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Aim: To examine the relationship of the consultation frequency and the perceived consultation time of psychiatric clinic attenders with their satisfaction towards the consultation and depression and anxiety (measured by the Hospital Anxiety and Depression Scale).
Methods: Questionnaires were distributed to 186 outpatients attending a psychiatric clinic.
Results: In a path analytic model, a longer session with shorter interval (‘dense’ session) predicted lowered depression and anxiety level of the patientsthrough the perceived satisfaction of the patients, and it was also predicted by the higher anxiety level. The dense session was also influenced by shorter duration of clinic attendance.
Conclusion: Dense psychiatric sessions in busy Japanese outpatient clinics may benefit patients.
DESPITE NUMEROUS EMPIRIC studies on the effectiveness of different psychotherapy methods in mental disorders, few studies have investigated whether everyday clinical practices in busy psychiatric clinics have therapeutic effects upon the patients' psychiatric symptoms. This is a desperately needed area of research because busy psychiatric clinics rarely practice a structured psychotherapy with a specified methodology. Most clinicians in busy clinics use eclectic methods, which are tailored to each patient. Vigorously designed research is difficult due to the heavy caseloads of the psychiatric sessions.
The frequency of patient attendance and the time spent in a session vary from patient to patient and from practitioner to practitioner. Factors that determine the frequency and the length per session may include practitioner workload, patient psychopathology, and patient session objectives. Some patients are busy and wish to have longer intervals between sessions, whereas others are anxious and desire more frequent sessions. There are also differences regarding the time spent in a single session. Many psychiatrists working for outpatient clinics do not have fixed appointment times. Consequently, they may have shorter sessions with patients with fewer needs and may have longer sessions with patients with more needs.
Regardless of the reason, longer sessions with shorter intervals may induce a higher patient satisfaction that he/she is heard. Being heard may elicit a sense of satisfaction and acceptance by the practitioner and may create a good relationship between the patients and the practitioner. Japanese clinics are often caricaturized as ‘an hour waiting for a 3-minute consultation’. Sufficiently long consultation sessions are the basis of better physician–patient communication.
Herein, the findings from a questionnaire study on the frequency and time spent in psychiatric sessions at busy Japanese outpatient clinics are presented. The aim is to examine whether ‘dense’ consultation sessions (longer sessions with shorter intervals) lead to an increase in patient satisfaction, which in turn, leads to lower level of depression and anxiety.
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This study indicates that in everyday clinical situations dense psychiatric sessions are linked to patient satisfaction with the communication with their practitioner, which in turn predicts lower levels of negative affectivity (depression and anxiety). This study has also found that anxious patients induce more dense sessions. The present study is unique because it probes typical clinical practices rather than carefully designed research settings. A recent systematic review on randomized controlled trials, controlled clinical trials, and controlled patient preference trials of counseling interventions in primary care patients with psychological and psychosocial problems documented that such counseling is associated with modest short-term improvement compared to the usual care, but does not provide additional long-term advantages and that it is associated with patient satisfaction.9 The results of the present study have suggested that the patients' mental state is better following sessions which are longer and occur more often.
Another unique feature of the present study is the mediation of the effects of the dense session on the negative affectivity by increased patient satisfaction in regards to communication with the clinician. This suggests that a better mental state is obtained not simply by dense sessions, but also by the patient's perception that the session is satisfactory. The communication satisfaction reflects good treatment relationship.
In contrast, clinicians seem pressed to dispense dense sessions to patients with severer anxiety symptoms. Anxious patients may have more things they wish to report to their clinician, whereas depressed patients are reluctant to do so. It is the clinicians' responsibility to respond to patient need even when the patients are reluctant to talk or too depressed to do so. Also, the present study indicated that as a patient continues to attend a clinic, the sessions become less dense.
The observed link between dense sessions and patient satisfaction both in bivariate analysis and path analytic modeling indicates that sufficiently perceived long sessions with regular short intervals at busy psychiatric outpatient clinics benefit the patients in both satisfaction and therapeutic effects. What remains to be clarified is the optimal time for a single session to achieve this.
The present study has shown that the longer the patient has been attending the clinic the less dense the psychiatric session becomes. Thus patients who have been attending the clinic for a long time may feel less satisfied with the session being mediated by the less dense session. Due to the cross-sectional nature of the present study we are unable to make any comments on this issue, but this should be further studied in a prospective study.
A limitation of the present study was that it was not designed to examine the effectiveness of psychological intervention for patients with specified mental disorders. The present study used a patient population with mixed diagnoses. Second, this was a cross-sectional study and, as such, causative interpretation should be made with caution. Third, the present study did not separately examine the model for patients with a given diagnosis. In addition, all the variables including the time spent for the current session were rated by the patients. Thus their measurement of time may be biased by their psychological state. It may also be possible that the patient's perception of the time spent in the session may be influenced by the degree of satisfaction he/she has obtained from the session. This should be examined by a more objective measure of time such as by an observer. The magnitude of path coefficients was not robust. Modest magnitude of path coefficients suggests that there are other variables unobserved here but strong in influencing the model.
Despite these shortcomings, this preliminary study suggests that dense psychiatric sessions in busy Japanese outpatient clinics benefit patients and that this issue merits further investigation with more refined research methodology.