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EFFECTIVENESS OF INVOLUNTARY OUTPATIENT COMMITMENT

非自愿门诊承诺的有效性

基本信息

批准号：
6476989
负责人：
MARVIN S SWARTZ
金额：
$ 22.81万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
1992
资助国家：
美国
起止时间：
1992-06-01 至 2003-11-30
项目状态：
已结题

项目摘要

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.

这项竞争性的延续扩展了杜克大学心理健康研究的第一个随机对照试验 (RCT)，该试验旨在研究非自愿门诊承诺 (OPC) 在减少重度精神疾病 (SMI) 患者的再住院率和改善预后方面的有效性。 OPC 是一种有前途但有争议的法律干预措施，旨在使那些需要持续的精神科护理和支持以防止危险的复发和再犯的 SMI 个体受益，但这些 SMI 个体需要持续的精神科护理和支持以防止危险的复发和再犯，但不愿意或难以寻求和遵循基于社区的治疗。 38 个州和哥伦比亚特区拥有明确的 OPC 法规。尽管如此，关于 OPC 的优点和缺点、如何发挥其作用、持续多长时间以及针对哪些临床亚组，仍缺乏关键信息。法院命令在社区中进行的治疗的强制方面是否值得为 SMI 消费者、照顾他们的人以及整个社会带来潜在利益？在最近完成的随机对照试验中，等待 OPC 的非自愿住院患者被随机分配在出院后继续接受 OPC 治疗，或者解除法院命令并接受自愿案件管理服务。对一年随访数据的分析表明，接受持续 OPC 和频繁门诊服务的受试者住院率和暴力行为显着减少。然而，我们尚未（并建议）检查其他关键结果（症状、功能、药物滥用、无家可归、逮捕、家庭/护理人员压力）和关键干预变量（治疗强度、药物依从性）。还必须检查 OPC 的潜在机制以及 OPC 后的长期结果。为了制定 OPC 实践指南，还需要对利益相关者对这一有争议的干预措施的效用进行评估。这一竞争性延续申请的目标是解决 NIMH 国家心理健康咨询委员会的临床治疗和服务工作组报告中概述的优先事项。 “架起科学与服务的桥梁。”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) 收集有关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有关 OPC 有效性和实用性的所有可用证据； (4) 评估指南实施和设计实践改进研究的策略。