June 1st, 2014

Research shows patient involvement in care helpful for minorities

A little training can go a long way for mental health patients – especially for ethnic or racial minorities, according to a recent study by Harvard Medical School researchers.

According to the article, published in the April issue of JAMA Psychiatry, previous studies have shown that patient involvement in their care is important for receiving better quality of care, especially for minorities who “may hold traditional role expectations against participation in clinical encounters and may leave treatment when services do not meet their needs.” Minority patients are less likely to state concerns, ask questions about medications, or seek information from providers to make decision about their care, according to the article.

“There is a quite a bit of research of racial minorities having lower intensity of care,” says Margarita Alegria, Ph.D., lead author of the study. “There is also research showing that (ethnic or racial minorities) were quite reluctant to go to care because they had heard that care may not be beneficial or did not work for other people.”

In this study, researchers tested the effectiveness of an “educational strategy” called DECIDE (Decide the problem; Explore the questions; Closed or open-ended questions; Identify the who, why, or how of the problem; Direct questions to your health care professional; Enjoy a shared solution). It’s a training “that teaches patients to ask questions and make collaborative decisions with their health care professional, improves patient activation and self-management, as well as engagement and retention in behavioral health care,” according to the study.

“We could definitely increase patient activation and patient self-management,” says Alegria, the director of the Center for Multicultural Mental Health Research at Cambridge Health Alliance and a professor of psychology in the Department of Psychiatry at Harvard Medical School. “Even with brief sessions of 45 minutes to an hour, people felt like they could ask more questions, people felt more confident and we also found particularly with self-management, Asian and mixed racial groups did even better in terms of patient activation and self-management.”

The study, which involved 647 patients from 13 outpatient mental health clinics in Massachusetts, Minnesota, New Jersey, New York, North Carolina and Puerto Rico, provided training to a group of patients involved in it while another group received a brochure on managing mental illness. Of the 647 patients in the intervention group, 16.4 percent were white (15.7 percent in the brochure group), 65.3 percent were Latino (67 percent in the brochure group), 10 percent were black (11.3 percent in the other group), and 8.2 percent other (6 percent in the brochure group).

For patients, Alegria says this study shows that “there are easy ways for patients to get their own voice into the medical encounter. Patients can acquire the skills, the beliefs and knowledge to actually be participating in the decision making about their care.”

Mental health care and substance abuse providers, she says, should be more of a role model for patients. They should be “asking questions and trying to make sure that what the patients bring as their concern is really the focal point of the visit, not implicitly, but explicitly.”

By Rivkela Brodsky

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