Landry Stéphanie, Provencher Martin D
École de psychologie, Université Laval.
École de psychologie, Université Laval ; Centre de recherche sur les soins et les services de première ligne de l'Université Laval ; Centre de recherche CERVO.
Sante Ment Que. 2020 Spring;45(1):31-52.
Objectives Bipolar disorder is a chronic condition which significantly impacts the functioning and quality of life of patients with the disorder. Recognized efficacious psychological interventions, such as group psychoeducation, can help better address some of the limitations observed when pharmacotherapy is used alone in the management of bipolar disorder. However, access to these evidence-based interventions seems to be limited for most patients. Indeed, the translation of knowledge acquired through research towards actual clinical settings poses a significant challenge. Assessing the implementation of these efficacious interventions in clinical practice is thus a priority. The objective of this study is to describe the implementation of a psychoeducative intervention, the Life Goals Program (LGP), for the treatment of bipolar disorder in community mental health settings in Quebec City. Methods The LGP was implemented in three different clinical settings located in Quebec City. Fifteen healthcare service providers chosen by their respective clinical site were trained to deliver the intervention. They delivered the treatment to 73 patients with a diagnosis of bipolar disorder. Healthcare service providers filled a log book after each group session, in order to assess whether they had properly delivered the content of the program. At the end of the study, they also participated in a group interview in order to get a better understanding of their experience delivering the intervention and their appreciation of the research process. Results Following qualitative content analysis, four main categories of factors that could influence the implementation of the intervention were identified: 1) healthcare service providers' characteristics (academic training, clinical experience, personality, knowledge of the program, and dynamic between animators); 2) participants' characteristics; 3) organizational context (physical and material environment, staff stability, administrative management and research requirements); and 4) facilitation (perception of research, research team support, and facilitation tools). These categories derived from data analysis coincide with those observed in the literature. The following factors seemed to have had the most impact in the differences observed between sites in the implementation of the LGP: the support offered by the research team; staff stability; and the academic training of healthcare services providers. Conclusion Dissemination and implantation studies can not only help determine factors that are important to consider when implementing a program, but can also help improve and adapt these programs in order to increase acceptability and effectiveness in real world clinical settings.
目标 双相情感障碍是一种慢性疾病，会对患有该疾病的患者的功能和生活质量产生重大影响。公认有效的心理干预措施，如团体心理教育，有助于更好地解决在双相情感障碍管理中单独使用药物治疗时所观察到的一些局限性。然而，对于大多数患者来说，获得这些基于证据的干预措施似乎有限。事实上，将通过研究获得的知识转化为实际临床环境是一项重大挑战。因此，评估这些有效干预措施在临床实践中的实施情况是当务之急。本研究的目的是描述一种心理教育干预措施——生活目标计划（LGP）在魁北克市社区心理健康环境中治疗双相情感障碍的实施情况。方法 LGP在魁北克市的三个不同临床环境中实施。由各自临床地点挑选的15名医疗服务提供者接受了实施该干预措施的培训。他们为73名被诊断为双相情感障碍的患者提供治疗。医疗服务提供者在每次小组会议后填写一本日志，以评估他们是否正确地提供了该计划的内容。在研究结束时，他们还参加了一次小组访谈，以便更好地了解他们实施干预措施的经验以及他们对研究过程的评价。结果 经过定性内容分析，确定了可能影响干预措施实施的四个主要因素类别：1）医疗服务提供者的特征（学术培训、临床经验、个性、对该计划的了解以及主持人之间的互动）；2）参与者的特征；3）组织背景（物理和物质环境、员工稳定性、行政管理和研究要求）；4）促进因素（对研究的认知、研究团队的支持以及促进工具）。这些从数据分析中得出的类别与文献中观察到的类别一致。以下因素似乎对LGP实施过程中各地点之间观察到的差异影响最大：研究团队提供的支持；员工稳定性；以及医疗服务提供者的学术培训。结论 传播和实施研究不仅有助于确定实施一个项目时需要考虑的重要因素，还可以帮助改进和调整这些项目，以提高在现实世界临床环境中的可接受性和有效性。
