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Social Psychiatry and Psychiatric Epidemiology

, Volume 46, Issue 8, pp 685–693 | Cite as

Non-uniform effectiveness of structured patient–clinician communication in community mental healthcare: an international comparison

  • Rob van den BrinkEmail author
  • Durk Wiersma
  • Kerstin Wolters
  • Jens Bullenkamp
  • Lars Hansson
  • Christoph Lauber
  • Rafael Martinez-Leal
  • Rosemarie McCabe
  • Wulf Rössler
  • Hans Salize
  • Bengt Svensson
  • Francisco Torres-Gonzales
  • Stefan Priebe
Original Paper

Abstract

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.

Keywords

Physician–patient relations Computer-assisted decision making Community mental health services Population characteristics Health services research 

Notes

Acknowledgments

The DIALOG group includes: Marta Ribes Leyva, Maria F. Soriano Peña, Beatriz Arroyo de Domingo (Granada); Aukelien Mulder, Jappie Tiersma (Groningen); Rakhee Haque, Donna Wright (London); Tommy Björkman (Lund); Marita Reichenbacher, Anette Axt (Mannheim); Patric Meyer, Minka Burgi (Zürich). We thank the clinicians and patients who took part in the DIALOG trial. The trial was funded by the Research Directorate of the European Commission within the Framework Programme 5 (QLG5-CT-2002-01938).

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Rob van den Brink
    • 1
    Email author
  • Durk Wiersma
    • 1
  • Kerstin Wolters
    • 1
  • Jens Bullenkamp
    • 2
  • Lars Hansson
    • 3
  • Christoph Lauber
    • 4
  • Rafael Martinez-Leal
    • 6
  • Rosemarie McCabe
    • 7
  • Wulf Rössler
    • 5
  • Hans Salize
    • 2
  • Bengt Svensson
    • 3
  • Francisco Torres-Gonzales
    • 6
  • Stefan Priebe
    • 7
  1. 1.Department of Psychiatry, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  2. 2.Central Institute for Mental HealthMannheimGermany
  3. 3.Department of Health SciencesUniversity of LundLundSweden
  4. 4.Division of PsychiatryUniversity of LiverpoolLiverpoolUK
  5. 5.Department for Social and Clinical PsychiatryPsychiatric University HospitalZürichSwitzerland
  6. 6.Department of PsychiatryUniversity of GranadaGranadaSpain
  7. 7.Unit for Social and Community PsychiatryQueen Mary University of LondonLondonUK

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