Document Detail

Shared decision making and long-term outcome in schizophrenia treatment.
MedLine Citation:
PMID:  17685733     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Compliance with antipsychotic medication is a major issue in schizophrenia treatment, and noncompliance with antipsychotic treatment is closely related to relapse and rehospitalization. An enhanced involvement of patients with schizophrenia in treatment decisions ("shared decision making") is expected to improve long-term compliance and reduce rehospitalizations. The aim of the present analysis was to study whether shared decision making (SDM) in antipsychotic drug choice would influence long-term outcome. METHOD: From February 2003 to January 2004, psychiatric state hospital inpatients with a diagnosis of schizophrenia (ICD-10; N = 107) were recruited for the trial using a cluster-randomized controlled design. An SDM program on antipsychotic drug choice consisting of a decision aid and a planning talk between patient and physician was compared with routine care with respect to long-term compliance and rehospitalizations (6-month and 18-month follow-up). RESULTS: On the whole, we found high rates of noncompliance and rehospitalization. There were no differences between intervention and control groups in the univariate analyses. However, when controlling for confounding factors in a multivariate analysis, there was a positive trend (p = .08) that patients in the SDM intervention had fewer rehospitalizations. Additionally, a higher desire of the patient for autonomy and better knowledge at discharge were associated with higher hospitalization rates. CONCLUSION: The intervention studied showed a positive trend but no clear beneficial effect on long-term outcomes. A more thorough implementation of SDM (e.g., iterative administration of decision aid) might yield larger effects. Those patients with higher participation preferences are at higher risk for poor treatment outcomes and therefore require special attention. Strategies to match these patients' needs might improve compliance and long-term outcomes.
Johannes Hamann; Rudolf Cohen; Stefan Leucht; Raymonde Busch; Werner Kissling
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of clinical psychiatry     Volume:  68     ISSN:  1555-2101     ISO Abbreviation:  J Clin Psychiatry     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-08-09     Completed Date:  2007-09-28     Revised Date:  2008-04-04    
Medline Journal Info:
Nlm Unique ID:  7801243     Medline TA:  J Clin Psychiatry     Country:  United States    
Other Details:
Languages:  eng     Pagination:  992-7     Citation Subset:  IM    
Department of Psychiatry, Technische Universität, Munich, Germany.
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MeSH Terms
Antipsychotic Agents / therapeutic use*
Decision Making*
Hospitals, Psychiatric
Intervention Studies
Middle Aged
Patient Compliance*
Patient Participation*
Patient Readmission
Schizophrenia / drug therapy*
Reg. No./Substance:
0/Antipsychotic Agents
Comment In:
J Clin Psychiatry. 2008 Feb;69(2):326; author reply 326-7   [PMID:  18363459 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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