Bridging the gap between best evidence and best practice in mental health Flashcards
scientist-practitioner model =
the practice of clinical psychology is built upon the principles of integrated evidence-based treatment and treatment-based evidence
science-practice gap=
the gap between clinical empirical findings and their integration into practice
supporting conclusions regarding the effectiveness of psychotherapies
- the provision of therapy has demonstrated greater effectiveness than no treatment and placebo treatment
- majority of patients make reliable or clinically significant improvement
- improvements often continue after the termination of treatment and are maintained in the longer term
maar wat weten we nog niet over psychotherapies
what the threshold of support has to be in order for a treatment to be empirically supported
2 strategies of incorporating evidence-base into practice=
- clinical guidelines towards particular diagnostic categories
- individualized case formations
by focusing on … it will be possible for clinicians to identify treatment successes and failures
session-to-session changes
wat is STAR*D programme
sequenced treatment alternatives to relieve depression
= incorporate the patients preferences by having the patients nominate the medication strategies that are suitable to them
CCS=
comprehensive cohort studies
what does CCS allow
it allows participants who do not wish to be in the randomized trial, to receive a target evidence-based treatment, with consistent data collection across all cohorts. dus mensen die hun eigen treatment willen kiezen (en dus niet gerandomiseerd kunnen worden) ook toevoegen aan de trial (soms als een aparte arm of zoiets).
maar hierbij wel risico op misinterpretatie
wat is de oplossing voor supershrinks en pseudoshrinks
national occupational standards: interactive competencies map reveals detailed lists of skills required to give a treatment
wat zijn 4 redenen dat clinicians niet perse randomized controlled trials gebruiken
- the patient sample in RCTs not representative of wider clinical population
- treatments are inflexible; dus niet persoonlijk
- clinicians sometimes reluctant with using evidence based
- clinical practice does not only focus on symptoms, but also life functioning, coping with stressors, life quality etc (meestal niet gemeten in rcts)
dodo bird verdict=
a view arguing that all treatments demonstrate equivalent efficacy, and that treatment effects are due to non-specific factors such as the therapeutic alliance between patient and clinician.
wat zegt het dodo bird effect dus over evidence based
dat de emphasis hierop niet nodig is
wat zijn 2 problemen met statistical significance=
- provides no info on the magnitude of change
- statistical significance provides no description of within group variability
wat zou dan beter zijn dan statistical significant
de effect size (geeft wel info over de magnitude, maar alleen bij een kleine effect size zegt het iets over de within-group variability)
two part criteria of clinical significance=
- statistically reliable change
- meaningful reduction in symptoms
(hiermee bereken je de reliable change index)
er is ook variatie in welke definities gebruikt worden, sommige trials gebruiken de RCI, of een andere clinical cut off, maar dit is niet duidelijk
oke
sommige mentale aandoeningen zullen ook niet zo snel verbeteren (bv chronic schizophrenia), dus hoe zie je ‘recovery’ dan in dat geval? dat is ook niet duidelijk
oke
wat zijn 5 redenen waarom treatments niet werken
- clinical judgement
- patients judgement
- dose-response and phase models
- length of treatment
- early response to treatment
clinical judgement
positive attributional bias to the treatment, negative towards the patient (patient centred attitude towards treatment failure)
oplossing: progress monitoring and feedback
patient judgement
soms is de self report van de patient heel anders dan zijn progress laat zien
dose-response and phase models
recovery is fast in the beginning, and slower but continued in the remainder of therapy. (= decelerating dose)
welke 3 phases zijn er van dose response and phase models
- remoralization
- remediation
- rehabilitation
remoralization =
alleviation of hopelessness and boosting of wellbeing
remediation=
therapeutic relationship and symptom reduction
rehabilitation=
modification of previous patterns and towards enhanced life functioning
length of treatment
door economische redenen zijn treatments korter geworden, maar dit kan voor de persoon zelf niet optimaal zijn
early response to treatment
for most patients, early treatment response is dramatic, and predicts a positive final outcome.
solution: mapped treatment response at every session
what are clinical implications of providing therapies with information about the client process
beiden data verzameling en clinical care quality in een keer
what could bridge the scientist-practitioner gap
patient focused research
waarom kan patients focused research daartoe leiden
- enables evaluation of treatment
- facilitates the study of variability between the samples
- allows for grouping of patients according to outcome, assess their trajectory
- risk of missing final session data is eliminated for drop outs
- ethical responsibilities of assessing practice and patient wellbeing are fulfilled
- greater accountability and transperancy in health care
wat is patient focused research
Patient-oriented research is conducted in collaboration with patients (including their families and informal caregivers), clinicians and decision-makers; focuses on priorities and outcomes that matter to patients; and ultimately aims to integrate research into policy and practice to improve health care outcomes
dus patients are active parts of the research team
2 challenges with patient-focused research
- nog geen goede monitoring systems
- evaluation with group-format may be helpful (want dan moeten ze anderen tolereren en leren van anderen)
internet heeft een grote invloed
oke
the use of risk-adjusted outcomes information has become standard, but is difficult to achieve without the use of physiological measures. by adjusting for case-mix, the quality of outcome evaluation would increase
oke
fair reporting=
difficulty to ensure that the public receives reliable data, and is able to make valid interpretations from them
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scientist practitioner has the opportunity to…
- match appropriate treatments
- monitor patient progress
- measurement of treatment outcomes
- management of services
