UCL Centre for Health Informatics & Multiprofessional Education

In a new paper in the journal Pain (published online, doi:10.1016/j.pain.2009.12.011), Amanda Williams (UCL Research Department for Clinical, Education and Health Psychology) and Henry Potts (CHIME) describe how contextual factors can affect patient outcome in the setting of a specialist treatment centre for persistent pain.

The study used retrospective data over a 12-year period on patients who had group cognitive-behavioural therapy, an established approach in persistent pain. Analysis demonstrated clinically significant group effects: that is, an individual's outcome could be pulled up or down by the group they were in. The study also showed that periods of higher staff turnover led to worse patient outcomes.

Few studies look at these sorts of contextual effects. Such effects may not be seen in prospective studies or trials, as these are often brief, with staff generally employed for the duration of the trial and adhering to a detailed protocol for treatment. Others have looked at the therapist/patient relationship in a one-to-one setting, but there is little known about group settings or how turnover in a multidisciplinary clinical team impacts in patients.

This was an exploratory study producing suggestive rather than definitive results, but there may be broad implications. Turnover and morale issues are widely relevant, for managers as well as for clinicians, since change is a constant in health systems, but the possible costs in decrements to patient outcomes are rarely considered.

UCL Eprints (open access)

Full-text available to subscribers

Contact: Henry Potts

Links: Pain