title: Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results.
abstract: OBJECTIVE
  Recommendations for improving care include increased patient-clinician collaboration, patient empowerment, and greater relational continuity of care. All rely upon good clinician-patient relationships, yet little is known about how relational continuity and clinician-patient relationships interact, or their effects on recovery from mental illness.
  
  
  METHODS
  Individuals (92 women, 85 men) with schizophrenia, schizoaffective disorder, affective psychosis, or bipolar disorder participated in this observational study. Participants completed in-depth interviews detailing personal and mental health histories. Questionnaires included quality of life and recovery assessments and were linked to records of services used. Qualitative analyses yielded a hypothesized model of the effects of relational continuity and clinician-patient relationships on recovery and quality of life, tested using covariance structure modeling.
  
  
  RESULTS
  Qualitative data showed that positive, trusting relationships with clinicians, developed over time, aid recovery. When "fit" with clinicians was good, long-term relational continuity of care allowed development of close, collaborative relationships, fostered good illness and medication management, and supported patient-directed decisions. Most valued were competent, caring, trustworthy, and trusting clinicians who treated clinical encounters "like friendships," increasing willingness to seek help and continue care when treatments were not effective and supporting "normal" rather than "mentally ill" identities. Statistical models showed positive relationships between recovery-oriented patient-driven care and satisfaction with clinicians, medication satisfaction, and recovery. Relational continuity indirectly affected quality of life via satisfaction with clinicians; medication satisfaction was associated with fewer symptoms; fewer symptoms were associated with recovery and better quality of life.
  
  
  CONCLUSIONS
  Strong clinician-patient relationships, relational continuity, and a caring, collaborative approach facilitate recovery from mental illness and improved quality of life.
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Oregon Health & Science University, Portland, OR 97227-1110, USA. carla.a.green@kpchr.org
authors.forename: Carla A
authors.initials: CA
authors.lastname: Green
authors.forename: Michael R
authors.initials: MR
authors.lastname: Polen
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Janoff
authors.forename: David K
authors.initials: DK
authors.lastname: Castleton
authors.forename: Jennifer P
authors.initials: JP
authors.lastname: Wisdom
authors.forename: Nancy
authors.initials: N
authors.lastname: Vuckovic
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Perrin
authors.forename: Robert I
authors.initials: RI
authors.lastname: Paulson
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Oken
mesh_terms: D000293:Adolescent; D000328:Adult; D000341:Affective Disorders, Psychotic / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D003266:Continuity of Patient Care; D005260:Female; D006302:Health Services Research; D006801:Humans; D007406:Interview, Psychological; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D010552:Personality Assessment; D010817:Physician-Patient Relations; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life / Q000523:psychology; D012559:Schizophrenia / Q000175:diagnosis / Q000534:rehabilitation; D012565:Schizophrenic Psychology