Making a Difference to Patient Experience

Fiona Mathieson’s two Whau Mental Health Research Foundation-funded research projects are quite different but both involve the practitioner’s ability to make a difference to a patient’s experience. 

The first project involved adapting for Māori a brief mental health intervention, which clinicians can offer patients in primary health care. 

Fiona, Clinical Psychologist and Senior Lecturer at the University of Otago’s Department of Psychological Medicine, says there is disparity in contact with mental health services between Māori and non-Māori, and when contact does occur it is often with primary care services, such as GPs. 

‘Near threshold’ anxiety, depression, and substance use are common presentations in primary care settings and while not meeting the threshold for diagnosis, the symptoms can carry a significant burden and could develop into a diagnosable disorder. 

With input from patients, clinicians and researchers, including Dr Kara Mihaere (Rangitāne, Ngāti Kahungunu ki Wairoa, Ngati Rakaipaaka) an innovative ultra-brief intervention (UBI) was designed for people aged 18-65 with ‘near threshold’ mental health symptoms. 

The UBI consists of three brief sessions of guided cognitive behaviour therapy-based self- management, with a focus on problem-solving and behaviour change, and delivered by the primary care physician in a primary care setting. 

The sessions comprise one hour total and are supported by a treatment manual and self-help booklets on the topics of relationships, stress, and breaking habits. 

The clinician works as a coach and change facilitator rather than therapist, as patients develop a specific plan for change, which is printed out as a prescription and integrated into computerised patient management systems. There is one follow-up email or phone call to see how the plan is working. 

Clinicians were trained in a two-hour session and satisfaction ratings from patients and clinicians were very positive. 

“What was significant with the UBI (Ultra Brief Intervention) Māori study is we were able to find a way to adapt the intervention for Māori and it hasn’t really been that difficult. We found that we were able to adapt it in a way that had a high level of acceptability with the Māori clients who participated in this study and also with the clinicians, most of who weren’t Māori. 

It was only a small study but using the intervention with patients may have helped with the clinician’s cultural competence. Hopefully this study will encourage other researchers to go ahead and adapt tools even if they aren’t Māori – there are still ways you can do that. 

Fiona and her co-researchers have presented their research at local and international conferences and had their findings published in the Journal of Primary Health Care. 

Fiona’s latest research, also funded by the Whau Mental Health Research Foundation, is looking at the impact on patients when mental health staff undergo postgraduate cognitive behavioural therapy training. It examines whether as well as students developing knowledge and skills, were their patients getting better with regards to reduced stress and improved functioning. 

Fiona says the funding for both projects has enabled the research to be completed, and the funding for the second study on patient outcomes allowed her to employ a research assistant to collect the data in a timely and efficient way. 

“Because I am trying to do this research on top of teaching, it is great to get that kind of support. I am fairly new to research and getting those grants has helped me find my feet and gain confidence. 

“It’s been a positive experience and I felt supported, especially with the patient outcome study where you have to report back annually about how the study is going. Recruitment has been quite difficult for that study but I didn’t feel criticised. I felt supported to try and work it through, which was helpful.” 

Fiona says her research deals with issues that have everyday benefits for clinicians and patients. 

“We want to know for staff going on intensive training courses, is that benefiting patients in a real way? And being able to have intervention at primary care level fits really well with meeting people’s needs in the community, many who wouldn’t go and see a counsellor or be eligible for secondary care services. It is real-world applicability which benefits end users.” 

The sessions comprise one hour total and are supported by a treatment manual and self-help booklets on the topics of relationships, stress, and breaking habits. 

The clinician works as a coach and change facilitator rather than therapist, as patients develop a specific plan for change, which is printed out as a prescription and integrated into computerised patient management systems. There is one follow-up email or phone call to see how the plan is working. 

Clinicians were trained in a two-hour session and satisfaction ratings from patients and clinicians were very positive. 

“What was significant with the UBI (Ultra Brief Intervention) Māori study is we were able to find a way to adapt the intervention for Māori and it hasn’t really been that difficult. We found that we were able to adapt it in a way that had a high level of acceptability with the Māori clients who participated in this study and also with the clinicians, most of who weren’t Māori.