Effects of peer review on outpatient psychotherapy: therapist and patient follow-up survey.

Interviews with 80 therapists and 50 patients at a community mental health center revealed that peer review effectively monitored the appropriateness of treatment and allocated limited treatment funds without unduly interfering with established treatment patterns, relationships, or outcomes. Most therapists reported receiving helpful consultation from the peer review committee, and the process encouraged them to focus more clearly on treatment goals. On the other hand, patients were concerned about the committee's role in making decisions about their treatment. Therapists noted as a problem the lack of certainty in establishing a treatment contract prior to peer review since the contract with the patient must remain fluid during the evaluation period. The therapists and patients demonstrated remarkable agreement in their assessment of treatment progress and whether further therapy was needed.

Therapists' acceptance of peer review in a community mental health center.

Eighty therapists, the entire attending staff of a community mental health center, were interviewed to assess their perceptions of the center's interdisciplinary peer review system after it had been in operation for three and a half years. While many expressed reservations about parts of the system, about two-thirds felt that the review committee generally maintained an appropriate balance between quality of care and allocation of funds. More than 90 per cent found peer review an educational experience, and more than half said they would now choose to present casses to the committee even if not required to do so. Fifteen per cent felt they had experienced bias because of the professional disciplines of the reviewers. After presenting additional findings, the authors tell why they believe this particular system has a high degree of acceptance.

Therapists', patients', and inpatient staff's views of treatment modes and outcomes.

Data were gathered on 199 consecutive admissions to a community mental health center in an exploratory study to compare patients, therapists, and inpatient staff's perceptions of inpatient treatment. The three groups showed little agreement on the identification of patients' symptoms or on assessments of change for those cases in which they agreed on the symptoms. There was also little concurrence between the inpatient staff and therapists in reporting which major therapeutic modalities they used, and in identifying cases in which there were communication problems between therapist and staff. However, neither the use of different treatment approaches nor the existence of communication problems was related to longer lengths of stay or poorer outcomes. The authors note that many of the findings are consistent with comparisons elsewhere of patients' and caregivers' perceptions of outpatient psychotherapy and general medical care.