Wednesday, September 18, 2019

Patients With Fewer Mental Health Symptoms May Fare Worse When Clinicians Leave

As it can both be costly and negatively impact care quality, clinician turnover is a concern within community behavioral health settings. When it comes to patient outcomes, though, a 12-month study published in Psychiatric Services in Advance observed mixed, and surprising, results, suggesting that turnover could have different impacts on patients depending on their initial symptoms.

Researchers found that turnover was associated with harmful effects for patients who were functioning well at the start of the study, yet, “Curiously, we also found that turnover was associated with no changes or positive changes” in patients with more difficulties at baseline, wrote Annalee Johnson-Kwochka, M.S., of Indiana University-Purdue University Indianapolis and colleagues. Patients “who are doing better may have more to lose when clinicians leave,” they noted.

Johnson-Kwochka and colleagues used observational data collected as part of a larger randomized, controlled trial from two community behavioral health centers (one in an urban setting and the other in a rural setting) for their analysis. As part of the trial, patients at the behavioral health centers identified the clinician they saw the most. The researchers also evaluated the participants for symptoms of depression (using the nine-item Patient Health Questionnaire), anxiety (using the Generalized Anxiety scale), and overall physical and mental health functioning (using the 12-item Short Form Health Survey) at the beginning of the study, after six months, and after 12 months. Of the 328 patients included in the analysis, 24% experienced clinician turnover.

Not only was turnover associated with clinical decline for those who had higher functioning at baseline, older patients also experienced a sharper decline.

“An important secondary finding [of this study] was that for physical health functioning, the relationship with turnover was moderated by age,” the researchers wrote. “Thus, for those who are younger, turnover may affect functioning less, possibly because their physical health may be more resilient in the face of disruptions in care.”

For related information, see the Psychiatric Services article “Clinicians’ Perceptions of How Burnout Affects Their Work.”

(Image: iStock/sturti)

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