EFFECTIVENESS OF INVOLUNTARY OUTPATIENT COMMITMENT

非自愿门诊承诺的有效性

• 批准号: 6330258
• 负责人: MARVIN S SWARTZ
• 金额: $ 26.79万
• 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 2002-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6330258
• 关键词: behavioral /social science research tag; clinical research; clinical trials; community mental health services; functional ability; health care model; health care service evaluation; health related legal; health services research tag; hospital length of stay; hospital utilization; human subject; human therapy evaluation; mental disorder diagnosis; mental health facility; outcomes research; outpatient care; posthospitalization care; psychological tests; psychosis; rural area; social support network; substance abuse related disorder; therapy compliance

This competing continuation extends the Duke Mental Health Study the first randomized controlled trial (RCT) of the effectiveness of involuntary outpatient commitment (OPC) in reducing rehospitalization and improving outcomes among persons with severe mental illnesses (SMI). OPC is a promising, but controversial legal intervention designed to benefit SMI individuals who need ongoing psychiatric care and support to prevent dangerous relapse and recidivism, but who are SMI individuals who need ongoing psychiatric care and support to prevent dangerous relapse and recidivism, but who are reluctant or have difficulty seeking and following through with community-based treatment. Thirty-eight states and the District of Columbia have explicit OPC statutes. Still, key information is lacking on the advantages and drawbacks of OPC how it exerts its effects, for how long, and for which clinical subgroups. Are the coercive aspects of court-ordered treatment in the community worth the potential benefits to SMI consumers, those who care for them, and to society in general? In the RCT recently completed, involuntarily hospitalized patients awaiting OPC were randomly assigned to continue under OPC upon discharge, or be released from their court order and receive voluntary case management services. Analyses of one-year follow-up data demonstrate that subjects who received sustained periods of OPC and frequent outpatient services had significantly reduced hospitalizations and violent behavior. However, we have yet to (and propose to) examine other key outcomes (symptoms, functioning, substance abuse, homelessness, arrests, family/caregiver strain), and key intervening variables (treatment intensity, medication adherence). Mechanisms underlying OPC must also be examined as well as long-term outcomes post-OPC. Assessment of stakeholders' utilities for this controversial intervention is also needed in order to develop OPC practice guidelines. The goal of this competing continuation application is to address the priorities outlined in the NIMH National Advisory Mental Health Council's Clinical Treatment and Services Workgroup Report. "Bridging Science and Service." We propose to: (1) Extend existing research on OPC's effectiveness by completing ongoing RCT analyses; (2) Gather data about consumers' and other stakeholders' preferences and attitudes regarding OPC; (3) Synthesize all available evidence on OPC effectiveness and utilities for an expert consensus panel charged with developing OPC practice guidelines; and (4) Assess strategies for guideline implementation and design practice improvement research.

这是杜克大学精神健康研究的第一个随机对照试验（RCT），该研究是关于非自愿门诊承诺（OPC）在减少严重精神疾病（SMI）患者再住院和改善预后方面的有效性的。OPC是一种很有前途的，但也有争议的法律干预措施，旨在使需要持续精神病学护理和支持以防止危险复发和再犯的重度精神障碍个体受益，但他们是需要持续精神病学护理和支持以防止危险复发和再犯的重度精神障碍个体，但他们不愿意或难以寻求和遵循社区治疗。38个州和哥伦比亚特区有明确的OPC法规。尽管如此，关于OPC的优点和缺点，它如何发挥作用，持续多长时间，以及对哪些临床亚组缺乏关键信息。对于重度精神障碍患者、照顾他们的人以及整个社会来说，法院命令的强制治疗是否值得？在最近完成的随机对照试验中，非自愿住院等待OPC的患者被随机分配到出院后继续OPC，或从法院命令中释放并接受自愿病例管理服务。对一年随访数据的分析表明，接受持续OPC治疗和频繁门诊服务的受试者的住院率和暴力行为显著减少。然而，我们还没有（并打算）检查其他关键结果（症状、功能、药物滥用、无家可归、被捕、家庭/照顾者压力）和关键干预变量（治疗强度、药物依从性）。还必须审查OPC的基本机制以及OPC后的长期结果。为了制定OPC实践指南，还需要评估利益相关者对这一有争议的干预措施的效用。这一竞争性延续申请的目标是解决NIMH国家咨询精神卫生委员会临床治疗和服务工作组报告中概述的优先事项。“连接科学与服务。”我们建议：(1)通过完成正在进行的RCT分析来扩展OPC有效性的现有研究；(2)收集消费者和其他利益相关者对OPC的偏好和态度的数据；(3)为负责制定OPC实践指南的专家共识小组综合所有关于OPC有效性和效用的现有证据；(4)评估指南实施策略和设计实践改进研究。