Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312, Guenzburg, Germany.
Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany.
Trials. 2020 Mar 18;21(1):275. doi: 10.1186/s13063-020-4200-z.
The German guideline on psychosocial interventions for people with severe mental disorders recommends a broad spectrum of evidence-based treatments. Structured implementation of the associated patient version of the guideline is missing to date. The study aims to assess whether structured implementation of a patient guideline improves the empowerment of patients with severe mental disorders, as well as knowledge, attitudes and experiences regarding psychosocial interventions, service use, treatment satisfaction, treatment needs, quality of life and burden of care.
The study is a multicentre, cluster-randomised, controlled study with two parallel groups. Inpatients and day hospital patients (all sexes; 18-65 years) with severe mental disorders will be included. Additionally, relatives of patients with mental disorders (all sexes; ≥ 18 years) will be included. In the experimental group, the patient guideline will be implemented using a multimodal strategy. Participants in the control group will receive treatment as usual but will be made aware of the patient guideline. The primary outcome is the change of empowerment, assessed by using the 'empowerment in the process of psychiatric treatment of patients with affective and schizophrenia disorders' (EPAS) scale. In addition, knowledge, attitudes and experiences regarding psychosocial interventions will be assessed as secondary outcomes, as well as service use, satisfaction with care, patient need and quality of life and participation and social inclusion. For relatives, the perceived burden of care also will be recorded. Results will be analysed using hierarchical linear models. For the health economic evaluation, the incremental cost-utility ratios will be computed using the differences in total costs of illness and the differences in quality-adjusted life years (QALY) between study groups.
The study will be the first to assess the effects of a structured implementation of the patient version of a psychiatric treatment guideline. The study has some limitations regarding the transferability of the results to other patients and other regions. Furthermore, problems with the recruitment of patients and relatives and with the implementation of intervention could occur during the study.
The study is registered in the German Clinical Trials Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00017577 (Date of registration: 23 October 2019.
德国精神障碍患者心理社会干预指南建议采用广泛的基于证据的治疗方法。目前尚缺乏对相关患者指南的结构化实施。本研究旨在评估结构化实施患者指南是否能提高严重精神障碍患者的赋权,以及他们对心理社会干预、服务使用、治疗满意度、治疗需求、生活质量和护理负担的知识、态度和经验。
这是一项多中心、集群随机、对照研究,有两个平行组。将纳入住院和日间医院患者(所有性别;18-65 岁)以及精神障碍患者的亲属(所有性别;≥18 岁)。实验组采用多模式策略实施患者指南。对照组将接受常规治疗,但会让他们了解患者指南。主要结局是使用“情感和精神分裂症患者精神治疗过程中的赋权评估量表”(EPAS)评估赋权的变化。此外,还将评估心理社会干预的知识、态度和经验作为次要结局,以及服务使用、护理满意度、患者需求和生活质量、参与和社会包容。对于亲属,还将记录他们感知到的护理负担。结果将使用分层线性模型进行分析。对于健康经济学评估,将使用研究组之间总疾病成本和质量调整生命年(QALY)的差异计算增量成本-效用比。
该研究将首次评估结构化实施精神科治疗指南患者版本的效果。该研究在结果向其他患者和其他地区的转移方面存在一些局限性。此外,在研究期间可能会出现招募患者和亲属以及实施干预的问题。
该研究在德国临床试验注册处(DRKS)和世界卫生组织国际临床试验注册平台(ICTRP)注册,注册号为 DRKS00017577(注册日期:2019 年 10 月 23 日)。