title: The determinants and effect of shared care on patient outcomes and psychiatric admissions - an inner city primary care cohort study.
abstract: OBJECTIVE
  The aim of this study was to determine the factors associated with receipt of different levels of shared care, and the effect of shared care on patient outcomes.
  
  
  METHODS
  A total of 349 patients with severe mental illness were selected from general practice lists. Patient functioning was assessed using standardised questionnaires, and GPs completed a questionnaire about patients' shared care arrangements at baseline (response-rate 79%). Patients were followed up at 12 months.
  
  
  RESULTS
  Receipt of high shared care was associated with greater patient satisfaction with services and social functioning at baseline (p < 0.005). Patients receiving high shared care showed greater improvements in SF-12 mental health scores at follow-up compared to low shared care groups (p = 0.02). This effect was abolished after adjustment for age, sex and psychiatric diagnosis.
  
  
  CONCLUSIONS
  Receipt of high shared care was not associated with demographic or clinical characteristics. High shared care had limited value for patients in terms of improved clinical, social or general health functioning over one year.
authors.affiliation: Department of Public Health Research, Westminster Primary Care Trust, Westminster Primary Care Trust Headquarters, 15 Marylebone Road, London NW1 5JD, UK. natalie.fitzpatrick@westminster-pct.nhs.uk
authors.forename: Natalie K
authors.initials: NK
authors.lastname: Fitzpatrick
authors.forename: Sunil
authors.initials: S
authors.lastname: Shah
authors.forename: Neil
authors.initials: N
authors.lastname: Walker
authors.forename: Shaeda
authors.initials: S
authors.lastname: Nourmand
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Tyrer
authors.forename: Thomas R E
authors.initials: TR
authors.lastname: Barnes
authors.forename: Anna
authors.initials: A
authors.lastname: Higgitt
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000458:organization & administration* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom