scholarly journals Structured patient–clinician communication and 1-year outcome in community mental healthcare

2007 ◽  
Vol 191 (5) ◽  
pp. 420-426 ◽  
Author(s):  
Stefan Priebe ◽  
Rosemarie McCabe ◽  
Jens Bullenkamp ◽  
Lars Hansson ◽  
Christoph Lauber ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Treatment Satisfaction ◽  
Unmet Needs ◽  
Controlled Trial ◽  
Mental Healthcare ◽  
Subjective Quality ◽  
Subjective Quality Of Life ◽  
Needs For Care ◽  
Clinician Communication

BackgroundPatient–clinician communication is central to mental healthcare but neglected in research.AimsTo test a new computer-mediated intervention structuring patient–clinician dialogue (DIALOG) focusing on patients' quality of life and needs for care.MethodIn a cluster randomised controlled trial, 134 keyworkers in six countries were allocated to DIALOG or treatment as usual; 507 people with schizophrenia or related disorders were included. Every 2 months for 1 year, clinicians asked patients to rate satisfaction with quality of life and treatment, and request additional or different support. Responses were fed back immediately in screen displays, compared with previous ratings and discussed. Primary outcome was subjective quality of life, and secondary outcomes were unmet needs and treatment satisfaction.ResultsOf 507 patients, 56 were lost to follow-up and 451 were included in intention-to-treat analyses. Patients receiving the DIALOG intervention had better subjective quality of life, fewer unmet needs and higher treatment satisfaction after 12 months.ConclusionsStructuring patient–clinician dialogue to focus on patients' views positively influenced quality of life, needs for care and treatment satisfaction.

scholarly journals The effect on subjective quality of life of occupational therapy based on adjusting the challenge–skill balance: a randomized controlled trial

2019 ◽  
Vol 33 (11) ◽  
pp. 1732-1746
Author(s):  
Ippei Yoshida ◽  
Kazuki Hirao ◽  
Ryuji Kobayashi
Keyword(s):  
Quality Of Life ◽  
Occupational Therapy ◽  
Controlled Trial ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Subjective Quality ◽  
Subjective Quality Of Life ◽  
Rehabilitation Process ◽  
And Control

Objective: To verify the effect of adjusting the challenge–skill balance with respect to rehabilitation process. Design: A single-blind, two-arm, parallel-group, randomized controlled trial. Setting: Recovery rehabilitation unit of Harue Hospital, Japan. Subjects: The trial included 72 clients (mean (SD): age, 74.64 (9.51) years; Functional Independence Measure score, 98.26 (15.27)) with cerebral or spinal disease or musculoskeletal disease. Interventions: Clients were randomly divided into two groups: the experimental group, who received occupational therapy with adjustment of the challenge–skill balance, and the control group who received conventional occupational therapy. Time from admission to discharge was considered the implementation period; the final evaluation was conducted at three months after discharge. Main measures: The primary outcome was subjective quality of life (Ikigai-9). Secondary outcomes were the health-related quality of life (EuroQol–5 Dimensions, Five Levels (EQ-5D-5L)), the Flow State Scale for Occupational Tasks, and the Functional Independence Measure. A cost-effectiveness analysis was conducted using total cost and quality-adjusted life-year based on the EQ-5D-5L. Results: Significant differences were observed between the experimental and control groups with respect to the Ikigai-9 score ( P = 0.008) and EQ-5D-5L ( P = 0.038), and the effect sizes were 0.76 (95% confidence interval [CI]: 0.27–1.24) and 0.62 (95% CI: 0.14–1.10), respectively. No significant between-group differences in other outcomes were observed, for example, the Functional Independence Measure score improved in both experimental and control groups (119.80 (5.50) and 118.84 (6.97), respectively. The incremental cost-effectiveness ratio was US$5518.38. Conclusions: Adjusting the challenge–skill balance may be a useful approach to improve the participant’s subjective quality of life in the rehabilitation process.

Predictors of quality of life in people with severe mental illness

1999 ◽  
Vol 175 (5) ◽  
pp. 426-432 ◽  
Author(s):  
Thomas Fahy ◽  
Andy Kent ◽  
Theresa Tattan ◽  
Elizabeth Van Horn ◽  
Ian White
Keyword(s):  
Quality Of Life ◽  
Mental Illness ◽  
Case Management ◽  
Severe Mental Illness ◽  
Unmet Needs ◽  
Subjective Quality ◽  
Improve Quality ◽  
Subjective Quality Of Life ◽  
Clinical Variables

BackgroundIt is not clear which model of case management is most likely to improve quality of life in people with severe mental illness.AimsTo use baseline data derived from the UK700 Case Management Trial to assess the relative importance of clinical, social and unmet needs variables as predictors of subjective quality of life in patients with severe mental illness.MethodPatients (n=708) were assessed on quality of life (Lancashire Quality of Life Profile), needs (Camber well Assessment of Need), psychopathology and social functioning. Variables that were amenable to change through case management were investigated as predictors of quality of life.ResultsSocial variables accounted for 7% of the variance for subjective quality of life, compared with 19% for clinical variables, and 20% for unmet needs. The strongest predictors of subjective quality of life were unmet basic, social and functioning needs, depression and positive psychotic symptoms.ConclusionsSubjective quality of life in severely mentally ill patients is predicted by clinical variables and unmet needs. The results identify priority areas for the attention of case managers who seek to improve quality of life in these patients.

scholarly journals Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care

2006 ◽  
Vol 188 (3) ◽  
pp. 243-249 ◽  
Author(s):  
Stefan Priebe ◽  
Gemma Jones ◽  
Rosemarie McCabe ◽  
Jane Briscoe ◽  
Donna Wright ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Care ◽  
Treatment Satisfaction ◽  
Psychiatric Treatment ◽  
Subjective Quality ◽  
Hospital Treatment ◽  
Day Hospital ◽  
Subjective Quality Of Life

BackgroundData on effectiveness of acute day hospital treatment for psychiatric illness are inconsistent.AimsTo establish the effectiveness and costs of care in a day hospital providing acute treatment exclusively.MethodIn a randomised controlled trial, 206 voluntarily admitted patients were allocated to either day hospital treatment or conventional wards. Psychopathology, treatment satisfaction and subjective quality of life at discharge, 3 months and 12 months after discharge, readmissions to acute psychiatric treatment within 3 and 12 months, and costs in the index treatment period were taken as outcome criteria.ResultsDay hospital patients showed significantly more favourable changes in psychopathology at discharge but not at follow-up. They also reported higher treatment satisfaction at discharge and after 3 months, but not after 12 months. There were no significant differences in subjective quality of life or in readmissions during follow-up. Mean total support costs were higher for the day hospital group.ConclusionsDay hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the short term and generates greater patient satisfaction than conventional in-patient care, but may be more costly.

scholarly journals Quality of Life and Treatment Satisfaction of Hospitalized and Day Hospital Psychiatric Patients

2021 ◽  
Vol 5 (1) ◽  
pp. 5-16
Author(s):  
Janja Vranješ ◽  
Daniela Petrić ◽  
Tanja Grahovac Juretić ◽  
Zdravko Tovilović
Keyword(s):  
Quality Of Life ◽  
Treatment Satisfaction ◽  
Psychiatric Hospitals ◽  
Subjective Quality ◽  
University Hospital ◽  
Psychiatric Ward ◽  
Day Hospital ◽  
Subjective Quality Of Life ◽  
Hospital Patients

Introduction. Day hospitals are becoming an increasingly common method of treatment for people with mental disorders in many Croatian psychiatric hospitals, but research examining their effectiveness is still rare. Aim. The aim of this study was to compare treatment satisfaction and quality of life between patients enrolled in a day hospital program and patients hospitalized on a psychiatric ward. Methods. The study design was cross-sectional with two outcome measures: treatment satisfaction and quality of life. The study sample consisted of 120 adult patients of the Clinic for Psychiatry of the University Hospital Centre Rijeka. The first group consisted of 60 patients included in the day hospital psychosocial program, while the second group consisted of 60 patients hospitalized on the inpatient ward. Results. Day hospital patients reported a significantly higher level of overall treatment satisfaction compared to hospitalized patients (mean rank: 55 vs. 17, p=0.000) and were significantly more satisfied in four out of seven different treatment domains: the explanations about treatment (mean rank: 68 vs. 53, p=0.013), carefulness and precision of medical examination (mean rank: 72 vs. 49, p=0.000), choices about treatment (mean rank: 67 vs. 57, p=0.027) and feeling of respect (mean rank: 68 vs. 53, p=0.010). Day hospital patients also reported a significant psychopaly higher level of overall subjective quality of life (mean: 4.26 vs. 3.71, p=0.005), being more satisfied with life in general (mean rank: 68 vs. 53, p=0,018), financial situation (mean rank: 67 vs. 54, p=0.046), accommodation (mean rank: 67 vs. 54, p=0.041), personal safety (mean rank: 68 vs. 53, p=0.014), people they live with or living alone (mean rank: 71 vs. 50, p=0.001), relationship with their family (mean rank: 49 vs. 53, p=0.000) and their mental health (mean rank: 69 vs. 52, p=0.008). Conclusion. Patients treated in the day hospital differed in the observed variables from those hospitalized on the ward, reporting higher levels of treatment satisfaction and higher subjective quality of life. Future studies should focus on different segments of day hospital programs and a broader set of outcomes.

Patterns and predictors of trajectories for subjective quality of life in patients with early psychosis: Three-year follow-up of the randomized controlled trial on extended early intervention

2021 ◽  
pp. 000486742110096
Author(s):  
Candice Tze Kwan Kam ◽  
Wing Chung Chang ◽  
Vivian Wing Yan Kwong ◽  
Emily Sin Ki Lau ◽  
Gloria Hoi Kei Chan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Early Intervention ◽  
Controlled Trial ◽  
Subjective Quality ◽  
Subjective Quality Of Life ◽  
Randomized Controlled ◽  
Life Trajectory

Objective: Subjective quality of life is an important outcome of psychotic disorders. However, longitudinal course of subjective quality of life in the early illness stage is under-studied. We aimed to investigate the patterns and baseline predictors of subjective quality of life trajectories over 3 years in early psychosis patients, utilizing growth mixing modeling analysis, in the context of a 3-year follow-up of a randomized controlled trial comparing 1-year extension of early intervention with step-down psychiatric care for first-episode psychosis. Method: One hundred sixty Chinese patients were recruited from specialized early intervention program for first-episode psychosis in Hong Kong after they had completed this 2-year early intervention service, and underwent 1-year randomized controlled trial as well as 2-year post–randomized controlled trial follow-up (i.e. 3-year follow-up). Assessments on premorbid adjustment, onset profile, psychopathology, functioning and treatment characteristics were conducted. Individual class membership of subjective quality of life trajectory derived from growth mixing modeling was based on the 36-Item Short Form Health Survey mental component summary scores measured at four different time-points (baseline, 1, 2 and 3 years) among 142 participants across 3-year follow-up. Results: Three distinct subjective quality of life trajectories were identified including higher-improving (68.3%, n = 97), lower-stable (24.6%, n = 35) and deteriorating (7%, n = 10) trajectories. Age of onset; duration of untreated psychosis; depressive, positive and negative symptoms; and intervention condition were significantly different between good (higher-improving trajectory) and poor (combined lower-stable and deteriorating trajectories) trajectory groups. Multiple regression analysis revealed that younger age of onset, more severe depression and receipt of step-down care independently predicted poor subjective quality of life trajectory. Conclusion: Approximately one-third of patients displayed poor subjective quality of life trajectory in the early phase of psychotic illness. Our results affirm depression as a critical determinant of prospective subjective quality of life and underscores positive effect of extended early intervention on sustained subjective quality of life improvement. Further longitudinal research is warranted to facilitate better characterization of subjective quality of life course patterns and development of targeted intervention to optimize subjective quality of life in patients with early psychosis.

Cognitive determinants of community functioning and quality of life in homeless adults with mental illness: 6-year follow-up from the At Home/Chez Soi Study Toronto site

2021 ◽  
pp. 1-9
Author(s):  
K. M. Gicas ◽  
C. Mejia-Lancheros ◽  
R. Nisenbaum ◽  
R. Wang ◽  
S. W. Hwang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Functional Outcomes ◽  
Verbal Learning ◽  
Subjective Quality ◽  
Subjective Quality Of Life ◽  
Homeless Adults ◽  
Community Functioning ◽  
At Home

Abstract Background High rates of physical and mental health comorbidities are associated with functional impairment among persons who are homeless. Cognitive dysfunction is common, but how it contributes to various functional outcomes in this population has not been well investigated. This study examines how cognition covaries with community functioning and subjective quality of life over a 6-year period while accounting for the effects of risk and protective factors. Methods Participants were 349 homeless adults (mean age = 39.8) recruited from the Toronto site of the At Home/Chez Soi study, a large Canadian randomized control trial of Housing First. Participants completed up to four clinical evaluations over 6 years. Factor scores were created to index verbal learning and memory (vLM) and processing speed-cognitive flexibility (PSCF). The primary outcomes were community functioning and subjective quality of life. Risk factors included lifetime homelessness, mental health diagnoses, medical comorbidity, and childhood adversity. Linear mixed-effects models were conducted to examine cognition-functional outcome associations over time, with resilience as a moderator. Results Better vLM (b = 0.787, p = 0.010) and PSCF (b = 1.66, p < 0.001) were associated with better community functioning, but not with quality of life. Resilience conferred a protective effect on subjective quality of life (b = 1.45, p = 0.011) but did not moderate outcomes. Conclusions Our findings suggest a need to consider the unique determinants of community functioning and quality of life among homeless adults. Cognition should be prioritized as a key intervention target within existing service delivery models to optimize long-term functional outcomes.

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