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The effectiveness of a patient-centred assessment with a solution-focused approach (DIALOG+) for patients with psychosis: a pragmatic cluster-randomised controlled trial in community care

The effectiveness of a patient-centred assessment with a solution-focused approach (DIALOG+) for patients with psychosis: a pragmatic cluster-randomised controlled trial in community care
The effectiveness of a patient-centred assessment with a solution-focused approach (DIALOG+) for patients with psychosis: a pragmatic cluster-randomised controlled trial in community care
Background: DIALOG+ was developed as a computer-mediated intervention, consisting of a structured assessment of patients' concerns combined with a solution-focused approach to initiate change. This study tested the effectiveness of DIALOG+ in the community treatment of patients with psychosis.

Method: this was a pragmatic, exploratory, parallel-group, cluster-randomised controlled trial. Clinicians within community teams - along with patients with psychosis under their care - were randomised to use DIALOG+ once per month for 6 months or an active control. The primary outcome (subjective quality of life, SQOL) and secondary outcomes were assessed after 3, 6 and 12 months by blinded assessors and analysed using mixed-effect models.

Results: a total of 49 clinicians and 179 patients were randomised. Implementation of DIALOG+ was variable, with an average of 1.8 sessions (SD = 1.6) in the first 3 months and 1.1 (SD = 1.2) in the following 3 months. Patients in the DIALOG+ arm had better SQOL at 3, 6 and 12 months (p = 0.035, 0.058 and 0.014, respectively; Cohen's d = 0.29-0.34). They also had significantly fewer unmet needs at 3 and 6 months, fewer general psychopathological symptoms at all time points and better objective social outcomes at 12 months, with no significant differences in other outcomes. Overall care costs were lower in the intervention group.

Conclusion: despite variable implementation, DIALOG+ is a beneficial intervention for community patients with psychosis. As a non-expensive and potentially cost-saving, generic intervention, DIALOG+ may be widely used and may improve the effectiveness of community treatment. Further trials should test DIALOG+ in different patient groups and contexts
computer mediation, psychiatric treatment, quality of life, schizophrenia, treatment outcomes
0033-3190
304 -313
Priebe, S.
37449b40-896c-49c1-944d-65fd11c72578
Kelley, L.
ab5a519d-0e09-4a0c-903d-3410fce6065b
Omer, S.
d40ab8ff-6787-4967-891f-0e7c1bcbd900
Walsh, S.
fca4c802-3bb2-4a5b-a57d-742b781f0bd7
Khanom, H.
a41820b9-2e8e-464c-95d9-775e64fe3649
Kingdon, D
14cdc422-10b4-4b2d-88ec-24fde5f4329b
Rutterford, C.
597c15a8-669f-4dd1-aad0-46e38df6d085
McCrone, P.
46acaeda-f726-49ca-b83a-0ed61cac7f83
McCabe, R.
a3fda569-5073-4697-bc9f-650948a396dc
Priebe, S.
37449b40-896c-49c1-944d-65fd11c72578
Kelley, L.
ab5a519d-0e09-4a0c-903d-3410fce6065b
Omer, S.
d40ab8ff-6787-4967-891f-0e7c1bcbd900
Walsh, S.
fca4c802-3bb2-4a5b-a57d-742b781f0bd7
Khanom, H.
a41820b9-2e8e-464c-95d9-775e64fe3649
Kingdon, D
14cdc422-10b4-4b2d-88ec-24fde5f4329b
Rutterford, C.
597c15a8-669f-4dd1-aad0-46e38df6d085
McCrone, P.
46acaeda-f726-49ca-b83a-0ed61cac7f83
McCabe, R.
a3fda569-5073-4697-bc9f-650948a396dc

Priebe, S., Kelley, L., Omer, S., Walsh, S., Khanom, H., Kingdon, D, Rutterford, C., McCrone, P. and McCabe, R. (2015) The effectiveness of a patient-centred assessment with a solution-focused approach (DIALOG+) for patients with psychosis: a pragmatic cluster-randomised controlled trial in community care. Psychotherapy and Psychosomatics, 84 (5), 304 -313. (doi:10.1159/000430991).

Record type: Article

Abstract

Background: DIALOG+ was developed as a computer-mediated intervention, consisting of a structured assessment of patients' concerns combined with a solution-focused approach to initiate change. This study tested the effectiveness of DIALOG+ in the community treatment of patients with psychosis.

Method: this was a pragmatic, exploratory, parallel-group, cluster-randomised controlled trial. Clinicians within community teams - along with patients with psychosis under their care - were randomised to use DIALOG+ once per month for 6 months or an active control. The primary outcome (subjective quality of life, SQOL) and secondary outcomes were assessed after 3, 6 and 12 months by blinded assessors and analysed using mixed-effect models.

Results: a total of 49 clinicians and 179 patients were randomised. Implementation of DIALOG+ was variable, with an average of 1.8 sessions (SD = 1.6) in the first 3 months and 1.1 (SD = 1.2) in the following 3 months. Patients in the DIALOG+ arm had better SQOL at 3, 6 and 12 months (p = 0.035, 0.058 and 0.014, respectively; Cohen's d = 0.29-0.34). They also had significantly fewer unmet needs at 3 and 6 months, fewer general psychopathological symptoms at all time points and better objective social outcomes at 12 months, with no significant differences in other outcomes. Overall care costs were lower in the intervention group.

Conclusion: despite variable implementation, DIALOG+ is a beneficial intervention for community patients with psychosis. As a non-expensive and potentially cost-saving, generic intervention, DIALOG+ may be widely used and may improve the effectiveness of community treatment. Further trials should test DIALOG+ in different patient groups and contexts

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Accepted/In Press date: 28 April 2015
Published date: 8 August 2015
Keywords: computer mediation, psychiatric treatment, quality of life, schizophrenia, treatment outcomes
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 376631
URI: https://eprints.soton.ac.uk/id/eprint/376631
ISSN: 0033-3190
PURE UUID: 9c756578-8393-4a6e-8afa-ace4333ee6c6

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Date deposited: 14 May 2015 11:06
Last modified: 17 Jul 2017 21:07

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