Inpatient behavioral health intervention improves satisfaction

Researchers discuss the value and implications of a more widespread use of the BATHE technique

hs-BATHE-CourtesyHealthDotMil

Studies have shown the benefit of BATHE in the preoperative and outpatient setting where patients do not require hospitalization.

Courtesy Health.mil

Family care physicians often serve as the first line of mental health providers in the medical system. A recent study from the School of Medicine assessed the value of a brief behavioral health intervention in the inpatient setting. 

Led by members of the Department of Family Medicine, including family medicine doctors Emma Pace and Nick Somerville and Claudia Allen, an associate Family Medicine professor and clinical psychologist, the research published in Family Medicine showed that patients of physicians who used the Background, Affect, Troubles, Handling, Empathic statement technique were more likely to report satisfaction with their hospitalization.

A part of the curriculum for family medicine residents, the BATHE technique is taught by Allen as one of the many interventions used by family physicians to obtain the patient’s psychosocial history and build the strongest possible collaborative relationship with patients. 

“So often, doctors and medical students are faced with a patient who’s upset angry, worried, whatever, and they need to have a technique to approach that just like they need a technique to deliver a baby or remove an infected toenail,” Allen said. “They need a technique for how to talk.”

According to Pace, BATHE specifically offers a structure that enables the physician to move through a progression of questions in a logical manner in order to uncover the patient’s most bothersome issue — medical or nonmedical — starting with simply, “What’s going on in your life?”  

“The first question you ask in BATHE is super open-ended, so [patients] can fill that in however they want to — whether a recent life event, their health, or a family or friend has been bothering them, it can go in whatever direction patients want,” Pace said.  

Studies have shown the benefit of BATHE in the preoperative and outpatient setting where patients do not require hospitalization. However, when Somerville was a student of Allen’s, he felt overwhelmed by the degree of pain, sickness, fear, and anger expressed by some of the patients he encountered during his inpatient rotations. There, he discovered that using BATHE allowed him to better calm and connect with his patients.

“We both realized [Somerville’s] success with BATHE seemed really important and that we should study this,” Allen said. “It’s not that BATHE has never been used in an inpatient setting — it’s never been studied in any kind of systematic way.”

The initial stages of the study required a lot of troubleshooting in terms of minimizing confounding variables in administering the intervention and convincing other family residents to BATHE their inpatients. Because doctors worry that they will be swamped by the fast-paced, demanding environment of inpatient care, they may hesitate to start conversations with patients about seemingly nonmedical issues.

“You don’t see mental health problems just in the outpatient setting — they’re everywhere,” Somerville said. 

The research group — comprised of other interested family physicians in addition to Allen, Pace and Somerville — also recognized that institutions care deeply about increasing their patient satisfaction, which encourages a positive profit margin. Hence, a patient satisfaction measure based on the long-validated Research and Development Health’s Patient Satisfaction Questionnaire was employed in the single-blind study.

“We picked questions from sections that had to do with general satisfaction with medical care and that had to do with communication and relationship with your physician,” Allen said. 

While patients in the control group and in the group treated with BATHE rated the time spent with the physician and level of respect felt by the physician similarly, the patients exposed to the BATHE intervention were more likely to report that their doctor took genuine interest in them as a person.

“I think [this realization] can instill some confidence in people and also accountability,” Pace said. “Your doctor spent a lot of time with you and really seemed to care how you were doing as a person. That can reflect back on you as a patient because if the doctor is putting [in] so much effort, that makes you reflect on how [much] effort you put into your own health, too.” 

Because BATHE is holistic and tends to strengthen doctor-patient relationships — which could improve patient compliance — Allen is interested in how the BATHE intervention could impact readmission rates. This type of study would span a series of months as readmission data for patients is collected.

“A lot of readmissions occur because of a failure to take into account so many other factors that affect patients’ health other than their medical conditions, like their psychosocial health, which includes their psychological health and social issues at home,” said John Gazewood, an associate professor of family medicine and the residency program director. “So I think this brief intervention provides a pretty good window into what patients are troubled by.”

According to Somerville, the initiator of the study, the team’s findings may help support nontraditional approaches to today’s health crises. 

“Obviously, something as brief as BATHE cannot treat depression, but given the opioid epidemic and general problems with addictive drugs, behavioral health interventions are a good alternative to try before prescribing drugs,” Somerville said.

As the group would like to increase the sample size and expand the study to other institutions, they hope to see the practice of BATHE become more prevalent in other specialities. 

related stories