Jochems Eline C, van der Feltz-Cornelis Christina M, van Dam Arno, Duivenvoorden Hugo J, Mulder Cornelis L
Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands ; GGz Breburg, Top Clinical Center for Body, Mind and Health, Tilburg, the Netherlands.
Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands ; GGz Breburg, Top Clinical Center for Body, Mind and Health, Tilburg, the Netherlands ; Tilburg University, Faculty of Social Sciences, Tranzo Department, Tilburg, the Netherlands.
Neuropsychiatr Dis Treat. 2015 Dec 11;11:3049-64. doi: 10.2147/NDT.S95190. eCollection 2015.
To evaluate the effectiveness of providing clinicians with regular feedback on the patient's motivation for treatment in increasing treatment engagement in patients with severe mental illness.
cluster randomized controlled trial (Dutch Trials Registry NTR2968).
adult outpatients with a primary diagnosis of a psychotic disorder or a personality disorder and their clinicians, treated in 12 community mental health teams (the clusters) of two mental health institutions in the Netherlands.
monthly motivation feedback (MF) generated by clinicians additional to treatment as usual (TAU) and TAU by the community mental health teams.
treatment engagement at patient level, assessed at 12 months by clinicians.
teams were allocated to MF or TAU by a computerized randomization program that randomized each team to a single treatment by blocks of varying size. All participants within these teams received similar treatment. Clinicians and patients were not blind to treatment allocation at the 12-month assessment.
The 294 randomized patients (148 MF, 146 TAU) and 57 clinicians (29 MF, 28 TAU) of 12 teams (6 MF, 6 TAU) were analyzed according to the intention-to-treat principle. No statistically significant differences between treatment groups on treatment engagement were found (adjusted mean difference =0.1, 95% confidence interval =-2.2 to 2.3, P=0.96, d=0). Preplanned ancillary analyses showed statistically significant interaction effects between treatment group and primary diagnosis on treatment motivation and quality of life (secondary outcomes), which were beneficial for patients with a primary diagnosis of a personality disorder but not for those with a psychotic disorder. There were no reports of adverse events.
The current findings imply that monitoring and discussing the patient's motivation is insufficient to improve motivation and treatment engagement, and suggests that more elaborate interventions for severe mental illness patients are needed.
评估定期向临床医生反馈患者治疗动机对提高重症精神疾病患者治疗参与度的有效性。
整群随机对照试验（荷兰试验注册编号NTR2968）。
在荷兰两家精神卫生机构的12个社区精神卫生团队（整群）接受治疗的，初步诊断为精神障碍或人格障碍的成年门诊患者及其临床医生。
临床医生除常规治疗（TAU）外每月提供动机反馈（MF），社区精神卫生团队提供TAU。
患者层面的治疗参与度，由临床医生在12个月时进行评估。
通过计算机随机程序将各团队分配至MF组或TAU组，该程序按不同大小的区组将每个团队随机分配至单一治疗组。这些团队中的所有参与者接受相似的治疗。在12个月评估时，临床医生和患者对治疗分配情况并非不知情。
根据意向性分析原则，对12个团队（6个MF组，6个TAU组）的294例随机分组患者（148例MF组，146例TAU组）和57名临床医生（29名MF组，28名TAU组）进行分析。治疗组之间在治疗参与度上未发现统计学显著差异（调整后平均差异=0.1，95%置信区间=-2.2至2.3，P=0.96，d=0）。预先计划的辅助分析显示，治疗组与初步诊断之间在治疗动机和生活质量（次要结局）方面存在统计学显著的交互作用，这对初步诊断为人格障碍的患者有益，但对精神障碍患者无益。未报告不良事件。
当前研究结果表明，监测和讨论患者的动机不足以提高动机和治疗参与度，并提示需要对重症精神疾病患者采取更精细的干预措施。
