Saxon David, Barkham Michael, Foster Alexis, Parry Glenys
Centre for Psychological Services Research, University of Sheffield, Sheffield, UK.
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Clin Psychol Psychother. 2017 May;24(3):575-588. doi: 10.1002/cpp.2028. Epub 2016 Jul 17.
In the psychological therapies, patient outcomes are not always positive. Some patients leave therapy prematurely (dropout), while others experience deterioration in their psychological well-being.
The sample for dropout comprised patients (n = 10 521) seen by 85 therapists, who attended at least the initial session of one-to-one therapy and completed a Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment. The subsample for patient deterioration comprised patients (n = 6405) seen by the same 85 therapists but who attended two or more sessions, completed therapy and returned a CORE-OM at pre-treatment and post-treatment. Multilevel modelling was used to estimate the extent of therapist effects for both outcomes after controlling for patient characteristics.
Therapist effects accounted for 12.6% of dropout variance and 10.1% of deterioration variance. Dropout rates for therapists ranged from 1.2% to 73.2%, while rates of deterioration ranged from 0% to 15.4%. There was no significant correlation between therapist dropout rate and deterioration rate (Spearman's rho = 0.07, p = 0.52).
The methods provide a reliable means for identifying therapists who return consistently poorer rates of patient dropout and deterioration compared with their peers. The variability between therapists and the identification of patient risk factors as significant predictors has implications for the delivery of safe psychological therapy services. Copyright © 2016 John Wiley & Sons, Ltd.
Therapists play an important role in contributing to patient dropout and deterioration, irrespective of case mix. Therapist effects on patient dropout and deterioration appear to act independently. Being unemployed as a patient was the strongest predictor of both dropout and deterioration. Patient risk to self or others was also an important predictor.
在心理治疗中，患者的治疗结果并非总是积极的。一些患者过早终止治疗（退出治疗），而另一些患者的心理健康状况则出现恶化。
退出治疗的样本包括由85名治疗师接待的患者（n = 10521），这些患者至少参加了一对一治疗的初始疗程，并在治疗前完成了常规评估临床结果-结果测量（CORE-OM）。患者病情恶化的子样本包括由相同的85名治疗师接待的患者（n = 6405），但这些患者参加了两个或更多疗程，完成了治疗，并在治疗前和治疗后返回了CORE-OM。在控制患者特征后，使用多水平模型来估计两种结果的治疗师效应程度。
治疗师效应分别占退出治疗方差的12.6%和病情恶化方差的10.1%。治疗师的退出率从1.2%到73.2%不等，而病情恶化率从0%到15.4%不等。治疗师退出率与病情恶化率之间无显著相关性（斯皮尔曼等级相关系数ρ = 0.07，p = 0.52）。
这些方法为识别与同行相比患者退出率和病情恶化率持续较差的治疗师提供了一种可靠的手段。治疗师之间的差异以及将患者风险因素识别为重要预测因素对提供安全的心理治疗服务具有重要意义。版权所有© 2016约翰威立父子有限公司。
无论病例组合如何，治疗师在导致患者退出治疗和病情恶化方面都起着重要作用。治疗师对患者退出治疗和病情恶化的影响似乎是独立起作用的。患者失业是退出治疗和病情恶化的最强预测因素。患者对自身或他人的风险也是一个重要的预测因素。
