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Randomized Controlled Trial
. 2014 May;71(5):557-65.
doi: 10.1001/jamapsychiatry.2013.4519.

Activation, self-management, engagement, and retention in behavioral health care: a randomized clinical trial of the DECIDE intervention

Margarita Alegría, Nicholas Carson, Michael Flores, Xinliang Li, Ping Shi, Anna Sophia Lessios, Antonio Polo, Michele Allen, Mary Fierro, Alejandro Interian, Aida Jimenez, Martin La Roche, Catherine Lee, Roberto Lewis-Fernández, Gabriela Livas-Stein, Laura Safar, Catherine Schuman, Joan Storey, Patrick E Shrout
Randomized Controlled Trial

Activation, self-management, engagement, and retention in behavioral health care: a randomized clinical trial of the DECIDE intervention

Margarita Alegría et al. JAMA Psychiatry. 2014 May.

Abstract

Importance: Given minority patients' unequal access to quality care, patient activation and self-management strategies have been suggested as a promising approach to improving mental health care.

Objective: To determine whether the DECIDE (Decide the problem; Explore the questions; Closed or open-ended questions; Identify the who, why, or how of the problem; Direct questions to your health care professional; Enjoy a shared solution) intervention, an educational strategy that teaches patients to ask questions and make collaborative decisions with their health care professional, improves patient activation and self-management, as well as engagement and retention in behavioral health care.

Design, setting, and patients: In this multisite randomized clinical trial performed from February 1, 2009, through October 9, 2011 (date of last follow-up interview), we recruited 647 English- or Spanish-speaking patients 18 to 70 years old from 13 outpatient community mental health clinics across 5 states and 1 US territory. A total of 722 patients were included in analyses of secondary outcomes.

Interventions: Three DECIDE training sessions delivered by a care manager vs giving patients a brochure on management of behavioral health.

Main outcomes and measures: Primary outcomes were patient assessment of activation (Patient Activation Scale) and self-management (Perceived Efficacy in Patient-Physician Interactions). Secondary outcomes included patient engagement (proportion of visits attended of those scheduled) and retention (attending at least 4 visits in the 6 months after the baseline research assessment), collected through medical record review or electronic records.

Results: Patients assigned to DECIDE reported significant increases in activation (mean β = 1.74, SD = 0.58; P = .003) and self-management (mean β = 2.42, SD = 0.90; P = .008) relative to control patients, but there was no evidence of an effect on engagement or retention in care.

Conclusions and relevance: The DECIDE intervention appears to help patients learn to effectively ask questions and participate in decisions about their behavioral health care, but a health care professional component might be needed to augment engagement in care. DECIDE appears to have promise as a strategy for changing the role of minority patients in behavioral health care.

Trial registration: clinicaltrials.gov Identifier: NCT01226329

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1
Figure 1
Flow of Study Participants Through Recruitment, Intervention, and Follow-up Assessment Of 1473 patients approached, 724 were randomized and 647 were included in the primary outcome analysis.
Figure 2
Figure 2
Timing of Interviews and Training for Participants in the Control and Intervention Arms CM indicates care manager; RA, research assistant.
See this image and copyright information in PMC

References

    1. Barry MJ, Edgman-Levitan S. Shared decision making: pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–781. - PubMed
    1. Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. N Engl J Med. 2013;368(1):6–8. - PubMed
    1. James J. Health policy brief: patient engagement. Health Affairs. 2013 Feb 14; http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86.
    1. McDermott MM, Reed G, Greenland P, et al. Activating peripheral arterial disease patients to reduce cholesterol: a randomized trial. Am J Med. 2011;124(6):557–565. - PMC - PubMed
    1. Lawn S, Battersby MW, Pols RG, Lawrence J, Parry T, Urukalo M. The mental health expert patient: findings from a pilot study of a generic chronic condition self-management programme for people with mental illness. Int J Soc Psychiatry. 2007;53(1):63–74. - PubMed

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