Department of Psychiatry, University of Melbourne, Coburg, Victoria, Australia.
NorthWestern Mental Health, Melbourne, Victoria, Australia.
Epidemiol Psychiatr Sci. 2019 Dec;28(6):613-629. doi: 10.1017/S2045796018000288. Epub 2018 Jun 12.
AIMS.: Clinical Practice Guidelines (CPGs) recommend evidence-based psychosocial interventions (EBPIs) to improve consumer recovery; however, availability appears limited. We describe receipt of six EBPIs, reported by people with psychoses, and associations with service and consumer characteristics, including indicators of need (eligibility) and benefit (suitability).
METHODS.: Participants in the 2010 Australian national survey of psychosis (n = 1825) were interviewed to assess demographic, functional, mental and physical health characteristics and service use in the previous year. Six EBPIs (Cognitive Behaviour Therapy for psychosis; Family Psycho-Education (FPE); Relapse Prevention Planning (RPP); Skills Training; Supported Employment; and Assertive Community Treatment) were chosen, based on the strength and consistency of CPG recommendations. Associations between receipt of interventions and eligibility and suitability indicators were examined via correlations and χ2. Logistic regression was used to predict receipt of one or more EBPIs and to identify predictors of each individual EBPI.
RESULTS.: Less than one-quarter of the sample reported receipt of an evidence-based level of any intervention: rates ranged from 3.4% (FPE) to 21.1% (RPP). The model predicting receipt of one or more EBPIs was statistically significant (χ2 (20, n = 1746) = 216.12, p < 0.01) and marginally useful. Nine variables contributed uniquely, of which six were service characteristics. The strongest predictors of receipt were being assigned a psychologist as a case manager (p < 0.01, OR(CI) = 2.36(1.50-3.72)) and accessing a non-clinical mental health support service in the past year (p < 0.01, OR(CI) = 2.01(1.60-2.51)).
CONCLUSIONS.: Prior reports of limited receipt of EBPIs are reinforced. There is patchy evidence for targeting of EBPIs to those who might benefit most. Service characteristics contribute more to the prediction of receipt than clinical characteristics. Greater implementation effort and better targeting are required to bridge evidence-practice gaps, including improved evidence-based practice literacy among professionals and needs-based service re-design to improve provision and optimise consumer outcomes.
临床实践指南（CPGs）推荐基于证据的心理社会干预措施（EBPIs）以改善消费者的康复效果；然而，这些干预措施的可及性似乎有限。我们描述了精神疾病患者报告的六种 EBPIs 的接受情况，并探讨了其与服务和消费者特征之间的关联，包括需求（资格）和获益（适宜性）的指标。
2010 年澳大利亚全国精神病学调查（n=1825）的参与者接受了访谈，以评估前一年的人口统计学、功能、精神和身体健康特征以及服务使用情况。根据 CPG 建议的强度和一致性，选择了六种 EBPIs（精神疾病的认知行为疗法；家庭心理教育（FPE）；复发预防计划（RPP）；技能培训；支持性就业；以及积极的社区治疗）。通过相关分析和卡方检验，研究了干预措施的接受情况与资格和适宜性指标之间的关联。使用逻辑回归预测一种或多种 EBPIs 的接受情况，并确定每种 EBPIs 的预测因素。
不到四分之一的样本报告接受了任何一种基于证据的干预措施：接受率从 3.4%（FPE）到 21.1%（RPP）不等。预测一种或多种 EBPIs 接受情况的模型具有统计学意义（χ2（20，n=1746）=216.12，p<0.01），且边际有用。有九个变量对预测有独特贡献，其中六个是服务特征。接受干预的最强预测因素是被分配为个案经理的心理学家（p<0.01，OR（CI）=2.36（1.50-3.72））和在过去一年中获得非临床心理健康支持服务（p<0.01，OR（CI）=2.01（1.60-2.51））。
先前关于 EBPIs 接受程度有限的报告得到了强化。针对最有可能受益的人群进行 EBPIs 靶向治疗的证据有限。服务特征对预测接受程度的贡献大于临床特征。需要付出更大的实施努力和更好的靶向治疗，以缩小证据与实践之间的差距，包括提高专业人员的循证实践素养和对服务进行基于需求的重新设计，以改善服务提供并优化消费者结果。
