Implementation of a new cost-effective treatment (HIT) for patients with therapy refractory auditory hallucinations
Projectomschrijving
HIT, voluit hallucinatiegerichte integratieve therapie, is een vorm van behandeling voor mensen die stemmen of andere geluiden horen die er niet zijn (auditieve hallucinaties). De ontwikkelaars van deze Groningse, kosteneffectieve therapie hebben getracht de behandeling actief te verspreiden onder andere GGZ-instellingen in Nederland. Een schriftelijke benadering van de instellingen leverde weinig respons op (23%). Persoonlijke contacten met instellingen leverden meer resultaat op. Uiteindelijk bleken 8 instellingen (29 behandelaars) bereid mee te doen aan de implementatie van HIT. De beoogde kernteams voor implementatie, bestaande uit een psychiater, psycholoog en sociaal psychiatrisch verpleegkundige (spv), kon in 4 instellingen worden samengesteld. De getrainde behandelaars zijn gestart met het behandelen van 69 patiënten. Uit interviews met de behandelaars bleek dat de implementatie van HIT binnen de instellingen met de nodige problemen gepaard is gegaan (o.a. beperkt beschikbare tijd,onvoldoende communicatie vanuit/met management). Het management vond evenwel dat de communicatie met de kernteamleden adequaat was verlopen.
Verslagen
Eindverslag
Samenvatting van de aanvraag
Objective is nationwide implementation of a new treatment for psychotic patients with therapy refractory auditory hallucinations. Processes of change accompanying the implementation will be studied and documented. Recommendations regarding implementation programs in mental healthcare will be made. Such implementation requires organizations to change for which dissemination and implementation of knowledge and skills are pivotal (Havelock,1971). Management theories unanimously accept that change approaches should fit the context of the change (Mintzberg,1979; Swan, Newell, and Robertson,1999; Plesk,2001). This project will apply a contextual risk management model for innovative change processes in organizations (Offenbeek & Koopman,1996) to identify and facilitate changes that are necessary for nationwide implementation of HIT, and adapt it to the specific circumstances of health care organizations. The applicability of the model in this setting will be studied. The model will be integrated with existing knowledge of the implementation of innovative practices in health care (Awoniyi et al.,2002; Clarke, 2002; Greenberg et al.,2003; Ravensbergen et al.,2003;Theunissen et al.,2003; Wieringa et al., 2003). Change process and outcomes will be also measured with an adjusted goal attainment scale (Wolff,1995). Implementation strategies (top-down and bottom-up): (1) informing management of institutions about the new intervention and this project. (2) Semi-structured interviews for assessing contextual risk factors underlying their decision-making. (3) Selecting institutions and trainees. (4) Setting project goals and preconditions for implementing change (Jick,1991). (5) Training nuclear teams in HIT. (6) Involving patient organizations. (7) Assessing effectiveness of the implementation project. The intervention to be implemented is HIT that appeared significantly more effective than routine treatment in improving subjective burden, psychopathology, quality of life and social functioning of patients with therapy refractory auditory hallucinations in a randomized controlled trial (Jenner et al., 1998, 2001, 2004). Satisfaction and compliance with treatment were good and the results could be maintained during follow-up (Wiersma et al.,2001,2004). Voice-hearing patients with dissociative and borderline personality disorders achieved similar results (Jenner et al.,1998). Results of an economic evaluation, which was part of the clinical study, indicated that HIT appears to be a cost-effective intervention (Stant et al.,2003). Implementation strategies will be: disseminating written information, contacting & motivational interviewing, risk diagnosis & evaluation prior to adoption, HIT-training, securing preconditions of implementing change (Jick TD,1991), and assessing attitude towards change of Key Players within the trainees' relevant network with commitment charting (Beekhard & Harris,1987). Outcome measures and process indicators are (1) recommendations regarding contextual risk analysis. (2) Number of certified trainees, national coverage with HIT-trained nuclei, number of nuclei and number of referrals 6 months after being trained. (3) Satisfaction and subjective burden of patients. Time schedule: months 0-3: steps 1&2 of the design; month 2-4: selection training group 1; 5-17 training group 1; 8-12: selection groups 2&3; 14- 26: training groups 2&3; outcome assessments in months 23-25 and 32-33 respectively. Months 34-36: Final report, conclusions and recommendations.