Mengchun Chiang1, Janet Chang1, Ora Nakash1, Mario Cruz-Gonzalez1, Mirko K Fillbrunn1, Margarita Alegría1. 1. Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría).
Abstract
OBJECTIVE: Patient activation involves patients' ability and motivation to communicate about their health and health care. Research has demonstrated that clinician or patient interventions may improve patient activation. This study explored the degree to which clinician and patient interventions affected both patient activation and symptoms of depression and anxiety in a racially and ethnically diverse clinical sample. METHODS: Data were from a randomized clinical trial that included 312 patients and 74 clinicians from 13 Massachusetts community- and hospital-based outpatient behavioral health clinics. Patients completed measures of patient activation and depression and anxiety symptoms. Secondary data analyses were conducted to examine the effect of patient and clinician interventions (DECIDE-PA and DECIDE-PC, respectively) on depression and anxiety symptoms and patient activation. A multilevel, mixed-effects simultaneous-equation model was estimated to assess the relationship between the interventions, changes in patients' symptoms, and patient activation. RESULTS: Clinicians' greater intervention dosage (i.e., more completed DECIDE-PC training sessions) was associated with patients' decreased anxiety symptoms, but associations with patient activation or depression symptoms were not significant. The effect of clinician training dosage on anxiety symptoms was stronger when patients and clinicians were not of the same race-ethnicity. The reduction in patients' anxiety symptoms appeared to increase patient activation. CONCLUSIONS: Clinician interventions designed to boost patient-clinician communication and the therapeutic alliance may serve to lessen patients' anxiety and may ultimately improve patient activation.
OBJECTIVE: Patient activation involves patients' ability and motivation to communicate about their health and health care. Research has demonstrated that clinician or patient interventions may improve patient activation. This study explored the degree to which clinician and patient interventions affected both patient activation and symptoms of depression and anxiety in a racially and ethnically diverse clinical sample. METHODS: Data were from a randomized clinical trial that included 312 patients and 74 clinicians from 13 Massachusetts community- and hospital-based outpatient behavioral health clinics. Patients completed measures of patient activation and depression and anxiety symptoms. Secondary data analyses were conducted to examine the effect of patient and clinician interventions (DECIDE-PA and DECIDE-PC, respectively) on depression and anxiety symptoms and patient activation. A multilevel, mixed-effects simultaneous-equation model was estimated to assess the relationship between the interventions, changes in patients' symptoms, and patient activation. RESULTS: Clinicians' greater intervention dosage (i.e., more completed DECIDE-PC training sessions) was associated with patients' decreased anxiety symptoms, but associations with patient activation or depression symptoms were not significant. The effect of clinician training dosage on anxiety symptoms was stronger when patients and clinicians were not of the same race-ethnicity. The reduction in patients' anxiety symptoms appeared to increase patient activation. CONCLUSIONS: Clinician interventions designed to boost patient-clinician communication and the therapeutic alliance may serve to lessen patients' anxiety and may ultimately improve patient activation.
Entities:
Keywords:
Anxiety; Depression; Minorities; Patient activation; Patient-provider communication
Authors: Margarita Alegria; Ora Nakash; Kirsten Johnson; Andrea Ault-Brutus; Nicholas Carson; Mirko Fillbrunn; Ye Wang; Alice Cheng; Treniece Harris; Antonio Polo; Alisa Lincoln; Elmer Freeman; Benjamin Bostdorf; Marcos Rosenbaum; Claudia Epelbaum; Martin LaRoche; Ebele Okpokwasili-Johnson; MaJose Carrasco; Patrick E Shrout Journal: JAMA Psychiatry Date: 2018-04-01 Impact factor: 21.596