Lay health worker-delivered case management for early episodes of psychosis in Bangkok, Thailand (Lay-CARE): a single-centre, pragmatic, randomised controlled trial

IF 6.2 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet regional health. Southeast Asia Pub Date : 2025-06-10 DOI:10.1016/j.lansea.2025.100617

Tawanchai Jirapramukpitak , Suttha Supanya

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引用次数: 0

Abstract

Background

While specialist-led early intervention services (EIS) have been shown to be effective for early-phase psychosis, the effectiveness of a non-specialist-led EIS is still unclear. The study aims to determine the effectiveness of a low-intensity case management (LICM) programme led by lay health workers for patients during early episodes of psychosis on six-month outcomes compared to usual care (UC) in Bangkok, Thailand.

Methods

This pragmatic randomised controlled trial (Lay-CARE) included patients aged ≥18 years with a history of a first or second episode of psychotic disorder residing in the Bangkok Metropolitan Region (Thammasat University hospital's catchment district). Participants were randomised to either LICM or UC group. LICM intervention consisted of family psychoeducation, facilitation of access to services, and home or telephone visits, whereas UC was the baseline of care participants were receiving. The intervention started in October 2020 and ended in May 2021. The 6-month endline assessment started in April 2021 and ended in May 2021. The primary outcome was social functioning measured by the Personal and Social Performance Scale Thai version. Secondary outcomes were symptom severity, service use and medication adherence. The treatment effect size was determined using the average treatment effect (ATE). Due to the nature of the intervention, blinding of participants and assessors was not possible. The trial was registered with the Thai Clinical Trial Registry (TCTR20210509001).

Findings

130 participants were randomised to LICM group and 125 to UC group. At the six-month endline, participants in LICM group demonstrated improved socially useful activities (ATE 0.06, 95% CI 0.00–0.13, p = 0.041), less aggressive or disturbing behaviour (ATE −0.17, 95% CI −0.27 to −0.06, p = 0.002), and better self-care (ATE 0.13 95% CI 0.05–0.22, p = 0.003) than participants in UC group. LICM intervention did not affect personal and social relationships, symptom severity, medication adherence, or service use.

Interpretation

In low-resource settings, LICM programme can improve areas of social functioning among patients with early episodes of psychosis over six months.

Funding

Health Systems Research Institute (HSRI), Thailand (Grant No. 60-087).

查看原文本刊更多论文

泰国曼谷非专业卫生工作者提供的精神病早期发作病例管理（Lay- care）：一项单中心、实用、随机对照试验

虽然专家主导的早期干预服务（EIS）已被证明对早期精神病有效，但非专家主导的EIS的有效性仍不清楚。该研究旨在确定由非专业卫生工作者领导的低强度病例管理（LICM）规划对泰国曼谷早期精神病发作患者六个月预后的有效性，并与常规护理（UC）进行比较。方法本实用随机对照试验（Lay-CARE）纳入年龄≥18岁、有首次或第二次精神障碍病史、居住在曼谷大都会区（法政大学医院集水区）的患者。参与者被随机分为LICM组或UC组。LICM干预包括家庭心理教育，便利获得服务，以及家庭或电话访问，而UC是参与者接受护理的基线。干预始于2020年10月，于2021年5月结束。为期6个月的期末评估于2021年4月开始，于2021年5月结束。主要结果是通过泰国版的个人和社会表现量表来衡量社会功能。次要结局是症状严重程度、服务使用和药物依从性。采用平均治疗效应（ATE）确定治疗效应大小。由于干预的性质，不可能对参与者和评估者进行盲法。该试验已在泰国临床试验注册中心注册（TCTR20210509001）。结果：130名参与者被随机分为LICM组，125名参与者被随机分为UC组。在六个月的终点线，与UC组相比，LICM组的参与者表现出更好的社会有用活动（ATE 0.06, 95% CI 0.00-0.13, p = 0.041），更少的攻击或干扰行为（ATE - 0.17, 95% CI 0.00 - 0.027至- 0.06,p = 0.002），更好的自我照顾（ATE 0.13 95% CI 0.05-0.22, p = 0.003）。LICM干预不影响个人和社会关系、症状严重程度、药物依从性或服务使用。在低资源环境下，LICM项目可以改善早期精神病患者超过6个月的社会功能。资助卫生系统研究所（HSRI），泰国（批准号60-087）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

The Lancet regional health. Southeast Asia

CiteScore

2.20

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0.00%

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