دانلود رایگان مقاله واکنش متفاوت افراد مختلف به درمان

Abstract

Background: This study aimed to identify patient characteristics associated with poor outcomes in psychological therapy, and to develop a patient profiling method. Method: Clinical assessment data for 1347 outpatients was analysed. Final treatment outcome was based on reliable and clinically significant improvement (RCSI) in depression (PHQ-9) and anxiety (GAD-7) measures. Thirteen patient characteristics were explored as potential outcome predictors using logistic regression in a cross-validation design. Results: Disability, employment status, age, functional impairment, baseline depression and outcome expectancy predicted post-treatment RCSI. Regression coefficients for these factors were used to derive a weighting scheme called Leeds Risk Index (LRI), used to assign risk scores to individual cases. After stratifying cases into three levels of LRI scores, we found significant differences in RCSI and treatment completion rates. Furthermore, LRI scores were significantly correlated with the proportion of treatment sessions classified as ‘not on track’. Conclusions: The LRI tool can identify cases at risk of poor progress to inform personalized treatment recommendations for low and high intensity psychological interventions

4.3. Considerations for clinical practice

The LRI method could be feasibly integrated into a spread-sheet or a web-application to help therapists to easily classify patients with different profiles using a ‘traffic light’ system (low, moderate, high risk). This risk stratification system could support personalized clinical decision making in stepped care services. Depression cases with low LRI and anxiety disorder cases with moderate LRI have an advantage if treated at Step 3. However, they are likely to complete treatment, so from a cost-efficiency perspective it is appropriate to offer Step 2 interventions initially, expecting that the smaller proportion of cases who require Step 3 are likely to attend and to gain further improvements. Depression cases with moderate LRI and anxiety disorder cases with low LRI attain similar outcomes in Step 2 or Step 3, and are likely to complete treatment. This clinical equipoise justifies offering conventional stepped care. On the contrary, depression and anxiety disorder cases with high LRI have a modest advantage (6%e9% RCSI difference) at Step 3, but the probability of dropout in these cases is particularly high at Step 2 (>50%). On this basis, we recommend patient-intensity-matching, where these cases are referred directly to Step 3.