Department of Nursing, Faculty of Health Sciences, Kagawa Prefectural University of Health Sciences, Takamatsu, Japan.
School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Jpn J Nurs Sci. 2021 Jan;18(1):e12371. doi: 10.1111/jjns.12371. Epub 2020 Aug 23.
To investigate whether the addition of a nurse-led cognitive behavioral group therapy for recovery of self-esteem (CBGTRS) program to usual care for individuals with mental disorders can improve clinical outcomes and reduce direct medical costs.
This study employed single-group pre-post design, and recruited 51 community-dwelling individuals with mental disorders. Participants received 12 weekly CBGTRS sessions by a nurse in addition to usual care. The primary outcome measure was the level of self-esteem, with other clinical outcomes and direct medical costs. The clinical outcomes were measured at pre-intervention (T0), intervention midpoint (T1), immediate post-intervention (T2), and 3 months post-intervention (T3). Direct medical costs were calculated for 3 months pre-intervention (A0), 3 months post-intervention (A1), between 4-6 months post-intervention (A2), and between 7-9 months post-intervention (A3).
Self-esteem scores were significantly improved from T0 to T2 and T3 (p = .009 and .006, respectively); within-group effect sizes were .49 (small) for T0-T2, and .51 (medium) for T0-T3. Other secondary clinical outcomes for mood, cognitive bias, global functioning, and quality of life were also improved by T3 (all p < .05). The mean total direct medical costs were significantly reduced from A0 (49,569.51 JPY) to A2 and A3 (21,845.76 JPY and 25,981.69 JPY, respectively) (p = .003 and .017, respectively).
The results suggest that nurse-led CBGTRS for mental disorders is a potentially effective approach in improving self-esteem and other clinical outcomes, and in reducing direct medical costs. Further controlled studies that address the limitations of this study are required.
探讨在精神障碍患者的常规护理基础上增加以护士为主导的认知行为团体治疗自尊恢复（CBGTRS）方案是否能改善临床结局并降低直接医疗成本。
本研究采用单组前后测设计，招募了 51 名社区居住的精神障碍患者。患者在接受常规护理的同时，每周接受 12 次由护士主导的 CBGTRS 治疗。主要结局测量指标为自尊水平，同时还测量了其他临床结局和直接医疗成本。临床结局在干预前（T0）、干预中点（T1）、干预即刻后（T2）和干预后 3 个月（T3）进行测量。直接医疗成本在干预前 3 个月（A0）、干预后 3 个月（A1）、干预后 4-6 个月（A2）和干预后 7-9 个月（A3）进行计算。
自尊评分从 T0 到 T2 和 T3 显著提高（p =.009 和.006）；组内效应量分别为 T0-T2 时为.49（小），T0-T3 时为.51（中）。情绪、认知偏差、总体功能和生活质量等其他次要临床结局也在 T3 时得到改善（均 p < .05）。直接医疗总成本从 A0（49569.51 日元）显著降低到 A2 和 A3（分别为 21845.76 日元和 25981.69 日元）（p =.003 和.017）。
结果表明，针对精神障碍患者的以护士为主导的 CBGTRS 是一种改善自尊和其他临床结局并降低直接医疗成本的潜在有效方法。需要进一步开展控制研究来解决本研究的局限性。
