Prediction of engagement of sevices following a hospital treatment among patients with psychotic disorders

精神分裂症和相关疾病的常规护理的循证实践指南中建议对精神病进行心理治疗。然而，只有很小一部分患有这些疾病的患者实际上接受了心理治疗干预。推荐程度最高的药物治疗也更为普遍，但患者在长期治疗过程中对药物的依从性较低。本研究的目的在于从服务使用者的角度分析服务使用率低的原因。住院精神病患者将被要求参加面谈，并在出院时填写自我报告。出院四周后，他们将被问及服务参与度和服药依从性。这项研究的理论框架是罗纳德·安德森的健康行为模型，该模型提出了易感特征、使能资源和需求作为服务使用的决定因素。在调查服务使用和服药依从性的研究中，一些变量具有预测性，并在本次调查中通过标准化测量进行检验：治疗关系、对疾病的洞察力、自我污名、对心理治疗的态度、精神病理学和在抗精神病药物下的主观幸福感。每次采访都会询问性别、受教育年限和医疗保险类型。在非标准化问题中，询问了服务参与度和服药依从性低的主观原因。在电话采访中，那些打算开始心理治疗或维持药物治疗但没有这样做的患者，将被问及服务使用率低和停止药物治疗的原因。二分因变量将采用Logistic回归。根据标准经验法则，122名患者的样本足以检验七个自变量和两个控制变量的影响。本次调查的结果将有助于改善住院治疗，克服住院患者和门诊治疗之间的接口问题。此外，结果将规定与负责门诊护理的同事进行对话。在接下来的一项研究中，计划从在门诊工作的医疗专业人员的角度来分析精神障碍患者心理治疗的低供应率。这一结果主要可以推广到其他内在改变动机减弱和在门诊护理中延长努力的患者组。

Psychotherapy for psychosis is recommended in evidence based practice guidelines for the routine care of schizophrenia and related disorders. However, only a very small rate of patients with these disorders is actually treated with psychotherapeutic intervention. Pharmacotherapy wich is also recommended with the highest degree of recommendation is much more widespread, but the adherence of patients to medication in the course of the long term treatment is low. The aim of this study is to contribute to the identification of reasons of low service-usage from the perspective of service-users. Inpatients with psychotic disorders will be asked to participate in interviews and to fill in self-reports at discharge from hospital. Four weeks after discharge they will be asked about service engagement and medication adherence. The theoretical framework for the study is the Health Behavior Model from Ronald Anderson which proposes predisposing characteristics, enabling resources and need as determinants for service-usage. In studies investigating service-usage and medication-adherence some variables were predictive and are checked in this investigation by standardized measurements: The therapeutic relationship, insight of illness, self-stigmatization, attitude to psychotherapy, psychopathology and subjective well-being under neuroleptics. Sex, years of education and type of health insurance were asked per interview. In non-standardized questions subjective causes for low service-engagement and medication-adherence are asked. In the telephone interview patients who intended to begin psychotherapy or maintain pharmacotherapy but did not, will be asked about the causes for low service usage and discontinuation of medication.Regression analyses with blockwise entry of the groups of independent variables are planned. Logistic regression will be used for dichotomous dependent variables. According to standard rules of thumb a sample of 122 patients is sufficient for checking the influence of seven independent and two control variables. The results of this investigation will help improving inpatient treatment and overcome the interface problem between inpatient an ambulatory treatment. Further, the results will stipulate a dialogue with colleagues responsible for outpatient care. In a following study it is planned to analyse the low provision rate of psychotherapy for patients with psychotic disorders from the perspective of medical professionals working in outpatient care. The results can mainly be generalized for other group of patients with diminished intrinsic change motivation and extended efforts in ambulatory care.