- citati u SCIndeksu: 0
- citati u CrossRef-u:0
- citati u Google Scholaru:[
 ]
- posete u poslednjih 30 dana:10
- preuzimanja u poslednjih 30 dana:2
|
|
|
2020, vol. 52, br. 1-2, str. 13-24
|
|
Trajanje posete psihijatru tokom lečenja osoba sa psihotičnim poremećajima u Srbiji - da li se značajno produžava primenom psihosocijalne intervencije DIALOG+?
Duration of psychiatric appointments for patients with Psychosis spectrum disorders in Serbia: Is it significantly prolonged by DIALOG+ psychosocial intervention?
aUniverzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Klinika za psihijatriju, Beograd bQueen Mary University of London, Unit for Social and Community Psychiatry, London, United Kingdom + WHO Collaborating Centre for Mental Health Services Development, London, United Kingdom cUniverzitet u Beogradu, Medicinski fakultet + Univerzitet u Beogradu, Medicinski fakultet, Institut za mentalno zdravlje
e-adresa: nadja.maric-bojovic@med.bg.ac.rs
Projekat: This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 779334.
Sažetak
Iako nacionalni i međunarodni vodiči preporučuju primenu psihoterapije i psihosocijalnih intervencija u lečenju pacijenata sa psihotičnim spektrom poremećaja (PSD), vanbolničko psihijatrijsko lečenje u Jugoistočnoj Evropi (SEE) je uglavnom ograničeno na propisivanje farmakoterapije. DIALOG+ je Nov, tehnološki zasnovan pristup u tretmanu pacijenata sa različitim poremećajima, koji pruža ekonomski isplativu terapijsku intervenciju uz sveobuhvatnu procenu radi poboljšanja adaptivnih mehanizama za svakodnevni život. Efektivnost ove intervencije u više psihijatrijskih poremećaja dokazana je kroz nekoliko studija u ekonomski razvijenim sredinama. Imlementacija i efektivnost DIALOG+ intervencije u SEE je u fazi ispitivanja. Pre završetka ovih ispitivanja, planirali smo da istražimo prve utiske kliničara koji se bave mentalnim zdravljem o ovoj intervenciji, kao i da poredimo trajanje uobičajenih (TAU) i DIALOG+ sesija kod pacijenata sa PSD. DIALOG+ je prezentovan učesnicima na tradicionalnom edukativnom simpozijumu Klinike za Psihijatriju KCS, nakon čega su popunili kratak upitnik o opštim utiscima prema intervenciji. Za prikupljanje podataka o trajanju ambulantnih poseta pacijenata sa PSD u Srbiji su korišćeni podaci iz randomizovane kliničke studije gde se testira efektivnost DIALOG+ intervencije. Upitnik su popunili uglavnom specijalisti i specijalizanti psihijatrije (n=110). Prvi utisci prema konceptu intervencije su bili pretežno pozitivni. Ono što bi mogla biti prepreka za implementaciju je bilo pitanje da li je TAU značajno produžen uvođenjem DIALOG+ intervencije, do mere koja bi mogla da ograniči njegovu implementaciju. Iako postoji značajna razlika u trajanju prosečne ambulantne posete između DIALOG+ i TAU (31.96±16.47 vs. 19.75±6.11 minuta, p<0.01), pružanje strukturisane intervencije i procene pacijenata bi moglo da pruži značajno poboljšanje dugotrajne nege i kvaliteta života pacijenata sa PSD. Ovo je prva procena trajanja ambulantnih poseta pacijenata sa PSD u Srbiji. Dobijene informacije bi mogle biti korisne u edukaciji budućih lekara, svih zainteresovanih zdrastvenih radnika i saradnika, kao i tokom implementacije DIALOG+ intervencije u zemlji i u regionu.
Abstract
Despite national and international guidelines recommending inclusion of psychotherapy and psychosocial interventions as regular part of treatment for patients with psychosis spectrum disorders (PSD), outpatient psychiatric care in Southeastern Europe (SEE) is mostly limited to medication prescription. DIALOG+ is a recently developed technology-based, patient centered psychosocial intervention that provides an economically viable intervention for treatment and comprehensive evaluation of multiple life domains. Its effectiveness in a range of psychiatric disorders has been shown in several studies conducted in high-income countries. Before an ongoing study evaluating DIALOG+ implementation and effectiveness in developing SEE countries is completed, we aimed to explore general impressions of mental health clinicians towards such an intervention and to compare the duration of treatment as usual (TAU) with DIALOG+ enriched appointments of PSD outpatients. The attendees of the national professional educational symposium were presented with DIALOG+, after which they completed a short survey on their general impressions towards the intervention. To obtain the information regarding duration of psychiatric appointments for patients with PSD in Serbia, we used data from a currently ongoing randomized clinical trial where DIALOG+ is being tested for effectiveness. The impressions of the survey (n=110) from mostly psychiatrists and psychiatry residents towards the concept of this intervention were overwhelmingly positive. However, the question arose if TAU is being prolonged by DIALOG+ to the extent that might limit its implementation. Although significant difference in average session duration was observed between DIALOG+ and TAU (31.96±16.47 vs. 19.75±6.11 minutes, p<0.01), providing structured interventions and patient evaluation might be of additional benefit for long term care and quality of life of PSD patients. To the best of our knowledge, this was the first evaluation of the duration of psychiatric appointments for outpatients with PSD in Serbia. Present information could be useful for different stakeholders in education of MH workers and implementation of DIALOG+ in the local settings.
|
|
|
|
Reference
|
|
  
|
Cruz, M., Roter, D.L., Cruz, R.F., Wieland, M., Larson, S., Cooper, L.A., et al. (2013) Appointment length, psychiatrists' communication behaviors, and medication management appointment adherence. Psychiatric Services, 64(9): 886-92
|
|
|
Fernholm, R., Holzmann, M.J., Wachtler, C., Szulkin, R., Carlsson, A.C., Pukk, H.K. (2020) Patient-related factors associated with an increased risk of being a reported case of preventable harm in first-line health care: A case-control study. BMC Family Practice, 21(1): 1-8
|
|
|
Jovanovic, N., Francis, J., Maric, N.P., Arenliu, A., Barjaktarov, S., Kulenovic, A.D., et al. (2019) Implementing a psychosocial intervention DIALOG+ for patients with psychotic disorders in low and middle income countries in South Eastern Europe: Protocol for a hybrid effectiveness-implementation cluster randomized clinical trial (IMPULSE). Glob Psychiatry, 0(0): 1-14
|
|
|
Lehman, A.F., Lieberman, J.A., Dixon, L.B., Mcglashan, T.H., Miller, A.L., Perkins, D.O., et al. (2004) Practice Guideline for the Treatment of Patients with Schizophrenia, Second Edition. American Journal of Psychiatry, Vol. 161
|
|
|
Luborsky, L., et al. (1971) Factors influencing the outcome of psychotherapy: A review of quantitative research. Psychological Bulletin, 75(3): 145-85
|
|
|
Mojtabai, R., Olfson, M. (2008) National trends in psychotherapy by officebased psychiatrists. Arch Gen Psychiatry, 65(8): 962-70
|
|
|
National Institute for Health and Care Excellence (NICE) (2014) Psychosis and schizophrenia in adults: Prevention and management
|
|
|
Nelson, C., Woodwell, D. (1998) National ambulatory medical care survey: 1993 summary. 13(136), Vital Heal Stat Ser 13 Data Heal Resour Util
|
|
|
Olfson, M., Cherry, D.K., Lewis-Fernández, R. (2009) Racial differences in visit duration of outpatient psychiatric visits. Archives of General Psychiatry, 66(2): 214-21
|
|
|
Omer, S., Golden, E., Priebe, S. (2016) Exploring the mechanisms of a patientcentred assessment with a solution focused approach (DIALOG+) in the community treatment of patients with psychosis: A process evaluation within a cluster-randomised controlled trial. PLoS One, 11(2): 1-17
|
|
|
Priebe, S., Golden, E., Mccabe, R., Reininghaus, U. (2012) Patient-reported outcome data generated in a clinical intervention in community mental health care - psychometric properties. BMC Psychiatry, 12
|
|
|
Priebe, S., Kelley, L., Omer, S., Golden, E., Walsh, S., Khanom, H., et al. (2015) The Effectiveness of a Patient-Centred Assessment with a SolutionFocused Approach (DIALOG+) for Patients with Psychosis: A Pragmatic Cluster-Randomised Controlled Trial in Community Care. Psychother Psychosom, 84(5): 304-13
|
|
|
Priebe, S., Mccabe, R., Bullenkamp, J., Hansson, L., Lauber, C., Martinez-Leal, R., et al. (2007) Structured patient-clinician communication and 1-year outcome in community mental healthcare: Cluster randomised controlled trial. Br J Psychiatry, 191(11): 420-6
|
|
1
|
Republička stručna komisija za izradu i implementaciju vodiča u kliničkoj praksi, Ministarstvo zdravlja Republike Srbije (2013) Nacionalni vodič dobre kliničke prakse za dijagnostikovanje i lečenje shizofrenije. Beograd: Ministarstvo zdravlja Republike Srbije, Lečić-Tosevski D. rukovodilac
|
|
|
Rössler, W., Joachim, S.H., van Os, J., Riecher-Rössler, A. (2005) Size of burden of schizophrenia and psychotic disorders. European Neuropsychopharmacology, 15(4): 399-409
|
|
|
Slade, M., Mccrone, P., Kuipers, E., Leese, M., Cahill, S., Parabiaghi, A., et al. (2006) Use of standardised outcome measures in adult mental health services: Randomised controlled trial. Br J Psychiatry, 189(10): 330-6
|
|
1
|
Winkler, P., Krupchanka, D., Roberts, T., Kondratova, L., Machů, V., Höschl, C., et al. (2017) A blind spot on the global mental health map: A scoping review of 25 years' development of mental health care for people with severe mental illnesses in Central and Eastern Europe. Lancet Psychiatry, 4(8): 634-42
|
|
1
|
Wittchen, H.U., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jönsson, B., et al. (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol, 21(9): 655-79, Available from: http://dx.doi.org/10.1016/j.euroneuro.2011.07.018
|
|
|
World Health Organization(WHO) (2015) Mental Health Atlas 2014. Geneva, http://www.who.int/mental_health/evidence/atlas/profiles-2014/en/, accessed 18.02.20
|
|
|
|
|