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Structured patient–clinician communication and 1-year outcome in community mental healthcare

Cluster randomised controlled trial

Unit for Social and Community Psychiatry, Queen Mary, University of London, UK

JENS BULLENKAMP, MD

Central Institute for Mental Health, Mannheim, Germany

LARS HANSSON, PhD

Department of Psychiatry, University of Lund, Sweden

CHRISTOPH LAUBER, MD

Department for Social and Clinical Psychiatry, Psychiatric University Hospital, Zurich, Switzerland

RAFAEL MARTINEZ-LEAL, MSc

Department of Psychiatry, University of Granada, Spain

WULF RÖSSLER, MD

Department for Social and Clinical Psychiatry, Psychiatric University Hospital, Zurich, Switzerland

HANS SALIZE, PhD

Central Institute for Mental Health, Mannheim, Germany

BENGT SVENSSON, PhD

Department of Psychiatry, University of Lund, Sweden

FRANCISCO TORRES-GONZALES, MD

Department of Psychiatry, University of Granada, Spain

ROB VAN DEN BRINK, PhD and DURK WIERSMA, PhD

Department of Psychiatry, University of Groningen, The Netherlands

DONNA J. WRIGHT, MSc

Unit for Social and Community Psychiatry, Queen Mary, University of London, UK

Correspondence: Dr Stefan Priebe, Unit for Social and Community Psychiatry, Queen Mary, University of London, Newham Centre for Mental Health, London E13 8SP, UK. Email: S.Priebe{at}qmul.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Patient–clinician communication is central to mental healthcare but neglected in research.

Aims To test a new computer-mediated intervention structuring patient–clinician dialogue (DIALOG) focusing on patients’ quality of life and needs for care.

Method In a cluster randomised controlled trial, 134 keyworkers in six countries were allocated to DIALOG or treatment as usual; 507 people with schizophrenia or related disorders were included. Every 2 months for 1 year, clinicians asked patients to rate satisfaction with quality of life and treatment, and request additional or different support. Responses were fed back immediately in screen displays, compared with previous ratings and discussed. Primary outcome was subjective quality of life, and secondary outcomes were unmet needs and treatment satisfaction.

Results Of 507 patients, 56 were lost to follow-up and 451 were included in intention-to-treat analyses. Patients receiving the DIALOG intervention had better subjective quality of life, fewer unmet needs and higher treatment satisfaction after 12 months.

Conclusions Structuring patient–clinician dialogue to focus on patients’ views positively influenced quality of life, needs for care and treatment satisfaction.

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