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Does staff–patient agreement on needs for care predict a better mental health outcome? A 4-year follow-up in a community service

Published online by Cambridge University Press:  31 May 2007

A. Lasalvia ,
C. Bonetto ,
M. Tansella ,
B. Stefani  and
M. Ruggeri
A. Lasalvia*
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
C. Bonetto
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
M. Tansella
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
B. Stefani
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
M. Ruggeri
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
*
*Address for correspondence: Dr A. Lasalvia, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico ‘G.B. Rossi’, P.le Scuro 10, 37134 Verona, Italy. (Email: [email protected])
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Abstract

Background

Patients treated in primary care settings report better mental outcomes when they agree with practitioners about the nature of their core presenting problems. However, no study has examined the impact of staff–patient agreement on treatment outcomes in specialist mental health services. We investigated whether a better staff–patient agreement on needs for care predicts more favourable outcome in patients receiving community-based psychiatric care.

Method

A 3-month prevalence cohort of 188 patients with the full spectrum of psychiatric conditions was assessed at baseline and at 4 years using the Camberwell Assessment of Need (CAN), both staff (CAN-S) and patient versions (CAN-P), and a set of standardized outcome measures. Baseline staff–patient agreement on needs was included among predictors of outcome. Both clinician-rated (psychopathology, social disability, global functioning) and patient-rated (subjective quality of life and satisfaction with services) outcomes were considered.

Results

Controlling for the effect of sociodemographics, service utilization and changes in clinical status, better staff–patient agreement makes a significant additional contribution in predicting treatment outcomes not only on patient-rated but also on clinician-rated measures.

Conclusions

Mental health care should be provided on the basis of a negotiation process involving both professionals and service users to ensure effective interventions; every effort should be made by services to implement strategies aiming to increase consensus between staff and patients.

Keywords

Community mental health serviceslongitudinal studiesneeds assessmentoutcome assessmentpatients' self-report
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 1 , January 2008 , pp. 123 - 133
Copyright
Copyright © Cambridge University Press 2007

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References

APA (1994). DSM-IV. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Baron, RM, Kenny, DA (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 1173–1182.CrossRefGoogle ScholarPubMed
Bentler, PM, Bonett, DG (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin 88, 588–606.CrossRefGoogle Scholar
Chamberlin, J (2005). User/consumer involvement in mental health service delivery. Epidemiologia e Psichiatria Sociale 14, 10–14.CrossRefGoogle ScholarPubMed
Comtois, G, Morin, C, Lesage, A, Lalonde, P, Likavcanova, E, L'Ecuyer, G (1998). Patients versus rehabilitation practitioners: a comparison of assessments of needs for care. Canadian Journal of Psychiatry 43, 159–165.CrossRefGoogle ScholarPubMed
Day, JC, Bentall, RP, Roberts, C, Randall, F, Rogers, A, Cattell, D, Healy, D, Rae, P, Power, C (2005). Attitudes toward antipsychotic medication: the impact of clinical variables and relationships with health professionals. Archives of General Psychiatry 62, 717–724.CrossRefGoogle ScholarPubMed
Dunn, G, Everitt, B, Pickles, A (1993). Modelling Covariances and Latent Variables using EQS. Chapman & Hall: London.Google Scholar
Fenton, WS, Blyler, CR, Heinssen, RK (1997). Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophrenia Bulletin 23, 637–651.CrossRefGoogle ScholarPubMed
Frank, A, Gunderson, JG (1990). The role of the therapeutic alliance in the treatment of schizophrenia. Archives of General Psychiatry 47, 228–236.CrossRefGoogle ScholarPubMed
Gabbay, M, Shiels, C, Bower, P, Sibbald, B, King, M, Ward, E (2003). Patient–practitioner agreement: does it matter? Psychological Medicine 33, 241–251.CrossRefGoogle ScholarPubMed
Hansson, L, Vinding, HR, Mackeprang, T, Sourander, A, Werdelin, G, Bengtsson-Tops, A, Bjarnason, O, Dybbro, J, Nilsson, L, Sandlund, M, Sorgaard, K, Middelboe, T (2001). Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study. Acta Psychiatrica Scandinavica 103, 45–51.CrossRefGoogle ScholarPubMed
House, A, House, B, Campbell, M (1981). Measures of inter-observer agreement: calculation formulas and distribution effects. Journal of Behavioural Assessment 1, 37–57.CrossRefGoogle Scholar
Howgego, IM, Yellowlees, P, Owen, C, Meldrum, L, Dark, F (2003). The therapeutic alliance: the key to effective patient outcome? A descriptive review of the evidence in community mental health case management. Australian and New Zealand Journal of Psychiatry 37, 169–183.CrossRefGoogle ScholarPubMed
Lasalvia, A, Bonetto, C, Malchiodi, F, Salvi, G, Parabiaghi, A, Tansella, M, Ruggeri, M (2005). Listening to patients' needs to improve their subjective quality of life. Psychological Medicine 35, 1655–1665.CrossRefGoogle ScholarPubMed
Lasalvia, A, Ruggeri, M, Mazzi, MA, Dall'Agnola, RB (2000). The perception of needs for care in staff and patients in community-based mental health services. The South-Verona Outcome Project 3. Acta Psychiatrica Scandinavica 102, 366–375.CrossRefGoogle ScholarPubMed
Lasalvia, A, Ruggeri, M, Santolini, N (2002). Subjective quality of life: its relationship with clinician-rated and patient-rated psychopathology. The South-Verona Outcome Project 6. Psychotherapy and Psychosomatics 71, 275–284.CrossRefGoogle ScholarPubMed
Leese, M, Johnson, S, Slade, M, Parkman, S, Kelly, F, Phelan, M, Thornicroft, G (1998). User perspective on needs and satisfaction with mental health services. PRiSM Psychosis Study 8. British Journal of Psychiatry 173, 409–415.CrossRefGoogle ScholarPubMed
Martin, D, Garske, JP, Davis, K (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytical review. Journal of Consulting and Clinical Psychology 68, 438–450.CrossRefGoogle Scholar
McCabe, R, Priebe, S (2004). The therapeutic relationship in the treatment of severe mental illness: a review of methods and findings. International Journal of Social Psychiatry 50, 115–128.CrossRefGoogle ScholarPubMed
McGuire-Snieckus, R, McCabe, R, Catty, J, Priebe, S (2007). A new scale to assess the therapeutic relationship in community mental health care: STAR. Psychological Medicine 36, 85–95.CrossRefGoogle Scholar
Ochoa, S, Haro, JM, Autonell, J, Pendas, A, Teba, F, Marquez, M (2003). Met and unmet needs of schizophrenia patients in a Spanish sample. Schizophrenia Bulletin 29, 201–210.CrossRefGoogle Scholar
Oliver, JP, Huxley, PJ, Priebe, S, Kaiser, W (1997). Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile. Social Psychiatry and Psychiatric Epidemiology 32, 76–83.CrossRefGoogle ScholarPubMed
Phelan, M, Slade, M, Thornicroft, G, Dunn, G, Holloway, F, Wykes, T, Strathdee, G, Loftus, L, McCrone, P, Hayward, P (1995). The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. British Journal of Psychiatry 167, 589–595.CrossRefGoogle ScholarPubMed
Priebe, S, Bullenkamp, J, McCabe, R, Hansson, L, Rössler, W, Torres-Gonzales, F, Wiersma, D (2002). The impact of routine outcome measurement on treatment processes in community mental health care: approach and methods of the MECCA study. Epidemiologia e Psichiatria Sociale 3, 198–205.CrossRefGoogle Scholar
Priebe, S, Gruyters, T (1993). The role of the helping alliance in psychiatric community care: a prospective study. Journal of Nervous and Mental Diseases 181, 552–557.CrossRefGoogle ScholarPubMed
Raykov, T, Tomer, A, Nesselroade, JR (1991). Reporting structural equation modelling results in psychology and aging: some proposed guidelines. Psychological Aging 6, 499–503.CrossRefGoogle Scholar
Ruggeri, M, Bisoffi, G, Fontecedro, L, Warner, R (2001). Subjective and objective dimensions of quality of life in psychiatric patients: a factor analytical approach: The South Verona Outcome Project 4. British Journal of Psychiatry 178, 268–275.CrossRefGoogle ScholarPubMed
Ruggeri, M, Dall'Agnola, R (1993). The development and use of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS) for measuring expectations and satisfaction with community-based psychiatric services in patients, relatives and professionals. Psychological Medicine 23, 511–523.CrossRefGoogle ScholarPubMed
Ruggeri, M, Leese, M, Slade, M, Bonizzato, P, Fontecedro, L, Tansella, M (2004). Demographic, clinical, social and service variables associated with higher needs for care in community psychiatric service patients. The South Verona Outcome Project 8. Social Psychiatry and Psychiatric Epidemiology 39, 60–68.CrossRefGoogle Scholar
Slade, M, Leese, M, Cahill, S, Thornicroft, G, Kuipers, E (2005). Patient-rated mental health needs and quality of life improvement. British Journal of Psychiatry 187, 256–261.CrossRefGoogle ScholarPubMed
Slade, M, McCrone, P, Kuipers, E, Leese, M, Cahill, S, Parabiaghi, A, Priebe, S, Thornicroft, G (2006). Use of standardised outcome measures in adult mental health services: randomised controlled trial. British Journal of Psychiatry 189, 330–336.CrossRefGoogle ScholarPubMed
Slade, M, Phelan, M, Thornicroft, G (1998). A comparison of needs assessed by staff and by an epidemiologically representative sample of patients with psychosis. Psychological Medicine 28, 543–555.CrossRefGoogle ScholarPubMed
Starfield, B, Wray, C, Hess, K, Gross, R, Birk, PS, D'Lugoff, BC (1981). The influence of patient–practitioner agreement on outcome of care. American Journal of Public Health 71, 127–131.CrossRefGoogle ScholarPubMed
Tansella, M, Amaddeo, F, Burti, L, Ruggeri, M (1998). Community-based mental health care in Verona, Italy. In Mental Health in our Future Cities (ed. Godberg, D. and Thornicroft, G.), pp. 239–262. Psychology Press: Hove.Google Scholar
Thornicroft, G, Tansella, M (2005). Growing recognition of the importance of service user involvement in mental health service planning and evaluation. Epidemiologia e Psichiatria Sociale 14, 1–3.CrossRefGoogle ScholarPubMed
Ventura, J, Green, M, Shaner, A, Lieberman, R (1993). Training and quality assurance with the Brief Psychiatric Rating Scale: ‘the drift busters’. International Journal of Methods in Psychiatric Research 3, 221–224.Google Scholar
WHO (1988). Disability Assessment Schedule (DAS-II). World Health Organization: Geneva.Google Scholar