A web-based program to empower patients who have schizophrenia to discuss quality of care with mental health providers.
OBJECTIVE
This study evaluated a Web-based tool to help patients with schizophrenia communicate with clinicians about evidence-based treatments.


METHODS
Fifty patients used an interactive Web-based intervention featuring actors simulating a patient discussing treatment concerns (intervention group; N=24) or were shown an educational video about schizophrenia treatment before an appointment for routine follow-up care (control group; N=26). The visits were recorded and analyzed by using the Roter Interaction Analysis System.


RESULTS
Visits by patients in the intervention group were longer (24 versus 19 minutes, p<.05) and had a proportionately greater patient contribution to the dialogue (288 versus 229 statements, p<.05) and a smaller ratio of clinician to patient talk (1.1 versus 1.4, p<.05) compared with visits by the control group. Patients in the intervention group asked more questions about treatment (2 versus .9, p<.05), disclosed more lifestyle information (76 versus 53 statements, p<.005), and more often checked that they understood information (3.6 versus 2.1 checks, p<.05). Clinicians asked more questions about treatment (7.5 versus 5.1, p<.05) and the medical condition (7.8 versus 4.7, p<.05) to control group patients but made more statements of empathy (1.3 versus .4, p<.03) and cues of interest (48 versus 22, p<.05) with the intervention group. The patient-centeredness ratio was greater for visits by patients in the intervention group than by the control group (8.5 versus 3.2, p<.05). Patients' tone was more dominant and respectful (p<.05) and clinicians' tone was more sympathetic (p<.05) during visits by patients in the intervention.


CONCLUSIONS
The Web-based tool empowered persons with schizophrenia to engage more fully in a patient-centered dialogue about their treatment.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. dsteinwa@jhsph.edu
Donald M
DM
Steinwachs
Debra L
DL
Roter
Elizabeth A
EA
Skinner
Anthony F
AF
Lehman
Maureen
M
Fahey
Bernadette
B
Cullen
Anita Smith
AS
Everett
Gerard
G
Gallucci
D001294:Attitude to Health; D003156:Community Mental Health Services; D003194:Computer-Assisted Instruction / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006282:Health Personnel; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011209:Power, Psychological; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D012559:Schizophrenia / Q000628:therapy*