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Patient satisfaction seems to lead to higher quality of care for depression

In a recent study, depressed patients who reported greater satisfaction with care at 18 months were more likely to receive higher quality care at 24 months. However, the reverse was not true. Higher quality of care at 18 months did not predict higher satisfaction at 24 months, according to the study, which was supported in part by the Agency for Healthcare Research and Quality (HS08349). These findings persisted, even after controlling for patient case mix, recent use of mental health care services, and stability of the doctor-patient relationship.

It may be that satisfied patients receive better technical care 6 months later because they tend to take a more active role in their care and are therefore more likely to stay on medications, show up for therapy, or both. These patients may also feel more confidence and trust in their doctors and, as a result, may be more comfortable disclosing their symptoms and relating their experiences. This gives the doctor more opportunity to deliver good quality care, explain Maria Orlando, Ph.D., and Lisa S. Meredith, Ph.D., of RAND.

The researchers examined the impact of two measures of interpersonal quality of care—care satisfaction and the patient-provider relationship (PPR)—on technical quality of care for depression at 18 and 24 months among 697 adults enrolled in the Partners in Care study. Technical quality of care for depression was evaluated based on appropriate antidepressant medication for at least 2 of the past 6 months or at least eight sessions of depression counseling from a mental health specialist during the past year. Patients who reported having the same doctor as they did 6 months previously tended to rate both satisfaction with care and the PPR higher than those with a different doctor.

More details are in "Understanding the causal relationship between patient-reported interpersonal and technical quality of care for depression," by Drs. Orlando and Meredith, in Medical Care 40(8), pp. 696-704, 2002.

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