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


METHODS
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.
Lasalvia
A
A
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy. antonio.lasalvia@medicina.univr.it
Bonetto
C
C
Tansella
M
M
Stefani
B
B
Ruggeri
M
M
D000328:Adult; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D032921:Consensus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D020380:Needs Assessment / Q000706:statistics & numerical data*; D017008:Negotiating; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011336:Probability; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011788:Quality of Life; D016896:Treatment Outcome