EFFECTIVENESS OF INVOLUNTARY OUTPATIENT COMMITMENT

非自愿门诊承诺的有效性

• 批准号: 3387709
• 负责人: MARVIN S SWARTZ
• 金额: $ 59.55万
• 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/3387709
• 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主要原因， 再住院、功能下降和其他不良结果 患有严重的精神病。 努力查明原因并采取补救措施 违规行为引发了广泛的临床调查 努力。 减少违规行为的一种有希望的方法是法院 强制门诊治疗称为非自愿门诊治疗 承诺（OPC）。 所有州都对门诊做出了规定 相信 OPC 将改善依从性和治疗的承诺 结果。 在实践中，OPC 可以作为调动资源的刺激因素 以获得更积极的治疗努力。 多项研究已 证明 OPC 降低了再住院率并改善了其他 结果；但调查结果好坏参半，部分原因是服务的可变性 条款。 没有研究检验 OPC 的影响程度 当基本服务始终如一时的依从性和治疗结果 测量也没有研究控制选择效应和其他 重要的混淆。 拟议的研究考察了 OPC 对 扣除服务系统动员后的依从性和治疗结果 OPC结合社区病例的随机临床试验 管理层并将寻求消除先前研究中的偏见来源 的OPC。 符合重症和重症标准的非自愿入院患者 持续性精神疾病和 OPC 的法律标准将是随机的 分配给两种治疗条件之一：OPC 加病例管理或 仅案件管理。 两组将包括相似比例的 黑人和农村患者。 主要关注的结果是： 再住院和住院时间，以及再住院之前的时间。 其他结果包括精神症状、功能、生活质量、 家庭负担、危险、逮捕和监禁。 除了 具体计划公告、心理健康的有效性和成果 农村地区心理健康服务的服务和研究，本研究 解决公共学术联络倡议的计划优先事项 并对服务系统的法律问题部分做出回应 为 NIMH 国家研究计划制定的研究小组报告 改善严重精神障碍的护理。