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Psychological intervention

About: Psychological intervention is a research topic. Over the lifetime, 82654 publications have been published within this topic receiving 2608356 citations.


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01 Nov 2008
TL;DR: There is a reasonably strong body of evidence to encourage integrated care, at least for depression, and there is no discernible effect of integration level, processes of care, or combination on patient outcomes for mental health services in primary care settings.
Abstract: Objectives To describe models of integrated care used in the United States, assess how integration of mental health services into primary care settings or primary health care into specialty outpatient settings impacts patient outcomes and describe barriers to sustainable programs, use of health information technology (IT), and reimbursement structures of integrated care programs within the United States. Data sources MEDLINE, CINAHL, Cochrane databases, and PsychINFO databases, the internet, and expert consultants for relevant trials and other literature that does not traditionally appear in peer reviewed journals. Review methods Randomized controlled trials and high quality quasi-experimental design studies were reviewed for integrated care model design components. For trials of mental health services in primary care settings, levels of integration codes were constructed and assigned for provider integration, integrated processes of care, and their interaction. Forest plots of patient symptom severity, treatment response, and remission were constructed to examine associations between level of integration and outcomes. Results Integrated care programs have been tested for depression, anxiety, at-risk alcohol, and ADHD in primary care settings and for alcohol disorders and persons with severe mental illness in specialty care settings. Although most interventions in either setting are effective, there is no discernible effect of integration level, processes of care, or combination, on patient outcomes for mental health services in primary care settings. Organizational and financial barriers persist to successfully implement sustainable integrated care programs. Health IT remains a mostly undocumented but promising tool. No reimbursement system has been subjected to experiment; no evidence exists as to which reimbursement system may most effectively support integrated care. Case studies will add to our understanding of their implementation and sustainability. Conclusions In general, integrated care achieved positive outcomes. However, it is not possible to distinguish the effects of increased attention to mental health problems from the effects of specific strategies, evidenced by the lack of correlation between measures of integration or a systematic approach to care processes and the various outcomes. Efforts to implement integrated care will have to address financial barriers. There is a reasonably strong body of evidence to encourage integrated care, at least for depression. Encouragement can include removing obstacles, creating incentives, or mandating integrated care. Encouragement will likely differ between fee-for-service care and managed care. However, without evidence for a clearly superior model, there is legitimate reason to worry about premature orthodoxy.

420 citations

Journal ArticleDOI
TL;DR: A meta-analytic review of randomized studies comparing psychosocial interventions targeted at the patient's closest family member or both patient and family member found positive effects on depression when the spouse was included and, in some cases, on mortality.
Abstract: Links between chronic illness and family relationships have led to psychosocial interventions targeted at the patient's closest family member or both patient and family member. The authors conducted a meta-analytic review of randomized studies comparing these interventions with usual medical care (k=70), focusing on patient outcomes (depression, anxiety, relationship satisfaction, disability, and mortality) and family member outcomes (depression, anxiety, relationship satisfaction, and caregiving burden). Among patients, interventions had positive effects on depression when the spouse was included and, in some cases, on mortality. Among family members, positive effects were found for caregiving burden, depression, and anxiety; these effects were strongest for nondementing illnesses and for interventions that targeted only the family member and that addressed relationship issues. Although statistically significant aggregate effects were found, they were generally small in magnitude. These findings provide guidance in developing future interventions in this area.

419 citations

Journal ArticleDOI
TL;DR: A comprehensive conceptual model of pediatric self- management is presented that articulates the individual, family, community, and health care system level influences that impact self-management behavior through cognitive, emotional, and social processes and describes the relationship among self- Management, adherence, and outcomes at both the patient and system level.
Abstract: Self-management of chronic pediatric conditions is a formidable challenge for patients, families, and clinicians, with research demonstrating a high prevalence of poor self-management and nonadherence across pediatric conditions. Nevertheless, effective self-management is necessary to maximize treatment efficacy and clinical outcomes and to reduce unnecessary health care utilization and costs. However, this complex behavior is poorly understood as a result of insufficient definitions, reliance on condition-specific and/or adult models of self-management, failure to consider the multitude of factors that influence patient self-management behavior, and lack of synthesis of research, clinical practice, and policy implications. To address this need, we present a comprehensive conceptual model of pediatric self-management that articulates the individual, family, community, and health care system level influences that impact self-management behavior through cognitive, emotional, and social processes. This model further describes the relationship among self-management, adherence, and outcomes at both the patient and system level. Implications for research, clinical practice, and health care policy concerning pediatric chronic care are emphasized with a particular focus on modifiable influences, evidence-based targets for intervention, and the role of clinicians in the provision of self-management support. We anticipate that this unified conceptual approach will equip stakeholders in pediatric health care to (1) develop evidence-based interventions to improve self-management, (2) design programs aimed at preventing the development of poor self-management behaviors, and (3) inform health care policy that will ultimately improve the health and psychosocial outcomes of children with chronic conditions.

419 citations

Journal ArticleDOI
TL;DR: Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient.
Abstract: Nonadherence with medication occurs in all chronic medical disorders It is a particular challenge in schizophrenia due to the illness's association with social isolation, stigma, and comorbid substance misuse, plus the effect of symptom domains on adherence, including positive and negative symptoms, lack of insight, depression, and cognitive impairment Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence There is no gold standard approach to the measurement of adherence as all methods have pros and cons Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence

419 citations

Journal ArticleDOI
TL;DR: Social skills training (SST) aims to increase the ability to perform key social behaviours that are important in achieving success in social situations, and has become a widely accepted component of multi-method approaches to the treatment of many emotional, behavioural and developmental disorders.
Abstract: Deficits in social skills and social competence play a significant role in the development and maintenance of many emotional and behavioural disorders of childhood and adolescence. Social skills training (SST) aims to increase the ability to perform key social behaviours that are important in achieving success in social situations. Behavioural SST methods include instructions, modelling, behaviour rehearsal, feedback and reinforcement, frequently used in association with interpersonal problem solving and social perception skills training. Effective change in social behaviour also requires interventions that reduce inhibiting and competing behaviours, such as cognitive restructuring, self- and emotional-regulation methods and contingency management. Research suggests that SST alone is unlikely to produce significant and lasting change in psychopathology or global indicators of social competence. Rather, SST has become a widely accepted component of multi-method approaches to the treatment of many emotional, behavioural and developmental disorders.

419 citations


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Performance
Metrics
No. of papers in the topic in previous years
YearPapers
20249
202320,339
202241,734
20218,513
20206,955
20195,585