RESUMO
BACKGROUND: The German guideline on psychosocial interventions for people with severe mental disorders recommends a broad spectrum of evidence-based treatments. Structured implementation of the associated patient version of the guideline is missing to date. The study aims to assess whether structured implementation of a patient guideline improves the empowerment of patients with severe mental disorders, as well as knowledge, attitudes and experiences regarding psychosocial interventions, service use, treatment satisfaction, treatment needs, quality of life and burden of care. METHODS: The study is a multicentre, cluster-randomised, controlled study with two parallel groups. Inpatients and day hospital patients (all sexes; 18-65 years) with severe mental disorders will be included. Additionally, relatives of patients with mental disorders (all sexes; ≥ 18 years) will be included. In the experimental group, the patient guideline will be implemented using a multimodal strategy. Participants in the control group will receive treatment as usual but will be made aware of the patient guideline. The primary outcome is the change of empowerment, assessed by using the 'empowerment in the process of psychiatric treatment of patients with affective and schizophrenia disorders' (EPAS) scale. In addition, knowledge, attitudes and experiences regarding psychosocial interventions will be assessed as secondary outcomes, as well as service use, satisfaction with care, patient need and quality of life and participation and social inclusion. For relatives, the perceived burden of care also will be recorded. Results will be analysed using hierarchical linear models. For the health economic evaluation, the incremental cost-utility ratios will be computed using the differences in total costs of illness and the differences in quality-adjusted life years (QALY) between study groups. DISCUSSION: The study will be the first to assess the effects of a structured implementation of the patient version of a psychiatric treatment guideline. The study has some limitations regarding the transferability of the results to other patients and other regions. Furthermore, problems with the recruitment of patients and relatives and with the implementation of intervention could occur during the study. TRIAL REGISTRATION: The study is registered in the German Clinical Trials Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00017577 (Date of registration: 23 October 2019.
Assuntos
Hospital Dia , Prática Clínica Baseada em Evidências , Hospitalização , Transtornos Mentais/terapia , Psicoterapia/normas , Análise Custo-Benefício , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Multicêntricos como Assunto , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: In this study trends in legal guardianship and involuntary treatment in a Bavarian catchment area in comparison to trends at federal state and federal level between 1999 and 2009 will be examined. METHODS: Data from the federal department of justice, from the federal health monitoring system and data from a district court were used to compute rates, quotas and quotients. Regression analyses were conducted to analyse associations between time series. RESULTS: In comparison to the federal state and the federal level the target region shows a significantly higher rate of new guardianships but a lower rate of judicial ordered mobility restrictions and at least in comparison to the federal state level a significantly lower rate of involuntary admissions according to guardianship law. CONCLUSIONS: The obtained differences indicate significant differences in the legal guardianship and involuntary admission practise which cannot be explained by epidemiological developments. Therefore it is necessary to investigate potential socio-cultural and socioeconomic sources for these varieties.
Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/tendências , Tutores Legais/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/tendências , Assistência Ambulatorial/legislação & jurisprudência , Assistência Ambulatorial/tendências , Área Programática de Saúde/legislação & jurisprudência , Área Programática de Saúde/estatística & dados numéricos , Previsões , Alemanha , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/tendências , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Competência Mental/legislação & jurisprudência , Equipe de Assistência ao Paciente/legislação & jurisprudência , Equipe de Assistência ao Paciente/tendências , Análise de Regressão , Meio Social , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricosRESUMO
Caregiver counselling is an indispensable feature of current concepts for dementia treatment. Self-support groups and psychoeducative programms for caregivers of patients with Alzheimer's disease may reduce the burden of nursing and psychological strain. Specific caregiver needs from patients with frontotemporal lobar dementia (FTLD [frontotemporal dementia, semantic dementia, progressive aphasia, corticobasal degeneration]) are only partially taken into account. We conducted a German wide epidemiologic study which revealed that specific counselling for supporting relatives and caregivers of patients with FTLD is only fragmentary in hospital services for old age psychiatry. In most cases, they are referred to the local Alzheimer's disease Associations (89 %). Besides that, the existence of large hospital care units has significant negative repercussions on psychosocial supply for caregivers of patients with FTLD. To establish decentralized support units by these hospitals would lead to a significant improvement of medical and social care in this field.