291P
Reducing Affliction and Promoting Equanimity As a Patient Empowerment Intervention Approach in Primary Care Setting: A Clinic-Based Psychosocial Intervention Study
Improving the mental well-being of primary care patients has traditionally focused on the detection and management of depression and anxiety, usually by referring to external psychiatric or social work services, or improving existing medication adherence. We attempt to approach this issue by empowering patients under the affliction-equanimity framework. Building on a previous pilot program in standardizing the intervention protoccol, a two-pronged study at a primary care clinic in Hong Kong tested the feasibility and effectiveness of this patient empowerment intervention approach. The first was a matched case-control study (N = 57) of an intensive group intervention offered by clinical social workers, and the second was a randomized controlled study (N = 101) of a clinic-based intervention provided by the healthcare providers.
Methods
Participants were recruited consecutively at a community clinic in Hong Kong. Inclusion criterion was mild to moderate depression and/or anxiety (as indicated by GAD-7 and PHQ-9 cutoff scores). In total, 28 participants were recruited in the intervention group which adopted the framework of integrative social work practice. Matching for their GAD-7 and PHQ-9 scores, an additional 29 participants were recruited as a comparison control group. Intervention was a 6-week, 18-hour group program where themes of affliction, equanimity and empowerment were discussed, and simple taiji and breathing exercises taught.
Separately, we worked with the healthcare providers at the clinic and developed a self-contained educational package on mental health empowerment. Healthcare providers systematically identified patients with mild depression (by their PHQ-9 scores) and integrated mental health information using the package during their regular consultation. During the 6-month recruitment period, 101 clinic users with mild depression were identified and recruited in the study, with half participating in the intervention group and half in the usual-care control group.
Results
In group intervention study, depression, anxiety, bodily and spiritual affliction were found to improve after the intervention program compared to control group (F = 5.0, 4.6, 4.5 and 5.8 respectively, all ps < .05). In the clinic-based intervention study, participants in intervention group had on average 2.91 consultations compared to 1.81 in control group (t = 2.78, p < .05). Depression and anxiety did not show improvement (F = 0.16 and 1.62, n.s.) but patient empowerment increased (F = 7.36, p< .05).
Implications
The two-pronged intervention programme suggested that the patient empowerment intervention approach based on the affliction-equanimity framework was effective in improving the mental health of primary care patients. While we saw different feasibility and logistic challenges during the testing of the two delivery models (group intervention by social workers and clinic-based intervention by healthcare providers), the findings offer supportive evidence that time-limited, low-cost mental health interventions can be implemented in primary care settings.