Khau Michelle, Tabbane Karim, Bloom David, Abadi Sherezad, Villemus Celine, Rabinovitch Mark, Shah Jai L, Veillette Alexandre, Iyer Srividya N, Boksa Patricia, Joober Ridha
Integrated Program of Neuroscience, McGill University, Montreal, Qc, Canada; Douglas Mental Health University Institute, Verdun, Qc, Canada.
Douglas Mental Health University Institute, Verdun, Qc, Canada; Department of Psychiatry, McGill University, Montreal, Qc, Canada.
J Psychiatr Res. 2022 Jun;150:8-16. doi: 10.1016/j.jpsychires.2022.03.012. Epub 2022 Mar 15.
Adherence to therapeutic guidelines in psychiatry is anchored and facilitated by rating scales. However, they are rarely used in routine care, particularly for psychotic disorders. Consequently, adherence to treatment guidelines are not ideal and patient outcomes are often sub-optimal. In this study, we used the clinician-rated Clinical Global Impressions Scale (CGI) to implement a measurement-based care (MBC) approach and derive indices of quality of care at a first episode psychosis (FEP) program.
At the individual level, an algorithm was created using CGI scores and their changes over time to define the concept of Patient Requiring Clinical Attention (PRCA) that encompasses several categories (e.g. episode of severity, treatment inertia, or treatment resistance). At the service level, CGI scores were used to derive several indices of quality of care: severity of illness and its change over time, conformity to the use of low doses of antipsychotic medications, and clozapine offer index.
135 Patients were included in this study of whom 19 patients were identified as PRCA. Of these, 12 (63%) received timely medication, and 7 (37%) were suspected cases of therapeutic inertia. Additionally, 15 patients met criteria for treatment resistance of whom 7 were offered clozapine (47%). At the service level, the average CGI improved by 2 points from baseline to month 1 and average doses of antipsychotic medications prescribed were in line with prescription guidelines for FEP patients.
The proposed CGI-based treatment algorithm and service evaluation strategy can help to optimize quality care and services for patients.
精神病学治疗指南的遵循情况通过评定量表得以确立和促进。然而，它们在常规护理中很少被使用，尤其是针对精神障碍。因此，对治疗指南的遵循情况并不理想，患者的治疗效果往往也不尽人意。在本研究中，我们使用临床医生评定的临床总体印象量表（CGI）来实施基于测量的护理（MBC）方法，并得出首发精神病（FEP）项目的护理质量指标。
在个体层面，利用CGI评分及其随时间的变化创建了一种算法，以定义需要临床关注的患者（PRCA）这一概念，该概念涵盖多个类别（例如严重程度发作、治疗惰性或治疗抵抗）。在服务层面，CGI评分被用于得出几个护理质量指标：疾病严重程度及其随时间的变化、低剂量抗精神病药物使用的符合情况以及氯氮平提供指数。
本研究纳入了135名患者，其中19名患者被确定为PRCA。在这些患者中，12名（63%）接受了及时用药，7名（37%）被怀疑存在治疗惰性。此外，15名患者符合治疗抵抗标准，其中7名患者被提供了氯氮平（47%）。在服务层面，从基线到第1个月，CGI平均提高了2分，所开具的抗精神病药物平均剂量符合FEP患者的处方指南。
所提出的基于CGI的治疗算法和服务评估策略有助于优化患者的优质护理和服务。
