Lasalvia A, Bonetto C, Tansella M, Stefani B, Ruggeri M
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy.
Psychol Med. 2008 Jan;38(1):123-33. doi: 10.1017/S0033291707000785. Epub 2007 May 31.
Patients treated in primary care settings report better mental outcomes when they agree with practitioners about the nature of their core presenting problems. However, no study has examined the impact of staff-patient agreement on treatment outcomes in specialist mental health services. We investigated whether a better staff-patient agreement on needs for care predicts more favourable outcome in patients receiving community-based psychiatric care.
A 3-month prevalence cohort of 188 patients with the full spectrum of psychiatric conditions was assessed at baseline and at 4 years using the Camberwell Assessment of Need (CAN), both staff (CAN-S) and patient versions (CAN-P), and a set of standardized outcome measures. Baseline staff-patient agreement on needs was included among predictors of outcome. Both clinician-rated (psychopathology, social disability, global functioning) and patient-rated (subjective quality of life and satisfaction with services) outcomes were considered.
Controlling for the effect of sociodemographics, service utilization and changes in clinical status, better staff-patient agreement makes a significant additional contribution in predicting treatment outcomes not only on patient-rated but also on clinician-rated measures.
Mental health care should be provided on the basis of a negotiation process involving both professionals and service users to ensure effective interventions; every effort should be made by services to implement strategies aiming to increase consensus between staff and patients.
在初级保健机构接受治疗的患者，若与从业者就其核心就诊问题的性质达成一致，其心理治疗效果更佳。然而，尚无研究探讨医患共识对专科心理健康服务治疗效果的影响。我们调查了在基于社区的精神科护理中，医患在护理需求上达成更好的共识是否预示着更有利的治疗结果。
对188名患有各种精神疾病的患者进行为期3个月的患病率队列研究，在基线和4年时使用坎伯韦尔需求评估量表（CAN）的工作人员版（CAN-S）和患者版（CAN-P）以及一组标准化的结局指标进行评估。基线时医患在需求上的共识被纳入结局预测指标。同时考虑临床医生评定的结局（精神病理学、社会残疾、整体功能）和患者评定的结局（主观生活质量和对服务的满意度）。
在控制了社会人口统计学、服务利用情况和临床状态变化的影响后，更好的医患共识不仅在预测患者评定的结局方面，而且在预测临床医生评定的指标方面，对治疗结局都有显著的额外贡献。
精神卫生保健应基于专业人员和服务使用者之间的协商过程来提供，以确保有效的干预措施；服务机构应尽一切努力实施旨在提高医患之间共识的策略。
