A Regional Assessment of the Quality of Care for People With Schizophrenia in the Netherlands

Weeghel, Jaap van; Lindt, S. van de; Slooff, C. J.; Kar, F. van de; Vugt, Maaike van; Wiersma, Durk

doi:10.1176/ps.62.7.pss6207_0789

Cited by 15 publications

(14 citation statements)

References 13 publications

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“…Recently, a distinct Dutch Personal Recovery Scale was developed with the aim to have it added as a mandatory component of routine outcome monitoring in the Netherlands. Other instruments used for voluntary assessment in routine mental health care are the recovery oriented practices index (ROPI), the Quality Indicator for Rehabilitative Care (QuIRC), [34] and QUARTS (quality assessment of regional treatment systems for schizophrenia) [35]. Recently a group of Dutch practitioners and researchers became interested in the Individual Recovery Outcomes Counter tool (I.ROC), which has been developed by Penumbra, a third sector voluntary organization in Scotland.…”

Section: Results—summary Of Recovery Programs and Initiatives Across mentioning

confidence: 99%

A review of mental health recovery programs in selected industrialized countries

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Spaeth-Rublee

Sara

et al. 2016

Int J Ment Health Syst

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The concept of recovery has gained increasing attention and many mental health systems have taken steps to move towards more recovery oriented practice and service structures. This article represents a description of current recovery-oriented programs in participating countries including recovery measurement tools. Although there is growing acceptance that recovery needs to be one of the key domains of quality in mental health care, the implementation and delivery of recovery oriented services and corresponding evaluation strategies as an integral part of mental health care have been lacking.

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Section: Results—summary Of Recovery Programs and Initiatives Across mentioning

confidence: 99%

A review of mental health recovery programs in selected industrialized countries

Pincus

Spaeth-Rublee

Sara

et al. 2016

Int J Ment Health Syst

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“…The lack of cost-effectiveness in our study may be partly explained by the already high quality of care provided to patients in standard practice, especially immediately after the first psychotic episode. The quality of care has much been boosted since the publication of the multidisciplinary guidelines for schizophrenia in the Netherlands [ 36 ]. In the treatment as usual condition much effort was directed at improving social functioning, and the findings from current study show that CBTsa does not provide an additional advantage in improving social withdrawal or quality of live compared to the well-developed and firmly implemented TAU.…”

Section: Discussionmentioning

confidence: 99%

Economic evaluation of brief cognitive behavioural therapy for social activation in recent-onset psychosis

et al. 2018

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BackgroundIn schizophrenia spectrum disorders, negative symptoms (e.g. social withdrawal) may persist after initial treatment with antipsychotics, much affecting the quality of life (QOL) of patients. This health-economic study evaluated if a dedicated form of cognitive behaviour therapy for social activation (CBTsa) would reduce negative symptoms and improve QOL in an economically sustainable way.MethodsA health-economic evaluation was conducted alongside a single-blind randomised controlled trial in two parallel groups: guideline congruent treatment as usual (TAU; n = 50) versus TAU augmented with adjunct CBTsa (n = 49). Outcomes were PANSS negative symptom severity and EQ-5D quality adjusted life years (QALYs) gained. The health-economic evaluation was conducted both from the societal and the health sector perspective.ResultsBoth conditions showed improvement in the respective outcomes over the follow-up period of six months, but QALY gains were significantly higher in the CBTsa condition compared to the TAU condition. Treatment response rate (i.e. ≥ 5-point decrease on the PANSS) was not significantly different. However, the add-on CBT intervention was associated with higher costs. This did not support the idea that CBTsa is a cost-effective adjunct. Various sensitivity analyses attested to the robustness of these findings.ConclusionsIn the Dutch context where TAU for psychosis is guideline congruent and well implemented there appears no added value for adjunct CBTsa. In other settings where the treatment for the schizophrenia spectrum disorders solely relies on antipsychotics, add-on CBTsa may lead to clinically superior outcomes, but it should still be evaluated if adjunct CBTsa therapy is a cost-effective alternative.Trial registrationClinicalTrials.gov registry under NCT03217955.

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“…Although, we cannot be sure that higher implementation is possible as there are no other studies on the CARe methodology, there is a change that we cannot ignore that a higher fidelity in CARe would lead to better outcomes. Implementation is a consistent problem in (mental) health care research [ 57 – 59 ]. Barriers in an implementation process can occur at organizational, team and individual levels [ 60 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

How effective is the comprehensive approach to rehabilitation (CARe) methodology? A cluster randomized controlled trial

et al. 2017

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BackgroundThe CARe methodology aims to improve the quality of life of people with severe mental illness by supporting them in realizing their goals, handling their vulnerability and improving the quality of their social environment. This study aims to investigate the effectiveness of the CARe methodology for people with severe mental illness on their quality of life, personal recovery, participation, hope, empowerment, self-efficacy beliefs and unmet needs.MethodsA cluster Randomized Controlled Trial (RCT) was conducted in 14 teams of three organizations for sheltered and supported housing in the Netherlands. Teams in the intervention group received training in the CARe methodology. Teams in the control group continued working according to care as usual. Questionnaires were filled out at baseline, after 10 months and after 20 months. A total of 263 clients participated in the study.ResultsQuality of life increased in both groups, however, no differences between the intervention and control group were found. Recovery and social functioning did not change over time. Regarding the secondary outcomes, the number of unmet needs decreased in both groups. All intervention teams received the complete training program. The model fidelity at T1 was 53.4% for the intervention group and 33.4% for the control group. At T2 this was 50.6% for the intervention group and 37.2% for the control group.ConclusionAll clients improved in quality of life. However we did not find significant differences between the clients of the both conditions on any outcome measure. Possible explanations of these results are: the difficulty to implement rehabilitation-supporting practice, the content of the methodology and the difficulty to improve the lives of a group of people with longstanding and severe impairments in a relatively short period. More research is needed on how to improve effects of rehabilitation trainings in practice and on outcome level.Trial registration ISRCTN77355880, retrospectively registered (05/07/2013).

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A Regional Assessment of the Quality of Care for People With Schizophrenia in the Netherlands

Abstract: Key clinicians in all regions perceived the guidelines as an important factor in improving the quality of schizophrenia care. QUARTS can be a helpful instrument for service monitoring and development.

Cited by 15 publications

References 13 publications

A review of mental health recovery programs in selected industrialized countries

A review of mental health recovery programs in selected industrialized countries

Economic evaluation of brief cognitive behavioural therapy for social activation in recent-onset psychosis

How effective is the comprehensive approach to rehabilitation (CARe) methodology? A cluster randomized controlled trial

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