Georganiseerde levering van behandelingen volgens het diagnose-ebp-richtlijn-romsymptoomreductiemodel

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Femke van Doorn
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1 Psychiatrisch Juridisch Gezelschap Van Os et al, 2015 De Toekomst van de (Forensische) GGZ Wat is GGZ? Georganiseerde levering van behandelingen volgens het diagnose-ebp-richtlijn-romsymptoomreductiemodel Van Os et al, 2019 Taylorism and the Harvard Business School Impact van zorgsysteem context Value-Based-Health-Care Nienke van Sambeek, Evelien Tonkens & Christian Bröer, 2011

Who gets to define value? Who gets to define value in health systems?

them, is gaining momentum. (Richards, 2017).

Modern Medicine 1948 2011 Symptoombestrijding Je (zingevende) ding kunnen doen Comes from

Deal 'De hulpverlener wordt onsterfelijk als hij een witte jas aantrekt Synthese = Nieuwe

2 Who gets to define value? Who gets to define value in health systems? The notion that it should be the people who use their services, rather than those who provide them, is gaining momentum. (Richards, 2017). Diagnose EBP symptoom reductie model Je ding kunnen doen ondanks ziekte Geen doel maar middel Modern Medicine Symptoombestrijding Je (zingevende) ding kunnen doen Comes from Fits in with Primary problem Secondary problem Professional-led Cure Care Person-led Heal Deal 'De hulpverlener wordt onsterfelijk als hij een witte jas aantrekt Synthese = Nieuwe Benadering? Professionele kennis De crux van de medische praktijk is twee sterfelijken in één kamer, waarvan de een iets sterfelijker is dan de ander. Awee Prins Ervaringskennis

User Values: CHIME-D Ziekte vanuit de patiënt: Herstel van

MEANING IN LIFE; EMPOWERMENT Difficulties.

strengths and support for self-narrative development,

inclusive communities enabling access to peer support as

styles which promote empowerment and self-management.

Identiteit, Verbinding, Doelen, Zingeving Worsteling Leven

Healing Community Social Holding Essence of Resilience

3 User Values: CHIME-D Ziekte vanuit de patiënt: Herstel van perspectief CONNECTEDNESS; HOPE AND OPTIMISM; IDENTITY; MEANING IN LIFE; EMPOWERMENT Difficulties..point to the need for a greater emphasis on assessment of strengths and support for self-narrative development, promoting the role of mental health systems in developing inclusive communities enabling access to peer support as well as providing retreats, and clinical interaction styles which promote empowerment and self-management. Leamey et al, 2011; Stuart et al, 2016 Existentiële Crisis Identiteit, Verbinding, Doelen, Zingeving Worsteling Leven met ziekte Leven voorbij ziekte Mental Health Care: Healing Community Social Holding Essence of Resilience WMO: Educational Approach Sense Connectedness Positive Acceptance of purpose affect Narrative development

Differential Course Clinical and Personal Recovery Participation

care Macpherson et al, Schiz Res, 2016 User-Driven Social Economy

ADHD is a Brain Disorder The Effect Size Fallacy: ADHD is a Brain

4 Differential Course Clinical and Personal Recovery Participation Personal Recovery 6B Social care 1 year Clinical Recovery 6B Health care Macpherson et al, Schiz Res, 2016 User-Driven Social Economy Diagnosis EBP Symptom Reduction Specialisation The Effect Size Fallacy: ADHD is a Brain Disorder The Effect Size Fallacy: ADHD is a Brain Disorder Cohen s d: 3.0 Cohen s d: 0.2 Corrigan & Whitaker, 2017 Corrigan & Whitaker, 2017

5 Medicine: the Status of Evidence-Based Practice JAMA, 2010 Antilla et al, Science, 2018 Wake up call Without Context no Evidence: About the Illusion of Evidence-Based Practice in Health Care BJPsych, 2018 The Typing Test Association between typing speed and error rate GROUP level + Association INDIVIDUAL level Association PNAS, 2018 De Vries et al, Psychol Med, 2018

outcome Placebo Natural course Treatment duration Treatment duration Additive Placebo Effect Evidence-Based GGZ Better outcome Treatment duration

6 Cumulative impact of reporting and citation biases on the evidence base Most Cost-Effective Treatment? De Vries et al, Psychol Med, 2018 Additive Placebo Effect Additive Placebo Effect Treatment Treatment Better outcome Placebo Natural course Better outcome Placebo Natural course Treatment duration Treatment duration Additive Placebo Effect Evidence-Based GGZ Better outcome Treatment duration Treatment Placebo Natural course Vaak: alle behandelingen zelfde effect Maar: hulpverlener / context maakt verschil Effecten psycho- & farmacotherapie gemedieerd door ritueel & relatie Van Os, et al, in press

Effect of CBT for depression is falling JAMA Psychiatry, 2014 Johnson & Friborg, Psychological Bulletin, 2015 Relationship makes the difference Clinician makes the difference, not Rx JAMA, 2010 10%

7 Effect of CBT for depression is falling JAMA Psychiatry, 2014 Johnson & Friborg, Psychological Bulletin, 2015 Relationship makes the difference Clinician makes the difference, not Rx JAMA, % 5% Re-analysis NIMH Treatment of Depression Collaborative Research Program % variance BDI antidepressant % variance BDI psychiatrist McKay et al, 2006 Placebo: geen kennis maar vaardigheden Transtheoretical ritual Context of trust, hope & healing Emotional bond Plausible explanatory model Theory of change Care seeker willing to engage BMJ, 2011

Relationist skills Relationisme: Voorwaarde of Mechanisme?

& acceptance Active & caring Empathy Collaborates Manages conflicts Relatie Technische

8 Relationist skills Relationisme: Voorwaarde of Mechanisme? Trust & disclosure Clarifies Positive expectations Motivates Emotional expression Warmth & acceptance Active & caring Empathy Collaborates Manages conflicts Relatie Technische behandeling Effect Relatie Effect Proefschrift, 2018 Lancet, 2018 (Evidence-Based) Toekomst GGZ? Verandering van binnen: Organisational Readiness Idiografie & relationeel werken Healing community /Educational approach / Social holding / Integratie domeinen social economy Lancet, 2013, Plos One, 2014

9 Community vital signs Proeftuinen DNG Fin The Placebo Effect BMJ, 2011

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