Patient empowerment in risk management: a mixed-method study to explore mental health professionals' perspective.

BACKGROUND: In the last years, patients' empowerment has been increasingly recognized as a crucial dimension of patient-centered healthcare and patient safety. Nevertheless, little work has been done so far in the field of patient safety to investigate strategies for empowering psychiatric patients. Therefore, the aim of this study was to identify, by using focus groups, whether and how psychiatric patients' empowerment can improve risk management according to the perspective of healthcare providers (HPs). METHODS: A mixed-method approach composed of a qualitative data collection method (i.e., focus groups) and a quantitative analysis technique (i.e., inductive content analysis) was applied. HPs working in mental health settings shared their perspectives on psychiatric patients' empowerment in risk management. After the transcription of the audio-taped discussions and the subsequent development of a hierarchical four-level coding system (strategy versus critical issue, thematic area, category, subcategory), two independent raters codified the transcripts and synthesized the content. Absolute frequencies are reported for quantitative data. RESULTS: Twelve focus groups consisting of six to ten participants, each with an overall sample size of 95 participants (65 women; average age ± SD 47 ± 9 yrs), were enrolled. A total of 1252 participants' verbal contributions (i.e., units of analysis) were assessed. Strategies and critical issues (Level 1) were mentioned almost equally (52 and 48%, respectively) by the HPs. Most of the contributions at Level 2 referred to the thematic areas Treatment and Cure (69%) and Emergency Management (21%). In the area Treatment and Cure, the category Therapeutic Compliance (Level 3) was discussed in one third of all contributions. CONCLUSIONS: Our results suggest that HPs consider patients as crucial partners in risk management and expect them to play a key role in actively enhancing safety. Policy makers should be aware that risk management in mental health settings particularly relies on the therapeutic relationship between HPs and patients. Therefore, allocating sufficient human and financial resources to mental health care aiming to further support the relationship between patients and HPs is of utmost importance.

Asking questions during breast cancer consultations: does being alone or being accompanied make a difference?

PURPOSE: Companions often accompany patients to cancer consultations. The number of questions asked by patients and companions is an indicator of their active participation. The present study aims to provide first descriptive evidence on the characteristics of unaccompanied and accompanied Italian breast cancer patients that attend the first consultation after surgery and to analyse companions contribution to the type and quantity of questions asked during the consultation. METHOD: Seventy consultations of female patients with breast cancer were audio taped. Questions were transcribed and coded by content. Companion's questions were also classified in terms of function. Socio-demographic and clinical data, patients' role preference and confidence in decision making measures were gathered for each patient. Post consultation satisfaction with decision and the perceived level of shared decision making were collected either for the patient and the companion. RESULTS: 69% of patients were accompanied, usually by one close family member, either husband or adult child. Non employed or retired patients and those with a preference for passive role in decision making were more likely to be accompanied. Unaccompanied patients and accompanied patients had comparable levels of anxiety, emotional distress and depression and were equally active in asking questions. These levels were far greater than those reported for other cancer patients in the literature. Companions did not increase significantly the number of questions per consultation. CONCLUSION: Accompanied and non accompanied patients differed more in socio-demographic than clinical characteristics. Companions sustained the patient and shared information without reducing the level of patient involvement.

Decisional strategies for the attribution of emotional distress in primary care.

BACKGROUND: In primary care the General Health Questionnaire (GHQ) is used to provide an independent assessment of probable caseness of psychological disorder against which to test the ability of the general practitioner (GP) to recognize patients with current emotional problems. METHOD: The aim of the present study was to identify those clinical and psychosocial data on patients that increase the likelihood of GPs' attribution of emotional distress (GP model) and those that predict patients' emotional distress as defined by the GHQ-12 (GHQ model). The associations were explored using a classification tree technique (CHAID) and compared using bivariate logistic regression. Six GPs and 444 primary care patients took part. RESULTS: The accuracy indices of the hierarchical GP and GHQ models were 72% and 69% respectively. The availability of information on patients' psychopharmacological and psychiatric/psychological treatment in the last year was the most important predictor of attribution. Occupational, financial and housing problems and life events of loss were the most important predictors of the GHQ-12 case definition. The overall accuracy of the bivariate model was 73%. Compared with the GHQ-12, GPs gave significantly more importance to psychiatric treatment, psychopharmacological drug use and chronic illness. CONCLUSIONS: The findings suggest that to improve the detection of current emotional distress in primary care patients GPs should pay foremost and systematic attention to social problems and recent life events of loss. These problems are important clues for the possible presence of emotional distress, whereas critical patient data, in particular psychiatric history and psychopharmacological treatment, increase the probability of attribution errors.

The perception of needs for care in staff and patients in community-based mental health services. The South-Verona Outcome Project 3.

OBJECTIVE: The present study aims to assess needs for care rated by patients and staff and their agreement on needs assessment in a community-based mental health service by using the Camberwell Assessment of Need (CAN). METHOD: The Italian version of the CAN was used in a sample of 247 patient-staff pairs. RESULTS: Patients and staff showed poor agreement on both the presence of a need and on whether need had been met or not. Higher disability predicted a higher number of patient-rated needs, while higher disability, higher number of service contacts and patient unemployment predicted a higher number of staff-rated needs. Lower global functioning predicted higher disagreement in patients and staff ratings of needs. CONCLUSION: Patients and staff show different perceptions of needs for care and therefore multiple perspectives should be taken into account for planning and providing effective needs-led mental health care.

The Personal Health Questionnaire: a new screening instrument for detection of ICD-10 depressive disorders in primary care.

BACKGROUND: The next generation of studies on antidepressant drug prescriptions in general practice needs to assess both the patterns of prescription and its appropriateness. This study aimed to assess the performance of the Personal Health Questionnaire (PHQ), a new questionnaire for detecting individuals with ICD- 10 depressive disorders, to be used in association with companion instruments for assessing the 'quality' of antidepressant prescriptions in primary care settings. METHODS: The PHQ was completed by 1,413 primary care attenders (100 were re-tested after 7-14 days) and 139 were selected and interviewed using the SCAN-2 and the 17-item HDRS. All data were analysed using appropriately weighted procedures to control for two-phase sampling design and non-response bias. Individual weights were estimated by logistic regression analysis and trimming strategy. RESULTS: PHQ internal consistency and test-retest on both Likert score and number of symptoms were high. The PHQ discriminated well between individuals with and without depressive disorders. A Likert score > or = 9 provided a good trade-off between sensitivity (0.78) and specificity (0.83). The screening accuracy of the PHQ in detecting subjects likely to benefit from antidepressant drug treatment (SCAN cases with a HDRS total score of 13 or higher) was satisfactory (ROC area 0.87: sensitivity 0.84; specificity 0.78). CONCLUSIONS: The PHQ can be strongly suggested as an accurate and economic screener to identify primary care attenders at high risk of being clinically depressed. However, in order to identify patients requiring antidepressant drug treatment, a second-phase assessment of PHQ high scorers (total score of > or = 10), using the HDRS, is needed.