Patients' perception of user involvement in psychiatric outpatient treatment: Associations with patient characteristics and satisfaction

Health professionals' perceptions of user involvement in a mental health centre: A critical discourse analysis

The objective of this study was to investigate the engagement between healthcare professionals and users of mental healthcare at the individual level in a mental health hospital. A qualitative research design with purposive sampling was adopted. Five audio-recorded focus group interviews were conducted with nurses and other health professionals at a mental health hospital in Copenhagen and were explored using Fairclough's discourse analysis framework. This study shows how users can be subject to paternalistic control despite the official aim that user involvement be an integral part of the care and treatment offered. As evidenced in discussions by health professionals, the users were involved in plans based on conditions determined by the health professionals who were predominantly focused on treating diseases and enabling the users to live a life independent of professional help. Our results can contribute to dealing with the challenges of incorporating user involvement as an ideology in mental health hospitals.

Healthcare Professionals' Experiences with Patient Participation in a Mental Healthcare Centre: A Qualitative Study

INTRODUCTION

Patient participation is a cornerstone of the debate concerning healthcare professionals and patients of mental health centres. It constitutes an objective in government health policy in Scandinavia and other Western countries. However, little is known about the experiences of healthcare professionals in mental healthcare practices involving patients under their treatment and care.

OBJECTIVE

This study aimed to explore the experiences of healthcare professionals with patient participation in the context of a mental health centre.

METHODOLOGICAL DESIGN

Four focus group interviews with healthcare professionals reflected differing experiences with unfolding patient participation in clinical practices in four wards of a mental health centre. A content analysis developed and framed themes.

RESULTS

Patient participation was based on structural conditions, which shows that predetermined structural methods predominantly control involvement. The structural methods are seen as promoting participation from the patient's perspective. At the same time, the methods also enable taking account of the individual patient's wishes and needs for involvement.

DISCUSSION AND CONCLUSION

This study illuminates the meaning of patient participation in a mental health centre based on the social interactions among nurses and other healthcare professionals. The approach can contribute to dealing with the challenges of incorporating patient participation as an ideology for all patients in a psychiatric context, which is important knowledge for healthcare professionals.

An Overview of Factors Influencing Psychiatric Out-Patient Satisfaction at a Tertiary Care Hospital in Pakistan

Objectives

Patient satisfaction is now becoming the assessment criterion for the quality of health care services provided to patients with mental health issues; therefore, this study aimed to quantify patient satisfaction in the psychiatric outpatient department of Jinnah Hospital, Lahore, Pakistan, and assess the effects of socio-demographic factors and cultural and ethical beliefs on patient satisfaction.

Methods

This is a cross-sectional, observational study with a sample size of 386 patients, using a simple random sampling technique. Patients older than 14 years were included in this study. A questionnaire comprising demographics and cultural and ethical beliefs using the Cultural Attitudes toward Healthcare and Mental Illness Questionnaire, and satisfaction rates using the Psychiatric Out-Patient Experience Questionnaire (POPEQ), was designed for the research project.

Results

The mean age ± SD was 31.2 ± 12.2 years. The POPEQ demonstrated a mean satisfaction score of 3.11 ± 0.90. The majority of the population considered stress (54.4%), family issues (33.4%), and medical illness (33.4%) as the cause of their mental illness. In comparison, the preferable type of treatment for most patients was medication (75.1%) and counseling (36.0%). Among socio-demographic characteristics, education was inversely related to satisfaction (p<0.01). The patients who believed medications to be their preferred treatment for their mental illness were most satisfied (p < 0.01).

Conclusion

This study demonstrates high overall satisfaction rates with psychiatric outpatient services. However, no significant association between sociodemographic characteristics and satisfaction levels was established except for the education status of the patients and their preferred method of treatment. The study did not reveal any influence of cultural beliefs on the degree of satisfaction of patients.

Improving Customisation in Clinical Pathways by Using a Modular Perspective

A standardised system of clinical pathways often conflicts with providing patient-centred heterogeneous care. Mental health care organisations are searching for new methods to become responsive towards unique treatment needs. Modularity is a method increasingly suggested to reconcile standardisation and customisation. The aim is to investigate the extent to which modularity can be applied to make clinical pathways in specialist mental health care more flexible in order to stimulate shared decision making (SDM) and thereby customise care processes to patient contexts while maintaining evidence-based standards. Methods consist of literature research and a theory-based case study including document analysis and semi-structured interviews, which were performed at a Dutch specialist mental health care organisation. The results show that in current literature two modularity-based structures are proposed that support flexibility and customisation, i.e., ‘Prototype’ and ‘Menu-based’. This study reveals that departments tend to use the prototype method if they have predictable patient needs, evidence-based methods are available and there is sequency in treatment components. The menu-based method is preferred if there are unpredictable needs, or the evidence needed to create interconnectedness in treatment is lacking. In conclusion, prototype or menu-based methods are both suitable for applying SDM and reaching customisation in practice. The choice is determined by three characteristics: predictability of needs, availability of evidence and the interconnectedness of treatment components.

Patients' perception of user involvement in psychiatric outpatient treatment: Associations with patient characteristics and satisfaction

BACKGROUND

The patient's right to be involved in treatment decisions is anchored in guidelines and legislation in many countries. Previous research suggests challenges in the implementation of user involvement across different areas of health care, including mental health. However, little is known about psychiatric outpatients' experiences of being involved in their treatment.

OBJECTIVE

To investigate how psychiatric outpatients after treatment rate the degree to which they were included in the treatment and explore the associations between perceived user involvement, demographic characteristics of the sample and patient satisfaction.

DESIGN

Cross-sectional.

SETTING AND PARTICIPANTS

The sample consisted of 188 psychiatric outpatients (67% female, mean age 42.2 years) who were discharged in the two years prior to data collection.

MAIN VARIABLES STUDIED

Perceived user involvement in psychiatric outpatient treatment and patient satisfaction as measured by the Psychiatric Out-Patient Experiences Questionnaire.

RESULTS

About half of the participants rated the overall degree of involvement in their treatment as high or very high. The lowest percentage of participants reporting high or very high involvement was found for sufficient information to contribute to treatment decisions (36%). Female gender, higher education and, to a small degree, younger age were associated with more involvement. Perceived user involvement was strongly associated with treatment satisfaction.

DISCUSSION AND CONCLUSION

The findings suggest that user involvement in psychiatric outpatient treatment can be improved. Patient information that facilitates user involvement should be given more attention.

PATIENT OR PUBLIC CONTRIBUTION

The hospital's user panel was involved in the development of items assessing user involvement.