Agenda setting in psychiatric consultations: an exploratory study.

Area of Science:

• Mental Health Services Research
• Health Care Quality Improvement
• Patient-Centered Care

Background:

• Patient-centeredness is vital in primary care quality but emerging in mental health.
• Collaborative agenda setting during clinic visits is an early opportunity for consumer engagement.
• Agenda setting influences the trajectory and quality of mental health care.

Purpose of the Study:

• To investigate agenda-setting practices in mental health encounters.
• To analyze the implementation of collaborative agenda setting with prescribers and consumers.
• To evaluate the use of essential agenda-setting elements in psychiatric and mental health settings.

Main Methods:

• Modified an existing agenda-setting rubric based on multidisciplinary review of visit transcripts.
• Two research assistants coded transcripts, with interrater reliability assessed on 25 samples.
• Studied 124 encounters with prescribers (psychiatrists, nurse practitioners) and consumers with severe mental illnesses.

Main Results:

• Identified 10 essential elements for effective agenda setting.
• Nearly 10% of visits lacked any agenda setting.
• Only one-third of encounters elicited a single concern, with few additional concerns solicited.

Conclusions:

• Collaborative agenda setting offers a pathway to consumer-centered mental health care.
• A reliable rating system for agenda setting was developed.
• Current practices show a significant gap in the utilization of essential agenda-setting elements.