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Content and implementation of clinical decisions in the routine care of people with severe mental illness


Konrad, Jana; Loos, Sabine; Neumann, Petra; Zentner, Nadja; Mayer, Benjamin; Slade, Mike; Jordan, Harriet; De Rosa, Corrado; Del Vecchio, Valeria; Égerházi, Anikó; Nagy, Marietta; Bording, Malene Krogsgaard; Sørensen, Helle Østermark; Kawohl, Wolfram; Rössler, Wulf; Puschner, Bernd (2015). Content and implementation of clinical decisions in the routine care of people with severe mental illness. Journal of Mental Health, 24(1):15-19.

Abstract

BACKGROUND: Clinical decision making (CDM) in the treatment of people with severe mental illness relates to a wide range of life domains.
AIMS: To examine content of CDM in mental health care from the perspectives of service users and staff and to investigate variation in implementation of decisions for differing content.
METHOD: As part of the European multicenter study clinical decision making and outcome in routine care for people with severe mental illness (ISRCTN75841675), 588 service users and their clinicians were asked to identify the decisions made during their last meeting. Decisions were then coded into content categories. Two months later, both parties reported if these decisions had been implemented.
RESULTS: Agreement between patients and staff regarding decision making was moderate (k = 0.21–0.49; p < 0.001). Decisions relating to medication and social issues were most frequently identified. Overall reported level of implementation was 73.5% for patients and 74.7% for staff, and implementation varied by decision content.
CONCLUSIONS: A variety of relevant decision topics were shown for mental health care.Implementation rates varied in relation to topic and may need different consideration within the therapeutic dyad.

Abstract

BACKGROUND: Clinical decision making (CDM) in the treatment of people with severe mental illness relates to a wide range of life domains.
AIMS: To examine content of CDM in mental health care from the perspectives of service users and staff and to investigate variation in implementation of decisions for differing content.
METHOD: As part of the European multicenter study clinical decision making and outcome in routine care for people with severe mental illness (ISRCTN75841675), 588 service users and their clinicians were asked to identify the decisions made during their last meeting. Decisions were then coded into content categories. Two months later, both parties reported if these decisions had been implemented.
RESULTS: Agreement between patients and staff regarding decision making was moderate (k = 0.21–0.49; p < 0.001). Decisions relating to medication and social issues were most frequently identified. Overall reported level of implementation was 73.5% for patients and 74.7% for staff, and implementation varied by decision content.
CONCLUSIONS: A variety of relevant decision topics were shown for mental health care.Implementation rates varied in relation to topic and may need different consideration within the therapeutic dyad.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Clinic for Psychiatry, Psychotherapy, and Psychosomatics
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:February 2015
Deposited On:18 Jan 2016 16:46
Last Modified:14 Feb 2018 10:31
Publisher:Informa Healthcare
ISSN:0963-8237
OA Status:Closed
Publisher DOI:https://doi.org/10.3109/09638237.2014.951478
PubMed ID:25734210

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