Citation

Cosh S, Zenter N, Ay ES, Loos S, Slade M, De Rosa C, Luciano M, Berecz R, Glaub T, Munk-Jørgensen P, Krogsgaard Bording M, Rossler W, Kawohl W, Puschner B. Psychiatr. Serv. 2017; 68(9): 970-974.

Affiliation

Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich.

Copyright

(Copyright © 2017, American Psychiatric Association)

DOI

10.1176/appi.ps.201600114

PMID

28502242

Abstract

OBJECTIVE: The study explored relationships between preferences for and experiences of clinical decision making (CDM) with service use among persons with severe mental illness.

METHODS: Data from a prospective observational study in six European countries were examined. Associations of baseline staff-rated (N=213) and patient-rated (N=588) preferred and experienced decision making with service use were examined at baseline by using binomial regressions and at 12-month follow-up by using multilevel models.

RESULTS: A preference by patients and staff for active patient involvement in decision making, rather than shared or passive decision making, was associated with longer hospital admissions and higher costs at baseline and with increases in admissions over 12 months (p=.043). Low patient-rated satisfaction with an experienced clinical decision was also related to increased costs over the study period (p=.005).

CONCLUSIONS: A preference for shared decision making may reduce health care costs by reducing inpatient admissions. Patient satisfaction with decisions was a predictor of costs, and clinicians should maximize patient satisfaction with CDM.

Language: en

Keywords

Community psychiatry; General hospital psychiatry; Inpatient treatment; Patient satisfaction; Psychotherapy/outcome studies; clinical decision making; costs; mental health care; service use; severe mental illness