Interpersonal Community Psychiatric Treatment for non-psychotic chronic patients and nurses in outpatient mental health care: A controlled pilot study on feasibility and effects

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• 作者：B. Koekkoek^a ; ^b ; ^{b.koekkoek@propersona.nl} ; B. van Meijel^c ; ^{berno.vanmeijel@inholland.nl} ; A. Schene^d ; ^{a.h.schene@amc.uva.nl} ; A. Smit^a ; ^{a.smit@propersona.nl} ; A. Kaasenbrood^a ; ^{a.kaasenbrood@propersona.nl} ; G. Hutschemaekers^a ; ^e ; ^{g.hutschemaekers@acsw.ru.nl}
• 关键词：Mental health care ; Long-term care ; Illness behaviour ; Nurse&ndash ; patient relations ; Mixed-methods research ; &lsquo ; Difficult&rsquo ; patients ; Community mental health nursing
• 刊名：International Journal of Nursing Studies
• 出版年：2012
• 期刊代码：134_00207489
• 类别：med
• 出版时间：May, 2012
• 卷：49
• 期：5
• 页码：549-559
• 文件大小：275 K

摘要

Background

In psychiatric care professionals perceive some patients as 鈥榙ifficult鈥? especially patients with long-term non-psychotic disorders. For these patients few evidence-based treatments exist. An intervention program, Interpersonal Community Psychiatric Treatment (ICPT), was developed by the authors. It was evaluated with the aim to increase effective behaviours by both patients and community psychiatric nurses (CPNs).

Objective

To assess the feasibility and effectiveness of an intervention program for use by CPNs in the care of 鈥榙ifficult鈥?patients with non-psychotic chronic disorders, in a controlled pilot study.

Design

A mixed-methods quasi-experimental study using process and outcome measures across several dimensions. Measurements took place at 0, 3, and 6 months.

Settings

Three community mental health centres in the centre of The Netherlands.

Participants

14 CPNs and 36 long-term non-psychotic patients who were perceived as 鈥榙ifficult鈥?were selected. Patients were offered either ICPT (20) or care as usual (16). All patients and CPNs could be followed up at all measurements.

Methods

Quantitative data included type and severity of psychiatric disorder, psychosocial functioning, needs for care, quality of life and social participation. Also, service use, satisfaction with care, and quality of the therapeutic alliance were measured. Qualitative interviews were conducted with all CPNs and patients in the experimental group.

Results

ICPT was found feasible by both CPNs and patients. Both the experimental and control condition showed improvement on a number of outcomes. ICPT, however, resulted in significantly better results in some areas. Patients鈥?social network size increased and their care utilization decreased. Also, the quality of the working alliance increased and perceived patient difficulty decreased, both as scored by professionals.

Conclusions

ICPT is one of very few intervention programs aimed at 鈥榙ifficult鈥?non-psychotic chronic patients. In this pilot study was found that it can be successfully carried out by CPNs, is generally experienced as acceptable and useful by patients and CPNs alike, and results in some significantly better effects on both process and outcome measures. In the main study, some alterations will be made to the instruction manual and training program. Also, the diagnostic interview may be briefer, and the characteristics and treatment integrity of CPNs will be included in measurements. Further controlled and randomized research is needed to test the effectiveness of the program in a larger group of patients.