Interpersonal Continuity Research Articles

Interpersonal continuity of care and type two diabetes

IntroductionContinuity of care is one of the core principles of primary care. The importance of interpersonal continuity in treating diabetic patients is unclear. AimTo examine the association of interpersonal continuity of care, by the primary care physician, on the process of diabetic care and on health end points including diabetes control, hospital admissions and mortality. MethodsWe conducted a population based cohort study, 23,294 eligible participants were identified in Clalit Health Services Central Region at January 1, 2011 and followed through to December 31, 2012. Multivariate logistic regression models were applied to the data to study simultaneously the independent relationship between low interpersonal continuity, adjusted for background characteristics, and outcomes of care, including hospitalization and mortality. ResultsAchieving clinical targets was more likely in the high interpersonal continuity group HBA1 C OR 1.11 (CI 1.04–1.19), blood pressure OR 1.12 (1.04–1.20), LDL OR 1.14 (1.06–1.22). Patients with high interpersonal continuity had lower odds for mortality OR 0.59 (0.50–0.70). Admissions to hospital were lower in the high interpersonal continuity group, OR 0.82 (0.75–0.90), however when adjusting for background characteristics the difference in OR for hospital admissions became non-significant 0.92 (0.84–1.01). ConclusionHigh interpersonal continuity was associated with improved outcomes of process, and both primary and secondary clinical targets amongst adult patients with diabetes. This study is the first to find an association between interpersonal continuity and mortality amongst adults with diabetes.

Advancing educational continuity in primary care residencies: an opportunity for patient-centered medical homes.

Continuity of care is a core value of patients and primary care physicians, yet in graduate medical education (GME), creating effective clinical teaching environments that emphasize continuity poses challenges. In this Perspective, the authors review three dimensions of continuity for patient care-informational, longitudinal, and interpersonal-and propose analogous dimensions describing continuity for learning that address both residents learning from patient care and supervisors and interprofessional team members supporting residents' competency development. The authors review primary care GME reform efforts through the lens of continuity, including the growing body of evidence that highlights the importance of longitudinal continuity between learners and supervisors for making competency judgments. The authors consider the challenges that primary care residency programs face in the wake of practice transformation to patient-centered medical home models and make recommendations to maximize the opportunity that these practice models provide. First, educators, researchers, and policy makers must be more precise with terms describing various dimensions of continuity. Second, research should prioritize developing assessments that enable the study of the impact of interpersonal continuity on clinical outcomes for patients and learning outcomes for residents. Third, residency programs should establish program structures that provide informational and longitudinal continuity to enable the development of interpersonal continuity for care and learning. Fourth, these educational models and continuity assessments should extend to the level of the interprofessional team. Fifth, policy leaders should develop a meaningful recognition process that rewards academic practices for training the primary care workforce.

The association of longitudinal and interpersonal continuity of care with emergency department use, hospitalization, and mortality among Medicare beneficiaries.

BackgroundContinuity of medical care is widely believed to lead to better health outcomes and service utilization patterns for patients. Most continuity studies, however, have only used administrative claims to assess longitudinal continuity with a provider. As a result, little is known about how interpersonal continuity (the patient's experience at the visit) relates to improved health outcomes and service use.MethodsWe linked claims-based longitudinal continuity and survey-based self-reported interpersonal continuity indicators for 1,219 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire. With these linked data, we prospectively evaluated the effect of both types of continuity of care indicators on emergency department use, hospitalization, and mortality over a five-year period.ResultsPatient-reported continuity was associated with reduced emergency department use, preventable hospitalization, and mortality. Most of the claims-based measures, including those most frequently used to assess continuity, were not associated with reduced utilization or mortality.ConclusionOur results indicate that the patient- and claims-based indicators of continuity have very different effects on these important health outcomes, suggesting that reform efforts must include the patient-provider experience when evaluating health care quality.

D2-5: Interpersonal Continuity of Care and Utilization Among Multimorbid Seniors in an Integrated Healthcare System

Background/Aims Greater continuity of care (CoC) is associated with lower hospital utilization. This has not been fully explored in integrated care delivery systems with high informational continuity.

Patient care experiences and perceptions of the patient-provider relationship: A mixed method study

Improving interpersonal continuity of care—the personal relationship forged between a patient and their primary care provider (PCP) over time—is often considered a goal of primary care. Continuity of care is frequently assessed in terms of longitudinal continuity, or the proportion of encounters with one practitioner, overlooking aspects of the patient-provider relationship that are key to interpersonal continuity of care. Further, few studies explore patients’ perspectives regarding which care experiences enhance or detract from the patient-provider relationship. This study, using focus group interviews, a patient experience CAHPS-PCMH survey, and electronic medical records, explored how patients’ experiences at 10 primary care clinics influenced their perceptions of their relationship with their PCPs. Focus group interviews with 63 participants indicated that patients’ experiences in the clinics, such as wait-times, influenced their perceptions of the patient-provider relationship. The relationship between patient experience and interpersonal continuity was empirically assessed using survey responses and medical records (n=645). We used patients’ perceptions that their provider knows them as a person as a measure of interpersonal continuity. Logistic regression results indicated that being seen within 15 minutes, receiving visit reminders, effective provider communication, and satisfaction, positively influenced patient perceptions of the patient-provider relationship. Furthermore, patients’ care experiences shaped their perceptions of the patient-provider relationship independent of their satisfaction with care. The mixed methods design adds depth to our understanding of patients’ care experiences, and illustrates that these experiences are critical for understanding the patient-provider relationship. Future research on interpersonal continuity should take patient experiences into account.

How outcomes are achieved through patient portals: a realist review

To examine how patient portals contribute to health service delivery and patient outcomes. The specific aims were to examine how outcomes are produced, and how variations in outcomes can be explained. We used a realist review method, which aims to describe how 'an intervention works, for whom, and in what circumstances' by analyzing patterns between context, mechanism, and outcomes. We reviewed 32 evaluation studies of patient portals published since 2003. The reviewed evaluations indicate that as a complement to existing health services, patient portals can lead to improvements in clinical outcomes, patient behavior, and experiences. Four different mechanisms are reported to yield the reported outcome improvements. These are patient insight into personal health information, activation of information, interpersonal continuity of care, and service convenience. The vast majority of evaluations were conducted in integrated health service networks in the USA, and we detected no substantial variation in outcomes across these networks. Patient portals may impact clinical outcomes and health service delivery through multiple mechanisms. Given the relative uniformity of evaluation contexts, we were not able to detect patterns in how patient portals work in different contexts. Nonetheless, it appears from the overwhelming proportion of patient portal evaluations coming from integrated health service networks, that these networks provide more fertile contexts for patient portals to be effective. To improve the understanding of how patient portals work, future evaluations of patient portals should capture information about mechanisms and context that influence their outcomes.

Trust, continuity and agency: Keys to understanding older patients′ attitudes to general practice trainees

Populations are ageing and therefore non-communicable diseases are becoming leading causes of global morbidity, which need to be the focus of primary care services and training. Some older patients are uncomfortable with general practitioner (GP) trainees managing their chronic conditions, reducing clinical experience opportunities for trainees. This Australian cross-sectional study explored the factors underlying patients' attitudes to trainees in an agency theory framework. Fifty patients aged 60 and over from each of 38 training practices were offered a questionnaire after their consultation. Principal component analysis of the results was undertaken. Factor scores were calculated. Binary logistic modelling was used to identify relationships between participant characteristics, behaviours, attitude items and factor scores. The response rate was 47.9% (n = 911). Three factors were identified: 'Interpersonal Trust' (IPT); 'Institution/system Trust' (ST); and 'Interpersonal Continuity' (IPC). Lower self-rated health (SRH) was associated with higher IPT factor scores (P = 0.023); higher SRH with higher ST scores (P = 0.001); and chronic illness with higher IPC scores (P = 0.005). Higher ST scores were associated with greater comfort with trainees' involvement in chronic care (P < 0.001) and frequency of trainee visits (P < 0.001), while higher IPC scores were negatively associated (P < 0.001 and P = 0.003, respectively). High IPT scores were associated with lower satisfaction with trainee visits (P = 0.001). These results indicate that better SRH, via higher institution/ST, is associated with favourable attitudes and attendance with trainees. In addition, chronic illness, via a higher need for IPC, is associated with lower comfort and attendance. These findings are consistent with agency theory, which shows potential as a framework for future interventions and research into older patient-trainee interactions.

Continuity of medication management and continuity of care: Conceptual and operational considerations

Objective:Continuity of care is considered foundational to high-quality care. Traditional continuity of care constructs may adequately characterize care quality in general populations, but may merit reconceptualization for patients with multiple chronic conditions. Specifically, interactions between multiple chronic condition patients and providers involve complex medication management; therefore care continuity measurement may be more relevant if focused on the provider subset who prescribes essential medications for chronic conditions—a construct we call continuity of medication management. Our objective was to explore conceptual distinctions between continuity of medication management and continuity of care, survey existing evidence in this area, and discuss implications of our findings for future research and intervention development.Methods:In this topical review, we discuss conceptual distinctions between continuity of medication management and continuity of care, review the limited continuity of medication management–related empirical evidence, and discuss implications for future research and interventions.Results:Continuity of medication management represents a potential conceptual and measurement advance by reflecting interpersonal continuity and management continuity, and may provide a means of identifying patients at high-risk of adverse events. Empirical evidence also establishes support for continuity of medication management as a meaningful measure of care continuity. Finally, continuity of medication management may also be a potential target for future intervention to improve care delivery among multiple chronic condition patients.Conclusion:If continuity of medication management is validated in diverse populations, correlated with patient outcomes, and responsive to change, then it may be an important target for improving the health and health care of multiple chronic condition patients.

A experiência de continuidade com o provedor de atenção primária em escolares

Objective: To know the schoolchildren experience of continuity of care according to their caregivers’ perspective and to analyse its association with the type of Primary Health Care provider (PHC) (doctor or health center) and its funding modality (public versus private, or social security). Methods: A cross-sectional study was carried out in four elementary schools in the city of Cordoba, Argentina, in 2011. Caregivers of children between 9 and 13 years old responded to a self-administered questionnaire that included the Primary Care Assessment Tool (AR-PCAT-CE) to measure the continuity function (affiliation and interpersonal continuity subdomains), the type of PHC providers, and children’s socio-demographic characteristics. Mean scores of affiliation and interpersonal continuity were obtained, and a value ?3 was considered optimal. Results: Eighty-nine percent of the respondents (n=230) were schoolchildren’s mothers. PHC provider was mainly (79.9%) a first level PHC unit, a hospital or a clinic, publicly funded in 60.5% of cases. The mean scores of the degree of affiliation to their PHC provider were 3.30 and 3.27 (p=0.86) when referring to a doctor and center, respectively, and the mean scores for interpersonal continuity were 3.47 and 3.09 (p=0.01), respectively. Among those who identified a health center as PHC provider, the affiliation score was 3.18 for public centers and 3.51 for social security or private centers (p=0.04). Conclusions: Caregivers report stronger affiliation when the PHC provider is private or a social security center; and a better experience of interpersonal continuity when they identify a physician as their provider rather than a health center.

Measuring interpersonal continuity in high‐frequency home healthcare services

To provide a method for assessing the degree of interpersonal continuity adapted to context and to measure and assess the degree of interpersonal continuity for long-term recipients dependent on daily home health care. Interpersonal continuity is important to the quality of care for long-term dependents. In high-frequency home healthcare services where patients receive daily care from many nurses or other health personnel over time, interpersonal continuity may be difficult to attain. A cross-sectional study with a descriptive design. Information concerning 79 patients receiving long-term frequent care was collected during four weeks in a maximum variation sample of Norwegian municipalities, from January 2009-May 2010. We measured interpersonal continuity objectively using indices of dispersion and the next-day sequence of health personnel. For each measure, we computed the highest feasible level of continuity that could be attained in this home healthcare context given a standard shift plan. This level was then used as benchmark against which the actual level of continuity was assessed. Patients received on average 51 visits from a mean of 17 different carers during four weeks. The results revealed a low degree of interpersonal continuity in practice, far below what was feasible according to the benchmarks. High-frequency home health care was characterized by interpersonal discontinuity, but with potential for improvement. Objective measures of interpersonal continuity, when the benchmark is adapted to the context, are useful tools for planning and surveying continuity of care.

Provider Practice Characteristics That Promote Interpersonal Continuity

Becoming certified as a patient-centered medical home now requires practices to measure how effectively they provide continuity of care. To understand how continuity can be improved, we studied the association between provider practice characteristics and interpersonal continuity using the Usual Provider Continuity Index (UPC). We conducted a mixed-methods study of the relationship between provider practice characteristics and UPC in 4 university-based family medicine clinics. For the quantitative part of the study, we analyzed data extracted from monthly provider performance reports for 63 primary care providers (PCPs) between July 2009 and June 2010. We tested the association of 5 practice parameters on UPC: (1) clinic frequency; (2) panel size; (3) patient load (ratio of panel size to clinic frequency); (4) attendance ratio; and (5) duration in practice (number of years working in the current practice). Clinic, care team, provider sex, and provider type (physicians versus nonphysician providers) were analyzed as covariates. Simple and multiple linear regressions were used for statistical modeling. Findings from the quantitative part of the study were validated using qualitative data from provider focus groups that were analyzed using sequential thematic coding. There were strong linear associations between UPC and both clinic frequency (β = 0.94; 95% CI, 0.62-1.27) and patient load (β = -0.37; 95% CI, -0.48 to -0.26). A multiple linear regression including clinic frequency, patient load, duration in practice, and provider type explained more than 60% of the variation in UPC (adjusted R(2) = 0.629). UPC for nurse practitioners and physician assistants was more strongly dependent on clinic frequency and was at least as high as it was for physicians. Focus groups identified 6 themes as other potential sources of variability in UPC. Variability in UPC between providers is strongly correlated with variables that can be modified by practice managers. Our study suggests that patients assigned to nurse practitioners and physician assistants have continuity similar to those assigned to physicians.

The woman's birth experience—The effect of interpersonal relationships and continuity of care

Objectivethe aim of the present study was to gain a deeper understanding of how relational continuity in the childbearing process may influence the woman's birth experience. Research design/settinga Q-methodological approach was chosen, as it allows the researcher to systematically assess subjectivity. 23 women were invited to sort a sample of 48 statements regarding their subjective view of birth experience after having participated in a pilot project in Norway, where six midwifery students provided continuity of care to 58 women throughout the childbearing process. The sorting patterns were subsequently factor-analysed, using the statistical software ‘PQ’ which reveals one strong and one weaker factor. The consensus statements and the defining statements for the two factors were later interpreted. Findingsboth factors seemed to represent experiences of psychological trust and a feeling of team work along with the midwifery student. Both factors indicated the importance of quality in the relation. Factor one represented experiences of presence and emotional support in the relationship. It also represented a feeling of personal growth for the women. Factor two was defined by experiences of predictability in the relation and process, as well as the feeling of interdependency in the relation. According to quality in the relation, women defining factor two experienced that the content, not only the continuity in the relation, was important for the birth experience. Key conclusionsrelational continuity is a key concept in the context of a positive birth experience. Quality in the relation gives the woman a possibility to experience positivity during the childbearing process. Continuity in care and personal growth related to birth promote empowerment for both the woman and her partner. Relational continuity gives an opportunity for midwives to provide care in a more holistic manner.

Cross-sectional survey of older patients’ views regarding multidisciplinary care for chronic conditions in general practice

The ageing population and increasing prevalence of chronic illness have contributed to the need for significant primary care reform, including increased use of multidisciplinary care and task substitution. This cross-sectional study explores conditions under which older patients would accept having health professionals other than their general practitioner (GP) involved in their care for chronic disease management (CDM). Ten practices were randomly sampled from a contiguous major city and inner regional area. Questionnaires were distributed to consecutive patients aged 60 years and over in each practice. Agency theory was used to inform analyses. Statistical analysis was undertaken using Wald's test, growth modelling and linear regression, controlling for the clustered design. The response rate was 53% (n=272). Most respondents (79%) had at least one chronic health condition. Respondents were more comfortable with GP than with practice nurse management in the CDM scenario (Wald's test=105.49, P<0.001). Comfort with practice nurse CDM was positively associated with increased contact with their GP at the time of the visit (β=0.41, P<0.001), negatively associated with the number of the respondent's chronic conditions (β=-0.13, P=0.030) and not associated with the frequency of other health professional visits. Agency theory suggests that patients employ continuity of care to optimise factors important in CDM: information symmetry and goal alignment. Our findings are consistent with the theory and lend support to ensuring that interpersonal continuity of care is not lost in health care reform. Further research exploring patients' acceptance of differing systems of care is required.

Traversing the Fault Lines: Trauma and Enactment

Trauma can shatter the mind, creating rifts in consciousness or fault lines in the psyche. Continuity within the self becomes fractured. This article explores links between trauma, dissociation, and enactment. When dissociation forms a primary response to trauma, the mind cuts off unbearable elements of experience from the subjective “I.” Later these disowned fragments may intrude in the present as transferential enactments. Internal fault lines often emerge as ruptures in relationships. Therapist and client must traverse these interpersonal fault lines to integrate unwanted parts of the self. The author presents two clinical vignettes to illustrate how the therapist's script can become entangled in mutual enactments. When enactments are resolved, bridges in the interpersonal realm increase continuity within the self as well as the capacity for intimacy. This article proposes that healing the fractured self requires an encounter with otherness, which expands Berne's (1961) thesis about the human hunger for recognition.

Do English patients want continuity of care, and do they receive it?

Interpersonal continuity of care is valued by patients, but there is concern that it has declined in recent years. To determine how often patients express preference for seeing a particular GP and the extent to which that preference is met. Analysis of data from the 2009/2010 English GP Patient Survey. A stratified random sample of adult patients registered with 8362 general practices in England (response rate 39%, yielding 2,169,718 responses). Weighted estimates were calculated of preference for and success in seeing a particular GP. Multilevel logistic regression was used to identify characteristics associated with these two outcomes. Excluding practices with one GP, 62% of patients expressed a preference for seeing a particular GP. Of these patients, 72% were successful in seeing their preferred GP most of the time. Certain patient groups were associated with more preference for and success in seeing a particular GP. These were older patients (preference odds ratio [OR] = 1.7, success OR = 1.8), those with chronic medical conditions (preference OR = 1.9, success OR = 1.3), those with chronic psychological conditions (preference OR = 1.6, success OR = 1.3), and those recently requesting only non-urgent versus urgent appointments (preference OR = 1.4, success OR = 1.6). Patient groups that had more frequent preference but less success in seeing a preferred GP were females (preference OR = 1.5, success OR = 0.9), patients in larger practices (preference OR = 1.3, success OR = 0.5), and those belonging to non-white ethnic groups. The majority of patients value interpersonal continuity, yet a large minority of patients and specific patient groups are not regularly able to see the GP they prefer.

The older patient, the general practitioner and the trainee: patients’ attitudes and implications for training

The training of future general practitioners (GPs) in the management of older and chronically ill patients is assuming increasing significance with population ageing. Such training, however, may be hampered by the reluctance of older patients to consult GP trainees for chronic problem care. This paper reports on a cross-sectional study investigating the attitudes of older patients to GP trainees, to inform strategies to improve older patient-trainee interaction. The primary hypothesis tested was that older patients' acceptance of trainees for their chronic disease management would be improved by strengthening the relational link with their regular GP around trainee consultations. The survey instrument was distributed to 1900 patients aged 60 and over from 38 training practices in five Australian states using a stratified, randomised cluster sampling process. Generalised estimating equation models were used to undertake logistic regression for analysis. The response rate was 47.9% (n=911). Eighty-three percent were happy to see a trainee for a minor problem. Of respondents with a chronic/complex condition, 25.4% were comfortable with independent trainee chronic/complex care, increasing to 77.9% if their usual GP was called in to double-check management. Modelling confirmed increased likelihood of comfort with trainee chronic/complex care with involvement of the regular GP (P<0.001). Strong agreement that their regular doctor was happy for them to see a trainee was associated with frequency of trainee visits (P=0.002); satisfaction with trainee consultations (P<0.001); and comfort in independent trainee chronic/complex care (P<0.001). There is the potential to develop models of trainee chronic/complex care that maintain older patient satisfaction and retain the favourable patient outcomes associated with interpersonal continuity. Strengthening interpersonal continuity of care with the patient's usual GP around trainee consultations, and open communication regarding having trainees involved in their care, appear key to such models. Further research involving prospective trials is required.

Comprehensiveness of Care from the Patient Perspective: Comparison of Primary Healthcare Evaluation Instruments

Comprehensiveness relates both to scope of services offered and to a whole-person clinical approach. Comprehensive services are defined as "the provision, either directly or indirectly, of a full range of services to meet most patients' healthcare needs"; whole-person care is "the extent to which a provider elicits and considers the physical, emotional and social aspects of a patient's health and considers the community context in their care." Among instruments that evaluate primary healthcare, two had subscales that mapped to comprehensive services and to the community component of whole-person care: the Primary Care Assessment Tool - Short Form (PCAT-S) and the Components of Primary Care Index (CPCI, a limited measure of whole-person care). To examine how well comprehensiveness is captured in validated instruments that evaluate primary healthcare from the patient's perspective. 645 adults with at least one healthcare contact in the previous 12 months responded to six instruments that evaluate primary healthcare. Scores were normalized for descriptive comparison. Exploratory and confirmatory (structural equation modelling) factor analysis examined fit to operational definition, and item response theory analysis examined item performance on common constructs. Over one-quarter of respondents had missing responses on services offered or doctor's knowledge of the community. The subscales did not load on a single factor; comprehensive services and community orientation were examined separately. The community orientation subscales did not perform satisfactorily. The three comprehensive services subscales fit very modestly onto two factors: (1) most healthcare needs (from one provider) (CPCI Comprehensive Care, PCAT-S First-Contact Utilization) and (2) range of services (PCAT-S Comprehensive Services Available). Individual item performance revealed several problems. Measurement of comprehensiveness is problematic, making this attribute a priority for measure development. Range of services offered is best obtained from providers. Whole-person care is not addressed as a separate construct, but some dimensions are covered by attributes such as interpersonal communication and relational continuity.

Together in the middle: Back-channel negotiation in the Irish peace process

This article examines the development of cooperative relationships in back-channel communication and their impact on intraparty negotiation. It draws on extensive newly available evidence on back-channel communication in the Irish peace process to expand the range of detailed case studies on a topic which is shrouded in secrecy and resistant to academic inquiry. The article analyses the operation of a secret back channel that linked the Irish Republican Army to the British government over a period of 20 years, drawing on unique material from the private papers of the intermediary, Brendan Duddy, and a range of other primary sources. The article finds that interaction through this back channel increased predictability and laid a foundation of extremely limited trust by providing information and increasing mutual understanding. Strong cooperative relationships developed at the intersection between the two sides, based to a great extent on strong interpersonal relationships and continuity in personnel. This in turn produced direct pressure for changes in the position of parties as negotiators acted as advocates of movement in intraparty negotiations. The article finds that this back channel was characterized by a short chain, the direct involvement of principals and the establishment of a single primary channel of communication and that these features combined with secrecy to generate the distinctive cooperative dynamics identified in this article. It concludes that the potential for the development of cooperative relationships is particularly strong in back-channel negotiation for two reasons; first, the joint project of secrecy creates an ongoing shared task that builds trust and mutual understanding regardless of progress in the negotiations. Secondly, as a shared project based on the explicit aim of bypassing spoilers, the process creates structural pressures for cooperation to manage internal opponents on both sides, pressures intensified by the secrecy of the process.

Individual Determinants of Recent Use of Dental Services by Low-income Adolescents and Young Adults

Objective: To evaluate the role of the individual determinants of recent use of dental services by low-income adolescents and young adults living in the area covered by the Family Health Strategy (ESF) in the city of Ponta Grossa, PR, Brazil. Methods: This investigation was a cross-sectional, exploratory, population-based study. The sample included 190 individuals aged 12 to 35 years, who answered a questionnaire on the socioeconomic conditions, perceived necessity and access to dental services. The data were analyzed by multivariate logistic regression, following a theoretical reference based on the Andersen’s Behavioral Model, considering the recent dental visit as dependent variable. Results: As much as 53% of the individuals reported recent dental visits, which were associated with higher income (OR 5.59; IC95% 1.18–26.63), pain episodes in the previous months (OR 2.67; 95%IC 1.07–6.64) and dentist for regular consultations (OR 2.60; 95%IC 1.11–6.07). The results indicate inequalities of access related to the socioeconomic conditions. The reference to a regular dentist was associated with recent dental visit, which reinforces the importance of interpersonal continuity as a facilitating the access to health services. Conclusion: There was a high prevalence of recent use of dental services among adolescents and young adults. The individual determinants showed to be important predictors of access to oral health services. The theoretical model confirmed social and psychosocial inequalities in the use of dental services among low-income adolescents and young adults.

The components of helping relationships with professionals in psychiatry: Users’ perspective

The quality of the relationship between professional and user is one of the important factors in the recovery process. However, more knowledge is needed concerning the components of helping relationships and characteristics of the helping professional. The aim of this study was to explore users' experiences of helping relationships with professionals. This was a grounded theory analysis of 71 qualitative interviews to explore users' experience of helping relationships and their components, in psychiatric care in Sweden. Within the three main categories - interpersonal continuity, emotional climate and social interaction - two core themes were found that described vital components of helping relationships: a non-stigmatizing attitude on the part of the professionals and their willingness to do something beyond established routines. The focus in psychiatric treatment research needs to be broadened. In addition to research on the outcome of particular methods and interventions, the common factors also need to be investigated, above all, what is the effect of the quality of the relationship between user and professional. Greater attention needs to be paid, as well, to how helping respective obstructive relationships in psychiatric services arise, are maintained or are modified.