精神障碍造成了全球重大的健康负担，英格兰公共卫生（PHE）表明，“精神疾病占英格兰所有不良健康状况的23％，并随时影响四分之一以上的人口。”这与来自世卫组织世界心理健康（WMH）调查estimating that more than 25% of the population worldwide will develop one or more mental disorders during their lifetime. The importance of the provision of psychological therapy services has received increasing attention over recent years. Indeed, the availability of effective mental health care is now a cornerstone of the UK’s National Health Service (NHS) and improving ‘Wellbeing and mental health’ is one of PHEs top priorities, alongside various physical health goals.
The NHS aims to provide patients with choice regarding their care in an effort to improve treatment outcomes. For many patients the choice within mental health care is perceived as being limited to pharmacological versus psychological treatment. But this is certainly not the case. Providers of psychological therapies are encouraged to offer patients choice about their treatment. However, there has been limited information about the preferences of patients or the impact that meeting these preferences may have on treatment outcomes.
New research出版today inBMC精神病学suggests that people who have preferences for how, when and where psychological treatment is delivered that are not met, are less likely to report that they were helped by it.
研究人员，由Mike Crawford来自伦敦帝国学院和Royal College of Psychiatrists College Centre for Quality Improvement，分析了来自国家对焦虑和抑郁心理疗法的审计(NAPT), a large scale examination of the practice of psychological therapies in England and Wales which was carried out between July 2012 and January 2013. 14,587 respondents who were receiving psychological therapies in 184 NHS services were asked about their treatment preferences and the extent to which these were met by their service. They were asked about five aspects of their treatment: venue, time of day, gender of therapist, language that the treatment was delivered in, and therapy type. They were also asked to rate the extent to which they felt the therapy helped them cope with their difficulties, using a five-point scale.
86％的患者表达了至少对治疗的一方面的偏爱。在这些中，有36.7％的人表示他们没有得到足够的选择，即没有满足他们的偏好。最常见的偏好是治疗时间的时间。对于五个变量中的每个变量，大多数患者都认为他们的偏好已得到满足。有趣的是，对于所有变量，超过80％的患者表明他们没有偏爱或偏爱他们的偏爱，报告说他们认为他们的治疗方法帮助他们应对了困难。相比之下，在那些认为自己偏好尚未达到有效性感知的患者中。作者得出的结论是，“大多数患者希望至少根据他们的偏好来量身定制其疗法的一部分”，并且“这些患者的重要子组觉得他们没有在这种情况下提供足够的选择范围他们的疗法的要素，并且他们的偏好不受医疗保健提供者的适应。”
In the past patients were given treatments how, when and where the service could provide it. This study demonstrates that most people have preferences for how, when and where treatment is delivered, and that services are often unable to meet them. Treatment may therefore be more effective when patient preferences are met by the service.
It is important to note that this study relied on quantitative survey data based on patient recall. As the authors are keen to point out, other methods, such as qualitative interviews with patients and psychological therapists, may have allowed more detailed information on preferences to be collected. In addition, the study only examined patient perceptions of the effectiveness of their treatment, with no assessment of clinical outcome measures. Despite these caveats, these results suggest that improving patient choice when providing psychological therapies may improve their effectiveness.
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