针对长期严重非精神病性精神障碍患者的人际社区精神治疗的成本效益：一项多中心随机对照试验方案

Cost effectiveness of interpersonal community psychiatric treatment for people with long-term severe non-psychotic mental disorders: protocol of a multi-centre randomized controlled trial.

作者信息

van Veen Mark, Koekkoek Bauke, Mulder Niels, Postulart Debby, Adang Eddy, Teerenstra Steven, Schoonhoven Lisette, van Achterberg Theo

机构信息

Research Group Social Psychiatry & Mental Health Nursing, University of Applied Sciences Arnhem Nijmegen, PO Box 6960, Nijmegen, GL, 6503, The Netherlands.

Altrecht Mental Health Services, Oude Arnhemseweg 260, Zeist, BK, 3705, The Netherlands.

出版信息

BMC Psychiatry. 2015 May 2;15:100. doi: 10.1186/s12888-015-0476-z.

DOI:10.1186/s12888-015-0476-z

PMID:25934175

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4422542/

Abstract

BACKGROUND

This study aims for health gain and cost reduction in the care for people with long-term non-psychotic psychiatric disorders. Present care for this population has a limited evidence base, is often open ended, little effective, and expensive. Recent epidemiological data shows that 43.5% of the Dutch are affected by mental illness during their life. About 80% of all patients receiving mental health services (MHS) have one or more non-psychotic disorders. Particularly for this group, long-term treatment and care is poorly developed. Care As Usual (CAU) currently is a form of low-structured treatment/care. Interpersonal Community Psychiatric Treatment (ICPT) is a structured treatment for people with long-term, non-psychotic disorders, developed together with patients, professionals, and experts. ICPT uses a number of evidence-based techniques and was positively evaluated in a controlled pilot study.

METHODS/DESIGN: Multi-centre cluster-randomized clinical trial: 36 professionals will be randomly allocated to either ICPT or CAU for an intervention period of 12 months, and a follow-up of 6 months. 180 Patients between 18-65 years of age will be included, who have been diagnosed with a non-psychotic psychiatric disorder (depressive, anxiety, personality or substance abuse disorder), have long-term (>2 years) or high care use (>1 outpatient contact per week or >2 crisis contacts per year or >1 inpatient admission per year), and who receive treatment in a specialized mental health care setting. The primary outcome variable is quality of life; secondary outcomes are costs, recovery, general mental health, therapeutic alliance, professional-perceived difficulty of patient, care needs and social contacts.

DISCUSSION

No RCT, nor cost-effectiveness study, has been conducted on ICPT so far. The empirical base for current CAU is weak, if not absent. This study will fill this void, and generate data needed to improve daily mental health care.

TRIAL REGISTRATION

Netherlands Trial Register (NTR): 3988 . Registered 13th of May 2013.

摘要

背景

本研究旨在改善长期非精神病性精神障碍患者的健康状况并降低护理成本。目前针对这一人群的护理证据有限，通常是开放式的，效果不佳且费用高昂。近期的流行病学数据显示，43.5%的荷兰人在其一生中受到精神疾病的影响。在所有接受心理健康服务（MHS）的患者中，约80%患有一种或多种非精神病性障碍。特别是对于这一群体，长期治疗和护理发展不足。常规护理（CAU）目前是一种低结构化的治疗/护理形式。人际社区精神治疗（ICPT）是一种针对长期非精神病性障碍患者的结构化治疗方法，由患者、专业人员和专家共同开发。ICPT采用了多种循证技术，并在一项对照试验研究中得到了积极评价。

方法/设计：多中心整群随机临床试验：36名专业人员将被随机分配到ICPT组或CAU组，进行为期12个月的干预，并随访6个月。将纳入180名年龄在18至65岁之间的患者，他们被诊断患有非精神病性精神障碍（抑郁、焦虑、人格或物质滥用障碍），有长期（>2年）或高护理需求（每周>1次门诊就诊或每年>2次危机干预接触或每年>1次住院治疗），且在专门的心理健康护理机构接受治疗。主要结局变量是生活质量；次要结局包括成本、康复、总体心理健康、治疗联盟、专业人员感知的患者困难程度、护理需求和社会接触。