小组报告， 改善严重精神障碍的护理。