Non-uniform effectiveness of structured patient-clinician communication in community mental healthcare: an international comparison.
BACKGROUND
The effectiveness of psychosocial interventions in community mental healthcare has been shown to depend on the setting in which they are implemented. Recently structured patient-clinician communication was found to be effective in a multi-centre trial in six European countries, the DIALOG trial. In the overall study, differences between centres were controlled for, not studied. Here, we test whether the effectiveness of structured patient-clinician communication varies between services in different countries, and explore setting characteristics associated with outcome.


METHODS
The study is part of the DIALOG trial, which included 507 patients with schizophrenia or related disorder, treated by 134 keyworkers. The keyworkers were allocated to intervention or treatment as usual.


RESULTS
Positive effects were found on quality of life (effect size 0.20: 95% CI 0.01-0.39) and treatment satisfaction (0.27: 0.06-0.47) in all centres, but reductions in unmet needs for care were only seen in two centres (-0.83 and -0.60), and in positive, negative and general symptoms in one (-0.87, -0.78, -0.87). The intervention was most effective in settings with patient populations with many unmet needs for care and high symptom levels.


CONCLUSIONS
Psychosocial interventions in community mental healthcare may not be assumed to have uniform effectiveness across settings. Differences in patient population served and mental healthcare provided, should be studied for their influence on the effectiveness of the intervention. Structured patient-clinician communication has a uniform effect on quality of life and treatment satisfaction, but on unmet needs for care and symptom levels its effect differs between mental healthcare settings.
van den Brink
Rob
R
Department of Psychiatry, University Medical Center Groningen, University of Groningen, CC73, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. r.h.s.van.den.brink@med.umcg.nl
Wiersma
Durk
D
Wolters
Kerstin
K
Bullenkamp
Jens
J
Hansson
Lars
L
Lauber
Christoph
C
Martinez-Leal
Rafael
R
McCabe
Rosemarie
R
Rössler
Wulf
W
Salize
Hans
H
Svensson
Bengt
B
Torres-Gonzales
Francisco
F
Priebe
Stefan
S
D000328:Adult; D003155:Community Mental Health Centers; D057186:Comparative Effectiveness Research / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D007406:Interview, Psychological / Q000379:methods* / Q000592:standards; D008131:London; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012559:Schizophrenia / Q000628:therapy*; D013030:Spain; D013548:Sweden; D013557:Switzerland; D016896:Treatment Outcome; D000078329:Workforce