scholarly journals Effectiveness and cost effectiveness of interpersonal community psychiatric treatment (ICPT) for people with long-term severe non-psychotic mental disorders: a multi-Centre randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mark van Veen ◽  
Bauke Koekkoek ◽  
Steven Teerenstra ◽  
Eddy Adang ◽  
Cornelis L. Mulder
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Cost Effectiveness ◽  
Community Mental Health ◽  
Mental Health Treatment ◽  
Psychiatric Treatment ◽  
Illness Management ◽  
Illness Management And Recovery ◽  
Perceived Difficulty

Abstract Background Long-term community mental health treatment for non-psychotic disorder patients with severe mental illness (SMI) who are perceived as difficult by clinicians, is poorly developed and lacks a structured, goal-centred approach. This study compares (cost-)effectiveness of Interpersonal Community Psychiatric Treatment (ICPT) with Care As Usual (CAU) on quality of life and clinician perceived difficulty in the care for non-psychotic disorder SMI-patients. A multi-centre cluster-randomized clinical tria was conducted in which Community Mental Health Nurses (Clinicians) in three large community mental health services in the Netherlands were randomly allocated to providing either ICPT or CAU to included patients. A total of 56 clinicians were randomized, who treated a total of 93 patients (59 in ICPT-group and 34 in CAU-group). Methods Primary outcome measure is patient-perceived quality of life as measured by the Manchester Short Assessment of Quality of Life (MANSA). Secondary outcome measures include clinician-perceived difficulty, general mental health, treatment outcomes, illness management and recovery, therapeutic relationship, care needs and social network. Patients were assessed at baseline, during treatment (6 months), after treatment (12 months) and at 6 months follow-up (18 months). Linear mixed-effects models for repeated measurements were used to compare mean changes in primary and secondary outcomes between intervention and control group of patients over time on an intention to treat basis. Potential efficiency was investigated from a societal perspective. Economic evaluation was based on general principles of a cost-effectiveness analysis. Outcome measures for health economic evaluation, were costs, and Quality Adjusted Life Years (QALYs). Results Half of the intended number of patients were recruited. There was no statistically significant treatment effect found in the MANSA (0.17, 95%-CI [− 0.058,0.431], p = 0.191). Treatment effects showed significant improvement in the Different Doctor-Patient Relationship Questionnaire-scores and a significant increase in the Illness Management and Recovery–scale Client-version scores). No effects of ICPT on societal and medical costs nor QALYs were found. Conclusions This is the first RCT to investigate the (cost)-effectiveness of ICPT. Compared with CAU, ICPT did not improve quality of life, but significantly reduced clinician-perceived difficulty, and increased subjective illness management and recovery. No effects on costs or QALY’s were found. Trial registration NTR 3988, registered 13 May 2013.

scholarly journals The impact of routine outcome measurement on treatment processes in community mental health care: approach and methods of the MECCA study

2002 ◽  
Vol 11 (3) ◽  
pp. 198-205 ◽  
Author(s):  
Stefan Priebe ◽  
Rosemarie McCabe ◽  
Jens Bullenkamp ◽  
Lars Hansson ◽  
Wulf Rössler ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Health Care ◽  
Community Mental Health ◽  
Mental Health Care ◽  
Psychotic Disorders ◽  
Outcome Measurement ◽  
Treatment Decisions ◽  
Community Mental Health Care

SUMMARYThree issues characterise the background to the MECCA study: A) Throughout Europe, most patients with severe forms of psychotic disorders are cared for in the community. The challenge now is to make processes in community mental health care more effective. B) There are widespread calls to implement regular outcome measurement in routine settings. This, however, is more likely to happen, if it provides a direct benefit to clinicians and patients. C) Whilst user involvement is relatively ?" easy to achieve on a political level, new mechanisms may have to be established to make the views of patients feed into individual treatment decisions. The MECCA study is a cluster randomised controlled trial following the same protocol in community mental health teams in six European countries. In the experimental group, patients' subjective quality of life, treatment satisfaction and wishes for different or additional help are assessed in key worker-patient meetings every two months and intended to inform the therapeutic dialogue and treatment decisions. The trial tests the hypothesis that the intervention – as compared to current best standard practice – will lead to a better outcome in terms of quality of life and other criteria in patients with psychotic disorders over a one year period. This more favourable outcome is assumed to be mediated through different treatment input based on more appropriate joint decisions or a more positive therapeutic relationship in line with a partnership model of care or both. Moreover, the study will hopefully reveal new insights into how therapeutic processes in community mental health care work and how they can be optimised.

Unmet mental health needs in patients with advanced B-cell lymphomas

2021 ◽  
pp. 1-6
Author(s):  
Chrystal Marte ◽  
Login S. George ◽  
Sarah C. Rutherford ◽  
Daniel Jie Ouyang ◽  
Peter Martin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Mental Health Service ◽  
B Cell ◽  
Mental Health Treatment ◽  
Health Service Utilization ◽  
Mental Health Service Utilization ◽  
B Cell Lymphomas ◽  
Health Treatment

Abstract Context Existing research on psychological distress and mental health service utilization has focused on common types of solid tumor cancers, leaving significant gaps in our understanding of patients experiencing rare forms of hematologic cancers. Objective To examine distress, quality of life, and mental health service utilization among patients with aggressive, refractory B-cell lymphomas. Method Patients (n = 26) with B-cell lymphomas that relapsed after first- or second-line treatment completed self-report measures of distress (Hospital Anxiety and Depression Scale) and quality of life (Short-Form Health Survey, SF-12). Patients also reported whether they had utilized mental health treatment since their cancer diagnosis. Results Approximately 42% (n = 11) of patients reported elevated levels of psychological distress. Of patients with elevated distress, only one quarter (27.2%; n = 3) received mental health treatment, while more than half did not receive mental health treatment (54.5%; n = 6), and 18.1% (n = 2) did not want treatment. Patients with elevated distress reported lower mental quality of life than patients without elevated distress [F (1, 25) = 15.32, p = 0.001]. Significance of the results A significant proportion of patients with advanced, progressive, B-cell lymphomas may experience elevated levels of distress. Yet, few of these distressed patients receive mental health treatment. Findings highlight the need to better identify and address barriers to mental health service utilization among patients with B-cell lymphoma, including among distressed patients who decline treatment.

How do Symptoms and Level of Functioning Affect the Quality of Life in Schizophrenia? a Study on the Community Mental Health Centre of Ferrara (Italy)

2011 ◽  
Vol 26 (S2) ◽  
pp. 1389-1389
Author(s):  
A. Galuppi ◽  
M.C. Turola ◽  
M.G. Nanni ◽  
P. Mazzoni ◽  
L. Grassi
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Community Mental Health ◽  
Social Functioning ◽  
Psychiatric Symptoms ◽  
Health Centre ◽  
Community Mental Health Centre ◽  
Level Of Functioning ◽  
Mental Health Centre

IntroductionA specific interest regarding quality of life(QoL) of patients with schizophrenia dates back to the de-institutionalisation process. Italy worked on decentralising its mental health services since 1978. It was apparent that capturing psychopathological symptoms alone was not sufficient to reflect relevant outcomes. In particular, information on the social functioning and quality of life is regarded as essential for evaluating long-term outcomes.ObjectiveThe relationship between Quality of life and global functioning and symptoms in outpatients with Schizophrenia.MethodIn the present study we examined all the subjects with a diagnosis of schizophrenia attending a same Community Mental Health Centre in Northern Italy, in 2008. Each patient completed the WHO QoL Instrument - Brief and was administerd the Brief Psychiatric Rating Scale-24 to assess psychiatric symptoms and the VADO Personal and social Functioning Scale to assess the level of functioning.ResultsThe population studied subjects showed an intermediate satisfaction on the overall QoL and health; these data can be juxtaposed to the national standard sample rates. QoL resulted positively associated to personal and social functioning, while it was negatively related to psychiatric symptoms.ConclusionThe QoL in our study is not extremely negative, though schizophrenia is an often an impairing chronic illness. Furthermore, the present research on social functioning, psychiatric symptoms and QoL in people with schizophrenia suggest that symptoms, but, above all, personal and social functioning are important elements to determine QoL. These studies point to the importance of looking beyond symptom-reduction strategies for improving QoL in schizophrenia.

scholarly journals Organization of Community Mental Health Services for Persons with a Severe Mental Illness and Comorbid Somatic Conditions: A Systematic Review on Somatic Outcomes and Health Related Quality of Life

2021 ◽  
Vol 18 (2) ◽  
pp. 462
Author(s):  
Nicolaas Martens ◽  
Marianne Destoop ◽  
Geert Dom
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Systematic Review ◽  
Mental Illness ◽  
Community Mental Health ◽  
Severe Mental Illness ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

It is well established that persons with a severe mental illness (SMI) have a greater risk of physical comorbid conditions and premature mortality. Most studies in the field of community mental health care (CMHC) have only focused on improving cardiovascular health in people with a SMI using lifestyle approaches. Studies using organizational modifications are rather scarce. This systematic review aimed to synthesize and describe possible organizational strategies to improve physical health for persons with a SMI in CMHC. The primary outcome was Health-related Quality of Life (HR-QOL). Results suggested modest effects on quality of life and were inconsistent throughout all the included studies. Despite these findings, it appears that a more integrated approach had a positive effect on health outcomes, patient satisfaction and HR-QOL. The complexity of the processes involved in community care delivery makes it difficult to compare different models and organizational approaches. Mental health nurses were identified as possible key professionals in care organization, but no clear description of their role was found. This review could provide new insights into contributing factors for integrated care. Future research targeting the identification of the nurses’ role and facilitating factors in integrated care, in order to improve treatment and follow-up of somatic comorbidities, is recommended.

scholarly journals Re-thinking reablement strategies for older adults in residential aged care: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lucy K. Lewis ◽  
Tim Henwood ◽  
Jo Boylan ◽  
Sarah Hunter ◽  
Belinda Lange ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Older Adults ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Physical Function ◽  
Aged Care ◽  
Residential Aged Care ◽  
Controlled Trials

Abstract Background The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults’ physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness). Method This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored. Results Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness. Conclusions There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted. Trial registration Prospectively registered review protocol (Open Science Framework: DOI 10.17605/OSF.IO/7NX9M).

Sign in / Sign up

Export Citation Format

Share Document