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Clinical Trial
. 2003 Mar;53(488):197-203.

A cluster randomised controlled trial of patient-held medical records for people with schizophrenia receiving shared care

Helen Lester  1 , Teresa Allan, Sue Wilson, Sue Jowett, Lesley Roberts
Affiliations
Clinical Trial

A cluster randomised controlled trial of patient-held medical records for people with schizophrenia receiving shared care

Helen Lester et al. Br J Gen Pract. 2003 Mar.

Abstract

Background: Patient-held records can improve communication across the primary-secondary interface. There has been no previous rigorous assessment of the utility of patient-held records for people with schizophrenia from a primary care perspective and their value for this population is unclear.

Aim: To evaluate the effectiveness of a patient-held record for patients with schizophrenia receiving shared care.

Design of study: Cluster randomised controlled trial.

Setting: Seventy-four general practices and six community mental health localities in Birmingham, England between June 1998 and June 1999.

Method: A sample of 201 patients with schizophrenia (ICD-10 classification F20) was recruited; of these, 100 were intervention and 101 were control. Patient-held records were given to the intervention patients. At 12-month follow-up, all patients were accounted for and 191 (95%) were revisited. Primary outcomes were the Verona Service Satisfaction Scale-54 (VSSS-54) and the Krawiecka and Goldberg (K & G) rating scale of psychopathology at 12-month follow-up. Secondary outcomes were use of primary and secondary care services.

Results: A total of 63/92 (68.5%) patients still had the patient-held record, 64/92 (69.6%) had used it, and 39 (60.9%) of the 64 who had used it said the patient-held record was regularly used by their keyworker. However the patient-held record had no significant effect on primary outcomes (VSSS-54: F1,116 = 0.06, P = 0.801, K & G: F1,116 = 0.6, P = 0.439) or on use of services. A higher symptom score was associated with not using the patient-held record.

Conclusions: The trial provides no good evidence to suggest that patient-held records should be introduced as part of routine shared care for all patients with schizophrenia. However, the patient-held record was acceptable to patients with schizophrenia and acted as a communication tool, particularly between patients and keyworkers.

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