Outcome measures and needs assessment tools for schizophrenia and related disorders

 

Abstract

Background

There has been a recent trend to encourage routine outcome measurement and needs assessment as an aid to decision making in clinical practice and patient care. Standardised instruments have been developed which measure clinical symptoms of disorders such as schizophrenia, wider health related quality of life and patients' needs. Such measures might usefully be applied to aid the recognition of psychosocial problems and to monitor the course of patients' progress over time in terms of disease severity and associated deficits in health related quality of life. They might also be used to help clinicians to make decisions about treatment and to assess subsequent therapeutic impact. Such an approach is not, however, without cost and the actual benefit of the adoption of routine outcome and needs assessment in the day-to-day care of those with schizophrenia remains unclear.

Objectives

To establish the value of the routine administration of outcome measures and needs assessment tools and the feedback they provide in improving the management and outcome of patients with schizophrenia and related disorders.

Search methods

The reviewers undertook electronic searches of the British Nursing Index (1994 to Sept 1999), the Cochrane Library (Issue 2, 2002), the Cochrane Schizophrenia Group Trials Register (2002), EMBASE (1980-2002), MEDLINE (1966-2002), and PsycLIT (1887-2002), together with hand searches of key journals. References of all identified studies were searched for further trials, and the reviewers contacted authors of trials.

Selection criteria

Randomised controlled trials comparing the feedback of routine standardised outcome measurement and needs assessment, to routine care for those with schizophrenia.

Data collection and analysis

Reviewers evaluated data independently. Studies which randomised clinicians or clinical teams (rather than individual patients) were considered to be the most robust. However only those which took account of potential clustering effects were considered further. Where possible and appropriate, risk ratios (RR) and their 95% confidence intervals (CI) were calculated. For continuous data Weighted Mean Differences (WMD) were calculated. Data were inspected for heterogeneity.

Main results

No randomised data were found which addressed the specified objectives. One unpublished and one ongoing trial was identified.

Authors' conclusions

The routine use of outcomes measures and needs assessment tools is, as yet, unsupported by high quality evidence of clinical and cost effectiveness. Clinicians, patients and policy makers alike may wish to see randomised evidence before this strategy is routinely adopted.

 

Plain language summary

Outcome measures and needs assessment tools for schizophrenia and related disorders

The routine use of outcome measures such as scales assessing the mental state is thought to improve decision making and patient care in the treatment of people with schizophrenia. This review, however, did not find a single randomised controlled trial which examined this strategy.

 

摘要

背景

精神分裂及其相關疾病的效果評估與需求評估工具

近來趨勢為鼓勵例行性評量效果及需求評估，以作為在臨床工作與病患照顧進行決策的輔助工具。已有標準化工具用來測量疾病的臨床症狀，如精神分裂症，和更廣泛的健康相關的生活品質，及患者需求。這些評估能用來輔助對心理社會問題的認識，以及監測患者在經過一段時間後，疾病的進展與嚴重性，此涉及到缺乏健康相關的生活品質。這些工具也可以用來幫助醫師決定治療，以及評估後續治療的影響。然而，在精神分裂患者的日常生活照顧採用例行性結果與需求評估，這樣的方式並非沒有成本與實際的效益，但其效益仍不清楚。

目標

建立有價值的日常管理措施的效果測量和需求評估工具，提供的回饋可改善精神分裂及其相關疾病的患者的管理與結果。

搜尋策略

回顧人員進行電子期刊搜尋：British Nursing Index (1994 to Sept 1999), the Cochrane Library (Issue 2, 2002), the Cochrane Schizophrenia Group Trials Register (2002), EMBASE (1980 – 2002), MEDLINE (1966 – 2002), and PsycLIT (1887 – 2002)，並一起手動搜尋相關的期刊。所有選定的研究的文獻也進行搜尋是否有更進一步的研究，並與這些研究作者進行聯繫。

選擇標準

隨機對照研究比較精神分裂症患者的常規照顧所給予常態性照顧的效果評量及需求評估的回饋。

資料收集與分析

評論者獨立評估數據。隨機抽取的醫師或臨床小組效果是最強的。然而只有考慮潛在群體效應會進一步審查。如果可能且適當的話，計算風險值(RR)和95%信賴區間(CI)。對於連續性數據則以加權平均差(WMD)計算。檢查數據的異質性。

主要結論

沒有找到是以特殊目的處理的隨機數據。有確認一個未發表與一個正在進行的研究。

作者結論

到目前為止，例行性使用效果測量與需求評估工具並沒有高品質的證據支持臨床成本效益。臨床醫生，患者和決策者都可能希望在例行採用這些策略前先看到隨機研究的證據。

翻譯人

本摘要由彰化基督教醫院陳美貴翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在例行性使用效果評量，如評估的精神狀態的程度，是改善治療精神分裂患者方面的護理與決定。然而，本篇回顧沒有找到一個單一的隨機對照研究可以此檢驗策略。