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.
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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.
Authors: Tom Burns; Jocelyn Catty; Thomas Becker; Robert E Drake; Angelo Fioritti; Martin Knapp; Christoph Lauber; Wulf Rössler; Toma Tomov; Jooske van Busschbach; Sarah White; Durk Wiersma Journal: Lancet Date: 2007-09-29 Impact factor: 79.321
Authors: Durk Wiersma; Rob van den Brink; Kerstin Wolters; Rosemarie McCabe; Jens Bullenkamp; Lars Hansson; Christoph Lauber; Rafael Martinez-Leal; Wulf Rössler; Hans Salize; Tommy Björkman; Francisco Torres-Gonzales; Donna J Wright; Stefan Priebe Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2008-09-08 Impact factor: 4.328
Authors: L Hansson; B Svensson; T Björkman; J Bullenkamp; C Lauber; R Martinez-Leal; R McCabe; W Rössler; H Salize; F Torres-Gonzales; R van den Brink; D Wiersma; S Priebe Journal: Acta Psychiatr Scand Date: 2008-08-27 Impact factor: 6.392
Authors: Y Feng; C Roukas; M Russo; S Repišti; A Džubur Kulenović; L Injac Stevović; J Konjufca; S Markovska-Simoska; L Novotni; I Ristić; E Smajić-Mešević; F Uka; M Zebić; L Vončina; A Bobinac; N Jovanović Journal: Eur Psychiatry Date: 2022-08-26 Impact factor: 7.156