Skip navigation

Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): a multisite, cluster, randomised, controlled trial

Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): a multisite, cluster, randomised, controlled trial

Slade, Mike, Bird, Victoria, Clarke, Eleanor, Le Boutillier, Clair, Mccrone, Paul, Macpherson, Rob, Pesola, Francesca, Wallace, Genevieve, Williams, Julie and Leamy, Mary (2015) Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): a multisite, cluster, randomised, controlled trial. The Lancet Psychiatry, 2 (6). pp. 503-514. ISSN 2215-0366 (Print), 2215-0374 (Online) (doi:https://doi.org/10.1016/S2215-0366(15)00086-3)

[img]
Preview
PDF (Author Accepted Manuscript)
26354 MCCRONE_Supporting_Recovery_in_Patients_With_Psychosis_(OA)_2015.pdf - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (635kB) | Preview

Abstract

Background:
Mental health policy in many countries is oriented around recovery. The evidence base for service-level pro-recovery interventions is lacking.

Methods:
Two-site cluster randomised controlled trial in England (ISRCTN02507940). REFOCUS is a one-year team-level intervention targeting staff behaviour (increasing focus on patient values, preferences, strengths, goal-striving) and staff-patient relationships (coaching, partnership). 27 community-based adult mental health teams were randomly allocated to treatment-as-usual (n=13) or treatment-as-usual plus REFOCUS (n=14). Baseline (n=403) and one-year follow-up (n=297) outcomes were assessed for randomly selected patients with psychosis, representing 88% of target recruitment. Primary outcome was recovery, assessed using Questionnaire about Processes of Recovery (QPR).

Findings:
Intention-to-treat analysis using multiple imputation found no difference in QPR Total (control 40·0 (s.d.10·2), intervention 40·6 (s.d.10·1), adjusted difference 0·68, 95%CI: 1·7 to 3·1, p=·58), or sub-scales. Secondary outcomes which improved in the intervention group were functioning (adjusted difference 6·96, 95%CI 2·8 to 9·2, p<·001) and staff-rated unmet need (adjusted difference 0·80, 95%CI 0·2 to 1·4, p=·01). This pattern remained after covariate adjustment and completer analysis (n=275). Higherparticipating teams had higher staff-rated pro-recovery behaviour change (adjusted difference -0·4, 95%CI -0·7 to -0·2, p=·001) and patients had higher QPR Interpersonal scores (adjusted difference -1·6, 95%CI -2·7 to -0·5, p=·005) at follow-up. Interventiongroup patients incurred £1,062 (95%CI -£1,103 to £3,017) lower adjusted costs.

Interpretation:
Supporting recovery may, from the staff perspective, improve functioning and reduce needs. Overcoming implementation barriers may increase staff pro-recovery behaviours and interpersonal aspects of patient-rated recovery.

Item Type: Article
Uncontrolled Keywords: psychosis, recovery, trial, costs, economic evaluation
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Faculty / Department / Research Group: Faculty of Education, Health & Human Sciences
Last Modified: 13 Dec 2019 17:03
Selected for GREAT 2016: None
Selected for GREAT 2017: None
Selected for GREAT 2018: None
Selected for GREAT 2019: None
URI: http://gala.gre.ac.uk/id/eprint/26354

Actions (login required)

View Item View Item

Downloads

Downloads per month over past year

View more statistics