Skip to main content

Advertisement

SpringerLink
Log in

Non-uniform effectiveness of structured patient–clinician communication in community mental healthcare: an international comparison

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

The effectiveness of psychosocial interventions in community mental healthcare has been shown to depend on the setting in which they are implemented. Recently structured patient–clinician communication was found to be effective in a multi-centre trial in six European countries, the DIALOG trial. In the overall study, differences between centres were controlled for, not studied. Here, we test whether the effectiveness of structured patient–clinician communication varies between services in different countries, and explore setting characteristics associated with outcome.

Methods

The study is part of the DIALOG trial, which included 507 patients with schizophrenia or related disorder, treated by 134 keyworkers. The keyworkers were allocated to intervention or treatment as usual.

Results

Positive effects were found on quality of life (effect size 0.20: 95% CI 0.01–0.39) and treatment satisfaction (0.27: 0.06–0.47) in all centres, but reductions in unmet needs for care were only seen in two centres (−0.83 and −0.60), and in positive, negative and general symptoms in one (−0.87, −0.78, −0.87). The intervention was most effective in settings with patient populations with many unmet needs for care and high symptom levels.

Conclusions

Psychosocial interventions in community mental healthcare may not be assumed to have uniform effectiveness across settings. Differences in patient population served and mental healthcare provided, should be studied for their influence on the effectiveness of the intervention. Structured patient–clinician communication has a uniform effect on quality of life and treatment satisfaction, but on unmet needs for care and symptom levels its effect differs between mental healthcare settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Burns T, Creed F, Fahy T, Thompson S, Tyrer P, White I (1999) Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet 353:2185–2189

    Article  PubMed  CAS  Google Scholar 

  2. Fiander M, Burns T, McHugo GJ, Drake RE (2003) Assertive community treatment across the Atlantic: comparison of model fidelity in the UK and USA. Br J Psychiatry 182:248–254

    Article  PubMed  Google Scholar 

  3. Burns T, Catty J, Becker T, Drake RE, Fioritti A, Knapp M, Lauber C, Rössler W, Tomov T, van Busschbach J, White S, Wiersma D (2007) The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet 370:1146–1152

    Article  PubMed  Google Scholar 

  4. Burns T, Catty J (2008) IPS in Europe: the EQOLISE trial. Psychiatr Rehab J 31:313–317

    Article  Google Scholar 

  5. Burns T, Priebe S (1996) Mental healthcare systems and their characteristics: a proposal. Acta Psychiatr Scand 94:381–385

    Article  PubMed  CAS  Google Scholar 

  6. Burns T, Fioritti A, Holloway F, Malm U, Rössler W (2001) Case management and assertive community treatment in Europe. Psychiatr Serv 52:631–636

    Article  PubMed  CAS  Google Scholar 

  7. Priebe S, McCabe R, Bullenkamp J, Hansson L, Lauber C, Martinez-Leal R, Rössler W, Salize H, Svensson B, Torres-Gonzales F, van den Brink R, Wiersma D, Wright DJ (2007) Structured patient-clinician communication and 1-year outcome in community mental healthcare. Cluster randomised controlled trial. Br J Psychiatry 191:420–426

    Article  PubMed  Google Scholar 

  8. Priebe S, McCabe R, Bullenkamp J, Hansson L, Rössler W, Torres-Gonzales F, Wiersma D (2002) The impact of routine outcome measurement on treatment process in community mental healthcare; approach and methods of the MECCA study. Epidemiol Psichiatr Soc 11:198–205

    PubMed  Google Scholar 

  9. Charles C, Gafni A, Whelan T, O’Brien AM (2006) Cultural influences on the physician-patient encounter: the case of shared treatment decision-making. Pat Educ Couns 63:262–267

    Article  Google Scholar 

  10. Cortes DE, Mulvaney-Day N, Fortuna L, Reinfeld S, Alegría M (2009) Patient-provider communication: understanding the role of patient activation for Latinos in mental health treatment. Health Educ Behav 36:138–154

    Article  PubMed  Google Scholar 

  11. Say R, Murtagh M, Thompson R (2006) Patients’ preference for involvement in medical decision making: a narrative review. Pat Educ Couns 60:102–114

    Article  Google Scholar 

  12. Hamann J, Cohen R, Leucht S, Busch R, Kissling W (2005) Do patients with schizophrenia wish to be involved in decisions about their medical treatment? Am J Psychiatry 162:2382–2384

    Article  PubMed  Google Scholar 

  13. Fisher H, Theodore K, Power P, Chisholm B, Fuller J, Marlowe K, Aitchison KJ, Tanna R, Joyce J, Sacks M, Craig T, Johnson S (2008) Routine evaluation in first episode psychosis services: feasibility and results from the MiData project. Soc Psychiatry Psychiatr Epidemiol 43:960–967

    Article  PubMed  Google Scholar 

  14. Priebe S, Huxley S, Knight S, Evans S (1999) Application and results of the Manchester Short Assessment of Quality of Life (MANSA). Int J Soc Psychiatr 45:7–12

    Article  CAS  Google Scholar 

  15. Slade M, Phelan M, Thornicroft G, Parkman S (1996) The Camberwell Assessment of Need (CAN): comparison of assessments by staff and patients of the needs of the severely mentally ill. Soc Psychiatry Psychiatr Epidemiol 31:109–113

    Article  PubMed  CAS  Google Scholar 

  16. Wiersma D, van den Brink R, Wolters K, McCabe R, Bullenkamp J, Hansson L, Lauber C, Martinez-Leal R, Rössler W, Salize H, Björkman T, Torres-Gonzales F, Wright D, Priebe J (2009) Individual unmet needs for care: are they sensitive as outcome criterion for the effectiveness of mental health services interventions? Soc Psychiatry Psychiatr Epidemiol 44:317–324

    Article  PubMed  Google Scholar 

  17. Nguyen TD, Attkisson CC, Stegner BL (1983) Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire. Eval Program Plann 6:299–313

    Article  PubMed  CAS  Google Scholar 

  18. Kay S, Fiszbein A, Opler L (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276

    PubMed  CAS  Google Scholar 

  19. McGuffin P, Farmer A, Harvey I (1991) A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Arch Gen Psychiatr 48:764–770

    PubMed  CAS  Google Scholar 

  20. Hansson L, Svensson B, Björkman T, Bullenkamp J, Lauber C, Martinez-Leal R, McCabe R, Rössler W, Salize H, Torres-Gonzales F, van den Brink R, Wiersma D, Priebe S (2008) What works for whom in a computer mediated communication intervention in community psychiatry? Moderators of outcome in a cluster randomized trial. Acta Psychiatr Scand 118:404–409

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The DIALOG group includes: Marta Ribes Leyva, Maria F. Soriano Peña, Beatriz Arroyo de Domingo (Granada); Aukelien Mulder, Jappie Tiersma (Groningen); Rakhee Haque, Donna Wright (London); Tommy Björkman (Lund); Marita Reichenbacher, Anette Axt (Mannheim); Patric Meyer, Minka Burgi (Zürich). We thank the clinicians and patients who took part in the DIALOG trial. The trial was funded by the Research Directorate of the European Commission within the Framework Programme 5 (QLG5-CT-2002-01938).

Author information

Authors and Affiliations

  1. Department of Psychiatry, University Medical Center Groningen, University of Groningen, CC73, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands

    Rob van den Brink, Durk Wiersma & Kerstin Wolters

  2. Central Institute for Mental Health, Mannheim, Germany

    Jens Bullenkamp & Hans Salize

  3. Department of Health Sciences, University of Lund, Lund, Sweden

    Lars Hansson & Bengt Svensson

  4. Division of Psychiatry, University of Liverpool, Liverpool, UK

    Christoph Lauber

  5. Department for Social and Clinical Psychiatry, Psychiatric University Hospital, Zürich, Switzerland

    Wulf Rössler

  6. Department of Psychiatry, University of Granada, Granada, Spain

    Rafael Martinez-Leal & Francisco Torres-Gonzales

  7. Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK

    Rosemarie McCabe & Stefan Priebe

Authors
  1. Rob van den Brink
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Durk Wiersma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kerstin Wolters
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jens Bullenkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lars Hansson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph Lauber
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rafael Martinez-Leal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rosemarie McCabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Wulf Rössler
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hans Salize
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Bengt Svensson
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Francisco Torres-Gonzales
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Stefan Priebe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rob van den Brink.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van den Brink, R., Wiersma, D., Wolters, K. et al. Non-uniform effectiveness of structured patient–clinician communication in community mental healthcare: an international comparison. Soc Psychiatry Psychiatr Epidemiol 46, 685–693 (2011). https://doi.org/10.1007/s00127-010-0235-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-010-0235-x

Keywords

Search

Navigation