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Ayre MJ, Lewis PJ, Phipps DL, Keers RN. unDerstandIng the cauSes of mediCation errOrs and adVerse drug evEnts for patients with mental illness in community caRe (DISCOVER): a qualitative study. Front Psychiatry 2023; 14:1241445. [PMID: 38144479 PMCID: PMC10746165 DOI: 10.3389/fpsyt.2023.1241445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Background It is estimated that 237 million medication errors occur in England each year with a significant number occurring in the community. Our understanding of the causes of preventable medication errors and adverse drug events (ADE) affecting patients with mental illness is limited in this setting. Better understanding of the factors that contribute to errors can support the development of theory-driven improvement interventions. Methods Remote qualitative semi-structured interviews with 26 community-based healthcare professionals in England and Wales were undertaken between June-November 2022. Recruitment was undertaken using purposive sampling via professional networks. Interviews were guided by the critical incident technique and analysed using the framework method. Any data that involved speculation was not included in the analysis. Independent analysis was carried out by the research team to extract themes guided by the London Protocol. Results A total of 43 medication errors and 12 preventable ADEs were discussed, with two ADEs having an unknown error origin. Prescribing errors were discussed most commonly (n = 24), followed by monitoring errors (n = 8). Six contributory factor themes were identified: the individual (staff); the work environment; the teams/interfaces; the organisation and management; the patient; and the task and technology. The individual (staff) factors were involved in just over 80% of all errors discussed. Participants reported a lack of knowledge regarding psychotropic medication and mental illnesses which accompanied diffusion of responsibility. There were difficulties with team communication, particularly across care interfaces, such as ambiguity/brevity of information being communicated and uncertainty concerning roles which created confusion amongst staff. Unique patient social/behavioural contributory factors were identified such as presenting with challenging behaviour and complex lifestyles, which caused difficulties attending appointments as well as affecting overall clinical management. Conclusion These findings highlight that the causes of errors are multifactorial with some unique to this patient group. Key areas to target for improvement include the education/training of healthcare professionals regarding neuropharmacology/mental illnesses and enhancing communication across care interfaces. Future research should explore patient perspectives regarding this topic to help develop a holistic picture. These findings can be used to guide future intervention research to ameliorate medication safety challenges for this patient group.
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Affiliation(s)
- Matthew J. Ayre
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Penny J. Lewis
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Denham L. Phipps
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
| | - Richard N. Keers
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
- Optimising Outcomes with Medicines (OptiMed) Research Unit, Pennine Care NHS Foundation Trust, Manchester, United Kingdom
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Dhakate N, Joshi R. Classification of reviews of e-healthcare services to improve patient satisfaction: Insights from an emerging economy. JOURNAL OF BUSINESS RESEARCH 2023; 164:114015. [PMID: 37192884 PMCID: PMC10168675 DOI: 10.1016/j.jbusres.2023.114015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
The COVID-19 pandemic has brought in many unique challenges and opportunities for patient care, and one is online healthcare practices. Patient satisfaction with online consultation is primary importance as online healthcare practices are evolving with time. Although previous research has examined how patient satisfaction with online doctor services can be further improved, there has been scant research on the satisfaction with online doctor services concerning Indian patients. Within the framework of service science theories, this study examines satisfaction and sentiments of Indian patients with online doctor services from multiple perspectives. A total of 38019 patient online feedback for 343 doctors was used for understanding patient sentiments. The sentiment analysis classified the reviews of the patients on online doctor consultation services. The finding suggests that healthcare service providers consider a systemic approach that includes core health services along with technical and marketing factors to proactively improve online patient satisfaction.
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Affiliation(s)
| | - Rohit Joshi
- Indian Institute of Management, Shillong, Meghalaya, India
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Kodeboina M, Piayda K, Jenniskens I, Vyas P, Chen S, Pesigan RJ, Ferko N, Patel BP, Dobrin A, Habib J, Franke J. Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095633. [PMID: 37174152 PMCID: PMC10177939 DOI: 10.3390/ijerph20095633] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5-10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.
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Affiliation(s)
- Monika Kodeboina
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
- Clinic for Internal Medicine and Cardiology, Marien Hospital, 52066 Aachen, Germany
| | - Kerstin Piayda
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Department of Cardiology and Vascular Medicine, Medical Faculty, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | | | | | | | | | | | | | | | | | - Jennifer Franke
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Philips Chief Medical Office, 22335 Hamburg, Germany
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4
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Biringer E, Helgeland J, Hellesen HB, Aβmus J, Hartveit M. Development and testing of the QDis-MH checklist for discharge letters from specialised mental healthcare: a stakeholder-centred study. BMJ Open Qual 2023; 12:bmjoq-2022-002036. [PMID: 37019467 PMCID: PMC10083855 DOI: 10.1136/bmjoq-2022-002036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The 'discharge letter' is the mandatory written report sent from specialists in the specialist services to general practitioners (GPs) on patient discharge. Clear recommendations from relevant stakeholders for contents of discharge letters and instruments to measure the quality of discharge letters in mental healthcare are needed. The objectives were to (1) detect which information relevant stakeholders defined as important to include in discharge letters from mental health specialist services, (2) develop a checklist to measure the quality of discharge letters and (3) test the psychometric properties of the checklist. METHODS We used a stepwise multimethod stakeholder-centred approach. Group interviews with GPs, mental health specialists and patient representatives defined 68 information items with 10 consensus-based thematic headings relevant to include in high-quality discharge letters. Information items rated as highly important by GPs (n=50) were included in the Quality of Discharge information-Mental Health (QDis-MH) checklist. The 26-item checklist was tested by GPs (n=18) and experts in healthcare improvement or health services research (n=15). Psychometric properties were assessed using estimates of intrascale consistency and linear mixed effects models. Inter-rater and test-retest reliability were assessed using Gwet's agreement coefficient (Gwet's AC1) and intraclass correlation coefficients. RESULTS The QDis-MH checklist had satisfactory intrascale consistency. Inter-rater reliability was poor to moderate, and test-retest reliability was moderate. In descriptive analyses, mean checklist scores were higher in the category of discharge letters defined as 'good' than in 'medium' or 'poor' letters, but differences did not reach statistical significance. CONCLUSIONS GPs, mental health specialists and patient representatives defined 26 information items relevant to include in discharge letters in mental healthcare. The QDis-MH checklist is valid and feasible. However, when using the checklist, raters should be trained and the number of raters kept to a minimum due to questionable inter-rater reliability.
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Affiliation(s)
- Eva Biringer
- Department of Research and Innovation, Helse Fonna HF, Haugesund/Valen/Stord, Norway
| | | | | | - Jörg Aβmus
- Centre for Clinical Research, Helse Bergen HF, Bergen, Norway
| | - M Hartveit
- Department of Research and Innovation, Helse Fonna HF, Haugesund/Valen/Stord, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Aydin S, Crone MR, Siebelink BM, Numans ME, Vermeiren RRJM, Westenberg PM. Informative value of referral letters from general practice for child and adolescent mental healthcare. Eur Child Adolesc Psychiatry 2023; 32:303-315. [PMID: 34417876 PMCID: PMC9970945 DOI: 10.1007/s00787-021-01859-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/08/2021] [Indexed: 11/29/2022]
Abstract
Although referral letters (RLs) form a nodal point in a patient's care journey, little is known about their informative value in child and adolescent mental healthcare. To determine the informative value of RLs to child and adolescent psychiatry, we conducted a chart review in medical records of minors registered at specialized mental healthcare between January 2015 and December 2017 (The Netherlands). Symptoms indicated in RLs originating from general practice (N = 723) were coded and cross-tabulated with the best estimate clinical classifications made in psychiatry. Results revealed that over half of the minors in the sample were classified in concordance with at least one reason for referral. We found fair to excellent discriminative ability for indications made in RLs concerning the most common psychiatric classifications (95% CI AUC: 60.9-70.6 for anxiety disorders to 90.5-100.0 for eating disorders). Logistic regression analyses suggested no statistically significant effects of gender, age, severity or mental healthcare history, with the exception of age and attention deficit hyperactivity disorders (ADHD), as RLs better predicted ADHD with increasing age (OR = 1.14, 95% CI 1.03-1.27). Contextual problems, such as difficulties studying, problems with parents or being bullied were indicated frequently and associated with classifications in various disorder groups. To conclude, general practitioners' RLs showed informative value, contrary to common beliefs. Replication studies are needed to reliably incorporate RLs into the diagnostic work-up.
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Affiliation(s)
- S Aydin
- Department of Developmental and Educational Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Centre, Oegstgeest, The Netherlands.
| | - M R Crone
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - B M Siebelink
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Centre, Oegstgeest, The Netherlands
| | - M E Numans
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - R R J M Vermeiren
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Centre, Oegstgeest, The Netherlands
- Youz, Parnassia Group, Rotterdam, The Netherlands
| | - P M Westenberg
- Department of Developmental and Educational Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
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Sather EW, Iversen VC, Svindseth MF, Crawford P, Vasset F. Exploring sustainable care pathways - a scoping review. BMC Health Serv Res 2022; 22:1595. [PMID: 36585672 PMCID: PMC9801530 DOI: 10.1186/s12913-022-08863-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/21/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients with mental health problems experience numerous transitions into and out of hospital. AIM The review studies assessing clinical care pathways between psychiatric hospitalization and community health services. METHODS We used publications between 2009-2020 to allow a broad scoping review of the published research. Sixteen review-articles were identified, 12 primary studies were chosen, both on care pathways in the transition between psychiatric hospital and community. RESULTS Organizational issues: Systems and procedures to ensure clear responsibilities and transparency at each stage of the pathways of care. RESOURCES Information-technology in objectively improving patient outcome. Information/documentation: Providing patients with adequate structured information and documented plans at the appropriate time. Patient/families: Continuous collaborative decision-making. Clinical care and teamwork: Collaboration between mental health and other professionals to guarantee that planned activities meet patient need. ETHICAL ISSUES Respectful communication and patient-centred, non-humiliating care. CONCLUSIONS System and procedures ensure clear responsibilities and transparency. Information technology support decision-making and referral and objectively improve patient outcomes in care pathways. Collaboration between mental health and other professionals guarantee that planned activities meet patients' needs along with regular meetings sharing key information. Around-the-clock ambulant-teams important to transition success. Informed-shared decision-making between parties, support patient participation and respectful communication.
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Affiliation(s)
- Eva Walderhaug Sather
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Department of Health Sciences, The Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Valentina Cabral Iversen
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Department of Health Sciences, The Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Marit Folsvik Svindseth
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Department of Health Sciences, The Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Paul Crawford
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Department of Health Sciences, The Norwegian University of Science and Technology (NTNU), Trondheim, Norway ,grid.4563.40000 0004 1936 8868Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Frøydis Vasset
- grid.411834.b0000 0004 0434 9525Department for Health and Social Sciences, University College in Molde, Molde, Norway
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Referral assessment and patient waiting time decisions in specialized mental healthcare: an exploratory study of early routine collection of PROM (LOVePROM). BMC Health Serv Res 2022; 22:1553. [PMID: 36536410 PMCID: PMC9764555 DOI: 10.1186/s12913-022-08877-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Norway has prioritized health services according to the principle of "severity of conditions", where waiting time reflects patients' medical urgency. We aim to investigate if the "severity-of-condition" principle performs well in the priority setting of waiting time, between and within groups of patients using community mental health services. We also aim to investigate the association between patients' diagnoses and symptom severity at the start of treatment and the corresponding waiting time. METHODS The study analyzed routine data from Lovisenberg electronic Patient-Reported Outcome Measurement (LOVePROM) at Lovisenberg Diaconal Hospital in Norway. We estimated patient-reported severity by using Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), together with patients' diagnoses to identify patients' needs in general. To assess the performance of current prioritization, we compared waiting times for patients with major depressive disorder and their maximum recommended waiting time. Multivariate regression models were used to assess the association between patient-reported severity, their diagnosis, and waiting times. RESULTS Of the 6108 mental health disorder patients, patients with moderate to severe conditions waited seven weeks, while patients with mild conditions or below clinical cutoff waited 8 weeks. Included in the sample, 1583 were diagnosed with depression. Results indicated that patients with moderate and severe depression had a slightly shorter wait-time than patients with mild depression. However, 32.4% patients with moderate depression and 83.3% patients with severe depression, waited longer than their maximum recommended waiting time. CORE-OM identified depressive patients with risk-to-self harm, who had a 0.84 weeks shorter wait-time. These results were also applied to patients with other common mental health disorders. CONCLUSION Overall, patients waited in accordance with the "severity of condition" principle, but the trend was not strong. Therefore, we advocate that there is substantial room for quality improvements in priority setting on waiting time. We suggest further research should investigate if routine collection of PROM and assessment of referral letters, can better inform specialists when deciding on waiting time.
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House S, Wilmoth M, Stucky C. Relational coordination as a merger and acquisition framework for healthcare organizations. Nurs Manag (Harrow) 2022; 53:36-42. [PMID: 35105844 DOI: 10.1097/01.numa.0000816256.13974.1b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sherita House
- Sherita House is a postdoctoral fellow at Indiana University School of Nursing in Indianapolis, Ind. Margaret Wilmoth is the executive vice dean of academic affairs at the University of North Carolina at Chapel Hill School of Nursing in Chapel Hill, N.C. Christopher Stucky is the deputy chief of the Center for Nursing Science and Clinical Inquiry at Landstuhl Regional Medical Center in Landstuhl, Germany
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McIntyre H, Loughhead M, Hayes L, Procter NG. National Disability Insurance Scheme and Lived Experience of People Presenting to the Emergency Department: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e33268. [PMID: 34554101 PMCID: PMC8603173 DOI: 10.2196/33268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background Currently, within Australia, 3.6% of all emergency department (ED) presentations are mental health–related. Information about the context of the person presenting to the ED (beyond immediate needs), including their psychosocial disability (PSD) National Disability Insurance Scheme (NDIS) plan, is reported as incomplete and fragmented. There are missed opportunities for early support and care continuity that could potentially inform ED practitioners to revise current practices. Objective The aims of this study are: (1) to obtain original data from the lived experience voice of those with the PSD NDIS plan and their experience when presenting to an ED, (2) to gather information from NDIS service providers to reveal communication pathways between the ED and NDIS services, and (3) to gain knowledge from ED clinicians around processes for improving continuity of care and consumer experience. Methods This inductive, mixed methods phenomenological study will involve data collection analyzed sequentially, with each stage informing future stages of the research. Interviews will focus on the lived experience voice exploring concerns that have led to an ED presentation, alongside an analysis of associated clinical and administrative documentation and communications. Focus groups with NDIS support workers and support coordinators will provide phenomenological data around the experience from their perspective. National quantitative surveys among those with a PSD NDIS plan and emergency services clinicians will provide insight into current practices within community care and ED presentations. The research project design includes a lived experience advisory group who are assisting with the design of the interview and focus group schedules and national surveys, as well as in shaping the interpretation of qualitative information. All transcripts will be subject to thematic analysis to understand individuals’ meaning-making of these complex and particular phenomena. The research team includes a lived experience researcher and a lived experience carer (PhD candidate). Results This study is funded by MIND Australia as a PhD industry scholarship, which commenced in April 2020. A systematic review as a preresearch activity has been completed and is currently under review. The Human Research Ethics Committee of the University of South Australia has approved this project. An advisory group has been selected, and interview, focus group, and survey schedules are currently being codesigned. Recruitment will commence in November 2021. It is envisaged that data collection will be completed by June 2022. Conclusions Understanding the lived experience of the precare, during care, and postcare stages of ED presentations from the perspective of those with a PSD NDIS plan will inform the research team around current practices and provide information about improvement for pathways of care for consumers and carers, while also informing health policy. International Registered Report Identifier (IRRID) PRR1-10.2196/33268
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Affiliation(s)
- Heather McIntyre
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, Adelaide, Australia
| | - Mark Loughhead
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, Adelaide, Australia
| | | | - Nicholas Gerard Procter
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, Adelaide, Australia
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10
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Blasi PR, Mettert KD, Coleman K, Lewis C, Wagner E, Coghill MN, Dang T, Richards JE. Transitioning patients from outpatient mental health services to primary care: A rapid literature review. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211041294. [PMID: 37089993 PMCID: PMC9981893 DOI: 10.1177/26334895211041294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background A lack of access to mental health services is a critical barrier to obtaining evidence-based care. One strategy to improve access is to transition stable patients out of mental health specialty services and into primary care, thus opening availability for new patients and those with acute mental health needs. To support these transitions, organizations might explore a range of new practices and implementation strategies. Methods We conducted a rapid literature review to summarize descriptions from the research literature about practices for transitioning stable patients from outpatient mental health services to primary care, as well as implementation strategies to enhance the adoption and sustainment of these practices. We searched PsycINFO and Cumulated Index to Nursing and Allied Health Literature (CINAHL) for articles published between January 2000 and August 2019. For articles meeting inclusion criteria, we abstracted data on study characteristics, transition practices, and implementation strategies. Results We included 11 articles representing diverse study designs, settings, and health care organizations. Across these articles, we identified six categories of commonly described transition practices, with patient engagement appearing the most frequently (10 articles), followed by shared treatment planning (eight articles), assessment of recovery and stability, care coordination, follow up and support, and medication management (seven articles each). Less frequently, articles included descriptions of implementation strategies, with five articles describing efforts to train and educate stakeholders and four articles describing the use of evaluative and iterative strategies. Conclusions We identified descriptions of several common practices to help patients transition from mental health specialty services to primary care, but there are opportunities for an increased focus on implementation strategies to enhance the adoption and sustainment of these transition practices. More research is needed to better understand the effectiveness of specific transition interventions and the feasibility of deploying these interventions in heterogeneous health care settings.
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Affiliation(s)
- Paula R. Blasi
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kayne D. Mettert
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Katie Coleman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Cara Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Edward Wagner
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Tobias Dang
- Kaiser Permanente Washington, Renton, WA, USA
| | - Julie E. Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
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11
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Nunnally ME, Ferrer R, Martin GS, Martin-Loeches I, Machado FR, De Backer D, Coopersmith CM, Deutschman CS. The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis. Intensive Care Med Exp 2021; 9:34. [PMID: 34212256 PMCID: PMC8249046 DOI: 10.1186/s40635-021-00400-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To identify priorities for administrative, epidemiologic and diagnostic research in sepsis. Design As a follow-up to a previous consensus statement about sepsis research, members of the Surviving Sepsis Campaign Research Committee, representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine addressed six questions regarding care delivery, epidemiology, organ dysfunction, screening, identification of septic shock, and information that can predict outcomes in sepsis. Methods Six questions from the Scoring/Identification and Administration sections of the original Research Priorities publication were explored in greater detail to better examine the knowledge gaps and rationales for questions that were previously identified through a consensus process. Results The document provides a framework for priorities in research to address the following questions: (1) What is the optimal model of delivering sepsis care?; (2) What is the epidemiology of sepsis susceptibility and response to treatment?; (3) What information identifies organ dysfunction?; (4) How can we screen for sepsis in various settings?; (5) How do we identify septic shock?; and (6) What in-hospital clinical information is associated with important outcomes in patients with sepsis? Conclusions There is substantial knowledge of sepsis epidemiology and ways to identify and treat sepsis patients, but many gaps remain. Areas of uncertainty identified in this manuscript can help prioritize initiatives to improve an understanding of individual patient and demographic heterogeneity with sepsis and septic shock, biomarkers and accurate patient identification, organ dysfunction, and ways to improve sepsis care.
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Affiliation(s)
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Greg S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Grady Memorial Hospital and Emory Critical Care Center, Emory University, Atlanta, GA, USA
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, St. James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.,Hospital Clinic, IDIBAPS, Universidad de Barcelona, CIBERes, Barcelona, Spain
| | | | - Daniel De Backer
- Chirec Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Craig M Coopersmith
- Department of Surgery and Emory Critical Care Center, Emory University, Atlanta, GA, USA
| | - Clifford S Deutschman
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA.,The Feinstein Institute for Medical Research/ Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
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12
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Lee M, Lu W, Mann-Barnes T, Nam JH, Nelson J, Ma GX. Mental Health Screening Needs and Preference in Treatment Types and Providers in African American and Asian American Older Adults. Brain Sci 2021; 11:597. [PMID: 34063018 PMCID: PMC8148007 DOI: 10.3390/brainsci11050597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022] Open
Abstract
Older African Americans and Asian Americans in the U.S. underuse mental health services, despite their vulnerability to diverse mental health problems. This study examined their perspectives on the importance of various mental health problems, mental health treatment, and provider type preference. A total of 243 participants residing in Philadelphia were recruited through community-based organizations. Chi-square, ANOVA, and logistic regression were conducted to examine ethnic differences in demographic characteristics, mental health screening needs, and treatment preferences. African Americans were more likely to endorse the screening needs for depression (AOR: 3.77; 95% CI: 1.19-11.93, p < 0.05) and less likely to endorse the screening needs for suicide (AOR: 0.24; 95% CI: 0.08-0.76, p < 0.05) compared to Asian Americans. For treatment preferences, African Americans were more likely to seek help from primary care physicians (AOR: 8.26; 95% CI: 1.71-32.86, p < 0.01) and less likely to prefer medication as a treatment option (AOR: 0.36; 95% CI: 0.09-0.79, p < 0.05) than Asian Americans. African Americans and Asian Americans prioritized mental health screening needs differently and had different treatment preferences, indicating that matching community needs and preferences regarding mental health services is critical to improve mental service utilization rates in the targeted populations.
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Affiliation(s)
- Minsun Lee
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA 19140, USA; (M.L.); (W.L.); (T.M.-B.); (J.-H.N.)
| | - Wenyue Lu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA 19140, USA; (M.L.); (W.L.); (T.M.-B.); (J.-H.N.)
| | - Tyrell Mann-Barnes
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA 19140, USA; (M.L.); (W.L.); (T.M.-B.); (J.-H.N.)
| | - Jin-Hyeok Nam
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA 19140, USA; (M.L.); (W.L.); (T.M.-B.); (J.-H.N.)
| | - Julie Nelson
- Philadelphia Senior Center, Philadelphia, PA 19147, USA;
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA 19140, USA; (M.L.); (W.L.); (T.M.-B.); (J.-H.N.)
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Philadelphia, PA 19140, USA
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Bernier J, Poitras MÈ, Lavoie M. Trajectoire et vécu des personnes traitées pour un infarctus du myocarde en région éloignée : étude exploratoire descriptive. Rech Soins Infirm 2021:111-122. [PMID: 33319714 DOI: 10.3917/rsi.142.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction : Cardiovascular disease is on the rise and is the second leading cause of death among Canadians. Background : The care pathway followed by myocardial infarction patients in remote areas has an impact on their continuity of care.Objective : To describe the care pathway of myocardial infarction patients living in a remote area.Methods : A qualitative formative research design was used. Two samples were created, the first comprising sixteen people who had undergone a percutaneous transluminal coronary angioplasty, and the second made up of four health professionals working in Family Medicine Groups (FMGs).Results : Eight steps were identified and three priority needs were raised, namely : 1) understanding the pathway of care and services ; 2) effectively communicating health information to the various establishments ; and 3) setting up follow-up by FMG health professionals when the patient returns home.Discussion : Nurses play a key role in all steps of the pathway and in meeting patients’ needs.Conclusion : The care and service pathway are suboptimal but the same for participants from this remote area.
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Exploring the Online Doctor-Patient Interaction on Patient Satisfaction Based on Text Mining and Empirical Analysis. Inf Process Manag 2020. [DOI: 10.1016/j.ipm.2020.102253] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Dinsdale E, Hannigan A, O'Connor R, O'Doherty J, Glynn L, Casey M, Hayes P, Kelly D, Cullen W, O'Regan A. Communication between primary and secondary care: deficits and danger. Fam Pract 2020; 37:63-68. [PMID: 31372649 DOI: 10.1093/fampra/cmz037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Timely and accurate communication between primary and secondary care is essential for delivering high-quality patient care. OBJECTIVE The aim of this study is to evaluate the content contained in both referral and response letters between primary and secondary care and measure this against the recommended national guidelines. METHODS Using an observational design, senior medical students and their general practice supervisors applied practice management software to identify 100 randomly selected adults, aged greater than 50 years, from a generated list of consults over a 2-year period (2013-2015). All data included in referral and response letters for these adults were examined and compared with the gold standard templates that were informed by international guidelines. RESULTS Data from 3293 referral letters and 2468 response letters from 68 general practices and 17 hospitals were analysed. The median time that had elapsed between a patient being referred and receiving a response letter was 4 weeks, ranging from 1 week for Emergency Department referral letters to 7 weeks for orthopaedic surgery referral letters. Referral letters included the reason for referral (98%), history of complaint (90%) and current medications (82%). Less commonly included were management prior to referral (65%) and medication allergies (57%). The majority of response letters included information on investigations (73%), results (70%) and follow-up plan (85%). Less commonly, response letters included medication changes (30%), medication lists (33%) and secondary diagnoses (13%). CONCLUSIONS Future research should be aimed at developing robust strategies to addressing communication gaps reported in this study.
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Affiliation(s)
- Elsa Dinsdale
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Ailish Hannigan
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Ray O'Connor
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Jane O'Doherty
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Monica Casey
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Peter Hayes
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Dervla Kelly
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Walter Cullen
- School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Andrew O'Regan
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
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Tyler N, Wright N, Grundy A, Gregoriou K, Campbell S, Waring J. Codesigning a Mental Health Discharge and Transitions of Care Intervention: A Modified Nominal Group Technique. Front Psychiatry 2020; 11:328. [PMID: 32372990 PMCID: PMC7186904 DOI: 10.3389/fpsyt.2020.00328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/01/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Discharge from acute mental health services has long been associated with mortality, risk, and related adverse outcomes for patients. Many of the interventions that currently aim to reduce adverse outcomes focus on a single group of healthcare professionals within a single healthcare setting. A recent systematic review highlights very few robust interventions that specifically aim to improve communication across services. However the importance of promoting interagency working and improving information flow between services is continually highlighted as a key priority. METHODS Using a novel codesign and experience based approach we worked with a multistakeholder group to develop possible solutions to reduce the adverse outcomes commonly associated with discharge from acute mental health services. This utilized a modified Nominal Group Technique and creative problem solving method to follow a four-stage process: Problem Identification, Solution Generation, Decision-Making, Prioritization and Implementation. Thirty-two healthcare professionals and an expert by lived experienced engaged with the process that took place over two stakeholder events. RESULTS Stakeholders at the first event identified and agreed upon 24 potential ideas to improve discharge from acute mental health services. These were refined at the second event to four elements of an interagency intervention: a multiagency 'Discharge Team' (with designated discharge coordinator), inclusive technology enabled team meetings, universal documentation and a patient generated discharge plan. CONCLUSION This is the first study to codesign an interagency mental health discharge intervention based around a discharge team. We developed a model for working that places a greater focus on a patient generated discharge plan, interagency working, and information flow. A pilot of the proposed intervention is now needed to test the feasibility and effectiveness in reducing adverse outcomes.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Nicola Wright
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Grundy
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | | | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom.,NIHR School for Primary Care Research, Manchester Academic Health Science Centre, School for Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, United Kingdom
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Peritogiannis V, Lixouriotis C. Mental Health Care Delivery for Older Adults in Rural Greece: Unmet Needs. J Neurosci Rural Pract 2019; 10:721-724. [PMID: 31831997 PMCID: PMC6906103 DOI: 10.1055/s-0039-3399603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mental disorders may go unrecognized and undertreated in older adults. This is the rationale for the launch of specialized mental health services for the elderly in high resourced settings. Rural areas, however, do not receive adequate mental health care owing to socioeconomic and geographical reasons, and this is the case of rural Greece, where research on mental health of the elderly is scarce. This article discusses the challenges of providing mental health care for older adults in rural Greece and the available options. Care can be delivered through the existing rural mental health services that are the mobile mental health units and through the primary care physicians. Training in psychogeriatrics for the personnel of the former and in mental health for the latter is warranted.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
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[Factors influencing the use of mechanisms for coordinating healthcare levels in Colombia]. GACETA SANITARIA 2019; 35:177-185. [PMID: 31630926 DOI: 10.1016/j.gaceta.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/09/2019] [Accepted: 06/28/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyse the factors influencing the use of mechanisms for the clinical coordination of two Colombian public healthcare networks' healthcare levels in Bogotá from the main social actors' perspective. METHOD This was a descriptive-interpretative, qualitative study of two public healthcare networks. Discussion groups and semi-structured interviews were used for collecting information. The approach involved two-stage theoretical sampling of a selection of centres operating at different healthcare levels and a selection of informants, including managers (n=19), healthcare employees (n=23) and administrative staff (n=20). Content analysis involved adopting a mixed method approach for generating categories, segmented by network, informant group and topic. RESULTS Both networks had few mechanisms for enabling the clinical coordination of healthcare levels; information transfer mechanisms predominated and clinical management coordination mechanisms only dealt with maternal-perinatal care. Organisational factor-related complications were found regarding their use: lack of time, staff turnover, administrative use and technological deficiency. Employee/staff-related difficulties were due to lack of interest. These factors directly affected coordination with limited information transfer, patient follow-up and healthcare quality (diagnosis and treatment delays). CONCLUSIONS The results highlighted the limited use of clinical coordination mechanisms in both public healthcare networks studied here, with problems in their use. Changes are required that affect directly organisational factors (time for coordination and working conditions) and professional factors (attitudes towards collaborative work).
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Boffin N, Van Casteren V, De Ridder K. Care of general practice patients preceding and following a suicide attempt: observational study in Flemish general practices. BMJ Open 2019; 9:e028546. [PMID: 31061060 PMCID: PMC6501981 DOI: 10.1136/bmjopen-2018-028546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES First, to examine general practitioner (GP) knowledge about the care (needs) of their patients; second, to examine the quality of GP follow-up care; third, to examine the transmission of patient care information from hospitals/emergency services (ES) to GPs. SETTING 105 general practices from the representative Belgian Network of Sentinel General Practices (SGP) in Flanders, the largest region of Belgium, during 2013-2016. PARTICIPANTS 245 suicide attempts by regular patients. OUTCOMES MEASURES Ten care-related measures, including three indicators of quality of follow-up care, were based on data reported by the SGP on structured forms at baseline and at two follow-up points in time. RESULTS As for GP knowledge, 10.5% of SGP failed to report whether suicidal risk was noticed in patients seen in the month preceding the attempt; 9.0% whether there were previous attempts; 22.5% whether the patient was receiving mental health treatment at follow-up and 22.0% whether suicidal behaviour was repeated at follow-up. Relatively more patients≥65 years had no suicide risk evaluation (OR 3.54; 95% CI 1.11 to 11.26). As for quality of follow-up care, there was a GP-patient contact following 90.5% of the attempts, follow-up appointments were planned following 43.4% of the attempts and there was a GP contact with patient proxies following 62.8% of the attempts. Patient age ≥65 years (OR 4.09; 95% CI 1.79 to 9.33), a recent GP-patient contact preceding the attempt (OR 1.97; 95% CI 1.13 to 3.43), depression of patient (OR 1.96; 95% CI 1.14 to 3.37) and a suburban SGP area (OR 2.34; 95% CI 1.13 to 4.82) were determinants of an increased quality of care sum. GPs received patient care information from a hospital (ES) for 67.8% of eligible attempts, with SGP practice location being a determinant. CONCLUSIONS GPs are highly involved in the care of suicide attempters but there is room for improvement, also in informational continuity from hospital (ES) to GPs.
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Affiliation(s)
- Nicole Boffin
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Karin De Ridder
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Oliveira CRFD, Samico IC, Mendes MFDM, Vargas I, Vázquez ML. [Awareness and use of mechanism for clinical coordination between levels in two health care networks in Pernambuco State, Brasil]. CAD SAUDE PUBLICA 2019; 35:e00119318. [PMID: 31066777 DOI: 10.1590/0102-311x00119318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/28/2019] [Indexed: 11/22/2022] Open
Abstract
This article assesses awareness and use of mechanisms for clinical coordination between service levels in two health care networks in the Pernambuco State, Brasil. It is a descriptive, cross-sectional, survey-based study. We interviewed 381 doctors from the public primary health care and specialized health care networks in the cities of Caruaru and Recife (Sanitary Districts III and VII). We used a structured questionnaire (COORDENA) in order to assess awareness, frequency and characteristics of the use of the following mechanisms: referral and reply letters, discharge summary, phone and notes (mutual adaptation mechanisms), Health Ministry protocols and joint clinical sessions (standardization mechanisms). We analyzed the data using simple frequencies, means and percentages. In general, primary health care doctors are more familiar with the mechanisms, and use them more frequently, than specialized health care doctors. In the comparison between networks, Recife had better results. Referral and reply letters were the most used (61.4%) and joint clinical sessions were the least used (8.6%), in addition to the existence of informal mechanisms (phone 58%, notes 56.6%, WhatsApp 2.6%). Underutilization of mechanisms, divergences in information sent and received between primary health care and specialized health care professionals and inadequate mechanism use suggest communication failures among professionals and service levels. The findings reveal a need for investments that enable awareness, communication and collaboration between professionals, contributing to a better coordination between the different services levels.
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Affiliation(s)
| | | | | | - Ingrid Vargas
- Consorci de Salut i Social de Catalunya, Barcelona, España
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Allwood C, O'Brien A, Glue P. Referrals from primary care to community mental health teams: what’s missing? J Prim Health Care 2019. [DOI: 10.1071/hc19053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONTransfer of care from primary to specialist mental health services almost always requires a referral by hardcopy letter or sent via a structured electronic form. The quality and content of referrals can vary, leading to delays in treatment.
AIMThe aim of the research was to explore the quality and content of referral letters received by two urban New Zealand community mental health teams.
METHODSA retrospective audit of 4 months’ worth of referrals (n=92) from primary care to specialist mental health services was undertaken using an audit tool created from a review of literature.
RESULTSThe audit identified gaps in the information provided by referrers, including a lack of evidence of treatment in primary care before referral, risk information, information relating to physical health concerns or co-existing problems, evidence of client consent to referral, and recording of ethnicity. Thirty-seven percent of referrals were considered to be of poor quality. Compared to hardcopy letters, referrals generated by an electronic referral system were of a better quality and contained more information. More than 40% of referrals were not accepted, although the reasons for this were not assessed as part of this audit.
DISCUSSIONBetter integration of primary and secondary mental health care by using electronic referral templates may reduce the number of inappropriate or incomplete referrals. Referrals from primary care to specialist mental health services vary in content and quality, with many falling below a level that specialist services can accept. This impacts on the efficacy of services and ultimately on patients’ journeys between primary and secondary care. Development of a standard referral template for use by primary care services may improve the quality of referrals.
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A Leiferman J, Farewell CV, E Lee-Winn A, Jewell J, Ulrickson C, Huberty J, Paulson J. Management of Prenatal Depression: Effectiveness of an Online Training Module Across Health Care Disciplines. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:178-184. [PMID: 31464821 DOI: 10.1097/ceh.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Maternal depression is associated with numerous deleterious maternal and child health outcomes. Although there are several treatment options for prenatal depression, many depressed women remain untreated. This study tested the effects of a low-intensity online training module on providers' attitudes, beliefs, and management practices of prenatal depression across a diverse group of providers. METHODS Health care providers who were providing care to pregnant women completed a 64-item survey consisting of items from the Management of Maternal Depression Inventory. Upon completion of the survey, providers were randomized into the intervention or the active control arm (wait-listed). The intervention consisted of an online training, which targeted knowledge and skills related to providing guidance on prenatal mood disorders. Approximately 6 to 8 weeks after randomization, all providers completed the survey again, and a general linear model framework was used to test change from baseline. RESULTS The final sample was comprised 74 compliant providers (intervention arm: n = 41; control arm: n = 33). Providers in the intervention arm reported significant increases in the sense of responsibility and self-efficacy when compared with their counterparts in the active control arm (all P < .001). Providers in the intervention arm also reported an increase in satisfaction related to communication with mental health specialists when compared with their counterparts in the active control arm (P = .05). DISCUSSION Our findings suggest that a brief, online training improved the attitudes, confidence, and communication of diverse providers related to the management of prenatal depression. Provider online training may help encourage patient-provider dialogue and in turn, enhance the management of prenatal depression.
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Affiliation(s)
- Jenn A Leiferman
- Dr. Leiferman: Associate Professor, Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO. Dr. Farewell: Senior Research Instructor, Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO. Dr. Lee-Winn: Assistant Professor, Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO. Ms. Jewell: DrPH Student, Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO. Ms. Ulrickson: Research Coordinator, Denver Health and Hospital Authority, Denver, CO. Dr. Huberty: Associate Professor, Arizona State University, Phoenix, AZ. Dr. Paulson: Associate Professor Old Dominion University, Norfolk, VA
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Hanson RF, Saunders BE, Ralston E, Moreland AD, Peer SO, Fitzgerald MM. Statewide implementation of child trauma-focused practices using the community-based learning collaborative model. Psychol Serv 2018; 16:170-181. [PMID: 30550316 DOI: 10.1037/ser0000319] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A significant number of youth in the United States experience traumatic events that substantially increase the risk of physical and behavioral health problems across the life span. This public health concern warrants concerted efforts to promote trauma-informed, evidence-based practices that facilitate recovery. Although youth-focused trauma-specific treatments exist, determining effective ways to disseminate and implement these services-so that they are available, accessible, and sustainable-poses an ongoing challenge. This paper describes a comprehensive model for such implementation, the community-based learning collaborative (CBLC), developed as part of Project BEST, a four-phase statewide initiative to promote trauma-focused practices. The CBLC augments the learning collaborative model by including clinical and nonclinical (i.e., broker) professionals from multiple service organizations within a targeted community. CBLCs aim to build capacity for sustained implementation of trauma-focused practices by promoting interprofessional collaboration among those involved in the coordination and provision of these services. This paper describes the iterative development of the CBLC by examining participant completion data across the three completed phases of Project BEST (N = 13 CBLCs; 1,190 participants). Additionally, data from Project BEST's third phase (N = 6 CBLCs; 639 participants) were used to evaluate changes in the frequency of specific practices, pre- to post-CBLC, and post-CBLC perceived utility of CBLC components. High participant completion rates, significant increases in reported trauma-focused practices, and positive ratings of the CBLC's utility provisionally support the feasibility and efficacy of the model's final iteration. Implications for implementation and CBLC improvements are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Miyoshi NSB, Azevedo-Marques JMD, Alves D, Azevedo-Marques PMD. An eHealth Platform for the Support of a Brazilian Regional Network of Mental Health Care (eHealth-Interop): Development of an Interoperability Platform for Mental Care Integration. JMIR Ment Health 2018; 5:e10129. [PMID: 30530455 PMCID: PMC6303678 DOI: 10.2196/10129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/20/2018] [Accepted: 09/03/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The electronic exchange of health-related data can support different professionals and services to act in a more coordinated and transparent manner and make the management of health service networks more efficient. Although mental health care is one of the areas that can benefit from a secure health information exchange (HIE), as it usually involves long-term and multiprofessional care, there are few published studies on this topic, particularly in low- and middle-income countries. OBJECTIVE The aim of this study was to design, implement, and evaluate an electronic health (eHealth) platform that allows the technical and informational support of a Brazilian regional network of mental health care. This solution was to enable HIE, improve data quality, and identify and monitor patients over time and in different services. METHODS The proposed platform is based on client-server architecture to be deployed on the Web following a Web services communication model. The interoperability information model was based on international and Brazilian health standards. To test platform usage, we have utilized the case of the mental health care network of the XIII Regional Health Department of the São Paulo state, Brazil. Data were extracted from 5 different sources, involving 26 municipalities, and included national demographic data, data from primary health care, data from requests for psychiatric hospitalizations performed by community services, and data obtained from 2 psychiatric hospitals about hospitalizations. Data quality metrics such as accuracy and completeness were evaluated to test the proposed solution. RESULTS The eHealth-Interop integration platform was designed, developed, and tested. It contains a built-in terminology server and a record linkage module to support patients' identification and deduplication. The proposed interoperability environment was able to integrate information in the mental health care network case with the support of 5 international and national terminologies. In total, 27,353 records containing demographic and clinical data were integrated into eHealth-Interop. Of these records, 34.91% (9548/27,353) were identified as patients who were present in more than 1 data source with different levels of accuracy and completeness. The data quality analysis was performed on 26 demographic attributes for each integrable patient record, totaling 248,248 comparisons. In general, it was possible to achieve an improvement of 18.40% (45,678/248,248) in completeness and 1.10% (2731/248,248) in syntactic accuracy over the test dataset after integration and deduplication. CONCLUSIONS The proposed platform established an eHealth solution to fill the gap in the availability and quality of information within a network of health services to improve the continuity of care and the health services management. It has been successfully applied in the context of mental health care and is flexible to be tested in other areas of care.
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Affiliation(s)
| | | | - Domingos Alves
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Vargas I, Garcia-Subirats I, Mogollón-Pérez AS, Ferreira-de-Medeiros-Mendes M, Eguiguren P, Cisneros AI, Muruaga MC, Bertolotto F, Vázquez ML. Understanding communication breakdown in the outpatient referral process in Latin America: a cross-sectional study on the use of clinical correspondence in public healthcare networks of six countries. Health Policy Plan 2018; 33:494-504. [PMID: 29452401 PMCID: PMC5894081 DOI: 10.1093/heapol/czy016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 01/17/2023] Open
Abstract
An adequate use of referral and reply letters—the main form of communication between primary care (PC) and out-patient secondary care (SC)—helps to avoid medical errors, test duplications and delays in diagnosis. However, it has been little studied to date in Latin America. The aim is to determine the level and characteristics of PC and SC doctors’ use of referral and reply letters and to explore influencing factors in public healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. A cross-sectional study was conducted through a survey of PC and SC doctors working in public healthcare networks (348 doctors per country). The COORDENA questionnaire was applied to measure the frequency of use and receipt of referral and reply letters, quality of contents, timeliness and difficulties in using them. Descriptive analyses were conducted and a multivariate logistic regression model was generated to assess the relationship between frequent use and associated factors. The great majority of doctors claim that they send referral letters to the other level. However, only half of SC doctors (a higher proportion in Chile and Mexico) report that they receive referral letters and <20% of PC doctors receive a reply from specialists. Insufficient recording of data is reported in terms of medical history, tests and medication and the reason for referral. The factor associated with frequent use of the referral letter is doctors’ age, while the use of reply letters is associated with identifying PC doctors as care coordinators, knowing them and trusting in their clinical skills, and receiving referral letters. Significant problems are revealed in the use of referral and reply letters which may affect quality of care. Multifaceted strategies are required that foster a direct contact between doctors and a better understanding of the PC-based model.
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Affiliation(s)
- Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
| | - Irene Garcia-Subirats
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
| | - Amparo-Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, 11001 Bogotá, Colombia
| | - Marina Ferreira-de-Medeiros-Mendes
- Grupo de Estudos de Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Rua Dos Coelhos No. 300, 50070-550 Boa Vista, Brasil Recife
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Avenida Independencia, 939 Santiago de Chile, Chile
| | - Angelica-Ivonne Cisneros
- Instituto de Salud Pública, Universidad Veracruzana, Av. Dr. Luis Castelazo Ayala s/n. Col. Industrial Ánimas, 91190 Xalapa, Veracruz, México
| | | | - Fernando Bertolotto
- Facultad de Enfermería, Universidad de la República, Jaime Cibils 2810, 11400 Montevideo, Uruguay
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
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Draper B, Krysinska K, Snowdon J, De Leo D. Awareness of Suicide Risk and Communication Between Health Care Professionals and Next-of-Kin of Suicides in the Month Before Suicide. Suicide Life Threat Behav 2018. [PMID: 28640962 DOI: 10.1111/sltb.12365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Based on psychological autopsy data, the study compared awareness of suicide risk in the deceased among next-of-kin (NOK) and health care professionals (HCPs), and communication between these two groups in the month before death. The NOKs had significantly more knowledge about the decedent's suicide warning signs than the HCPs (90.5% vs. 44.6%). Contact between NOK and HCP was initiated more often by the family than the HCPs (29.4% vs. 5.9%). The study found communication gaps between HCPs and NOK and stresses the need for suicide prevention strategies strengthening communication between these two groups.
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Affiliation(s)
- Brian Draper
- School of Psychiatry, University of NSW, Sydney, NSW, Australia
| | | | - John Snowdon
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Qld, Australia
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Potential predictive factors for successful referral from specialist mental-health services to less intensive treatment: A concept mapping study. PLoS One 2018; 13:e0199668. [PMID: 29944699 PMCID: PMC6019256 DOI: 10.1371/journal.pone.0199668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
Referring patients from specialist mental-health services (provided by multiple healthcare service providers and aimed at relieving symptoms of mental illness) to less intensive care (provided by a nurse or psychologist in cooperation with a general practitioner and aimed at improving quality of life) is feasible from the perspective of patients, service providers, and mental-health services. However, it is unclear which patients are most suitable for referral to less intensive care. In this study, we used concept mapping to identify factors that might determine whether a referral from specialist mental services to less intensive care might be successful. Participants (N = 34) were recruited from different parts of the Netherlands and included general practitioners, peer workers, community mental-health nurses, and social workers from several services who were based in different neighborhoods. The participants generated 54 statements (31 after clean-up), which were sorted into five clusters and rated on their expected ability to predict successful referral. Ordered from highest to lowest on expected predictive value, the clusters of factors were: Patient characteristics, patients’ informal support system, patients’ social situation, organization of services, and service provider related factors. The ordering was the same for all of the service providers, except that general practitioners expected the organization of services to be the most predictive. The ordering of the clusters is mostly consistent with existing knowledge about recovery during mental healthcare. In order to further improve the number of successful referrals from specialist mental-health services to less intensive care, a prospective prediction study is needed.
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Sather EW, Svindseth MF, Crawford P, Iversen VC. Care pathways in the transition of patients between district psychiatric hospital centres (DPCs) and community mental health services. Health Sci Rep 2018; 1:e37. [PMID: 30623072 PMCID: PMC6266453 DOI: 10.1002/hsr2.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/28/2018] [Accepted: 03/13/2018] [Indexed: 11/06/2022] Open
Abstract
RATIONALE AIMS AND OBJECTIVES Patients with mental health problems experience numerous transitions into and out of hospital. Primary care providers have mixed success in identifying and managing patients' needs. This study explores health personnel's experience of care pathways in patient transition between inpatient and community mental health services. METHODS A descriptive qualitative design was chosen. Four focus group interviews with 12 informants from 7 different communities were conducted. Interviews were analyzed thematically. RESULTS Two main themes were identified: integrated care and patient activation. The participants shared their experiences on topics that can affect smooth care pathways in mental health. Six promoting factors were identified for successful patient transition: opportunities for information sharing, implementation of systematic plans, use of e-messages, around-the-clock care, designating one responsible health person in each system for each patient, and the involvement of patients and their families. The following barriers were all found to impede the patients' transition between levels of care: the lack of a single responsible person at each health care level, insufficient meetings, the absence of systematic plans, difficulties in identifying the right staff at different levels, delays in information sharing, and the complexity of welfare systems negatively affecting patient dignity. CONCLUSIONS Systems and procedures should be developed to ensure clear responsibilities and transparency at each stage of the pathways of care. A single person should take charge of ensuring sufficient connection and communication between inpatient and community mental health services. Finally, both patient and staff in community services should be linked through a direct telephone number with around-the-clock availability.
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Affiliation(s)
- Eva W. Sather
- Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Marit F. Svindseth
- Faculty of Medicine and Health ScienceNorwegian University of Science and TechnologyAalesundNorway
| | - Paul Crawford
- Faculty of Medicine and Health SciencesUniversity of NottinghamUK
| | - Valentina C. Iversen
- Faculty of Medicine and Health Sciences, Department of Mental HealthNorwegian University of Science and Technology, St Olav's University Hospital HF, Tiller District Psychiatric CentreTrondheimNorway
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Ahmed S, Almario CV, Chey WD, Robbins LA, Chang B, Ahn J, Ko J, Gu P, Siu A, Spiegel BMR. Electronic patient agenda forms: comparing agreement between the reason for specialty consultation reported by referring providers and patients. Inform Health Soc Care 2018; 44:105-113. [PMID: 29509054 DOI: 10.1080/17538157.2018.1437041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Little is known about the agreement between referring providers' reason for specialty evaluation and patients' understanding of why they are referred for consultation. Here, we compared the reason for consult (RFC) documented by referring providers during usual care vs. the perceived RFC independently reported by patients through an e-portal just prior to the specialist visit. METHODS We performed an observational study among patients referred for gastrointestinal (GI) evaluation. Patients referred to the specialty clinic submitted their self-reported RFC using an online patient agenda form prior to their visit. Therefore, each participant had a referring provider- and patient-documented RFC. Blinded physicians reviewed the RFCs in random order using a priori coding criteria. We then compared whether the provider and patient RFC pairs were concordant (i.e., ≥1 clinical topic[s] in the RFCs matched). RESULTS Sixty patients completed the e-portal prior to their visit, leading to 60 provider-patient RFC pairs. The RFC pairs were concordant in only 52% of cases. CONCLUSIONS There is poor agreement between referring providers' reason for GI referral and patients' understanding of why they are visiting the clinic. Future research examining whether electronic patient agenda forms impact diagnostic and management precision, patient satisfaction, and healthcare utilization is warranted.
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Affiliation(s)
- Shahzad Ahmed
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Christopher V Almario
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,c Division of Health Services Research , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,d Division of Informatics , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,e Cedars-Sinai Center for Outcomes Research and Education (CS-CORE) , Los Angeles , CA , USA
| | - William D Chey
- f Division of Gastroenterology , University of Michigan , Ann Arbor , MI , USA
| | - Lori A Robbins
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Bianca Chang
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Joseph Ahn
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Jeffrey Ko
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Phillip Gu
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Alvin Siu
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Brennan M R Spiegel
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,c Division of Health Services Research , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,d Division of Informatics , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,e Cedars-Sinai Center for Outcomes Research and Education (CS-CORE) , Los Angeles , CA , USA
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Holzinger F, Fahrenkrog S, Roll S, Kleefeld F, Adli M, Heintze C. Discharge management strategies and post-discharge care interventions for depression - Systematic review and meta-analysis. J Affect Disord 2017; 223:82-94. [PMID: 28734149 DOI: 10.1016/j.jad.2017.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/14/2017] [Accepted: 07/08/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with depression require treatment continuity when discharged from inpatient care. Interventions aimed at optimizing transition into outpatient care may be effective in preventing symptom deterioration and readmission. We aimed to evaluate the effectiveness of care transition interventions for patients with depression after psychiatric hospitalization. METHODS Systematic review and random-effects meta-analysis of controlled trials. Primary outcomes were readmissions and symptoms of depression. The control condition was treatment as usual. RESULTS We included 16 publications reporting the results of 13 different studies. Studies were heterogeneous concerning patient selection and interventional approach. Effects on readmissions and depression symptoms were non-significant in meta-analysis of 8 studies/710 patients and 7 studies/592 patients, respectively. Overall risk ratio for readmission during follow-up was 0.65 (95% CI [0.42;1.01], p=0.06), standardized mean difference for depression symptoms was -0.09 (95% CI [-0.37;0.19], p=0.53). Subgroup analyses indicated no preference for a specific interventional strategy. Data point to considerable risk for selection and publication bias. LIMITATIONS Included studies are heterogeneous; subgroups are often small and may not attain the power to detect effects. Reasonable classification of interventions into groups of comparable approaches was a challenge and may be arbitrary in some cases. CONCLUSIONS This systematic review and meta-analysis could not identify any convincingly effective interventional transition approach for patients with depression after psychiatric hospitalization. Current evidence regarding discharge management for depression is limited, heterogeneous and potentially prone to bias. Interventions might be more appropriate for patients with other diagnoses than depression. Further high-quality randomized studies are required.
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Affiliation(s)
- F Holzinger
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Germany.
| | - S Fahrenkrog
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Germany
| | - S Roll
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Germany
| | - F Kleefeld
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Germany
| | - M Adli
- Department of Psychiatry and Psychotherapy, Research Group Mood Disorders, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Germany; Fliedner Klinik Berlin, Germany
| | - C Heintze
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Germany
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Hartveit M, Vanhaecht K, Thorsen O, Biringer E, Haug K, Aslaksen A. Quality indicators for the referral process from primary to specialised mental health care: an explorative study in accordance with the RAND appropriateness method. BMC Health Serv Res 2017; 17:4. [PMID: 28049470 PMCID: PMC5209847 DOI: 10.1186/s12913-016-1941-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Communication between involved parties is essential to ensure coordinated and safe health care delivery. However, existing literature reveals that the information relayed in the referral process is seen as insufficient by the receivers. It is unknown how this insufficiency affects the quality of care, and valid performance measures to explore it are lacking. The aim of the present study was to develop quality indicators to detect the impact that the quality of referral letters from primary care to specialised mental health care has on the quality of mental health services. Methods Using a modified version of the RAND/UCLA appropriateness method, a systematic literature review and focus group interviews were conducted to define quality indicators for mental health care expected to be affected by the quality of referral information. Focus group participants included psychiatrists, psychologists, general practitioners, patient representatives and managers. The existing evidence and suggested indicators were presented to expert panels, who assessed the indicators by their validity, reliability, sensitivity and feasibility. Results Sixteen preliminary indicators emerged during the focus group interviews and literature review. The expert panels recommended four of the 16 indicators. The recommended indicators measure a) timely access, b) delay in the process of assessing the referral, c) delay in the onset of care and d) the appropriateness of the referral. Adjustment was necessary for five other indicators, and seven indicators were rejected because of expected confounding factors reducing their validity and sensitivity. Conclusions The quality of information relayed in the referral process from primary care to specialised mental health care is expected to affect a wide range of dimensions defining high quality care. The expected importance of the referral process for ensuring ‘timely access’-one of the six aims of high-quality health care defined by the Institute of Medicine-is highlighted. Exploring the underlying mechanisms for the potential impact of referral information on patient outcomes is recommended to enhance quality of care. Trial registration ClinicalTrials.gov: NCT01374035 (28 April 2011).
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Affiliation(s)
- Miriam Hartveit
- Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Helse Fonna HF, Box 2170, 5504, Haugesund, Norway. .,Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway. .,Leuven Institute for Healthcare Policy, School of Public Health, University of Leuven, Leuven, Belgium.
| | - Kris Vanhaecht
- Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Helse Fonna HF, Box 2170, 5504, Haugesund, Norway.,School of Public Health, KU Leuven, University of Leuven, Leuven, Belgium.,Department of quality management, University Hospitals Leuven, Leuven, Belgium.,Leuven Institute for Healthcare Policy, School of Public Health, University of Leuven, Leuven, Belgium
| | - Olav Thorsen
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Eva Biringer
- Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Helse Fonna HF, Box 2170, 5504, Haugesund, Norway
| | - Kjell Haug
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Aslak Aslaksen
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Bergen, Norway
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Abstract
Mounting evidence supports the value of integrated healthcare and the need for interprofessional practice within patient-centered medical homes (PCMH). Incorporating behavioral health services is key to fully implementing the PCMH concept. Unfortunately, psychologists have not been front and center in this integrative and interprofessional care movement nor have they typically received adequate training or experience to work effectively in these integrated care programs. This article builds the case for the value of PCMHs, particularly those that incorporate behavioral health services. Attention is paid to the diverse roles psychologists play in these settings, including as direct service providers, consultants, teachers/supervisors, scholars/program evaluators, and leaders. There is a discussion of the competencies psychologists must possess to play these roles effectively. Future directions are discussed, with a focus on ways psychologists can bolster the PCMH model by engaging in interprofessional partnerships related to education and training, practice, research, and leadership.
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Gleason N, Prasad PA, Ackerman S, Ho C, Monacelli J, Wang M, Collado D, Gonzales R. Adoption and impact of an eConsult system in a fee-for-service setting. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2016; 5:40-45. [PMID: 27469441 DOI: 10.1016/j.hjdsi.2016.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/04/2016] [Accepted: 05/18/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Nathaniel Gleason
- Division of General Internal Medicine, University of California, San Francisco, United States.
| | - Priya A Prasad
- Division of General Internal Medicine, University of California, San Francisco, United States
| | - Sara Ackerman
- Division of General Internal Medicine, University of California, San Francisco, United States
| | - Chanda Ho
- California Pacific Medical Center, Division of Hepatology, United States
| | | | - Michael Wang
- Division of General Internal Medicine, University of California, San Francisco, United States
| | - Don Collado
- Division of General Internal Medicine, University of California, San Francisco, United States
| | - Ralph Gonzales
- Division of General Internal Medicine, University of California, San Francisco, United States
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Penney LS, Ritenbaugh C, Elder C, Schneider J, Deyo RA, DeBar LL. Primary care physicians, acupuncture and chiropractic clinicians, and chronic pain patients: a qualitative analysis of communication and care coordination patterns. Altern Ther Health Med 2016; 16:30. [PMID: 26810302 PMCID: PMC4727288 DOI: 10.1186/s12906-016-1005-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/20/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND A variety of people, with multiple perspectives, make up the system comprising chronic musculoskeletal pain (CMP) treatment. While there are frequently problems in communication and coordination of care within conventional health systems, more opportunities for communicative disruptions seem possible when providers use different explanatory models and are not within the same health management system. We sought to describe the communication system surrounding the management of chronic pain from the perspectives of allopathic providers, acupuncture and chiropractor (A/C) providers, and CMP patients. METHODS We collected qualitative data from CMP patients (n = 90) and primary care physicians (PCPs) (n = 25) in a managed care system, and community acupuncture and chiropractic care providers (n = 14) who received high levels of referrals from the system, in the context of a longitudinal study of CMP patients' experience. RESULTS Multiple points of divergence and communicative barriers were identified among the main stakeholders in the system. Those that were most frequently mentioned included issues surrounding the referral process (requesting, approving) and lack of consistent information flow back to providers that impairs overall management of patient care. We found that because of these problems, CMP patients were frequently tasked and sometimes overwhelmed with integrating and coordinating their own care, with little help from the system. CONCLUSIONS Patients, PCPs, and A/C providers desire more communication; thus systems need to be created to facilitate more open communication which could positively benefit patient outcomes.
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McCurdy K, Croxford A. Improving feedback from outpatient medical appointments attended by escorted psychiatric patients in the North London Forensic Service. BMJ QUALITY IMPROVEMENT REPORTS 2016; 4:bmjquality_uu205791.w2356. [PMID: 26734347 PMCID: PMC4645873 DOI: 10.1136/bmjquality.u205791.w2356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/24/2015] [Indexed: 11/18/2022]
Abstract
It is well established that patients with mental illness are known to have a high level of morbidity and mortality compared to the general population. This is particularly prominent in long-stay psychiatric patients, such as those in secure settings. The Royal College of Psychiatrists recommends that psychiatrists should promote the physical health of their patients and liaise with other specialties. However, there is evidence that communication between psychiatry and other specialties is poor. A survey was carried out at the North London Forensic Service in June 2014. This looked at the views of clinical staff about the frequency and quality of feedback obtained when inpatients attend outpatient hospital appointments at local general hospitals. This survey highlighted the general perception among staff that feedback is poor, with 68.43% of respondents saying that they were “very unsatisfied” or “unsatisfied” with the level and quality of feedback. Clinical staff felt that many patients who attended hospital outpatient appointments, even when escorted by staff, returned with little or no feedback. This was confirmed by a baseline audit across 3 wards showing that details of the appointment (date, time, hospital, and specialty) were only documented in 54.5% of cases and the content of the appointment documented in even fewer cases. A form was designed by junior doctors that provided a simple framework of 6 questions to be answered at the outpatient clinic about the problem, diagnosis, and further actions needed. This was introduced and its impact assessed with a 3-month and 6-month audit of electronic notes, as well as a follow-up survey after 6 months. The audit showed significant improvement in the quality of feedback about the appointment at both the 3-month and 6-month point. The follow-up survey showed that 70% of respondents were aware of the form and 100% of those who were aware of the form had used it at least once and found it helpful. The general satisfaction level improved, but remained low, with 40% of respondents saying that they were “very unsatisfied” or “unsatisfied” with the level and quality of feedback. This QIP shows that the outpatient appointment form is a useful and effective tool when staff know about it and use it. We plan to look at the barriers to using the form and consider future solutions to the need for increased engagement with nursing staff stakeholders in future PDSA cycles.
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Chenoweth L, Kable A, Pond D. Research in hospital discharge procedures addresses gaps in care continuity in the community, but leaves gaping holes for people with dementia: a review of the literature. Australas J Ageing 2015; 34:9-14. [PMID: 25735471 DOI: 10.1111/ajag.12205] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To examine the literature on the impact of the discharge experience of patients with dementia and their continuity of care. METHODS Peer-reviewed and grey literature published in the English language between 1995 and 2014 were systematically searched using Medline, CINAHL, PubMed, PsycINFO and Cochrane library databases, using a combination of the search terms Dementia, Caregivers, Integrated Health Care Systems, Managed Care, Patient Discharge. Also reviewed were Department of Health and Ageing and Alzheimer's Australia research reports between 2000 and 2014. RESULTS The review found a wide range of studies that raise concerns in relation to the quality of care provided to people with dementia during hospital discharge and in transitional care. CONCLUSION Discharge planning and transitional care for patients with dementia are not adequate and are likely to lead to readmission and other poor health outcomes.
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Affiliation(s)
- Lynn Chenoweth
- Centre for Healthy Brain Ageing, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Improving general practitioners’ referral details of antidepressant use for patients referred for depression to primary mental health care: re-audit. Ir J Psychol Med 2015. [DOI: 10.1017/ipm.2014.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BackgroundThis audit cycle looked at details of antidepressants given in general practitioners’ (GPs) referral letters to Primary Mental Health Care (PMHC). With adequate information when patients are referred, time spent in clarifying details could be put into better use by clinicians and prompt effective treatment would help to reduce the direct and indirect costs of depression.ObjectiveTo evaluate how effective our intervention was 7 months after a previous audit and identify areas that need improvement.MethodAudit of 33 referral letters of patients referred for depression from GPs to a PMHC service in Northern Ireland, followed by the intervention (feedback and pro forma) and re-audit after 7 months.ResultsThe April audit showed 100% documentation of current antidepressant treatment and dose, but showed poor documentation of previous antidepressant use (33%), dose or duration (15%) and the reason for stopping the treatment (3%). Following intervention, the re-audit showed 25% and 24% rise in documenting previous antidepressant used and maximum dose reached, respectively, and 20% rise in documenting the reason for stopping.ConclusionsOur interventions made modest improvement in providing relevant data in referral letters. This study adds to the existing evidence that relying mainly on feedback as a method of implementing change is ineffective. Lack of enthusiasm for using the newly introduced pro forma suggests that mental health services should obtain more effective ways of engaging GPs in service development. Using a systematic approach, which includes identifying local barriers to change and providing a supportive environment are important before the next re-audit.
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Vermeir P, Vandijck D, Degroote S, Peleman R, Verhaeghe R, Mortier E, Hallaert G, Van Daele S, Buylaert W, Vogelaers D. Communication in healthcare: a narrative review of the literature and practical recommendations. Int J Clin Pract 2015; 69:1257-67. [PMID: 26147310 PMCID: PMC4758389 DOI: 10.1111/ijcp.12686] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/29/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Effective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialised and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare. DESIGN Narrative literature review. METHODS A search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (MeSH)terms 'communication', 'primary health care', 'correspondence', 'patient safety', 'patient handoff' and 'continuity of patient care'. Reviewers screened 4609 records and 462 full texts were checked according following inclusion criteria: (1) publication between January 1985 and March 2014, (2) availability as full text in English, (3) categorisation as original research, reviews, meta-analyses or letters to the editor. RESULTS A total of 69 articles were included in this review. It was found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences. CONCLUSION There is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Peer review, process indicators and follow-up tools are required to measure the impact of quality improvement initiatives. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver.
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Affiliation(s)
- P Vermeir
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - D Vandijck
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Public Health, Ghent University Hospital, Ghent, Belgium
- Department of Business Economics, Hasselt University, Diepenbeek, Belgium
| | - S Degroote
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Public Health, Ghent University Hospital, Ghent, Belgium
| | - R Peleman
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - R Verhaeghe
- Department of Public Health, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - E Mortier
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - G Hallaert
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - S Van Daele
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - W Buylaert
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - D Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
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Benzer JK, Cramer IE, Burgess JF, Mohr DC, Sullivan JL, Charns MP. How personal and standardized coordination impact implementation of integrated care. BMC Health Serv Res 2015; 15:448. [PMID: 26432790 PMCID: PMC4592548 DOI: 10.1186/s12913-015-1079-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 09/18/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care. METHODS Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations. RESULTS Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures. DISCUSSION This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation. CONCLUSION Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal coordination amongst leaders. Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings.
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Affiliation(s)
- Justin K Benzer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.
| | - Irene E Cramer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - James F Burgess
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - Martin P Charns
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
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Vermeir P, Vandijck D, Degroote S, Ommeslag D, Van De Putte M, Heytens S, Reniers J, Hanoulle I, Peleman R, Vogelaers D. Mutual perception of communication between general practitioners and hospital-based specialists. Acta Clin Belg 2015; 70:350-6. [PMID: 26043268 DOI: 10.1179/2295333715y.0000000032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Communication between general practitioners (GPs) and specialists is an important aspect of qualitative care. Efficient communication exchange is essential and key in guaranteeing continuity of care. Inefficient communication is related to several negative outcomes, including patient harm. This study aimed to investigate the perception of GPs and hospital-based specialists in Belgium of the quality of their mutual communication. METHODS A cross-sectional study was conducted among GPs and specialists. Participants were asked to complete a validated questionnaire on several aspects of their mutual communication. RESULTS Response rates of 17.9% (343/1.912) for GPs and 17.3% (392/2.263) for specialists were obtained. Both specialists and GPs qualify their mutual telephone accessibility as suboptimal. Specialists think poorly of the GP referral letter, in contrast to GP perception. Eighty per cent of the GPs feel that specialists address their questions appropriately; specialists have a similar perception of their own performance. According to 16.7% of the specialists, GPs not always follow their recommendations. Contrarily, GPs rate their compliance much higher (90.7%). Less than half of the GPs feel that the specialists' letter arrives on time, whereas specialists have a different and a more positive perception. CONCLUSIONS GPs and specialists disagree on several aspects of their mutual communication. These include the perception of accessibility, in both directions, and of the timeliness of written communication. Feedback is positively appreciated, again in both directions. Nevertheless, specialists feel that uptake of their recommendations is insufficient. Hence, there may remain significant room for improvement, which could contribute significantly to continuity of care and patient safety.
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Affiliation(s)
- P Vermeir
- Department of General Internal Medicine, Ghent University Hospital , Belgium
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Hartveit M, Aslaksen A, Vanhaecht K, Thorsen O, Hove O, Haug K, Hovlid E, Assmus J, Biringer E. Development and testing of an instrument in Western Norway to measure the quality of referral information from primary care to specialised mental health care. INTERNATIONAL JOURNAL OF CARE COORDINATION 2015. [DOI: 10.1177/2053434515589012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Several studies have indicated that medical referral letters do not convey the necessary information to ensure sufficient coordination of care. However, there is no definition of the core set of information items that should be communicated in a referral process, and no valid measurements to assess, and thus improve, the quality of such information. The present study aimed to develop and test an instrument to measure the quality of referral information provided by general practitioners to specialised mental health care services for adults. Methods Based on a recommendation taking the users’ standpoint into account, a minimum set of items for referral communication seen as essential by experienced specialists ( N = 42) was developed. An instrument to assess the quality of referral information for specialised mental health care for adults was then examined based on its psychometric properties. The examination was conducted within the region of Western Norway Regional Health Authority ( www.helse-vest.no ), representing the public specialised mental health care for approximately 1 million citizens. Results Nineteen items were recommended, and the instrument was found valid and reliable. The inter-rater correlation varied, and the test–retest was found to be substantial or almost perfect for a majority of the raters. Discussion This study embeds an exploration of improvement potential, impact of quality improvement efforts and sustainability of such efforts for facilitating effective communication in the interface between the two main health services for people with mental health problems. Further exploration on the instruments generalisability to other contexts and to the inter-rater correlation are recommended.
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Affiliation(s)
- Miriam Hartveit
- Research Network on Integrated Health Care in Western Norway, Helse Fonna HF, Norway
- University of Bergen, Norway
| | - Aslak Aslaksen
- University of Bergen, Norway
- Haukeland University Hospital, Norway
| | - Kris Vanhaecht
- Research Network on Integrated Health Care in Western Norway, Helse Fonna HF, Norway
- Department of Global Public Health and Primary Care, University of Leuven, Belgium
| | - Olav Thorsen
- University of Bergen, Norway
- Stavanger University Hospital, Norway
| | - Oddbjorn Hove
- Section of Mental Health Research, Helse Fonna HF, Norway
| | | | | | - Jorg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Norway
| | - Eva Biringer
- Research Network on Integrated Health Care in Western Norway, Helse Fonna HF, Norway
- Section of Mental Health Research, Helse Fonna HF, Norway
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Hardy SA, Kingsnorth R. Mental health nurses can increase capability and capacity in primary care by educating practice nurses: an evaluation of an education programme in England. J Psychiatr Ment Health Nurs 2015; 22:270-7. [PMID: 25858036 DOI: 10.1111/jpm.12208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2015] [Indexed: 11/29/2022]
Abstract
Most people with a mental health problem in England are cared for by clinicians in primary care who may have had little or no training in this area. Our aim was to develop an accessible education programme which was appropriate to the learning needs of this workforce. A survey of the mental health and well-being training needs and preferred learning methods of practice nurses was undertaken, then a programme of education was developed by a primary care mental health expert. Teaching was delivered by mental health nurses who were trained as educators. Both the practice nurses and mental health nurses felt their clinical practice would improve as a result of being involved in this programme. To sustain the learning, mental health nurses were supported by attending and then leading their own action learning sets. This model of education can be adapted and used by health organizations both nationally and internationally. Research is required to find out whether training practice nurses using this programme has an impact on patients.
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Affiliation(s)
- S A Hardy
- Northamptonshire Healthcare NHS Trust, Northampton, UK
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Clanet R, Bansard M, Humbert X, Marie V, Raginel T. Revue systématique sur les documents de sortie d’hospitalisation et les attentes des médecins généralistes. SANTE PUBLIQUE 2015. [DOI: 10.3917/spub.155.0701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Dykes PC, Samal L, Donahue M, Greenberg JO, Hurley AC, Hasan O, O'Malley TA, Venkatesh AK, Volk LA, Bates DW. A patient-centered longitudinal care plan: vision versus reality. J Am Med Inform Assoc 2014; 21:1082-90. [PMID: 24996874 PMCID: PMC4215040 DOI: 10.1136/amiajnl-2013-002454] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 06/08/2014] [Accepted: 06/17/2014] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE As healthcare systems and providers move toward meaningful use of electronic health records, longitudinal care plans (LCPs) may provide a means to improve communication and coordination as patients transition across settings. The objective of this study was to determine the current state of communication of LCPs across settings and levels of care. MATERIALS AND METHODS We conducted surveys and interviews with professionals from emergency departments, acute care hospitals, skilled nursing facilities, and home health agency settings in six regions in the USA. We coded the transcripts according to the Agency for Healthcare Research and Quality (AHRQ) 'Broad Approaches' to care coordination to understand the degree to which current practice meets the definition of an LCP. RESULTS Participants (n=22) from all settings reported that LCPs do not exist in their current state. We found LCPs in practice, and none of these were shared or reconciled across settings. Moreover, we found wide variation in the types and formats of care plan information that was communicated as patients transitioned. The most common formats, even when care plan information was communicated within the same healthcare system, were paper and fax. DISCUSSION These findings have implications for data reuse, interoperability, and achieving widespread adoption of LCPs. CONCLUSIONS The use of LCPs to support care transitions is suboptimal. Strategies are needed to transform the LCP from vision to reality.
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Affiliation(s)
- Patricia C Dykes
- Center for Patient Safety, Research, & Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lipika Samal
- Center for Patient Safety, Research, & Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jeffrey O Greenberg
- Center for Patient Safety, Research, & Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ann C Hurley
- Western Connecticut Health Network, Danbury, Connecticut, USA
| | - Omar Hasan
- American Medical Association, Chicago, Illinois, USA
| | - Terrance A O'Malley
- Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | | | - Lynn A Volk
- Partners HealthCare System, Boston, Massachusetts, USA
| | - David W Bates
- Center for Patient Safety, Research, & Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Partners HealthCare System, Boston, Massachusetts, USA
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Rowley E, Wright N, Waring J, Gregoriou K, Chopra A. Protocol for an exploration of knowledge sharing for improved discharge from a mental health ward. BMJ Open 2014; 4:e005176. [PMID: 25273812 PMCID: PMC4185338 DOI: 10.1136/bmjopen-2014-005176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Strategies to reduce hospital admissions for mental health service users have received vast amounts of attention, yet the transfer of care from hospital to the community has been ignored. The discharge process is complex, messy, disjointed and inefficient, relying on cross-agency and organisational working. Focusing on one acute mental health admission ward, we will investigate whether the discharge process for people with severe mental health problems can be enhanced through the creation, implementation and utilisation of a knowledge sharing proforma that is used on their admission to the ward. METHODS AND ANALYSIS The project uses qualitative interviews to understand the complex processes associated with being admitted and discharged from inpatient mental health wards. Practitioners will be asked to identify and map the relevant stakeholders involved in admission and discharge, and discuss any problems with the process. The study team will work with clinicians to develop a knowledge collection proforma, which will be piloted for 2 months. Qualitative interviews will be carried out to collect reflections on the experiences of using the tool, with data used for further refinement of the intervention. Baseline and repeat quantitative measures will be taken to illustrate any changes to length of stay and readmission rates achieved as a result of the study. ETHICS AND DISSEMINATION A key issue is that participants are able to comment frankly on something that is a core part of their work, without fear or reprise. It is equally important that all participants are offered the opportunity to develop and coproduce the knowledge collection proforma, in order that the intervention produced is fit for purpose and usable in the real world, away from a research environment. The study has received ethical approval from Nottingham University Business School ethics committee, and has all appropriate National Health Service research governance clearances.
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Affiliation(s)
- Emma Rowley
- Centre for Health Innovation, Leadership & Learning, Nottingham University Business School, Nottingham, UK
| | - Nicola Wright
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Justin Waring
- Centre for Health Innovation, Leadership & Learning, Nottingham University Business School, Nottingham, UK
| | - Kyri Gregoriou
- Adult Mental Health Services, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | - Arun Chopra
- Adult Mental Health Services, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
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Katz A, Martens P, Chateau D, Bogdanovic B, Koseva I. Do primary care physicians coordinate ambulatory care for chronic disease patients in Canada? BMC FAMILY PRACTICE 2014; 15:148. [PMID: 25175589 PMCID: PMC4160545 DOI: 10.1186/1471-2296-15-148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
Background Adults with chronic disease are the most frequent users of the primary healthcare system. In Manitoba, patients are allowed to seek ambulatory (outpatient) care from the provider of their choosing (primary care physician or specialist), with referrals to specialists preferred but not always required. Some patients receive their routine care from specialists. We conducted this study to determine the patterns by which adults with chronic disease access ambulatory care as a prelude to exploring the impact these patterns may have on the quality of care received. Methods Physician claims for all visits between 2007/8-2009/10 were extracted from the Data Repository at the Manitoba Centre for Health Policy. Patients included in the analysis made at least four ambulatory visits to a primary care physician or specialist within the study period, and met the definition criteria for at least one of six chronic diseases: diabetes mellitus; congestive heart failure; mood disorders; ischemic heart disease; total respiratory morbidity; and/or hypertension. Patients were “assigned” to the physician they visited most regularly. Physician visit patterns were assessed by dividing visits into nine visit types based on the type of physician patients visited (assigned primary care physician, other primary care physician, or specialist) and whether or not they received a referral. Results 347,606 patients with 7,662,411 physician visits were included in the analysis. Most visits were to the patients’ assigned primary care physician. About 50% of the visits to specialists were by referral from the assigned primary care physician. However, 26-29% of all visits to a primary care physician were not to the assigned primary care physician, and non-assigned physicians were more likely to refer patients to specialists than assigned primary care physicians. Conclusion The findings suggest that the current primary care system in Manitoba may not adequately support coordination of ambulatory care. Ambulatory visits to a primary care provider who is not the patient’s regular provider may represent a lost opportunity for coordination and continuity of care, and may affect the quality of care patients receive. Primary care renewal initiatives in this province should address this challenge to service provision. Electronic supplementary material The online version of this article (doi:10.1186/1471-2296-15-148) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alan Katz
- Departments of Family Medicine and Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, Manitoba R3E 3P5, Canada.
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Chang ET, Wells KB, Young AS, Stockdale S, Johnson MD, Fickel JJ, Jou K, Rubenstein LV. The anatomy of primary care and mental health clinician communication: a quality improvement case study. J Gen Intern Med 2014; 29 Suppl 2:S598-606. [PMID: 24715400 PMCID: PMC4070235 DOI: 10.1007/s11606-013-2731-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The high prevalence of comorbid physical and mental illnesses among veterans is well known. Therefore, ensuring effective communication between primary care (PC) and mental health (MH) clinicians in the Veterans Affairs (VA) health care system is essential. The VA's Patient Aligned Care Teams (PACT) initiative has further raised awareness of the need for communication between PC and MH. Improving such communication, however, has proven challenging. OBJECTIVE To qualitatively understand barriers to PC-MH communication in an academic community-based clinic by using continuous quality improvement (CQI) tools and then initiate a change strategy. DESIGN, PARTICIPANTS, AND APPROACH An interdisciplinary quality improvement (QI) work group composed of 11 on-site PC and MH providers, administrators, and researchers identified communication barriers and facilitators using fishbone diagrams and process flow maps. The work group then verified and provided context for the diagram and flow maps through medical record review (32 patients who received both PC and MH care), interviews (6 stakeholders), and reports from four previously completed focus groups. Based on these findings and a previous systematic review of interventions to improve interspecialty communication, the team initiated plans for improvement. KEY RESULTS Key communication barriers included lack of effective standardized communication processes, practice style differences, and inadequate PC training in MH. Clinicians often accessed advice or formal consultation based on pre-existing across-discipline personal relationships. The work group identified collocated collaborative care, joint care planning, and joint case conferences as feasible, evidence-based interventions for improving communication. CONCLUSIONS CQI tools enabled providers to systematically assess local communication barriers and facilitators and engaged stakeholders in developing possible solutions. A locally tailored CQI process focusing on communication helped initiate change strategies and ongoing improvement efforts.
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Affiliation(s)
- Evelyn T Chang
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA,
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