School of Psychology, University of Wollongong, Wollongong, NSW, Australia.
School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.
Personal Ment Health. 2019 Nov;13(4):230-238. doi: 10.1002/pmh.1467. Epub 2019 Aug 14.
Individuals with personality disorders-particularly borderline personality disorder-are high users of mental health treatment services. Emergency service responses often focus on crisis management, and there are limited opportunities to provide appropriate longer term evidence-based treatment. Many individuals with personality disorders find themselves in a revolving cycle between emergency departments and waiting for community treatment. A stepped care approach may help to triage clients and allow access to interventions with minimal client, clinician and system burden. This study aims to understand the facilitators and barriers to real-world implementation of a stepped care approach to treating personality disorders.
Managers and clinicians of health services engaged in implementation were interviewed to obtain accounts of experiences. Interviews were transcribed and thematically analysed to generate themes describing barriers and facilitators.
Participants identified personal attitudes, knowledge and skills as important for successful implementation. Existing positive attitudes and beliefs about treating people with a personality disorder contributed to the emergence of clinical champions. Training facilitated positive attitudes by justifying the psychological approach. Management support was found to bi-directionally effect implementation.
This study suggests specific organizational and individual factors may increase timely and efficient implementation of interventions for people with personality disorders. © 2019 John Wiley & Sons, Ltd.
人格障碍患者——尤其是边缘型人格障碍患者——是精神卫生治疗服务的高频使用者。紧急服务的应对措施通常侧重于危机管理，而提供适当的长期循证治疗的机会有限。许多人格障碍患者发现自己在急诊部门和等待社区治疗之间循环往复。阶梯式护理方法可以帮助甄别患者，并在最小的患者、临床医生和系统负担下为他们提供干预措施。本研究旨在了解在现实世界中实施人格障碍阶梯式护理方法的促进因素和障碍。
参与实施的卫生服务管理人员和临床医生接受了访谈，以获取他们的经验。对访谈进行了转录和主题分析，以生成描述障碍和促进因素的主题。
参与者确定个人态度、知识和技能对于成功实施至关重要。现有的对治疗人格障碍患者的积极态度和信念有助于培养临床拥护者。培训通过为心理方法提供依据，促进了积极的态度。管理支持被发现对实施具有双向影响。
本研究表明，特定的组织和个人因素可能会增加对人格障碍患者干预措施的及时和有效的实施。© 2019 约翰威立父子公司
