VA Desert Pacific Mental Health Research, Education and Clinical Center, Los Angeles, CA 90073, USA.
J Gen Intern Med. 2010 Jan;25 Suppl 1(Suppl 1):32-7. doi: 10.1007/s11606-009-1136-0.
Families are rarely included in clinical care despite research showing that family involvement has a positive effect on individuals with schizophrenia by reducing relapse, improving work functioning, and social adjustment.
The VA QUERI study, EQUIP (Enhancing QUality of care In Psychosis), implemented family services for this population.
At two VA medical centers, veterans with schizophrenia and their clinicians were interviewed separately at baseline and 15 months. A family intervention was implemented, and a process evaluation of the implementation was conducted.
Veterans with schizophrenia (n = 173) and their clinicians (n = 29).
Consent to contact family was obtained, mailers to engage families were sent, families were prioritized as high need for family services, and staff volunteers were trained in a brief three-session family intervention.
Of those enrolled, 100 provided consent for family involvement. Seventy-three of the 100 were sent a mailer to engage them in care; none became involved. Clinicians were provided assessment data on their patients and notified of 50 patients needing family services. Of those 50, 6 families were already involved, 34 were never contacted, and 10 were contacted; 7 new families became involved in care. No families were referred to the family psychoeducational program.
Uptake of the family intervention failed due to barriers from all stakeholders. Families did not respond to the mailer, patients were concerned about privacy and burdening family, clinicians had misperceptions of family-patient contact, and organizations did not free up time or offer incentives to provide the service. If a full partnership with patients and families is to be achieved, these barriers will need to be addressed, and a family-friendly environment will need to be supported by clinicians and their organizations. Applicability to family involvement in other disorders is discussed.
尽管研究表明家庭参与对精神分裂症患者有积极影响，可减少复发、改善工作功能和社会适应，但家庭很少被纳入临床护理。
VA QUERI 研究（EQUIP，改善精神病患者的护理质量）为这一人群实施了家庭服务。
在两个退伍军人事务部医疗中心，精神分裂症患者及其临床医生分别在基线和 15 个月时接受访谈。实施了家庭干预，并对实施情况进行了过程评估。
精神分裂症患者（n = 173）及其临床医生（n = 29）。
征得与家庭联系的同意，向家庭寄发邮件以争取其参与，优先考虑有家庭服务需求的家庭，并培训工作人员志愿者进行简短的三阶段家庭干预。
在入组的患者中，有 100 人同意让家人参与。向这 100 人中有 73 人寄发了争取他们参与治疗的邮件，但无人参与。临床医生收到了患者的评估数据，并被告知有 50 名患者需要家庭服务。在这 50 人中，有 6 个家庭已经参与，34 个从未联系过，10 个家庭联系过，有 7 个新家庭参与了治疗。没有家庭被转介到家庭心理教育计划。
由于所有利益相关者的障碍，家庭干预的参与率很低。家庭没有回应邮件，患者担心隐私和给家庭带来负担，临床医生对家庭与患者的接触存在误解，组织没有腾出时间或提供激励措施来提供服务。如果要与患者和家庭建立全面的合作关系，就需要解决这些障碍，并为临床医生及其组织提供一个有利于家庭的环境。文中还讨论了该研究结果在其他精神障碍中的适用性。
