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Discrepancies between patients and professionals in the assessment of patient needs: a quantitative study of Norwegian mental health care.

BACKGROUND
Sensitivity to and respect for the user perspective are important facets of user-centred services and empowerment in contemporary mental health care. Little is known about the extent to which new policies influence mental health work in practice.


AIMS
To investigate discrepancy between patients and professionals in the assessment of patient needs. Analyses could indicate emphasis on user orientation in Norwegian mental health care.


METHODS
Patients and their respective health professionals (n = 1080) completed separate questionnaires regarding patient characteristics and needs. Identifiers were removed from the data locally and then entered into a national database. Descriptive statistics and multiple regression analysis were used to explore mean levels of discrepancy and predictors of discrepancy.


RESULTS
Mean discrepancy was low, as, on average, 30 of the listed 40 needs were considered absent by both the patients and their respective professional. However, the parties showed distinct disagreement as to the amount and type of needs that were present. Specifically, professionals identified more needs than patients (9.3 vs. 4.3, respectively) and this difference was characterized by a strong professional emphasis on needs regarding professional monitoring and follow-up. Results showed that symptoms of severe cognitive disability were over-represented in the group of patients with the highest level of discrepancy, however, the majority of high-discrepancy patients were not severely disabled on cognitive functions. A multiple regression analysis revealed 10 predictors of high discrepancy.


DISCUSSION
A low professional emphasis on user-orientation may be indicated in some cases. Results are discussed with relation to the tension between autonomy and beneficence. Suggestions for practice and further research conclude the paper.