A cluster randomised controlled trial of patient-held medical records for people with schizophrenia receiving shared care

Background Patient-held records can improve communication across the primary-secondary interface. There has been no previous rigorous assessment of the utility of patient-held records for people with schizophrenia from a primary care perspective and their value for this-population is unclear. Aim. To evaluate the effectiveness of a patient-held record for patients with schizophrenia. receiving shared care. Design of study Cluster randomised controlled trial. Setting: Seventy-four general practices and six community mental health localities in Birmingham, England between June 1998 and June 1999. Method. A sample of 201 patients with schizophrenia (ICD-10 classification F20) was recruited; of these, 100 were intervention and 101 were control Patient-held records were given to the intervention patients. At 12-month follow-up, all patients were accounted for and 191 (95961) were revisited. Primary outcomes were the Verona Service Satisfaction Scale-54 (VS55-54) and the Krawiecka and Goldberg (K & G) rating scale of psycho-pathology at 12-month follow-up. secondary outcomes were use of primary and secondary care services. Results. A total of 63/92 (6&59b) patients still had the patient-held record, 64/92 (69.6%) had used it, and 39 (60.9%) of the 64 who had used it said the patient-held record was regularly used by their keyworker However the patient-held record had no significant effect on primary outcomes (VSSS-54: F-1.116 = 0.06, P = 0.801, K & G. F-1.116 = 0.61 P = 0.439) or on use of services. A higher symptom score was associated with not using the patient-held record. Conclusions. The trial provides no good evidence to suggest that patient-held records should be introduced as part of routine shared care or all patient with schizophrenia. However the patient-held record was acceptable to patients with schizophrenia and acted as a communication tool, particularly between patients and keyworkers.