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van Duin D, van Wamel A, de Winter L, Kroon H, Veling W, van Weeghel J. Implementing Evidence-Based Interventions to Improve Vocational Recovery in Early Psychosis: A Quality-Improvement Report. Psychiatr Serv 2021; 72:1168-1177. [PMID: 34235946 DOI: 10.1176/appi.ps.201900342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE After young adults experience a first episode of psychosis, many express a need for help with education and employment. A quality improvement collaborative (QIC) launched in the Netherlands aimed to reinforce vocational recovery by improving participation in education and employment and by enhancing cognitive skills and self-management. This study examined methods used to implement interventions, barriers and facilitators, and implementation outcomes (fidelity, uptake, and availability). METHODS The Breakthrough Series was the model for change. Three evidence-based interventions were implemented to achieve targeted goals: individual placement and support (IPS), cognitive remediation, and shared decision making. Fidelity scores were obtained with fidelity scales. RESULTS Eighty-five professionals and 332 patients representing 14 teams treating patients with early psychosis were included in the 24-month QIC. Of this group, 252 patients participated in IPS, 52 in cognitive remediation, and 39 in shared decision making. By month 22, teams attained moderate-to-high mean fidelity scores, with an average of 3.2 on a 4-point scale for cognitive remediation, 3.7 on a 5-point scale for IPS, and 4.9 on a 6-point scale for shared decision making. CONCLUSIONS Over 24 months, use of a Breakthrough QIC to implement three interventions aimed at improving vocational recovery in teams delivering services for early psychosis yielded mixed results in terms of uptake and availability and moderate-to-high results in terms of fidelity. When implementing these types of interventions in this population, a multifaceted implementation model and a focused testing phase for computerized interventions appear needed, preferably with a maximum of two interventions implemented simultaneously.
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Affiliation(s)
- Daniëlle van Duin
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
| | - Anneke van Wamel
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
| | - Lars de Winter
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
| | - Hans Kroon
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
| | - Wim Veling
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
| | - Jaap van Weeghel
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
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Quantitative Preferences for Lung Cancer Treatment from the Patients' Perspective: A Systematic Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:521-536. [PMID: 32686052 DOI: 10.1007/s40271-020-00434-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Regulatory agencies as well as private organizations pursue programs that advocate patient centricity and emphasize the importance of dialog with patients. Various methods are applied to elicit the preferences of patients regarding the aspects of treatment they lend more importance to. Decisions on treatment choices are critical to patients with lung cancer because of their poor prognosis and the serious trade-off between safety and efficacy in traditional cytotoxic chemotherapy. METHODS We conducted a systematic literature review of quantitative patient preference studies of patients with lung cancer. Our exhaustive search of MEDLINE, CINAHL, EMBASE, PLOS, and SpringerLink identified 15 relevant studies published from January 2000 to April 2020 that enabled us to assess the relative importance of treatment attributes according to lung cancer patients' perspective. RESULTS The literature review revealed that patients with lung cancer tend to place a higher weight on efficacy and quality of life (QoL) attributes than on other attributes. Overall survival was found to be the most important among the efficacy attributes. The consequences of adverse events seemed less important than the possible efficacy from therapies. The clinical utility of treatment, such as the route of administration, was generally not considered important. It remains inconclusive whether sociodemographic factors and/or medical history affect the relative importance of a patient's preference. CONCLUSION Our systematic review clarified that patients generally prefer a better efficacy profile to a better safety profile, which underscores the importance of improved benefits in anti-lung cancer drug development.
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Sugitani Y, Ito K, Ono S. Patient Preferences for Attributes of Chemotherapy for Lung Cancer: Discrete Choice Experiment Study in Japan. Front Pharmacol 2021; 12:697711. [PMID: 34354590 PMCID: PMC8329447 DOI: 10.3389/fphar.2021.697711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Our study objective was to determine lung cancer chemotherapy attributes that are important to patients in Japan. A discrete choice experiment survey in an anonymous web-based questionnaire format with a reward was completed by 200 lung cancer patients in Japan from November 25, 2019, to November 27, 2019. The relative importance of patient preferences for each attribute was estimated using a conditional logit model. A hierarchical Bayesian logit model was also used to estimate the impact of each demographic characteristic on the relative importance of each attribute. Of the 200 respondents, 191 with consistent responses were included in the analysis. In their preference, overall survival was the most important, followed by diarrhea, nausea, rash, bone marrow suppression (BMS), progression-free survival, fatigue, interstitial lung disease, frequency of administration, and duration of administration. The preferences were influenced by demographic characteristics (e.g., gender and age) and disease background (e.g., cancer type and stage). Interestingly, the experience of cancer drug therapies and adverse events had a substantial impact on the hypothetical drug preferences. For the Japanese lung cancer patients, improved survival was the most important attribute that influenced their preference for chemotherapy, followed by adverse events, including diarrhea, nausea, rash, and BMS. The preferences varied depending on the patient’s demographic and experience. As drug attributes can affect patient preferences, pharmaceutical companies should be aware of the patient preferences and develop drugs that respond to segmented market needs.
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Affiliation(s)
- Yasuo Sugitani
- Biometrics Department, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan.,Laboratory of Pharmaceutical Regulation and Sciences, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Kyoko Ito
- Sustainability Department, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Shunsuke Ono
- Laboratory of Pharmaceutical Regulation and Sciences, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
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Carlo AD, Basu A, Unützer J. Associations of Common Depression Treatment Metrics With Patient-centered Outcomes. Med Care 2021; 59:579-587. [PMID: 33827105 PMCID: PMC8187281 DOI: 10.1097/mlr.0000000000001540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Various metrics predicated on Patient Health Questionnaire-9 (PHQ-9) scores denote depression "response" or "remission" over time, but few have been empirically validated. We compare the associations of depression response and remission metrics with concomitant clinical improvement in patient-centered outcomes (PCOs). SUBJECTS Secondary analysis of PHQ-9 and PCO data from the treatment arm (n=906) of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial. RESEARCH DESIGN We conducted univariate correlations between 9 depression treatment metrics and 4 PCOs. For each PCO, we specified a multivariate linear fixed-effects regression model with penalized LASSO (least absolute shrinkage and selection operator) variable selection that included parameters for each incremental absolute PHQ-9 decrease between 0 and 16 points. Model predictive properties were assessed using a split sample analysis. RESULTS There was a notable variation in depression improvement rates across metrics. Each metric was significantly associated with PCOs in univariate analyses. In the multivariate models, the cumulative likelihood of PCO improvement was most improved by absolute PHQ-9 score decreases of 7-9 and 14-16 points. The multivariate models showed greater area under the curve (0.671-0.804) in out-of-sample predictions of PCO changes than the univariate models (0.529-0.649). CONCLUSIONS Choice of depression response metric impacts observed response and remission rates, though PCOs tend to improve with depression improvement regardless of metric choice. Absolute incremental PHQ-9 score decreases are broadly associated with an increased likelihood of favorable PCO scores. Our findings support a novel PHQ-9 metric defined by an absolute score change of 8 points or greater.
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Affiliation(s)
- Andrew D Carlo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Anirban Basu
- Departments of Pharmacy
- Health Services
- Economics, University of Washington, Seattle, WA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
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Xu RH, Zhou LM, Wang D. The Relationship Between Decisional Regret and Well-Being in Patients With and Without Depressive Disorders: Mediating Role of Shared Decision-Making. Front Psychiatry 2021; 12:657224. [PMID: 34220572 PMCID: PMC8242166 DOI: 10.3389/fpsyt.2021.657224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The objectives of this study were two-fold: (1) to assess the relationship between patients' decisional regret and their well-being and (2) to examine the mediated effect of shared decision-making (SDM) on this relationship. Methods: A cross-sectional survey was conducted in five cities in Southern China. Patients were asked to fill out questionnaires assessing their decisional regret, SDM, subjective well-being, and depressive status. Mediation analysis was used to investigate the effect of SDM on the relationship between patients' decisional regret and their subjective well-being. Results: The findings showed significant direct negative effects of decisional regret on subjective well-being and SDM. For non-depressive patients, SDM exerted a significant and indirect effect on reducing the negative influence of decisional regret on subjective well-being. Conclusions: Findings suggest that implementation of SDM can decrease patients' decisional regret and improve their well-being; however, there is a need to examine their depressive status as part of routine healthcare.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.,Center for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ling-Ming Zhou
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
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Saleh M, Virarkar M, Bhosale P, Elsherif S, Javadi S, Faria SC. Endometrial Cancer, the Current International Federation of Gynecology and Obstetrics Staging System, and the Role of Imaging. J Comput Assist Tomogr 2020; 44:714-729. [PMID: 32842057 DOI: 10.1097/rct.0000000000001025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Imaging plays a crucial role in the diagnosis, staging, and follow-up of endometrial cancer. Endometrial cancer is staged surgically using the International Federation of Gynecology and Obstetrics (FIGO) staging system. Preoperative imaging can complement surgical staging but is not yet considered a required component in the current FIGO staging system. Preoperative imaging can help identify some tumor characteristics and tumor spread, both locally and distally. More accurate assessment of endometrial cancers optimizes management and treatment plan, including degree of surgical intervention. In this article, we review the epidemiology, FIGO staging system, and the importance of imaging in the staging of endometrial cancer.
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Affiliation(s)
- Mohammed Saleh
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mayur Virarkar
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Bhosale
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sherif Elsherif
- Department of Internal Medicine, Weiss Memorial Hospital, Affiliate of the University of Illinois at Chicago, Chicago, IL
| | - Sanaz Javadi
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Silvana C Faria
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Gao S, Corrigan PW, Qin S, Nieweglowski K. Comparing Chinese and European American mental health decision making. J Ment Health 2017; 28:141-147. [PMID: 29260922 DOI: 10.1080/09638237.2017.1417543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Shared decision making (SDM) tends to reflect more Western values of individualism and empowerment, values that may be foreign to East Asian healthcare preferences for collectivism and family involvement: family centered decision making (FCDM). AIMS To show that Chinese will be more likely to believe FCDM would be more pleasing for them if they were the patient. Conversely, European Americans will respond more favorably to SDM. To examine effects of Western acculturation on FCDM compared to SDM. METHOD In this study, preferences for FCDM versus SDM and doctor-led decision making (DrDM) were examined in a vignette study completed online by European Americans (n = 298) and Chinese (n = 327). Research participants read a vignette about Lily (a depression patient) presenting with symptoms of depression. After reading the vignette, participants completed items representing two sets of outcomes: three perceptions of impact on Lily and how participants might respond for themselves in a similar decision making situation. RESULTS Chinese rated FCDM greater than European and Chinese Americans. Chinese Americans mostly responded similar to European Americans and not Chinese. CONCLUSION European Americans prefer SDM more for mental health services. Chinese value FCDM more than European Americans. Preferences of Chinese living in America seem to parallel European Americans.
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Affiliation(s)
- Shanshan Gao
- a Department of Psychology, Hunan Normal University , Hunan , China and.,b Department of Psychology , Illinois Institute of Technology , Chicago , IL , USA
| | - Patrick W Corrigan
- b Department of Psychology , Illinois Institute of Technology , Chicago , IL , USA
| | - Sang Qin
- b Department of Psychology , Illinois Institute of Technology , Chicago , IL , USA
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Wanders RBK, van Loo HM, Vermunt JK, Meijer RR, Hartman CA, Schoevers RA, Wardenaar KJ, de Jonge P. Casting wider nets for anxiety and depression: disability-driven cross-diagnostic subtypes in a large cohort. Psychol Med 2016; 46:3371-3382. [PMID: 27624913 DOI: 10.1017/s0033291716002221] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND In search of empirical classifications of depression and anxiety, most subtyping studies focus solely on symptoms and do so within a single disorder. This study aimed to identify and validate cross-diagnostic subtypes by simultaneously considering symptoms of depression and anxiety, and disability measures. METHOD A large cohort of adults (Lifelines, n = 73 403) had a full assessment of 16 symptoms of mood and anxiety disorders, and measurement of physical, social and occupational disability. The best-fitting subtyping model was identified by comparing different hybrid mixture models with and without disability covariates on fit criteria in an independent test sample. The best model's classes were compared across a range of external variables. RESULTS The best-fitting Mixed Measurement Item Response Theory model with disability covariates identified five classes. Accounting for disability improved differentiation between people reporting isolated non-specific symptoms ['Somatic' (13.0%), and 'Worried' (14.0%)] and psychopathological symptoms ['Subclinical' (8.8%), and 'Clinical' (3.3%)]. Classes showed distinct associations with clinically relevant external variables [e.g. somatization: odds ratio (OR) 8.1-12.3, and chronic stress: OR 3.7-4.4]. The Subclinical class reported symptomatology at subthreshold levels while experiencing disability. No pure depression or anxiety, but only mixed classes were found. CONCLUSIONS An empirical classification model, incorporating both symptoms and disability identified clearly distinct cross-diagnostic subtypes, indicating that diagnostic nets should be cast wider than current phenomenology-based categorical systems.
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Affiliation(s)
- R B K Wanders
- University of Groningen, University Medical Center Groningen,Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),Groningen,The Netherlands
| | - H M van Loo
- University of Groningen, University Medical Center Groningen,Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),Groningen,The Netherlands
| | - J K Vermunt
- Department of Methodology and Statistics,Tilburg University,Tilburg,The Netherlands
| | - R R Meijer
- Department of Psychometrics and Statistics,University of Groningen,Groningen,The Netherlands
| | - C A Hartman
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,Groningen,The Netherlands
| | - R A Schoevers
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,Groningen,The Netherlands
| | - K J Wardenaar
- University of Groningen, University Medical Center Groningen,Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),Groningen,The Netherlands
| | - P de Jonge
- University of Groningen, University Medical Center Groningen,Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),Groningen,The Netherlands
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Friedrichs A, Spies M, Härter M, Buchholz A. Patient Preferences and Shared Decision Making in the Treatment of Substance Use Disorders: A Systematic Review of the Literature. PLoS One 2016; 11:e0145817. [PMID: 26731679 PMCID: PMC4701396 DOI: 10.1371/journal.pone.0145817] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/09/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Shared Decision Making (SDM) as means to the involvement of patients in medical decision making is increasingly demanded by treatment guidelines and legislation. Also, matching of patients' preferences to treatments has been shown to be effective regarding symptom reduction. Despite promising results for patients with substance use disorders (SUD) no systematic evaluation of the literature has been provided. The aim is therefore to give a systematic overview of the literature of patient preferences and SDM in the treatment of patients with SUD. METHODS An electronic literature search of the databases Medline, Embase, Psyndex and Clinical Trials Register was performed. Variations of the search terms substance use disorders, patient preferences and SDM were used. For data synthesis the populations, interventions and outcomes were summarized and described according to the PRISMA statement. Methodological quality of the included articles was assessed with the Mixed Methods Appraisal Tool. RESULTS N = 25 trials were included in this review. These were conducted between 1986 and 2014 with altogether n = 8.729 patients. Two studies found that patients with SUD preferred to be actively involved in treatment decisions. Treatment preferences were assessed in n = 18 studies, where the majority of patients preferred outpatient compared with inpatient treatment. Matching patients to preferences resulted in a reduction on substance use (n = 3 studies), but the majority of studies found no significant effect. Interventions for SDM differed across patient populations and optional therapeutic techniques. DISCUSSION Patients with substance use disorders should be involved in medical treatment decisions, as patients with other health conditions. A suitable approach is Shared Decision Making, emphasizing the patients' preferences. However, due to the heterogeneity of the included studies, results should be interpreted with caution. Further research is needed regarding SDM interventions in patient populations with substance use disorders.
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Affiliation(s)
- Anke Friedrichs
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maren Spies
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ducasse D, Courtet P, Sénèque M, Genty C, Picot MC, Schwan R, Olié E. Effectiveness of the first French psychoeducational program on unipolar depression: study protocol for a randomized controlled trial. BMC Psychiatry 2015; 15:294. [PMID: 26578205 PMCID: PMC4650332 DOI: 10.1186/s12888-015-0667-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/29/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) is highly prevalent and was associated with greater morbidity, mortality (including suicide), and healthcare costs. By 2030, MDD will become the leading cause of disability in high-income countries. Notably, among patients with a previous experience of a major depressive episode, it was indeed estimated that up to 85 % of those patients will suffer from relapse. Two main factors were associated with a significantly higher risk of relapse: poor medication adherence and low self-efficacy in disease management. Interestingly, these issues could become the targets of psychoeducational programs for chronic diseases. Indded psychoeducational program for depression are recommended in international guidelines, but have not yet been proposed in France. METHODS/DESIGN We propose to evaluate the first French psychoeducational program for depression "ENVIE" in a multicenter randomized controlled trial. The group intervention will include 9 weekly sessions. Its aim is to educate patients on the latest knowledge on depression and effective treatments through didactic and interactive sessions. Patients will experiment the latest innovating psychological skills (from acceptance and commitment therapy) to cope with depressive symptoms and maintain motivation in behavioral activation. In total, 332 unipolar non-chronic (<2 years) outpatients with moderate to severe depression, without psychotic features, will be randomly allocated to the add-on ENVIE program (N = 166) or to a waiting list (N = 166). The follow-up will last 15 months and include 5 assessment visits. The primary endpoint will be the remission rate of the index episode at 15 months post-inclusion, defined by a Montgomery and Asberg Depression Rating Scale (MADRS) score ≤ 12 over an 8-week period, and without relapse during follow-up. We will also assess the response rate and relapse at 15 months post-inclusion, hospitalization rate and adherence to treatment during the follow-up period, quality of life and global functioning upon inclusion and at 9 and 15 months post inclusion. DISCUSSION If the proposed trial shows the effectiveness of the intervention, but also an increased remission rate in depressed outpatients at 15-months post-inclusion, in addition to improved treatment adherence in patients, it will further promotes arguments in favor of a wide dissemination of psychoeducational programs for depression. TRIAL REGISTRATION This trial is registered under number 2015-A00249-40 (PURE clinical trial: NCT02501226 ) (June 30th, 2015).
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Affiliation(s)
- Déborah Ducasse
- Department of Emergency Psychiatry and Post Acute Care, CHU Montpellier, Hôpital Lapeyronie, 371 Avenue Gaston Giraud, 34295, Montpellier, France. .,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France. .,FondaMental Foundation, ᅟ, France.
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post Acute Care, CHU Montpellier, Hôpital Lapeyronie, 371 Avenue Gaston Giraud, 34295, Montpellier, France. .,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France. .,FondaMental Foundation, ᅟ, France.
| | - Maude Sénèque
- Department of Emergency Psychiatry and Post Acute Care, CHU Montpellier, Hôpital Lapeyronie, 371 Avenue Gaston Giraud, 34295, Montpellier, France. .,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France. .,FondaMental Foundation, ᅟ, France.
| | - Catherine Genty
- Department of Emergency Psychiatry and Post Acute Care, CHU Montpellier, Hôpital Lapeyronie, 371 Avenue Gaston Giraud, 34295, Montpellier, France. .,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France. .,FondaMental Foundation, ᅟ, France.
| | | | | | - Emilie Olié
- Department of Emergency Psychiatry and Post Acute Care, CHU Montpellier, Hôpital Lapeyronie, 371 Avenue Gaston Giraud, 34295, Montpellier, France. .,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France. .,FondaMental Foundation, ᅟ, France.
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Interventions for preventing relapse or recurrence of depression in primary health care settings: A systematic review. Prev Med 2015; 76 Suppl:S16-21. [PMID: 25192769 DOI: 10.1016/j.ypmed.2014.07.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/04/2014] [Accepted: 07/23/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A systematic review was conducted to assess the efficacy of pharmacological and psychological interventions for preventing relapse or recurrence of depression in adults with depression in primary care. METHOD Papers published from inception to January 28th 2014 were identified searching the electronic databases MEDLINE, EMBASE, PsycINFO, and CENTRAL. Randomized controlled trials of any pharmacological, psychological or psychosocial intervention or combination of interventions delivered in primary care settings were included, with relapse or recurrence of a depressive disorder as a main outcome. The Cochrane Collaboration risk of bias tool was used to assess study quality. RESULTS Only three studies with a small number of patients fulfilled the inclusion criteria. None of the three randomized controlled trials included in our review showed a statistically significant superiority of an intervention for the prevention of depression relapse or recurrence. CONCLUSIONS There is limited evidence to inform relapse or recurrence prevention strategies specifically in primary care.
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Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev 2015; 2015:CD010523. [PMID: 25733495 PMCID: PMC6486144 DOI: 10.1002/14651858.cd010523.pub2] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Personalised care planning is a collaborative process used in chronic condition management in which patients and clinicians identify and discuss problems caused by or related to the patient's condition, and develop a plan for tackling these. In essence it is a conversation, or series of conversations, in which they jointly agree goals and actions for managing the patient's condition. OBJECTIVES To assess the effects of personalised care planning for adults with long-term health conditions compared to usual care (i.e. forms of care in which active involvement of patients in treatment and management decisions is not explicitly attempted or achieved). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ProQuest, clinicaltrials.gov and WHO International Clinical Trials Registry Platform to July 2013. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised trials involving adults with long-term conditions where the intervention included collaborative (between individual patients and clinicians) goal setting and action planning. We excluded studies where there was little or no opportunity for the patient to have meaningful influence on goal selection, choice of treatment or support package, or both. DATA COLLECTION AND ANALYSIS Two of three review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes were effects on physical health, psychological health, subjective health status, and capabilities for self management. Secondary outcomes included effects on health-related behaviours, resource use and costs, and type of intervention. A patient advisory group of people with experience of living with long-term conditions advised on various aspects of the review, including the protocol, selection of outcome measures and emerging findings. MAIN RESULTS We included 19 studies involving a total of 10,856 participants. Twelve of these studies focused on diabetes, three on mental health, one on heart failure, one on end-stage renal disease, one on asthma, and one on various chronic conditions. All 19 studies included components that were intended to support behaviour change among patients, involving either face-to-face or telephone support. All but three of the personalised care planning interventions took place in primary care or community settings; the remaining three were located in hospital clinics. There was some concern about risk of bias for each of the included studies in respect of one or more criteria, usually due to inadequate or unclear descriptions of research methods. Physical healthNine studies measured glycated haemoglobin (HbA1c), giving a combined mean difference (MD) between intervention and control of -0.24% (95% confidence interval (CI) -0.35 to -0.14), a small positive effect in favour of personalised care planning compared to usual care (moderate quality evidence).Six studies measured systolic blood pressure, a combined mean difference of -2.64 mm/Hg (95% CI -4.47 to -0.82) favouring personalised care (moderate quality evidence). The pooled results from four studies showed no significant effect on diastolic blood pressure, MD -0.71 mm/Hg (95% CI -2.26 to 0.84).We found no evidence of an effect on cholesterol (LDL-C), standardised mean difference (SMD) 0.01 (95% CI -0.09 to 0.11) (five studies) or body mass index, MD -0.11 (95% CI -0.35 to 0.13) (four studies).A single study of people with asthma reported that personalised care planning led to improvements in lung function and asthma control. Psychological healthSix studies measured depression. We were able to pool results from five of these, giving an SMD of -0.36 (95% CI -0.52 to -0.20), a small effect in favour of personalised care (moderate quality evidence). The remaining study found greater improvement in the control group than the intervention group.Four other studies used a variety of psychological measures that were conceptually different so could not be pooled. Of these, three found greater improvement for the personalised care group than the usual care group and one was too small to detect differences in outcomes. Subjective health statusTen studies used various patient-reported measures of health status (or health-related quality of life), including both generic health status measures and condition-specific ones. We were able to pool data from three studies that used the SF-36 or SF-12, but found no effect on the physical component summary score SMD 0.16 (95% CI -0.05 to 0.38) or the mental component summary score SMD 0.07 (95% CI -0.15 to 0.28) (moderate quality evidence). Of the three other studies that measured generic health status, two found improvements related to personalised care and one did not.Four studies measured condition-specific health status. The combined results showed no difference between the intervention and control groups, SMD -0.01 (95% CI -0.11 to 0.10) (moderate quality evidence). Self-management capabilitiesNine studies looked at the effect of personalised care on self-management capabilities using a variety of outcome measures, but they focused primarily on self efficacy. We were able to pool results from five studies that measured self efficacy, giving a small positive result in favour of personalised care planning: SMD 0.25 (95% CI 0.07 to 0.43) (moderate quality evidence).A further five studies measured other attributes that contribute to self-management capabilities. The results from these were mixed: two studies found evidence of an effect on patient activation, one found an effect on empowerment, and one found improvements in perceived interpersonal support. Other outcomesPooled data from five studies on exercise levels showed no effect due to personalised care planning, but there was a positive effect on people's self-reported ability to carry out self-care activities: SMD 0.35 (95% CI 0.17 to 0.52).We found no evidence of adverse effects due to personalised care planning.The effects of personalised care planning were greater when more stages of the care planning cycle were completed, when contacts between patients and health professionals were more frequent, and when the patient's usual clinician was involved in the process. AUTHORS' CONCLUSIONS Personalised care planning leads to improvements in certain indicators of physical and psychological health status, and people's capability to self-manage their condition when compared to usual care. The effects are not large, but they appear greater when the intervention is more comprehensive, more intensive, and better integrated into routine care.
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Affiliation(s)
- Angela Coulter
- University of OxfordHealth Services Research Unit, Nuffield Department of Population HealthOld Road Campus, HeadingtonOxfordUKOX3 7LF
| | - Vikki A Entwistle
- University of AberdeenHealth Services Research UnitHealth Services Building Level 3ForesterhillAberdeenUKAB25 2ZD
| | - Abi Eccles
- University of OxfordDepartment of Primary Care Health Sciences23‐28 Hythe Bridge StreetOxfordUKOX1 2ET
| | - Sara Ryan
- University of OxfordQuality and Outcomes Research Unit and Health Experiences Research Group23‐28 Hythe Bridge StreetOxfordUKOX1 2ET
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordUKOX3 7LF
| | - Rafael Perera
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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[Attitudes towards anti-depressive therapy: acceptance vs. stigmatization]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2015; 29:14-22. [PMID: 25708250 DOI: 10.1007/s40211-014-0134-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The current study investigates the attitude towards antidepressant treatment among general public. METHODS A total of 234 probands (139 women and 95 men) were asked to complete individually provided questionnaires examining socio-demographic data, psychoeducational levels, as well as personal beliefs concerning antidepressant treatment and levels of present stigmatisation. Three scales were used to quantify stigmatisation levels-"Revised Perceived Devaluation Discrimination Scale"/"Revised Internalized Stigma of Mental Illness Scale"/"Attitudes Toward Mental Health Treatment Scale", "Revised Perceived Devaluation Discrimination Scale". RESULTS 65 people (27.8 %) reported to have had one or more episodes of depression during their lifetime; 169 people (72.2 %) indicated to have never had any episode of that type before. The words "sickness" and "anxiety" were the terms primarily associated with the word "depression". It was a common belief among interviewees that lonely individuals or those not receiving social support have a higher risk of becoming depressed. We further found that people experience higher levels of internalized stigma when talking about their antidepressant drug-therapy, than the level of perceived stigma would suggest. Opposed to those not indicating depression depressed people indicated that they considered the use of antidepressant medication helpful and a good option, if necessary. Stigma can still be found among those not indicating depression as well as among those with symptoms of depression. Based on the current study we conclude that work in the field of destigmatisation is of great importance.
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Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, Agoritsas T, Mistry N, Iorio A, Jack S, Sivaramalingam B, Iserman E, Mustafa RA, Jedraszewski D, Cotoi C, Haynes RB. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2014; 2014:CD000011. [PMID: 25412402 PMCID: PMC7263418 DOI: 10.1002/14651858.cd000011.pub4] [Citation(s) in RCA: 671] [Impact Index Per Article: 67.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND People who are prescribed self administered medications typically take only about half their prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications. OBJECTIVES The primary objective of this review is to assess the effects of interventions intended to enhance patient adherence to prescribed medications for medical conditions, on both medication adherence and clinical outcomes. SEARCH METHODS We updated searches of The Cochrane Library, including CENTRAL (via http://onlinelibrary.wiley.com/cochranelibrary/search/), MEDLINE, EMBASE, PsycINFO (all via Ovid), CINAHL (via EBSCO), and Sociological Abstracts (via ProQuest) on 11 January 2013 with no language restriction. We also reviewed bibliographies in articles on patient adherence, and contacted authors of relevant original and review articles. SELECTION CRITERIA We included unconfounded RCTs of interventions to improve adherence with prescribed medications, measuring both medication adherence and clinical outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive findings at earlier time points. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data and a third author resolved disagreements. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Pooling results according to one of these characteristics still leaves highly heterogeneous groups, and we could not justify meta-analysis. Instead, we conducted a qualitative analysis with a focus on the RCTs with the lowest risk of bias for study design and the primary clinical outcome. MAIN RESULTS The present update included 109 new RCTs published since the previous update in January 2007, bringing the total number of RCTs to 182; we found five RCTs from the previous update to be ineligible and excluded them. Studies were heterogeneous for patients, medical problems, treatment regimens, adherence interventions, and adherence and clinical outcome measurements, and most had high risk of bias. The main changes in comparison with the previous update include that we now: 1) report a lack of convincing evidence also specifically among the studies with the lowest risk of bias; 2) do not try to classify studies according to intervention type any more, due to the large heterogeneity; 3) make our database available for collaboration on sub-analyses, in acknowledgement of the need to make collective advancement in this difficult field of research. Of all 182 RCTs, 17 had the lowest risk of bias for study design features and their primary clinical outcome, 11 from the present update and six from the previous update. The RCTs at lowest risk of bias generally involved complex interventions with multiple components, trying to overcome barriers to adherence by means of tailored ongoing support from allied health professionals such as pharmacists, who often delivered intense education, counseling (including motivational interviewing or cognitive behavioral therapy by professionals) or daily treatment support (or both), and sometimes additional support from family or peers. Only five of these RCTs reported improvements in both adherence and clinical outcomes, and no common intervention characteristics were apparent. Even the most effective interventions did not lead to large improvements in adherence or clinical outcomes. AUTHORS' CONCLUSIONS Across the body of evidence, effects were inconsistent from study to study, and only a minority of lowest risk of bias RCTs improved both adherence and clinical outcomes. Current methods of improving medication adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. The research in this field needs advances, including improved design of feasible long-term interventions, objective adherence measures, and sufficient study power to detect improvements in patient-important clinical outcomes. By making our comprehensive database available for sharing we hope to contribute to achieving these advances.
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Affiliation(s)
- Robby Nieuwlaat
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Nancy Wilczynski
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Tamara Navarro
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Nicholas Hobson
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Rebecca Jeffery
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Arun Keepanasseril
- McMaster UniversityDepartments of Clinical Epidemiology & Biostatistics, and Medicine, Faculty of Health Sciences1280 Main Street WestHamiltonONCanadaL8S 4L8
| | - Thomas Agoritsas
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Niraj Mistry
- St. Michael's HospitalDepartment of Pediatrics30 Bond StreetTorontoONCanadaM5B 1W8
| | - Alfonso Iorio
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Susan Jack
- McMaster UniversitySchool of Nursing, Faculty of Health SciencesHealth Sciences CentreRoom 2J32, 1280 Main Street WestHamiltonONCanadaL8S 4K1
| | | | - Emma Iserman
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Reem A Mustafa
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Dawn Jedraszewski
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Chris Cotoi
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - R. Brian Haynes
- McMaster UniversityDepartments of Clinical Epidemiology & Biostatistics, and Medicine, Faculty of Health Sciences1280 Main Street WestHamiltonONCanadaL8S 4L8
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Pumar MI, Gray CR, Walsh JR, Yang IA, Rolls TA, Ward DL. Anxiety and depression-Important psychological comorbidities of COPD. J Thorac Dis 2014; 6:1615-31. [PMID: 25478202 PMCID: PMC4255157 DOI: 10.3978/j.issn.2072-1439.2014.09.28] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/03/2014] [Indexed: 12/28/2022]
Abstract
Anxiety and depression are common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). The pathophysiology of these psychological comorbidities in COPD is complex and possibly explained by common risk factors, response to symptomatology and biochemical alterations. The presence of anxiety and/or depression in COPD patients is associated with increased mortality, exacerbation rates, length of hospital stay, and decreased quality of life and functional status. There is currently no consensus on the most appropriate approach to screening for anxiety and depression in COPD. Treatment options include psychological [relaxation, cognitive behavioural therapy (CBT), self-management] and pharmacological interventions. Although there is some evidence to support these treatments in COPD, the data are limited and mainly comprised by small studies. Pulmonary rehabilitation improves anxiety and depression, and conversely these conditions impact rehabilitation completion rates. Additional high quality studies are urgently required to optimise screening and effective treatment of anxiety and depression in patients with COPD, to enhance complex chronic disease management for these patients.
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Shared clinician-patient decision-making about treatment of pediatric asthma: what do we know and how can we use it? Curr Opin Allergy Clin Immunol 2014; 14:161-7. [PMID: 24553296 DOI: 10.1097/aci.0000000000000046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Shared decision-making (SDM) is an emerging field that promises to improve healthcare. We aim to explore the concept of SDM, how it has been studied or applied in the treatment of asthma, and how it might be implemented to improve adherence and outcomes in pediatric asthma. RECENT FINDINGS Healthcare providers often fail to involve their patients in clinical decision-making by not presenting all available options, associated risks and benefits, in light of the patient's values, preferences, concerns, lifestyle, and perceived barriers to following various treatment regimens. It has been argued that SDM is preferable to a clinician-controlled approach and may improve patient outcomes (increase satisfaction with care, reduce decisional conflict and decisional regret, improve health-related quality of life, and increase decision-specific knowledge). This may be especially important in managing chronic conditions in which adherence to treatment regimen may increase if the patient was actively involved in the decision-making. In pediatrics, the decision process is further complicated by the clinician-parent(s)-child interaction. We found no studies on how to effectively involve and communicate with children at different developmental levels, or how to coalesce the parent and child's perspective to work as a unit. SUMMARY SDM has the promise to improve satisfaction with disease management, treatment adherence and patient-centered outcomes in pediatric asthma, but further research is needed to determine its effectiveness and to establish guidelines on how to implement SDM in the clinical setting and incorporate the input and preferences of all stakeholders' perspectives.
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Corrigan PW, Druss BG, Perlick DA. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychol Sci Public Interest 2014; 15:37-70. [PMID: 26171956 DOI: 10.1177/1529100614531398] [Citation(s) in RCA: 640] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.
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Ghane A, Huynh HP, Andrews SE, Legg AM, Tabuenca A, Sweeny K. The relative importance of patients’ decisional control preferences and experiences. Psychol Health 2014; 29:1105-18. [DOI: 10.1080/08870446.2014.911873] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tursi MFDS, Baes CVW, Camacho FRDB, Tofoli SMDC, Juruena MF. Effectiveness of psychoeducation for depression: a systematic review. Aust N Z J Psychiatry 2013; 47:1019-31. [PMID: 23739312 DOI: 10.1177/0004867413491154] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Pharmacological treatment is considered indispensable to major depressive disorder. In spite of this, a significant number of patients do not respond adequately to treatment based only on medication, presenting high relapse and recurrence rates. Therefore, psychosocial interventions, such as psychoeducation, have been increasingly recognized as an essential component in the treatment of depression, associated with pharmacological strategies. Thus, the aim of the present systematic review was to evaluate the effectiveness of psychoeducation for patients with unipolar depression, analyzing the evidence from the literature. METHOD Searches were undertaken from April to October 2012 in LILACS, PsycINFO, PubMed, SCOPUS and ISI Web of Knowledge with keywords including 'psychoeducation', 'psychoeducational intervention' and 'depression', with no restriction regarding publishing dates. RESULTS Fifteen studies were included in the review, 13 of which evaluated the effectiveness of psychoeducation for patients with depression: 10 papers evaluated in-person psychoeducation approaches and three papers evaluated long-distance approaches. In addition to these 13 papers, one evaluated psychoeducational interventions for patients' families and patients' responses and another evaluated psychoeducational interventions for patients' families and families' responses. Findings suggest that increased knowledge about depression and its treatment is associated with better prognosis in depression, as well as with the reduction of the psychosocial burden for the family. CONCLUSIONS Psychoeducation is a psychosocial treatment that has been well documented as an adjunct to pharmacological therapy. However, there are only a few studies regarding its effectiveness on adult patients with major depressive disorder. Although the publications in this area are still very limited, the articles selected in this review suggest that psychoeducation is effective in improving the clinical course, treatment adherence, and psychosocial functioning of depressive patients.
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Affiliation(s)
- Mariana Flávia de Souza Tursi
- 1Department of Neuroscience and Behavior, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Rise MB, Steinsbekk A. Does implementing a development plan for user participation in a mental hospital change patients' experience? A non-randomized controlled study. Health Expect 2013; 18:809-25. [PMID: 23837534 DOI: 10.1111/hex.12105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Governments in several countries attempt to strengthen user participation through instructing health-care organizations to implement user participation initiatives. There is, however, little knowledge on the effect on patients' experience from comprehensive plans for enhancing user participation in whole health service organizations. OBJECTIVE To investigate whether implementing a development plan intending to enhance user participation in a mental hospital had any effect on the patients' experience of user participation. DESIGN, SETTING AND PARTICIPANTS A non-randomized controlled study including patients in three mental hospitals in Central Norway, one intervention hospital and two control hospitals. INTERVENTIONS A development plan intended to enhance user participation was implemented in the intervention hospital as a part of a larger reorganizational process. The plan included establishment of a patient education centre and a user office, purchase of user expertise, appointment of contact professionals for next of kin and improvement of the centre's information and the professional culture. MAIN OUTCOME MEASURES Perceptions of Care, Inpatient Treatment Alliance Scale and questions made for this study. RESULTS A total of 1651 patients participated. Implementing a development plan in a mental hospital intending to enhance user participation had no significant effect on the patients' experience of user participation. DISCUSSIONS AND CONCLUSIONS The lack of effect can be due to inappropriate initiatives or challenges in implementation processes. Further research should ensure that initiatives and implementation processes are appropriate to impact the patients' experience.
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Affiliation(s)
- Marit B Rise
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Pan YJ, Liu SK, Yeh LL. Factors affecting early attrition and later treatment course of antidepressant treatment of depression in naturalistic settings: an 18-month nationwide population-based study. J Psychiatr Res 2013; 47:916-25. [PMID: 23566422 DOI: 10.1016/j.jpsychires.2013.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Early attrition can impede treatment success of depression; its contributing factors and impacts on subsequent treatment course need further clarification. METHODS All Taiwanese adult patients prescribed with antidepressants for depression (n=216,557) in 2003 were identified through a total population health insurance claims database; their initial contact patterns could be classified into three types of attrition: non-attrition, returning attrition and non-returning attrition. Demographic and clinical characteristics associated with each attrition type were described and relationships between attrition type and subsequent treatment course over an 18-month follow-up period were examined with these demographic/clinical confounders being controlled for. RESULTS 41.6% of Study subjects had early attrition; among them, 35.3% returned to treatment later. Type of depression, medical/psychiatric comorbidities, painful physical symptoms and past treatment history, as well as prescribing physician specialty and choice of antidepressants, were associated with early attrition. Three types of follow-up pattern over the 18-month follow-up period were identified: sustained treatment-free, continuous treatment and late re-contacts. Patients remaining engaged with treatment within the first three months had higher odds of achieving sustained treatment-free (OR=1.21; 99% CI: 1.16, 1.27) and lower odds of having late re-contacts (OR=0.20; 99% CI: 0.19, 0.21) over the 18-month period, compared to those who returned after early attrition. CONCLUSIONS Early attrition is a significant barrier for depression treatment in daily clinical practice and has negative impacts on later treatment course and/or outcome. Early attrition needs to be minimized through shared decision-making, exchange of treatment preferences and proper patient-physician communication.
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Affiliation(s)
- Yi-Ju Pan
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, United Kingdom
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Houle J, Gascon-Depatie M, Bélanger-Dumontier G, Cardinal C. Depression self-management support: a systematic review. PATIENT EDUCATION AND COUNSELING 2013; 91:271-279. [PMID: 23414831 DOI: 10.1016/j.pec.2013.01.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/14/2013] [Accepted: 01/17/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To systematically review empirical evidence regarding the efficacy of depression self-management support (SMS) interventions for improving depression symptomatology and preventing relapse. METHODS Pubmed and PsycINFO databases were searched for relevant articles on depression SMS interventions. Scanning of references in the articles and relevant reviews and communications with field experts yielded additional articles. Two independent reviewers analyzed the articles for inclusion and data was extracted from the selected articles. RESULTS 13 papers met the inclusion criteria and reported the results of six separate studies, including three pilot studies. The results were mostly positive. A majority of the trials assessing depression severity changes found SMS to be superior to care as usual. SMS interventions were found to improve self-management behaviors and self-efficacy. Mixed results were found concerning relapse rates. Promising results were found on assessments of functional status. Based on the findings, cost-effectiveness remains unclear. CONCLUSION SMS has been mostly examined through pilot studies with insufficient power. The results are promising, but larger randomized controlled trials are needed. PRACTICE IMPLICATIONS SMS interventions can be administered by non-physician professionals and are well accepted by patients, but more research is needed before we can recommend implementing specific depression SMS approaches in primary care.
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Affiliation(s)
- Janie Houle
- Department of Psychology, Université du Québec à Montréal, Canada.
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Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence. Community Ment Health J 2013; 49:185-92. [PMID: 22837104 DOI: 10.1007/s10597-012-9528-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes.
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Wroe AL, Salkovskis PM, Rees M, Jack T. Information giving and involvement in treatment decisions: is more really better? Psychological effects and relation with adherence. Psychol Health 2013; 28:954-71. [PMID: 23537190 DOI: 10.1080/08870446.2013.777964] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study is to improve our understanding of the ways in which a medical consultation style relates to satisfaction and adherence. DESIGN Participants completed questionnaires about preferred and perceived consultation styles; psychological variables such as satisfaction, anxiety and depression; and questions about taking medication. Questionnaires were completed prior to the consultation, immediately after, three months later and one year later. Doctors also completed a scale on completion of the consultation. The decisions in question related to women seeking advice about Hormone Replacement Therapy (HRT) and decisions about pain management. RESULTS Patients expressed preferences for information about the treatment options and for active involvement in the decision process. The extent to which patients perceived themselves as having received information about the treatment options was a particularly consistent predictor of satisfaction. The extent to which patients perceived themselves as having been prepared for the side effects of HRT was a consistent predictor of anxiety. CONCLUSIONS Perceptions of the amount of information received about medical options, including information preparing individuals for potential side effects of medication, appears to be more important to satisfaction and anxiety, than actual involvement in the decision.
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Affiliation(s)
- Abigail L Wroe
- Department of Clinical Psychology, Royal Holloway University of London, Egham, Surrey.
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Westermann GMA, Verheij F, Winkens B, Verhulst FC, Van Oort FVA. Structured shared decision-making using dialogue and visualization: a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2013; 90:74-81. [PMID: 23107362 DOI: 10.1016/j.pec.2012.09.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 09/04/2012] [Accepted: 09/22/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate a method, "Counseling in Dialogue" (CD), developed to increase the quality of counseling in youth mental health. Decisional conflict was used as indicator of the quality of counseling and shared decision-making. METHODS 94 children aged 2-12 years were randomized into a CD group and a care as usual (CU) group. In a before-and-after design decisional conflict was measured using the decisional conflict scale (DCS) for parents (N=133) and the Provider Decision Process Assessment Instrument for therapists (PDPAI, N=20). 81 children had follow-up data. RESULTS Compared with parents of the CU group, parents of the CD group reported significantly less decisional conflict after counseling (difference mothers: -0.38 (95%CI -0.56; -0.19), p<.001; fathers: -0.22 (95%CI -0.44; -0.01), p=.045). 98% of the mothers and 96% of the fathers in the CD group accepted the recommended treatment, compared to 71% (fathers) and 77% (mothers) in the CU group, p<0.05. Decisional conflict of the therapists was low in both groups after counseling (difference: -0.03 (95%CI -0.19; 0.14), p=.741). CONCLUSION The counseling procedure significantly lowered decisional conflict of the parents and promoted the acceptance of the recommended treatment.
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Dell'Osso B, Prati G, Palazzo MC, Rumi MG, Cavallaro F, Aghemo A, Colombo M, Altamura AC. Predictors of psychopathological outcome during peg-interferon and ribavirin therapy in patients with chronic HCV-correlated hepatitis. J Interferon Cytokine Res 2012; 33:9-14. [PMID: 23276143 DOI: 10.1089/jir.2012.0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Peg-interferon (Peg-IFN) and ribavirin (RBV) therapy is reported to induce psychiatric symptoms and syndromes in 20% of patients treated for Hepatitis C Virus (HCV) infection. Present study was aimed to quantify the phenomenon and assess the influence of psychiatric counseling over antiviral completion rate and the use of psychometric tools, in terms of prediction of psychopathological outcome. Ninety-six HCV patients were assessed, before antiviral treatment, by means of the Sheehan Disability Scale (SDS), Mood Disorder Questionnaire (MDQ), Symptom Checklist-90, and Internal State Scale (ISS). Sociodemographic and clinical variables and completion rate were collected. Binary logistic regression was performed to evaluate whether scores were predictive of psychiatric visit, development of psychiatric disorders, and need for treatment. Ninety-five patients (99%) completed antiviral treatment; 27 subjects (29%) needed psychiatric visit: among them, mood disorder was diagnosed in 15 (16%) and were pharmacologically treated. Baseline SDS and MDQ higher scores were found to be predictive of psychiatric visit [odds ratio (OR)=1.258, P<0.001 and OR=1.425, P=0.05, respectively]. Furthermore, higher MDQ score (P=0.017) and ISS hostility scores (OR=1.048, P=0.014) at baseline predicted the subsequent development of mood episodes, while ISS activation correlated negatively (OR=0.948, P=0.009). Finally, the need for treatment was predicted by higher scores at the MDQ and ISS activation items (OR=2.467, P=0.030; OR=0.970, P=0.038). Present findings suggest that psychiatric counseling may be needed in almost 30% of HCV patients on antiviral treatment, with positive influence over the completion rate. Baseline higher scores at psychometric questionnaires-MDQ-in particular, predictors of psychopathological outcome during Peg-IFN and RBV therapy in patients with chronic HCV-correlated hepatitis reflecting individual functioning before starting antiviral therapy and positive history for mood disorders, seem to predict psychiatric visit, onset of mood episodes, and need for psychopharmacological treatment. Further investigation is warranted to confirm results.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Psychiatry, Fondazione IRCSS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
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Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525. [PMID: 23076925 DOI: 10.1002/14651858.cd006525.pub2] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES To assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. AUTHORS' CONCLUSIONS Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.
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Affiliation(s)
- Janine Archer
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Thompson L, McCabe R. The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review. BMC Psychiatry 2012; 12:87. [PMID: 22828119 PMCID: PMC3528426 DOI: 10.1186/1471-244x-12-87] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 07/06/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Nonadherence to mental health treatment incurs clinical and economic burdens. The clinician-patient alliance, negotiated through clinical interaction, presents a critical intervention point. Recent medical reviews of communication and adherence behaviour exclude studies with psychiatric samples. The following examines the impact of clinician-patient alliance and communication on adherence in mental health, identifying the specific mechanisms that mobilise patient engagement. METHODS In December 2010, a systematic search was conducted in Pubmed, PsychInfo, Web of Science, Cochrane Library, Embase and Cinahl and yielded 6672 titles. A secondary hand search was performed in relevant journals, grey literature and reference. RESULTS 23 studies met the inclusion criteria for the review. The methodological quality overall was moderate. 17 studies reported positive associations with adherence, only four of which employed intervention designs. 10 studies examined the association between clinician-patient alliance and adherence. Subjective ratings of clinical communication styles and messages were assessed in 12 studies. 1 study examined the association between objectively rated communication and adherence. Meta-analysis was not possible due to heterogeneity of methods. Findings were presented as a narrative synthesis. CONCLUSIONS Clinician-patient alliance and communication are associated with more favourable patient adherence. Further research of observer rated communication would better facilitate the application of findings in clinical practice. Establishing agreement on the tasks of treatment, utilising collaborative styles of communication and discussion of treatment specifics may be important for clinicians in promoting cooperation with regimens. These findings align with those in health communication. However, the benefits of shared decision making for adherence in mental health are less conclusive than in general medicine.
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Affiliation(s)
- Laura Thompson
- Unit for Social and Community Psychiatry, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK
| | - Rose McCabe
- Unit for Social and Community Psychiatry, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK
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Fountoulakis KN, Lekka E, Kouidi E, Chouvarda I, Deligiannis A, Maglaveras N. Development of the Global Disability Scale (Glo.Di.S): preliminary results. Ann Gen Psychiatry 2012; 11:14. [PMID: 22594786 PMCID: PMC3434028 DOI: 10.1186/1744-859x-11-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/24/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The assessment of functioning and disability is an important part of the clinical evaluation, since it measures disease burden and reflects the effectiveness of therapeutic planning and interventions. The aim of the current study was to develop such a self-report instrument on the basis of a review of the literature, and compatible with the WHO approach. MATERIAL AND METHODS The review of the literature led to the development of the Global Disability Scale (Glo.Di.S) with 25 items assessing different aspects of disability. The study sample included 728 persons from vulnerable populations (homeless, jobless, very low income, single parent families etc.; (29.12% males and 70.88% females; aged 55.96 ± 15.22 years). The protocol included also the STAI and the CES-D. The statistical analysis included factor analysis item analysis and ANCOVA. RESULTS The factor analysis revealed the presence of 4 factors explaining 71% of total variance (Everyday functioning, Social and interpersonal functioning, Severity and Mental disability). Chronbach's alpha for the whole scale was 0.95 and for subscales were 0.74-0.94. DISCUSSION The results of the current study suggest that the Glo.Di.S. has the potential to serve as a reliable and valid tool for assessing functioning and disability. Further research is needed to prove that it could be useful across countries, populations and diseases, and whether it provides data that are culturally meaningful and comparable. It can be used in surveys and in clinical research settings and it can generate information of use in evaluating health needs and the effectiveness of interventions to reduce disability and improve health.
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Affiliation(s)
- Konstantinos N Fountoulakis
- Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Pylaia 55535, Greece.
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Holma IAK, Holma KM, Melartin TK, Rytsälä HJ, Isometsä ET. A 5-year prospective study of predictors for disability pension among patients with major depressive disorder. Acta Psychiatr Scand 2012; 125:325-34. [PMID: 22054701 DOI: 10.1111/j.1600-0447.2011.01785.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is a scarcity of prospective long-term studies on work disability caused by depression. We investigated predictors for disability pension among psychiatric patients with MDD. METHOD The Vantaa Depression Study followed up prospectively 269 psychiatric in- and out-patients with DSM-IV MDD for 5 years with a life chart, including 230 (91.3%) patients belonging to labour force. Information on disability pensions was obtained from interviews, patient records and registers. RESULTS Within 5 years, 20% of the patients belonging to labour force at baseline were granted a disability pension. In multivariate analyses, the significant baseline predictors for granted disability pension were age ≥50 years (HR = 3.91, P < 0.001), subjective inability to work (HR = 2.14, P = 0.008) and introversion (HR = 1.08, P = 0.049). When follow-up variables were included, the predictors were age more than 50 (OR = 6.25, P < 0.001), proportion of time spent depressed (OR = 14.6, P < 0.001), number of comorbid somatic disorders (OR = 1.47, P = 0.013) and lack of vocational education (OR = 2.38, P = 0.032). CONCLUSION Of psychiatric patients with depression, one-fifth were granted a disability pension within 5 years. Future disability pension can be predicted by baseline older age, personality factors, functional disability, lack of vocational education and comorbid somatic disorders. Longitudinally, accumulation of time spent depressed appears decisive for pensioning.
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Affiliation(s)
- I A K Holma
- Mood, Depression, and Suicidal Behaviour Unit, National Institute for Health and Welfare, Helsinki, Finland
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Politi MC, Studts JL, Hayslip JW. Shared decision making in oncology practice: what do oncologists need to know? Oncologist 2012; 17:91-100. [PMID: 22234632 DOI: 10.1634/theoncologist.2011-0261] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is growing interest by patients, policy makers, and clinicians in shared decision making (SDM) as a means to involve patients in health decisions and translate evidence into clinical practice. However, few clinicians feel optimally trained to implement SDM in practice, and many patients report that they are less involved than they desire to be in their cancer care decisions. SDM might help address the wide practice variation reported for many preference-sensitive decisions by incorporating patient preferences into decision discussions. METHODS This paper provides a perspective on how to incorporate SDM into routine oncology practice to facilitate patient-centered communication and promote effective treatment decisions. Oncology practice is uniquely positioned to lead the adoption of SDM because of the vast number of preference-sensitive decisions in which SDM can enhance the clinical encounter. RESULTS Clinicians can facilitate cancer decision making by: (a) determining the situations in which SDM is critical; (b) acknowledging the decision to a patient; (c) describing the available options, including the risks, benefits, and uncertainty associated with options; (d) eliciting patients' preferences; and (e) agreeing on a plan for the next steps in the decision-making process. CONCLUSION Given recent policy movements toward incorporating SDM and translating evidence into routine clinical practice, oncologists are likely to continue expanding their use of SDM and will have to confront the challenges of incorporating SDM into their clinical workflow. More research is needed to explore ways to overcome these challenges such that both quality evidence and patient preferences are appropriately translated and incorporated into oncology care decisions.
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Affiliation(s)
- Mary C Politi
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, CB 8100, St. Louis, Missouri 63110, USA.
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Luxton DD, Sirotin AP, Mishkind MC. Safety of telemental healthcare delivered to clinically unsupervised settings: a systematic review. Telemed J E Health 2011; 16:705-11. [PMID: 20583951 DOI: 10.1089/tmj.2009.0179] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The safety of telemental healthcare delivered to clinically unsupervised settings, such as a personal residence, must be established to inform policy and further the dissemination of telemental health programs. The aim of this article is to provide an overview of safety issues associated with telemental healthcare and, through a systematic literature review, evaluate the safety of telemental healthcare delivered to unsupervised settings. The review resulted in a total of nine studies that specifically evaluated the delivery of telemental healthcare to unsupervised settings. Six of the nine studies reviewed explicitly described safety plans or specific precautions that could be used if necessary. Two of the nine studies reported events that required the researchers to use safety procedures to effectively respond to concerns they had regarding participant safety. In both of these studies, the issues were resolved with prescribed safety procedures. Recommendations and future directions for the development and evaluation of safety protocols are discussed.
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Affiliation(s)
- David D Luxton
- The National Center for Telehealth and Technology, Tacoma, Washington 98431, USA.
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Gabriel A, Violato C. Knowledge of and attitudes towards depression and adherence to treatment: the Antidepressant Adherence Scale (AAS). J Affect Disord 2010; 126:388-94. [PMID: 20708273 DOI: 10.1016/j.jad.2010.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 07/17/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Non-adherence to treatment can result from forgetting, carelessness, stopping the drug when feeling worse, or stopping the drug when feeling better. OBJECTIVE To develop and psychometrically assess a brief instrument that can be easily used in clinical practice to measure adherence to antidepressants. METHOD We developed the Antidepressants Adherence Scale (AAS); a self report rating scale including four items to assess the degree to which forgetting, carelessness, and stopping due to feeling worse or feeling better interfere with adherence in the last 4 weeks. Our proposed four-item adherence instrument was developed based on previous research and theory. PARTICIPANTS Experts in mood disorders (n=12) participated in the formal validity assessment of the instrument, and the developed instrument was administered to patients who were prescribed antidepressants (n=63). All patients also completed a multiple choice question instrument to measure knowledge of depression, and a Likert self report questionnaire to assess attitudes towards depression and its treatment. RESULTS There was 90% agreement among experts that the items were highly relevant providing strong evidence for content validity. Also, there was empirical evidence for validity. There were significant correlations (p<0.05) between knowledge and attitude subscales and adherence items. The internal consistency reliability (Cronbach's alpha) was 0.66 for the instrument. CONCLUSION AND SIGNIFICANCE Knowledge of and attitudes to depression and its treatment may have significant impact on the adherence to antidepressants. The AAS can be used in clinical settings (2-3 min to administer) to evaluate patients' adherence to antidepressants.
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Affiliation(s)
- Adel Gabriel
- University of Calgary And Calgary Health region, Canada.
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Perestelo-Perez L, Perez-Ramos J, Gonzalez-Lorenzo M, Rivero-Santana A, Serrano-Aguilar P. Decision aids for patients facing health treatment decisions in Spain: preliminary results. PATIENT EDUCATION AND COUNSELING 2010; 80:364-371. [PMID: 20598470 DOI: 10.1016/j.pec.2010.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 05/30/2010] [Accepted: 06/01/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This study presents ongoing research aimed at understanding the suitability and impact of various decision aids (DAs) on patients with different chronic conditions in the Spanish National Health System. METHODS A three-phase process was employed to develop and evaluate DAs for patients with hip or knee osteoarthritis (OA), benign prostatic hyperplasia (BPH), and depression, including: (1) systematic reviews on the effectiveness of shared decision making (SDM) interventions (including DAs); (2) the development of DAs; (3) a pilot study assessing the DAs. RESULTS Systematic reviews carried out highlight that there are few studies assessing the effectiveness of DAs for OA, BPH, and depression. The development of DAs and their assessment currently differs for each medical condition. The DAs assessed for OA and BHP are well accepted. In a pilot study with OA patients, the DA produced a significant improvement in the decisional conflict "informed" subscale. CONCLUSION Research on SDM and DAs for different chronic conditions is at a very early stage in Spain. It is not possible to draw any definite conclusions about the effectiveness of DAs for clinical practice. PRACTICE IMPLICATIONS It is necessary to conduct more high quality studies to evaluate the effects of DAs in the Spanish context.
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Langlieb AM, Guico-Pabia CJ. Beyond symptomatic improvement:assessing real-world outcomes in patients with major depressive disorder. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12. [PMID: 20694113 DOI: 10.4088/pcc.09r00826blu] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 08/04/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To quantify the negative impact that major depressive disorder (MDD) has on quality of life, disability, and work, family, and overall psychosocial functioning. Available scales that assess these areas of impairment as they relate to patients with MDD are described. DATA SOURCES PUBMED SEARCHES WERE CONDUCTED USING THE FOLLOWING TERMS: (MDD OR major depressive disorder) AND (absenteeism OR absente*); AND (quality of life OR QOL); AND (psychosocial function*); AND (presente* OR presenteeism); AND (health care cost* OR [health care] cost*); AND (health outcome*); AND (functional outcome*); AND (family life); AND (disabil* OR disability); AND (work function*); AND (unemployment OR unemploy*). The literature search was conducted in July 2008 and was restricted to English language articles. There were no limits set on the dates of the search. STUDY SELECTION Two hundred twenty potential articles were identified. Among these studies, 48 presented primary data directly demonstrating the effect of MDD on quality of life, disability, and work, family, and overall psychosocial functioning. DATA EXTRACTION Primary data were compiled from these studies and are summarily described. Available scales that assess quality of life, disability, and work, family, and overall psychosocial functioning are also described. DATA SYNTHESIS MDD was found to be associated with significant disability and declines in functioning and quality of life. The Sheehan Disability Scale, the 36-item Short-Form Health Survey, and the Work Limitations Questionnaire were the most commonly used scales according to this review of the literature, but the majority of studies used direct and indirect disability measures, such as health care and other disability-related costs. CONCLUSIONS In addition to assessing symptomatic outcomes, physicians should routinely assess their depressed patients on "real-world" outcomes. The development of a concise functional outcome measure specific to MDD is necessary for busy clinical practices.
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Affiliation(s)
- Alan M Langlieb
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland and Pfizer Inc, formerly Wyeth Research, Collegeville, Pennsylvania.
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Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J, Vollmer WM. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med 2010; 181:566-77. [PMID: 20019345 PMCID: PMC2841026 DOI: 10.1164/rccm.200906-0907oc] [Citation(s) in RCA: 473] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 12/17/2009] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Poor adherence to asthma controller medications results in poor treatment outcomes. OBJECTIVES To compare controller medication adherence and clinical outcomes in 612 adults with poorly controlled asthma randomized to one of two different treatment decision-making models or to usual care. METHODS In shared decision making (SDM), nonphysician clinicians and patients negotiated a treatment regimen that accommodated patient goals and preferences. In clinician decision making, treatment was prescribed without specifically eliciting patient goals/preferences. The otherwise identical intervention protocols both provided asthma education and involved two in-person and three brief phone encounters. MEASUREMENTS AND MAIN RESULTS Refill adherence was measured using continuous medication acquisition (CMA) indices-the total days' supply acquired per year divided by 365 days. Cumulative controller medication dose was measured in beclomethasone canister equivalents. In follow-up Year 1, compared with usual care, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.46; P < 0.0001) and long-acting beta-agonist adherence (CMA, 0.51 vs. 0.40; P = 0.0225); higher cumulative controller medication dose (canister equivalent, 10.9 vs. 5.2; P < 0.0001); significantly better clinical outcomes (asthma-related quality of life, health care use, rescue medication use, asthma control, and lung function). In Year 2, compared with usual care, SDM resulted in significantly lower rescue medication use, the sole clinical outcome available for that year. Compared with clinician decision making, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.59; P = 0.03) and long-acting beta-agonist adherence (CMA, 0.51 vs. 0.41; P = 0.0143); higher cumulative controller dose (CMA, 10.9 vs. 9.1; P = 0.005); and quantitatively, but not significantly, better outcomes on all clinical measures. CONCLUSIONS Negotiating patients' treatment decisions significantly improves adherence to asthma pharmacotherapy and clinical outcomes. Clinical trials registered with www.clinicaltrials.gov (NCT00217945 and NCT00149526).
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Affiliation(s)
- Sandra R Wilson
- Palo Alto Medical Foundation Research Institute, CA 94301, USA.
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Drake RE, Cimpean D, Torrey WC. Shared decision making in mental health: prospects for personalized medicine. DIALOGUES IN CLINICAL NEUROSCIENCE 2010. [PMID: 20135903 PMCID: PMC3181931 DOI: 10.31887/dcns.2009.11.4/redrake] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper describes the shared decision-making model, reviews its current status in the mental health field, and discusses its potential impact on personalized medicine. Shared decision making denotes a structured process that encourages full participation by patient and provider. Current research shows that shared decision making can improve the participation of mental health patients and the quality of decisions in terms of knowledge and values. The impact of shared decision making on adherence, illness self-management, and health outcomes remains to be studied. Implementing shared decision making broadly will require re-engineering the flow of clinical care in routine practice settings and much greater use of information technology Similar changes will be needed to combine genomic and other biological data with patients' values and preferences and with clinicians' expertise. The future of personalized medicine is dearly linked with our ability to create the infrastructure and cultural receptivity to these changes.
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Affiliation(s)
- Robert E Drake
- Dartmouth Psychiatric Research Center, Lebanon, New Hampshire 03766, USA.
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Abstract
BACKGROUND One person in every four will suffer from a diagnosable mental health condition during their life course. Such conditions can have a devastating impact on the lives of the individual, their family and society. Increasingly partnership models of mental health care have been advocated and enshrined in international healthcare policy. Shared decision making is one such partnership approach. Shared decision making is a form of patient-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This is advocated on the basis that patients have a right to self-determination and also in the expectation that it will increase treatment adherence. OBJECTIVES To assess the effects of provider-, consumer- or carer-directed shared decision making interventions for people of all ages with mental health conditions, on a range of outcomes including: patient satisfaction, clinical outcomes, and health service outcomes. SEARCH STRATEGY We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2008, Issue 4), MEDLINE (1950 to November 2008), EMBASE (1980 to November 2008), PsycINFO (1967 to November 2008), CINAHL (1982 to November 2008), British Nursing Index and Archive (1985 to November 2008) and SIGLE (1890 to September 2005 (database end date)). We also searched online trial registers and the bibliographies of relevant papers, and contacted authors of included studies. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-randomised controlled trials (q-RCTs), controlled before-and-after studies (CBAs); and interrupted time series (ITS) studies of interventions to increase shared decision making in people with mental health conditions (by DSM or ICD-10 criteria). DATA COLLECTION AND ANALYSIS Data on recruitment methods, eligibility criteria, sample characteristics, interventions, outcome measures, participant flow and outcome data from each study were extracted by one author and checked by another. Data are presented in a narrative synthesis. MAIN RESULTS We included two separate German studies involving a total of 518 participants. One study was undertaken in the inpatient treatment of schizophrenia and the other in the treatment of people newly diagnosed with depression in primary care. Regarding the primary outcomes, one study reported statistically significant increases in patient satisfaction, the other study did not. There was no evidence of effect on clinical outcomes or hospital readmission rates in either study. Regarding secondary outcomes, there was an indication that interventions to increase shared decision making increased doctor facilitation of patient involvement in decision making, and did not increase consultation times. Nor did the interventions increase patient compliance with treatment plans. Neither study reported any harms of the intervention. Definite conclusions cannot be drawn, however, on the basis of these two studies. AUTHORS' CONCLUSIONS No firm conclusions can be drawn at present about the effects of shared decision making interventions for people with mental health conditions. There is no evidence of harm, but there is an urgent need for further research in this area.
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Affiliation(s)
- Edward Duncan
- The University of StirlingNursing, Midwifery and Allied Health Professions Research UnitIris Murdoch BuildingStirlingScotlandUKFK9 4LA
| | - Catherine Best
- The University of StirlingNursing, Midwifery and Allied Health Professions Research UnitIris Murdoch BuildingStirlingScotlandUKFK9 4LA
| | - Suzanne Hagen
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitGlasgowUKG4 0BA
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Knapp C, Huang IC, Madden V, Vadaparampil S, Quinn G, Shenkman E. An evaluation of two decision-making scales for children with life-limiting illnesses. Palliat Med 2009; 23:518-25. [PMID: 19346274 PMCID: PMC3810449 DOI: 10.1177/0269216309104892] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Annually, about 500,000 children are coping with life-limiting illnesses. Many of these children could benefit from pediatric palliative care which provides supportive services. These services can also aid parents in decision making. In order to measure the effect of pediatric palliative care programs on decision making, a valid and reliable tool must be identified. This study aims to validate the psychometric properties of the Decisional Conflict Scale (DCS) and the COMRADE instruments for children with life-limiting illnesses. METHODS Analyses were conducted using survey data collected from 266 parents whose Medicaid enrolled children have life-limiting illnesses. RESULTS Results of the analyses suggest that the DCS has better psychometric properties for measuring decision making within the population of children with life-limiting illnesses than the COMRADE. CONCLUSION Pediatric palliative care programs should use the DCS to measure the effectiveness of services aimed at supporting families with high levels of decisional conflict.
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Affiliation(s)
- C Knapp
- Department of Epidemiology, University of Florida, Gainesville, Florida 32610, USA.
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Beaucage C, Cardinal L, Kavanagh M, Aubé D. [Major depression in primary care and clinical impacts of treatment strategies: a literature review]. SANTE MENTALE AU QUEBEC 2009; 34:77-100. [PMID: 19475195 DOI: 10.7202/029760ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Major or clinical depression represents a frequent mental illness that is often associated with a high level of morbidity and mortality. Yet, major depression remains under-diagnosed and under-treated. On the level of treatment, it would appear desirable for reasons of better prognosis, to aim more than the simple reduction of depressive symptoms and target their remission resolutely and the fastest return to the individual's optimal functioning. This article presents a systematic review of the literature relating to the clinical impacts of treatment strategies aiming at the improvement of services offered to people who suffer of clinical depression and who consult in primary care. The authors summarize results drawn from 41 studies that include a measurement of the clinical impacts (reduction of symptoms, response, remission and functioning) of various treatment strategies. It appears that using complex treatment strategies favour positive outcomes. The authors propose various paths of research to further increase current knowledge.
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McKnight PE, Kashdan TB. The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research. Clin Psychol Rev 2009; 29:243-59. [PMID: 19269076 PMCID: PMC2814224 DOI: 10.1016/j.cpr.2009.01.005] [Citation(s) in RCA: 243] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 12/12/2008] [Accepted: 01/21/2009] [Indexed: 11/22/2022]
Abstract
Outcomes in depression treatment research include both changes in symptom severity and functional impairment. Symptom measures tend to be the standard outcome but we argue that there are benefits to considering functional outcomes. An exhaustive literature review shows that the relationship between symptoms and functioning remains unexpectedly weak and often bidirectional. Changes in functioning often lag symptom changes. As a result, functional outcomes might offer depression researchers more critical feedback and better guidance when studying depression treatment outcomes. The paper presents a case for the necessity of both functional and symptom outcomes in depression treatment research by addressing three aims-1) review the research relating symptoms and functioning, 2) provide a rationale for measuring both outcomes, and 3) discuss potential artifacts in measuring functional outcomes. The three aims are supported by an empirical review of the treatment outcome and epidemiological literatures.
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Affiliation(s)
- Patrick E McKnight
- Department of Psychology, George Mason University, MSN 3F5, 4400 University Drive, Fairfax, VA 22030-4400, United States.
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Maurer J, Rebbapragada V, Borson S, Goldstein R, Kunik ME, Yohannes AM, Hanania NA. Anxiety and depression in COPD: current understanding, unanswered questions, and research needs. Chest 2008; 134:43S-56S. [PMID: 18842932 DOI: 10.1378/chest.08-0342] [Citation(s) in RCA: 457] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Approximately 60 million people in the United States live with one of four chronic conditions: heart disease, diabetes, chronic respiratory disease, and major depression. Anxiety and depression are very common comorbidities in COPD and have significant impact on patients, their families, society, and the course of the disease. METHODS We report the proceedings of a multidisciplinary workshop on anxiety and depression in COPD that aimed to shed light on the current understanding of these comorbidities, and outline unanswered questions and areas of future research needs. RESULTS Estimates of prevalence of anxiety and depression in COPD vary widely but are generally higher than those reported in some other advanced chronic diseases. Untreated and undetected anxiety and depressive symptoms may increase physical disability, morbidity, and health-care utilization. Several patient, physician, and system barriers contribute to the underdiagnosis of these disorders in patients with COPD. While few published studies demonstrate that these disorders associated with COPD respond well to appropriate pharmacologic and nonpharmacologic therapy, only a small proportion of COPD patients with these disorders receive effective treatment. CONCLUSION Future research is needed to address the impact, early detection, and management of anxiety and depression in COPD.
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Abstract
The similar efficacies of currently available antipsychotic medications (other than clozapine) make them appropriate for preference-sensitive care; therefore, prescribing these medications is amenable to shared decision-making. In this conceptual article, we describe the current state of antipsychotic prescribing based on a review of the literature from recent landmark studies and updated prescribing guidelines. Recent literature and guidelines on schizophrenia treatment in the United States do not reveal strong endorsement of the idea of shared decision-making. We suggest methods for incorporating shared decision-making into antipsychotic prescribing in the future, with an emphasis on the use of information technology.
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Abstract
BACKGROUND People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications, but also might increase their adverse effects. OBJECTIVES To update a review summarizing the results of randomized controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, including mental disorders but not addictions. SEARCH STRATEGY We updated searches of The Cochrane Library, MEDLINE, CINAHL, EMBASE, International Pharmaceutical Abstracts (IPA), PsycINFO (all via OVID) and Sociological Abstracts (via CSA) in January 2007 with no language restriction. We also reviewed bibliographies in articles on patient adherence and articles in our personal collections, and contacted authors of relevant original and review articles. SELECTION CRITERIA Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings. DATA COLLECTION AND ANALYSIS Study design features, interventions and controls, and results were extracted by one review author and confirmed by at least one other review author. We extracted adherence rates and their measures of variance for all methods of measuring adherence in each study, and all outcome rates and their measures of variance for each study group, as well as levels of statistical significance for differences between study groups, consulting authors and verifying or correcting analyses as needed. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Therefore, we did not feel that quantitative analysis was scientifically justified; rather, we conducted a qualitative analysis. MAIN RESULTS For short-term treatments, four of ten interventions reported in nine RCTs showed an effect on both adherence and at least one clinical outcome, while one intervention reported in one RCT significantly improved patient adherence, but did not enhance the clinical outcome. For long-term treatments, 36 of 81 interventions reported in 69 RCTs were associated with improvements in adherence, but only 25 interventions led to improvement in at least one treatment outcome. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes. AUTHORS' CONCLUSIONS For short-term treatments several quite simple interventions increased adherence and improved patient outcomes, but the effects were inconsistent from study to study with less than half of studies showing benefits. Current methods of improving adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. High priority should be given to fundamental and applied research concerning innovations to assist patients to follow medication prescriptions for long-term medical disorders.
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Affiliation(s)
- R B Haynes
- McMaster University, Clinical Epidemiology & Biostatistics and Medicine, Faculty of Health Sciences, 1200 Main Street West, Rm. 2C10B, Hamilton, Ontario, Canada L8N 3Z5.
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Loh A, Simon D, Wills CE, Kriston L, Niebling W, Härter M. The effects of a shared decision-making intervention in primary care of depression: a cluster-randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2007; 67:324-32. [PMID: 17509808 DOI: 10.1016/j.pec.2007.03.023] [Citation(s) in RCA: 250] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 03/30/2007] [Accepted: 03/30/2007] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Patient-centred depression care approaches should better address barriers of insufficient patient information and involvement in the treatment decision process. Additional research is needed to test the effect of increased patient participation on outcomes. The aim of this study was to assess, if patient participation in decision-making via a shared decision-making intervention leads to improved treatment adherence, satisfaction, and clinical outcome without increasing consultation time. METHODS Cluster-randomized controlled intervention study based on physician training and patient-centered decision aid compared to usual care in primary care settings in Südbaden region of Germany. Twenty-three primary care physicians treating 405 patients with newly diagnosed depression were enrolled. Patient involvement was measured with the patient perceived involvement in care scale (PICS) and a patient participation scale (MSH-scale). Patient satisfaction was measured by the CSQ-8 questionnaire. Treatment adherence was evaluated by patient and provider self-report. Depression severity and remission outcomes were assessed with the Brief PHQ-D. RESULTS Physician facilitation of patient participation improved significantly and to a greater extent in the intervention compared to the control group. There was no intervention effect for depression severity reduction. Doctor facilitation of patient participation, patient-rated involvement, and physician assessment of adherence improved only in the intervention group. Patient satisfaction at post-intervention was higher in the intervention group compared to the control group. The consultation time did not differ between groups. CONCLUSION A shared decision-making intervention was better than usual care for improving patient participation in treatment decision-making, and patient satisfaction without increasing consultation time. Additional research is needed to model causal linkages in the decision-making process in regard to outcomes. PRACTICE IMPLICATIONS The study results encourage the implementation of patient participation in primary care of depression.
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Affiliation(s)
- Andreas Loh
- University Hospital of Freiburg, Department of Psychiatry and Psychotherapy, Section Clinical Epidemiology and Health Services Research, Freiburg, Germany.
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Rytsälä HJ, Melartin TK, Leskelä US, Sokero TP, Lestelä-Mielonen PS, Isometsä ET. Predictors of long-term work disability in Major Depressive Disorder: a prospective study. Acta Psychiatr Scand 2007; 115:206-13. [PMID: 17302620 DOI: 10.1111/j.1600-0447.2006.00878.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Major Depressive Disorder (MDD) is a major cause of long-term work disability. However, factors predicting this are not well known. METHOD In the Vantaa Depression Study, predictors for being granted a disability pension during an 18-month follow-up were examined among the 186 psychiatric MDD in- and out-patients belonging to the labour force at baseline. RESULTS The 21 patients (11.3%) granted a disability pension were significantly older, more hopeless, had worse social and occupational functioning, and spent more time depressed during follow-up. After adjusting for these predictors, being on sick leave at baseline still strongly predicted disability pension during follow-up. CONCLUSION Disability pension is predicted by multiple sociodemographic and clinical factors. Baseline level of functioning and duration of depressive episodes are key clinical predictors. The positive and negative consequences of sick leave warrant closer attention.
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Affiliation(s)
- H J Rytsälä
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
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Donohue JM, Pincus HA. Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. PHARMACOECONOMICS 2007; 25:7-24. [PMID: 17192115 DOI: 10.2165/00019053-200725010-00003] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Depression is a highly prevalent condition that results in substantial functional impairment. Advocates have attempted in recent years to make the 'business case' for investing in quality improvement efforts in depression care, particularly in primary care settings. The business case suggests that the costs of depression treatment may be offset by gains in worker productivity and/or reductions in other healthcare spending. In this paper, we review the evidence in support of this argument for improving the quality of depression treatment. We examined the impact of depression on two of the primary drivers of the societal burden of depression: healthcare utilisation and worker productivity. Depression leads to higher healthcare utilisation and spending, most of which is not the result of depression treatment costs. Depression is also a leading cause of absenteeism and reduced productivity at work. It is clear that the economic burden of depression is substantial; however, critical gaps in the literature remain and need to be addressed. For instance, we do not know the economic burden of untreated and/or inappropriately treated versus appropriately treated depression. There remain considerable problems with access to and quality of depression treatment. Progress has been made in terms of access to care, but quality of care is seldom consistent with national treatment guidelines. A wide range of effective treatments and care programmes for depression are available, yet rigorously tested clinical models to improve depression care have not been widely adopted by healthcare systems. Barriers to improving depression care exist at the patient, healthcare provider, practice, plan and purchaser levels, and may be both economic and non-economic. Studies evaluating interventions to improve the quality of depression treatment have found that the cost per QALY associated with improved depression care ranges from a low of 2519 US dollars to a high of 49,500 US dollars. We conclude from our review of the literature that effective treatment of depression is cost effective, but that evidence of a medical or productivity cost offset for depression treatment remains equivocal, and this points to the need for further research in this area.
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Affiliation(s)
- Julie M Donohue
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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Loh A, Leonhart R, Wills CE, Simon D, Härter M. The impact of patient participation on adherence and clinical outcome in primary care of depression. PATIENT EDUCATION AND COUNSELING 2007; 65:69-78. [PMID: 17141112 DOI: 10.1016/j.pec.2006.05.007] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Revised: 05/18/2006] [Accepted: 05/20/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Patient participation in shared treatment decision-making is hypothesized to improve depression treatment adherence and clinical outcomes in depressed patients. The study aim was to evaluate the impact of patient participation on these factors and to determine the variance of clinical outcome as the primary outcome variable. METHODS A survey was administered to 30 general practitioners and 207 depressed patients, at initial consultation and 6-8 weeks later. General practitioners documented their clinical practice and patients completed questionnaires including Brief-PHQ for depression and clinical outcome, patient participation scale, and visual analogue scales for treatment adherence. Assessment of correlations was followed by the development of a structural equation model (as a latent variable analysis) to define a model to explain the entire set of the variables' relationships. RESULTS Sixty percent of the variance in clinical outcome was attributable to patient adherence (beta=0.41) and baseline depression severity (beta=0.65). Depression severity predicted clinical outcome but not patient participation. Participation predicted adherence (beta=0.39) but did not directly affect clinical outcome. Adherence was explainable by physician- (beta=0.57) and patient-reported treatment adherence (beta=0.66). CONCLUSION In a specific pathway via adherence, patient participation in decision-making influences clinical outcome in primary care of depression. PRACTICE IMPLICATIONS The research findings reveal the significance of patient participation as a key factor to address for improving treatment adherence and clinical outcome. Quality improvement strategies for depression treatment should emphasize patient participation.
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Affiliation(s)
- Andreas Loh
- University Hospital of Freiburg, Department of Psychiatry and Psychotherapy, Section Clinical Epidemiology and Health Services Research, D-79104 Freiburg, Germany.
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