A cluster randomised controlled trial of patient-held medical records for people with schizophrenia receiving shared care.
BACKGROUND
Patient-held records can improve communication across the primary-secondary interface. There has been no previous rigorous assessment of the utility of patient-held records for people with schizophrenia from a primary care perspective and their value for this population is unclear.


OBJECTIVE
To evaluate the effectiveness of a patient-held record for patients with schizophrenia receiving shared care.


METHODS
Cluster randomised controlled trial.


METHODS
Seventy-four general practices and six community mental health localities in Birmingham, England between June 1998 and June 1999.


METHODS
A sample of 201 patients with schizophrenia (ICD-10 classification F20) was recruited; of these, 100 were intervention and 101 were control. Patient-held records were given to the intervention patients. At 12-month follow-up, all patients were accounted for and 191 (95%) were revisited. Primary outcomes were the Verona Service Satisfaction Scale-54 (VSSS-54) and the Krawiecka and Goldberg (K & G) rating scale of psychopathology at 12-month follow-up. Secondary outcomes were use of primary and secondary care services.


RESULTS
A total of 63/92 (68.5%) patients still had the patient-held record, 64/92 (69.6%) had used it, and 39 (60.9%) of the 64 who had used it said the patient-held record was regularly used by their keyworker. However the patient-held record had no significant effect on primary outcomes (VSSS-54: F1,116 = 0.06, P = 0.801, K & G: F1,116 = 0.6, P = 0.439) or on use of services. A higher symptom score was associated with not using the patient-held record.


CONCLUSIONS
The trial provides no good evidence to suggest that patient-held records should be introduced as part of routine shared care for all patients with schizophrenia. However, the patient-held record was acceptable to patients with schizophrenia and acted as a communication tool, particularly between patients and keyworkers.
Lester
Helen
H
Department of Primary Care and General Practice, Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT. H.E.Lester@bham.ac.uk
Allan
Teresa
T
Wilson
Sue
S
Jowett
Sue
S
Roberts
Lesley
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003266:Continuity of Patient Care / Q000458:organization & administration; D005194:Family Practice; D005260:Female; D005568:Forms and Records Control; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008499:Medical Records / Q000592:standards*; D008875:Middle Aged; D010348:Patient Care Team; D010349:Patient Compliance; D017060:Patient Satisfaction; D012559:Schizophrenia / Q000628:therapy*