Ince Paul, Haddock Gillian, Tai Sara
School of Psychological Sciences and Clinical Psychology Department, Manchester Mental Health and Social Care Trust, University of Manchester, UK.
Psychol Psychother. 2016 Sep;89(3):324-50. doi: 10.1111/papt.12084. Epub 2015 Nov 5.
A systematic review of the literature exploring if the UK recommendations for psychological interventions for schizophrenia were being met was carried out. Rates of implementation for cognitive behavioural therapy (CBT) and family intervention (FI) were compared. The barriers against implementation and described strategies aimed at improving implementation were reviewed.
A literature search of electronic bibliography databases (Psychinfo, Medline, Pubmed, AMED, CINHAL, and EMBASE), reference and citation lists, the Evaluation and Review of NICE Implementation (ERNIE) database, a manual search of Clinical Psychology Forum, governmental reports, charity, and service user group reports was conducted.
Twenty-six articles met the inclusion criteria, 11 provided data on implementation rates, 13 explored the barriers to implementation, and 10 gave information about improvement strategies. Rates of implementation varied from 4% to 100% for CBT and 0% to 53% for FI, and studies varied in the methodology used and quality of the articles. Previously reported barriers to implementation were found, with organisational barriers being most commonly followed by barriers met by staff members and service users. Implementation strategies discovered included training packages for CBT, FI, and psychosocial interventions as well as empirical evidence suggesting methods for engagement with service users.
Rates of implementation for CBT and FI are still below recommended levels with wide variation of rates found. This suggests inequalities in the provision of psychological interventions for schizophrenia are still present. Previously identified barriers to implementation were confirmed. Attempted implementation strategies have been met with modest success.
Inequalities in the provision of psychological therapies for schizophrenia persist. Good quality cognitive behavioural therapy and FI training do not ensure implementation. Collaboration at all levels of healthcare is needed for effective implementation.
对文献进行系统综述，以探究英国关于精神分裂症心理干预的建议是否得到落实。比较了认知行为疗法（CBT）和家庭干预（FI）的实施率。对实施过程中的障碍以及旨在改善实施情况的既定策略进行了综述。
对电子文献数据库（Psychinfo、Medline、Pubmed、AMED、CINHAL和EMBASE）、参考文献和引用列表、英国国家卫生与临床优化研究所实施评估与综述（ERNIE）数据库进行文献检索，并手动检索《临床心理学论坛》、政府报告、慈善机构和服务使用者团体报告。
26篇文章符合纳入标准，11篇提供了实施率数据，13篇探究了实施障碍，10篇提供了关于改善策略的信息。CBT的实施率在4%至100%之间，FI的实施率在0%至53%之间，各研究在所用方法和文章质量上存在差异。发现了先前报道的实施障碍，其中组织障碍最为常见，其次是工作人员和服务使用者遇到的障碍。发现的实施策略包括针对CBT、FI和心理社会干预的培训包，以及表明与服务使用者接触方法的实证证据。
CBT和FI的实施率仍低于推荐水平，且实施率差异很大。这表明在精神分裂症心理干预的提供方面仍存在不平等现象。先前确定的实施障碍得到了证实。尝试的实施策略取得了一定程度的成功。
精神分裂症心理治疗提供方面的不平等现象依然存在。高质量的认知行为疗法和FI培训并不能确保实施。有效实施需要各级医疗保健机构的协作。
