Effective patient–clinician interaction to improve treatment outcomes for patients with psychosis: a mixed-methods design

Priebe, Stefan; Golden, Eoin; Kingdon, David; Omer, Serif; Walsh, Sophie; Katevas, Kleomenis; McCrone, Paul; Eldridge, Sandra

doi:10.3310/pgfar05060

Cited by 24 publications

(28 citation statements)

References 67 publications

(86 reference statements)

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“…Clinicians are asked to encourage patients to attend the next session even if they did not manage to complete agreed actions. More details can be found in DIALOG+ Manual (Priebe et al, 2016). Clinicians randomised to the intervention will receive a computer tablet with the intervention software (DIALOG+) uploaded.…”

Section: Implementation Strategymentioning

confidence: 99%

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)

et al. 2020

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ObjectivesPsychotic disorders have large treatment gap in low- and middle-income countries (LMICs) in South-Eastern Europe, where up to 45% of affected people do not receive care for their condition. This study will assess the implementation of a generic psychosocial intervention called DIALOG+ in mental health care services and its effectiveness at improving patients’ clinical and social outcomes.MethodsThis is a protocol for a multi-country, pragmatic, hybrid effectiveness–implementation, cluster-randomised, clinical trial. The trial aims to recruit 80 clinicians and 400 patients across 5 South-Eastern European LMICs: Bosnia and Herzegovina, Kosovo*, Montenegro, Republic of North Macedonia and Serbia. Clusters are clinicians working with patients with psychosis, and each clinician will deliver the intervention to five patients. After patient baseline assessments, clinicians will be randomly assigned to either the DIALOG+ intervention or treatment as usual, with an allocation ratio of 1:1. The intervention will be delivered six times over 12 months during routine clinical meetings. TThe primary outcome measure is the quality of life at 12 months [Manchester Short Assessment of Quality of Life (MANSA)]; the secondary outcomes include mental health symptoms [Brief Psychiatric Rating Scale (BPRS), Clinical Assessment Interview for Negative Symptoms (CAINS), Brief Symptom Inventory (BSI)], satisfaction with services [Client Satisfaction Questionnaire (CSQ-8)] and economic costs at 12 months [based on Client Service Receipt Inventory (CSRI), EQ-5D-5L and Recovering Quality of Life (ReQOL-10)]. The study will assess the intervention fidelity and the experience of clinicians and patients’ about implementing DIALOG+ in real-life mental health care settings. In the health economic assessment, the incremental cost-effectiveness ratio is calculated with effectiveness measured by quality-adjusted life year. Data will also be collected on sustainability and reach to inform guidelines for potentially scaling up and implementing the intervention widely. Conclusion: The study is expected to generate new scientific knowledge on the treatment of people with psychosis in health care systems with limited resources. The learning from LMICs could potentially help other countries to expand the access to care and alleviate the suffering of patients with psychosis and their families.Trial registration: ISRCTN 11913964

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Section: Implementation Strategymentioning

confidence: 99%

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)

et al. 2020

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“…After conducting the initial trial for effectiveness of DIALOG as a therapeutic intervention [ 15 ], assessment of the psychometric qualities of the DIALOG scale confirmed its usability as outcome measure in routine community mental health care [ 13 ]. Following that, the intervention was further refined into DIALOG+ and shown clinically effective in two randomised controlled trials in community mental health teams in East London [ 16 ] and medium-secure services in South England [ 17 ], respectively, as well as a small pilot study in Austria [ 18 ]. Since 2017, DIALOG+ has been implemented within East London NHS Foundation Trust (ELFT) as part of a new care plan approach and to collect patient outcome and treatment experience data; the latter will be the focus of the paper.…”

Section: Introductionmentioning

confidence: 99%

Routine measurement of satisfaction with life and treatment aspects in mental health patients – the DIALOG scale in East London

Mosler

Priebe

Bird

2020

BMC Health Serv Res

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Aims The DIALOG scale has been implemented as a routine patient outcome and experience measure (PROM/PREM) in a mental health trust in East London since 2017. The resulting healthcare dataset was used to estimate satisfaction with life and treatment aspects over time and factors associated with it. Methods Variables available from the Trust were DIALOG items, service level, clinical and basic demographic data. Data was extracted in February 2019. Data is described using a range of descriptive statistics and looking at the subgroups: treatment stage, diagnosis, service type. Predictors for average DIALOG scores across patients was explored with clustered linear regression models. A fixed effect model was chosen to estimate the impact of clinical and service related variables on patient’s average DIALOG scores over time. Sensitivity analyses with the whole data set and complete cases were carried out. Results Of the original 18,481 DIALOG records 12, 592 were kept after data cleaning (5646 patients). The average DIALOG score was 4.8 (SD 1.0) on the 7-point scale. Average satisfaction with life aspects (PROM) was 4.65 (SD 1.1) and with treatment aspects (PREM) was 5.25 (SD 1.17). Across all 11 items, “job situation” scored lowest (mean 4.05) and “meetings with professionals” highest (mean 5.5). Satisfaction for all items increased over time (average increase 0.47). The largest increase was in “mental health” (0.94) and the smallest in “family relationships” (0.34). Conclusions Patients in mental healthcare services were “fairly satisfied” in both life and treatment aspects with improvements seen over time. These results will act as a benchmark for clinical services currently implementing DIALOG across the UK and inform local service developments.

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“…The ratings are displayed on the tablet screen, allowing for comparisons with ratings from previous sessions. Each rating is reviewed through positive reinforcement and particular areas of concern are addressed in more detail in a four-step, solution-focused approach which aims to identify and utilize the patient's existing resources [7]. Additional le 1 and 2 contain visual representations of DIALOG+ and the Template for Intervention Description and Replication Checklist [8], respectively.…”

Section: Introductionmentioning

confidence: 99%

Implementing a Digital Mental Health Intervention for Individuals With Psychosis - A Multi-country Qualitative Study

Pemovska

Arënliu

Konjufca

et al. 2020

Preprint

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Background: Implementation of psychosocial interventions in mental health services has the potential to improve the treatment of psychosis spectrum disorders (PSD) in low- and middle-income countries (LMICs) where care is predominantly focused on pharmacotherapy. The first step is to understand the views of key stakeholders. We conducted a multi-language qualitative study to explore the contextual barriers and facilitators to implementation of a cost-effective, digital psychosocial intervention, called DIALOG+, for treating PSD. DIALOG+ builds on existing clinician-patient relationships without requiring development of new services, making it well-fitting for healthcare systems with scarce resources.Methods: The focus group study included 174 participants (patients, clinicians, policymakers and carers), who were familiarized with DIALOG+ through a presentation. The Southeast European LMICs included in this research were: Bosnia and Herzegovina, Kosovo[1], North Macedonia, Montenegro and Serbia. Framework analysis was used to analyse the participants’ accounts.Results: Six major themes were identified. Three themes (Intervention characteristics; Carers’ involvement; Patient and organisational benefits) were interpreted as perceived implementation facilitators. The theme Attitudes and perceived preparedness of potential adopters comprised of subthemes that were interpreted as both perceived implementation facilitators and barriers. Two other themes (Frequency of intervention delivery; Suggested changes to the intervention) were more broadly related to the intervention’s implementation. Participants were exceedingly supportive of the implementation of a digital psychosocial intervention such as DIALOG+. The attractive intervention’s characteristics, efficient use of scarce resources for its implementation and potential to improve mental health services were seen as the main implementation facilitators. The major implementation barrier identified was psychiatrists’ time constrains.Conclusions: This study yielded important insights regarding implementation of digital psychosocial interventions for people with PSD in low-resource settings by including perspectives from four stakeholder groups in five LMICs in Southeast Europe – a population and region rarely explored in the literature. The perceived limited availability of psychiatrists could be potentially resolved by increased inclusion of other mental health professionals in service delivery for PSD. These findings will be used to inform the implementation strategy of DIALOG+ across the participating countries. The study also offers insights into multi-country qualitative research. [1] By United Nations resolution 1244

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Effective patient–clinician interaction to improve treatment outcomes for patients with psychosis: a mixed-methods design

Cited by 24 publications

References 67 publications

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)

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)

Routine measurement of satisfaction with life and treatment aspects in mental health patients – the DIALOG scale in East London

Implementing a Digital Mental Health Intervention for Individuals With Psychosis - A Multi-country Qualitative Study

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