JAMA Psychiatry. 2014 May;71(5):557-65. doi: 10.1001/jamapsychiatry.2013.4519.
Given minority patients' unequal access to quality care, patient activation and self-management strategies have been suggested as a promising approach to improving mental health care.
To determine whether the DECIDE (Decide the problem; Explore the questions; Closed or open-ended questions; Identify the who, why, or how of the problem; Direct questions to your health care professional; Enjoy a shared solution) intervention, an educational strategy that teaches patients to ask questions and make collaborative decisions with their health care professional, improves patient activation and self-management, as well as engagement and retention in behavioral health care.
DESIGN, SETTING, AND PATIENTS: In this multisite randomized clinical trial performed from February 1, 2009, through October 9, 2011 (date of last follow-up interview), we recruited 647 English- or Spanish-speaking patients 18 to 70 years old from 13 outpatient community mental health clinics across 5 states and 1 US territory. A total of 722 patients were included in analyses of secondary outcomes.
Three DECIDE training sessions delivered by a care manager vs giving patients a brochure on management of behavioral health.
Primary outcomes were patient assessment of activation (Patient Activation Scale) and self-management (Perceived Efficacy in Patient-Physician Interactions). Secondary outcomes included patient engagement (proportion of visits attended of those scheduled) and retention (attending at least 4 visits in the 6 months after the baseline research assessment), collected through medical record review or electronic records.
Patients assigned to DECIDE reported significant increases in activation (mean β = 1.74, SD = 0.58; P = .003) and self-management (mean β = 2.42, SD = 0.90; P = .008) relative to control patients, but there was no evidence of an effect on engagement or retention in care.
The DECIDE intervention appears to help patients learn to effectively ask questions and participate in decisions about their behavioral health care, but a health care professional component might be needed to augment engagement in care. DECIDE appears to have promise as a strategy for changing the role of minority patients in behavioral health care.
clinicaltrials.gov Identifier: NCT01226329
鉴于少数族裔患者获得高质量医疗服务的机会不平等，患者激活和自我管理策略已被认为是改善精神卫生保健的一种有前途的方法。
确定 DECIDE（决定问题；探索问题；封闭式或开放式问题；确定问题的相关人员、原因或方式；向您的医疗保健专业人员提问；共同解决问题）干预措施是否可以改善患者的激活和自我管理，以及参与和保留在行为健康护理中的作用。DECIDE 是一种教育策略，教患者向他们的医疗保健专业人员提问并共同做出决策。
设计、地点和患者：这是一项多地点随机临床试验，于 2009 年 2 月 1 日至 2011 年 10 月 9 日（最后随访访谈日期）进行，我们从 5 个州和 1 个美国领土的 13 个社区精神卫生门诊招募了 647 名 18 至 70 岁的英语或西班牙语患者。共有 722 名患者被纳入次要结局分析。
由护理经理提供 3 次 DECIDE 培训课程，而不是给患者一本关于行为健康管理的小册子。
主要结果是患者对激活（患者激活量表）和自我管理（医患互动感知效能）的评估。次要结果包括通过病历审查或电子记录收集的患者参与度（计划就诊次数中的就诊比例）和保留率（在基线研究评估后 6 个月内至少就诊 4 次）。
与对照组相比，接受 DECIDE 治疗的患者在激活（平均β=1.74，SD=0.58；P=0.003）和自我管理（平均β=2.42，SD=0.90；P=0.008）方面的报告显著增加，但在参与护理或保留方面没有证据表明有影响。
DECIDE 干预措施似乎有助于患者学习有效地询问问题并参与他们的行为保健护理决策，但可能需要医疗保健专业人员的参与来增强对护理的参与。DECIDE 似乎有希望成为改变少数族裔患者在行为保健护理中角色的一种策略。
clinicaltrials.gov 标识符：NCT01226329
