Implementing patient-centered decision support for mental health

说明(由申请人提供)：背景/理由：重要的是，严重精神病患者能够获得符合其偏好的治疗，并在知情的情况下在替代治疗中做出选择。太多时候，患者的偏好并不是例行公事地获得，也不是用来指导提供哪些治疗方法的。精神分裂症是一种严重的精神疾病，很常见，如果治疗不当会导致严重残疾。国家治疗指南规定，精神分裂症患者应该接受以证据为基础的心理社会治疗，以改善结果。例如，肥胖在这个人群中是一个紧迫的问题，是常用药物的副作用，也是心血管疾病和过早死亡的原因。对于体重管理，有多种不同的心理社会疗法可以导致体重减轻。没有一种被广泛使用。如果定期评估患者的偏好，那么临床医生和管理人员就会知道何时提供替代治疗，以及针对哪些患者。目的：本项目实施并评估了一种常规评估精神分裂症患者治疗偏好的方法。目标是：1)开发一个电脑化的、以Kiosk为基础的系统，向患者提供有关体重治疗选择的教育，使用联合分析来得出患者的偏好，并满足精神分裂症患者的认知需求；2)研究在精神健康诊所实施这种方法的可行性和可接受性；以及3)评估这种方法预测基于证据的体重服务的使用程度，以及在三个月后对服务的满意度。方法：这是对精神分裂症患者的偏好、治疗使用和满意度的前瞻性评估。94名超重患者在一家繁忙的城市心理健康诊所接受治疗。这些参与者使用一个Kiosk系统，该系统为他们提供关于治疗选择的教育，并评估他们对超重替代治疗的偏好。然后，他们每周接受一次强化的、基于证据的心理社会减肥治疗。研究评估在基线和3个月进行。分析治疗偏好，以确定它们与体重治疗的使用以及对治疗的满意度之间的关系。意义：患有严重精神疾病的人可以从获得有效的心理社会治疗中受益。通过例行公事地收集有关个别患者偏好的信息，将有助于实施这些治疗。如果这项研究中的评估方法被发现是可行的、可接受的和准确的，它可以用于支持诊所、医疗中心和社区项目改善护理的实施。

DESCRIPTION (provided by applicant): Background/Rationale: It is important that patients with serious mental illness have access to treatments that meet their preferences, and make informed choices among alternative treatments. Too often, preferences are not being routinely elicited from patients, nor used to guide which treatments are made available. Schizophrenia is a serious mental illness that is common and can produce substantial disability when poorly treated. National treatment guidelines specify that patients with schizophrenia should receive evidence-based psychosocial treatments that improve outcomes. For example, obesity is a pressing problem in this population, a side-effect of commonly used medications, and a cause of cardiovascular disease and premature mortality. There are multiple, different psychosocial treatments for weight management that can lead to reduced weight. None are widely used. If patient preferences were routinely assessed, then clinicians and managers would know when to make alternative treatments available, and for which patients. Objectives: This project implements and evaluates a method for routinely assessing the treatment preferences of patients with schizophrenia. The objectives are to: 1) develop a computerized, kiosk-based system that delivers patient education regarding treatment options for weight, uses conjoint analysis to elicit patient preferences, and meets the cognitive needs of individuals with schizophrenia; 2) study the feasibility and acceptability of implementing this method at a mental health clinic; and, 3) evaluate the extent to which this method predicts use of an evidence-based weight service, and satisfaction with the service at three months. Methods: This is a prospective evaluation of preferences, treatment use, and satisfaction in patients with schizophrenia. 94 patients are enrolled who are overweight and receiving treatment at a busy, urban mental health clinic. These participants use a kiosk system that provides them with education about treatment options, and assesses their preferences regarding alternative treatments for overweight. They are then offered a weekly, intensive, evidence-based psychosocial treatment for weight. Research assessments occur at baseline and 3 months. Treatment preferences are analyzed to determine how they relate to use of weight treatment, and satisfaction with treatment. Significance: People with serious mental illness could benefit from access to effective psychosocial treatments. Implementing these treatments would be facilitated by routinely collecting information regarding individual patients' preferences. If the assessment method in this study is found to be feasible, acceptable, and accurate, it could be used to support implementation of improved care at clinics, medical centers, and community-based programs.