Non-adherence to medication is highly prevalent in patients with schizophrenia. Adherence therapy aims to improve medication adherence of these patients by applying techniques of cognitive behavioural therapy, psycho-education, and motivational interviewing. Even though adherence therapy is frequently discussed and researched, its effectiveness is still uncertain. This paper aims to review the effectiveness of adherence therapy on the medication adherence of patients with schizophrenia. To this end, six electronic databases were systematically searched for randomized, controlled trials on adherence therapy from January 2002 to March 2013. Four trials met the inclusion criteria and were incorporated into the review. The findings suggest that adherence therapy does not improve patients' medication adherence in comparison to treatment as usual or a control intervention. However, all the studies reviewed showed high-adherence ratings at baseline. Thus, further well-designed studies that target adherence therapy to patients who are non-adherent to their medication are needed for a more profound understanding of its effectiveness. In addition, if adherence therapy is aimed not only at improving medication adherence, but also to reach an agreement whereby the patient's decision not to take his medication is accepted, the shared decision-making process needs to be assessed as well.
Background: The transition from psychiatric hospital to community is often hindered by challenges that influence community adjustment and continuity of care. Transitional interventions with bridging components are provided prior to discharge and continue beyond inpatient care. They provide continuity of care and may be effective in preventing readmission. We aimed to assess the effectiveness of transitional interventions with predischarge and postdischarge components in reducing readmissions and improving health-related or social outcomes of patients discharged from psychiatric hospitals.
Methods:We conducted a systematic review by searching electronic databases (MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Psyndex) and included randomized, nonrandomized, and one-group study designs. A random effects metaanalysis was conducted with randomized controlled trials (RCTs) reporting data on readmission rates. Other study designs were synthesized qualitatively.Results: After screening 2,673 publications, 16 studies (10 RCTs, three quasiexperimental, and three cohort studies) were included and nine RCTs were included in the meta-analysis. The tested interventions included components from case management, psychoeducation, cognitive behavioral therapy, and peer support. All studies with significant improvements in at least one outcome provided elements of case management, most frequently in combination with cognitive behavioral therapy and psychoeducation. Readmission rates during follow-up ranged between 13% and 63% in intervention groups and 19% and 69% in control groups. Overall, we found an odds ratio of 0.76 (95% confidence interval = 0.55-1.05) for readmission due to transitional Frontiers in Psychiatry | www.frontiersin.org January 2020 | Volume 10 | Article 969 1
Clear role descriptions, well-defined expectations, team preparation, acknowledgement of vulnerabilities and institution-level support PSWs are important to safeguard both PSWs and service users by minimising the destabilisation risk. Future EX-IN training graduates can benefit from the establishment of remunerated PSW roles in psychiatric services.
Discharge from psychiatric inpatient care is frequently described as chaotic, stressful, and emotionally charged. Following discharge, service users are vulnerable to becoming overwhelmed by the challenges involved in readapting to their home environments, which could result in serious problems and lead to readmission. The short transitional intervention in psychiatry (STeP) is a bridging intervention that includes pre- and post-discharge sections. It aims to prepare patients for specific situations in the period immediately following discharge from a psychiatric hospital. We conducted a quasi-experimental pilot study to determine the feasibility of the intervention, and gain insight into the effects of the STeP. Two inpatient wards at a Swiss psychiatric hospital participated in the study, and represented the intervention and control arms. Patient recruitment and baseline assessment were performed 2 weeks prior to discharge. Follow-up data were collected 1 week subsequent to discharge. Questionnaires measured coping, admission and health-care usage, self-efficacy, working alliance, experience of transition, and the number of difficulties experienced following discharge. Fourteen and 15 patients completed the follow-up assessment in the control and intervention groups, respectively. The STeP did not affect primary or secondary outcomes; however, it was shown to be feasible, and patients' feedback highlighted the importance of post-discharge contact sessions. Further research is required to improve understanding of the discharge experience, identify relevant patient outcomes, and assess the effectiveness of the intervention in an adequately-powered randomized, controlled trial.
The ‘Experienced Involvement’ (EX‐IN) training programme prepares and certifies individuals who have experienced mental health problems to work as peer support workers and to support others challenged by similar conditions. We aimed to assess the impact of the EX‐IN training on hope, self‐efficacy, introspection, stigma resistance, personal recovery, health‐related quality of life and employment in participants. Data was collected using standardized assessment instruments before the training started (t1) and upon course completion (t2). Data from 103 participants who participated in both measurement times were included into data analysis. Participants significantly improved their recovery, stigma resistance and introspection during the EX‐IN training. In addition, a significant higher proportion of participants were employed at t2. Participants whose last inpatient stay was 0–1 year before the start of the EX‐IN training showed significantly lower levels of stigma resistance, and self‐efficacy at t1 than participants with two or more years since the last inpatient stay. There were no significant changes in mean values over time, or in the mean values at t2 between the two groups. EX‐IN training has a positive influence on the handling of stigma, on one's recovery path and introspection. This indicates that EX‐IN training has a therapeutic effect on the participants. EX‐IN training seems to meet the challenges of peer support work. Therefore, the training can be recommended as preparation for working as a peer support worker as well as an intervention to improve one´s recovery process.
Scientists promote the fostering of caring communities as a means of sustainably coping with demographic changes. They consider community-based technologies to have a high potential for supporting the establishment of caring communities. However, implementing community-based technologies is a complex endeavor, making sustainable adoption difficult. We have developed a maturity model aimed at standardizing the monitoring and evaluation of neighborhood projects. Based on a maturity model for integrated care, we conducted a Delphi study, to develop a maturity model for information and communication technology (ICT)-supported neighborhood development. In eight case studies, the model was validated and subsequently adapted to the specific needs and requirements of neighborhood projects. These studies emphasized the importance of at least 12 decisive dimensions and showed that the maturity model could be applied at different stages of a project. The current form of the maturity model can be used to help orient, as well as monitor and evaluate, neighborhood development projects. Future work will be necessary to further develop accompanying materials and services and to foster the exchange of best practices and experience between projects.
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