Is there a correlation between physicians' clinical impressions and patients' perceptions of change? Use of the Perceived Change Scale with inpatients with mental disorders

Abstract

Introduction: Assessment of the results of treatment for mental disorders becomes more complete when the patient's perspective is incorporated. Here, we aimed to evaluate the psychometric properties and application of the Perceived Change Scale - Patient version (PCS-P) in a sample of inpatients with mental disorders. Methods: One hundred and ninety-one psychiatric inpatients answered the PCS-P and the Patients' Satisfaction with Mental Health Services Scale (SATIS) and were evaluated in terms of clinical and sociodemographic data. An exploratory factor analysis (EFA) was performed and internal consistency was calculated. The clinical impressions of the patient, family, and physician were correlated with the patient's perception of change. Results: The EFA indicated a psychometrically suitable four-factor solution. The PCS-P exhibited a coherent relationship with SATIS and had a Cronbach's alpha value of 0.856. No correlations were found between the physician's clinical global impression of improvement and the patient's perception of change, although a moderate positive correlation was found between the patients' clinical global impression of improvement and the change perceived by the patient. Conclusions: The PCS-P exhibited adequate psychometric proprieties in a sample of inpatients with mental disorders. The patient's perception of change is an important dimension for evaluation of outcomes in the treatment of mental disorders and differs from the physician's clinical impression of improvement. Evaluation of positive and negative perceptions of the various dimensions of the patient's life enables more precise consideration of the patient's priorities and interests.

Satisfaction with care in a Brazilian psychiatric inpatient unit: differences in perceptions among patients according to type of health insurance

“…Routine application of the instruments has been described previously. 5 Briefly, at the time of patient discharge, the attending physician answered the Clinical Global Impression Scale -Improvement (CGI-I). This same worker also applied the family versions of the instruments EMP and CGI (EMP-F and CGI-F).…”

“…There was a slightly different factor structure in relation to the original scale. 5 In our sample, we used the total scores of the instrument and its factors in the analyses, with an internal consistency result of α=0.847.…”

“…1 In recent decades, patient opinions have gained the interest of clinicians, administrators and service accreditation agencies. 2,3 Patients may perceive their health status, symptoms, and improvement differently from the clinical and assistant staff, [4][5][6][7] adding an important perspective to the evaluation of outcomes. Patient satisfaction indexes are important indicators of quality of care.…”

“…[11][12][13][14][15] To the authors' knowledge, only one study has evaluated the outcome based on the patient's outlook. 5 Satisfaction with treatment is an important factor in the quality of treatment and is related to greater adherence, greater frequency of service use and reduction of treatment abandonment rates. 16 Satisfaction assessment can predict treatment results and can also be considered a result in itself.…”

“…16 Satisfaction assessment can predict treatment results and can also be considered a result in itself. 17 Studies involving psychiatric inpatients have shown that factors such as older age, 3,18,19 male gender, 3,18,19 better health status, 19 general hospital admission (relative to psychiatric hospital), pleasant atmosphere, shorter hospitalization time, 19 treatments received, staff availability 17 and perception of improvement 5 are factors associated with greater satisfaction with treatment. However, the Brazilian perspective poses even greater challenges to the theme, since the national health system has mixed financing.…”