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Mao W, Shalaby R, Agyapong VIO. Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature. Healthcare (Basel) 2023; 11:healthcare11081161. [PMID: 37107995 PMCID: PMC10138571 DOI: 10.3390/healthcare11081161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The number of readmissions to the emergency department (ED) for mental health services each year is significant, which increases healthcare costs and negatively affects the morale and quality of life of patients and their families. OBJECT This scoping review aimed to establish a better understanding of interventions that have been implemented to reduce psychiatric patient readmission and ED use within the ED, to identify areas for improvement, and therefore to assist in the development of more effective actions in the future. METHOD The scoping review was conducted on several bibliographic databases to identify relevant studies. Two researchers independently screened and reviewed titles, abstracts, and full-text articles that met the inclusion criteria. Using Covidence software, 26 out of 6951 studies were eligible for inclusion in this scoping review based on the PRISMA checklist. Data were extracted, collated, summarized, presented, and discussed. RESULT This review identified 26 studies which examined interventions aimed to reduce ED visits, such as the High Alert Program (HAP), the Patient-Centered Medical Home (PCMH), the Primary Behavioral Health Care Integration (PBHCI), and the Collaborative Care (CC) Program, etc. Twenty-three of the studies were conducted in North America, while the rest were conducted in Europe and Australia. A total of 16 studies examined interventions directed to any mental health conditions, while the rest addressed specific health conditions, such as substance use disorders, schizophrenia, anxiety, depression. Interventions involved comprehensive and multidisciplinary services, incorporation of evidence-based behavioral and pharmacological strategies, and emphasized the case management that was found to be effective. Additionally, there was a marked consideration for diverse mental health groups, such as those with substance use disorder and of young age. Most interventions showed a positive effect on reducing psychiatric ED visits. CONCLUSION Various initiatives have been implemented worldwide to reduce the number of emergency department visits and the associated burden on healthcare systems. This review highlights the greater need for developing more accessible interventions, as well as setting up a comprehensive community health care system aiming to reduce frequent ED presentations.
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Affiliation(s)
- Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans, Memorial Lane, 8th Floor Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada
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2
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Lim CT, Caan MP, Kim CH, Chow CM, Leff HS, Tepper MC. Care Management for Serious Mental Illness: A Systematic Review and Meta-Analysis. Psychiatr Serv 2022; 73:180-187. [PMID: 34253036 DOI: 10.1176/appi.ps.202000473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Persons with serious mental illness face adverse psychiatric and medical outcomes, and their care is associated with a large burden of health care costs. Care management, in which assessment, care planning, and care coordination are provided, is a common model of support, yet the evidence supporting its use among psychiatric populations is mixed. A systematic review and a meta-analysis were undertaken to determine the impact of care management on clinical outcomes, acute care utilization, cost, and satisfaction among adults with serious mental illness. METHODS A multidatabase literature search was performed. Articles were included if they compared standard outpatient care plus care management with standard outpatient care alone for adults with serious mental illness and reported on one or more predefined outcomes. Randomized controlled trials (RCTs) and other study designs were permitted for inclusion in the systematic review. The meta-analysis included only RCTs. RESULTS For the systematic review, 34 articles representing 28 unique studies were included. Fifteen of these articles, representing 12 unique studies, were included in the meta-analysis, which indicated that care management was associated with small, statistically significant improvements in psychiatric symptoms, overall quality of life (QOL), and mental QOL (Hedges' g range 0.13-0.26). In addition, care management was associated with a small, statistically significant reduction in inpatient psychiatric hospital days (Hedges' g=0.16, p=0.02). CONCLUSIONS Care management is associated with fewer psychiatric symptoms and greater QOL for persons with serious mental illness. Further work is needed to determine which components of the intervention are associated with effectiveness.
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Affiliation(s)
- Christopher T Lim
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Marissa P Caan
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Clara H Kim
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Clifton M Chow
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - H Stephen Leff
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Miriam C Tepper
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
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Loranger C, Fleury MJ. Factors Associated with Perceived Continuity of Care Among Patients Suffering from Mental Disorders. Community Ment Health J 2020; 56:670-679. [PMID: 31863224 DOI: 10.1007/s10597-019-00528-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 12/11/2019] [Indexed: 11/29/2022]
Abstract
This cross-sectional study identified variables associated with continuity of care among 327 patients with mental disorders receiving services from a variety of professionals in different Quebec settings. Based on the Andersen's Behavioral Model, a linear regression analysis was performed. Attention deficit and mood disorders were negatively associated with continuity of care, while substance use disorders and quality of life revealed positive associations. Consulting a psychologist was linked to weaker continuity of care whereas visiting a drug rehabilitation center, social support, and satisfaction with services were positively related. Fostering social support, comprehensive and integrated care, and facilitating access to psychologists could lead to improved continuity of care.
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Affiliation(s)
- Claudie Loranger
- Research Centre, Centre intégré de santé Et Services Sociaux de L'Outaouais, 20 rue Pharand, Gatineau, QC, J9A 1K7, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, McGill University, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montréal, QC, Canada.
- Department of Psychiatry, McGill University, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
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Kerkemeyer L, Wasem J, Neumann A, Brannath W, Mester B, Timm J, Wobrock T, Bartels C, Falkai P, Biermann J. Effectiveness and cost-effectiveness of an integrated care program for schizophrenia: an analysis of routine data. Eur Arch Psychiatry Clin Neurosci 2018; 268:611-619. [PMID: 28791485 DOI: 10.1007/s00406-017-0830-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/24/2017] [Indexed: 11/24/2022]
Abstract
In Germany, a regional social health insurance fund provides an integrated care program for patients with schizophrenia (IVS). Based on routine data of the social health insurance, this evaluation examined the effectiveness and cost-effectiveness of the IVS compared to the standard care (control group, CG). The primary outcome was the reduction of psychiatric inpatient treatment (days in hospital), and secondary outcomes were schizophrenia-related inpatient treatment, readmission rates, and costs. To reduce selection bias, a propensity score matching was performed. The matched sample included 752 patients. Mean number of psychiatric and schizophrenia-related hospital days of patients receiving IVS (2.3 ± 6.5, 1.7 ± 5.0) per quarter was reduced, but did not differ statistically significantly from CG (2.7 ± 7.6, 1.9 ± 6.2; p = 0.772, p = 0.352). Statistically significant between-group differences were found in costs per quarter per person caused by outpatient treatment by office-based psychiatrists (IVS: €74.18 ± 42.30, CG: €53.20 ± 47.96; p < 0.001), by psychiatric institutional outpatient departments (IVS: €4.83 ± 29.57, CG: €27.35 ± 76.48; p < 0.001), by medication (IVS: €471.75 ± 493.09, CG: €429.45 ± 532.73; p = 0.015), and by psychiatric outpatient nursing (IVS: €3.52 ± 23.83, CG: €12.67 ± 57.86, p = 0.045). Mean total psychiatric costs per quarter per person in IVS (€1117.49 ± 1662.73) were not significantly lower than in CG (€1180.09 ± 1948.24; p = 0.150). No statistically significant differences in total schizophrenia-related costs per quarter per person were detected between IVS (€979.46 ± 1358.79) and CG (€989.45 ± 1611.47; p = 0.084). The cost-effectiveness analysis showed cost savings of €148.59 per reduced psychiatric and €305.40 per reduced schizophrenia-related hospital day. However, limitations, especially non-inclusion of costs related to management of the IVS and additional home treatment within the IVS, restrict the interpretation of the results. Therefore, the long-term impact of this IVS deserves further evaluation.
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Affiliation(s)
- Linda Kerkemeyer
- Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, 45127, Essen, Germany.
| | - Jürgen Wasem
- Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, 45127, Essen, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, 45127, Essen, Germany
| | - Werner Brannath
- Competence Centre for Clinical Trials/Biometry, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Benjamin Mester
- Competence Centre for Clinical Trials/Biometry, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Jürgen Timm
- Competence Centre for Clinical Trials/Biometry, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Thomas Wobrock
- Centre of Mental Health, County Hospitals Darmstadt-Dieburg, Krankenhausstraße 7, 64823, Groß-Umstadt, Germany.,Department of Psychiatry and Psychotherapy, Georg-August University, von-Siebold-Straße 5, 37075, Göttingen, Germany
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, Georg-August University, von-Siebold-Straße 5, 37075, Göttingen, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstraße 7, 80336, Munich, Germany
| | - Janine Biermann
- Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, 45127, Essen, Germany
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Fortin M, Bamvita JM, Fleury MJ. Patient satisfaction with mental health services based on Andersen's Behavioral Model. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:103-114. [PMID: 29056085 PMCID: PMC5788132 DOI: 10.1177/0706743717737030] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this article was to assess the satisfaction of adult patients who received mental health services (MHS) in healthcare networks staffed by multidisciplinary professionals and offering a range of MHS, and to identify variables associated with patient satisfaction. METHODS This cross-sectional study included 325 patients with mental disorders (MDs) among 4 Quebec health service networks. Data were collected using 9 standardized instruments and participant medical records. A 3-factor conceptual framework (predisposing, enabling, and needs-related factors) based on Andersen's Behavioral Model was used, integrating sociodemographic, clinical, needs-related, service utilization, social support, and quality-of-life (QOL) variables. An adjusted multiple linear regression model was performed. RESULTS The global mean score for patient satisfaction was 4.11 (minimum: 2.0; maximum: 5.0). Among the enabling factors, continuity of care, having a case manager, and help received from services were positively associated with patient satisfaction, whereas being hospitalized was negatively associated. Among the needs-related factors, the number of needs was negatively associated with satisfaction. CONCLUSIONS Findings demonstrated higher levels of satisfaction among patients who received good continuity of care and well-managed, frequent services in relation to their needs. Dissatisfaction was higher for patients with serious unmet needs or those hospitalized, which underlines the importance of taking these particular variables into account in the interest of improving MHS delivery and patient recovery.
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Affiliation(s)
- Marilyn Fortin
- 1 Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,2 Douglas Hospital Research Centre, Montreal, Quebec, Canada
| | | | - Marie-Josée Fleury
- 1 Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,2 Douglas Hospital Research Centre, Montreal, Quebec, Canada
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Hospital utilization outcome of an assertive outreach model for schizophrenic patients - results of a quasi-experimental study. Psychiatry Res 2016; 241:249-55. [PMID: 27208511 DOI: 10.1016/j.psychres.2016.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 03/31/2016] [Accepted: 05/02/2016] [Indexed: 11/19/2022]
Abstract
We assessed whether an Assertive Outreach (AO) program for patients with schizophrenia implemented in German routine care in rural areas reduces psychiatric hospital admissions and/or psychiatric hospital days. We conducted a quasi-experimental controlled study with 5 assessments in 12 months. Data collection included health care utilization (Client Sociodemographic and Service Receipt Inventory), and clinical parameters. The assessments took place in the practices of the psychiatrists. Admission incidence rates were calculated. For bivariate group comparison, we used U-tests, T-tests and Chi(2)-Tests, multivariate analysis was conducted using zero-inflated regression models. For hospital outcomes, data of 295 patients was analysed. No statistically significant differences between AO and TAU patients in terms of hospital admissions or hospital days were found. Overall hospital utilization was low (8%). Advantages of AO over TAU referring to hospital utilization were not found. However, a spill-over effect might have reduced hospital utilization in both groups. Further research should differentiate patient subgroups. These two appear to be key factors to explain effects or absence of effects and to draw conclusions for the mental health care delivery.
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Vandyk AD, VanDenkerkhof EG, Graham ID, Harrison MB. Using the Alberta Continuity of Services Observer-Rated Scale to Measure Continuity of Care in a Psychiatric Population. J Nurs Meas 2016; 24:131-46. [PMID: 27103249 DOI: 10.1891/1061-3749.24.1.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Continuity of care (CoC) is an important component in the delivery of quality mental health care. Yet, its measurement is inconsistent. We explored the use of the Alberta Continuity of Services Scale for Mental Health (ACSS-MH) observer-rated scale and compared CoC scores in 2 groups (N = 140) of individuals with mental health complaints (5+ and 1 emergency department [ED] visits/year). METHODS Secondary analysis of health record data. RESULTS The application of the ACSS-MH observer-rated scale in our population is discussed, as well as differences in CoC scores by group. CONCLUSIONS The ACSS-MH observer-rated scale may be useful for obtaining CoC scores in several mental health populations. Minor modifications (e.g., to response options) are suggested that may improve scoring accuracy. Research is needed to further explore the relationship between CoC and ED use.
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8
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Myklebust LH, Sørgaard K, Wynn R. Local inpatient units may increase patients' utilization of outpatient services: a comparative cohort-study in Nordland County, Norway. Psychol Res Behav Manag 2015; 8:251-7. [PMID: 26604843 PMCID: PMC4630195 DOI: 10.2147/prbm.s94857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES In the last few decades, there has been a restructuring of the psychiatric services in many countries. The complexity of these systems may represent a challenge to patients that suffer from serious psychiatric disorders. We examined whether local integration of inpatient and outpatient services in contrast to centralized institutions strengthened continuity of care. METHODS Two different service-systems were compared. Service-utilization over a 4-year period for 690 inpatients was extracted from the patient registries. The results were controlled for demographic variables, model of service-system, central inpatient admission or local inpatient admission, diagnoses, and duration of inpatient stays. RESULTS The majority of inpatients in the area with local integration of inpatient and outpatient services used both types of care. In the area that did not have beds locally, many patients that had been hospitalized did not receive outpatient follow-up. Predictors of inpatients' use of outpatient psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of affective disorder, central inpatient admission only, and duration of inpatient stays. CONCLUSION Psychiatric centers with local inpatient units may positively affect continuity of care for patients with severe psychiatric disorders, probably because of a high functional integration of inpatient and outpatient care.
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Affiliation(s)
| | - Knut Sørgaard
- Psychiatric Research Centre of North Norway, Nordland Hospital Trust, Bodø, Norway ; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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9
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Thakarar K, Morgan JR, Gaeta JM, Hohl C, Drainoni ML. Predictors of Frequent Emergency Room Visits among a Homeless Population. PLoS One 2015; 10:e0124552. [PMID: 25906394 PMCID: PMC4407893 DOI: 10.1371/journal.pone.0124552] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 03/06/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Homelessness, HIV, and substance use are interwoven problems. Furthermore, homeless individuals are frequent users of emergency services. The main purpose of this study was to identify risk factors for frequent emergency room (ER) visits and to examine the effects of housing status and HIV serostatus on ER utilization. The second purpose was to identify risk factors for frequent ER visits in patients with a history of illicit drug use. METHODS A retrospective analysis was performed on 412 patients enrolled in a Boston-based health care for the homeless program (HCH). This study population was selected as a 2:1 HIV seronegative versus HIV seropositive match based on age, sex, and housing status. A subgroup analysis was performed on 287 patients with history of illicit drug use. Chart data were analyzed to compare demographics, health characteristics, and health service utilization. Results were stratified by housing status. Logistic models using generalized estimating equations were used to predict frequent ER visits. RESULTS In homeless patients, hepatitis C was the only predictor of frequent ER visits (OR 4.49, p<0.01). HIV seropositivity was not predictive of frequent ER visits. In patients with history of illicit drug use, mental health (OR 2.53, 95% CI 1.07-5.95) and hepatitis C (OR 2.85, 95% CI 1.37-5.93) were predictors of frequent ER use. HIV seropositivity did not predict ER use (OR 0.45, 95% CI 0.21 - 0.97). CONCLUSIONS In a HCH population, hepatitis C predicted frequent ER visits in homeless patients. HIV seropositivity did not predict frequent ER visits, likely because HIV seropositive HCH patients are engaged in care. In patients with history of illicit drug use, hepatitis C and mental health disorders predicted frequent ER visits. Supportive housing for patients with mental health disorders and hepatitis C may help prevent unnecessary ER visits in this population.
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Affiliation(s)
- Kinna Thakarar
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Jake R. Morgan
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Jessie M. Gaeta
- Boston Health Care for the Homeless Program, Boston, Massachusetts
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Carole Hohl
- Boston Health Care for the Homeless Program, Boston, Massachusetts
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts
- Center for Healthcare Organization and Implementation Research, ENRM Memorial VA Hospital, Bedford, Massachusetts
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10
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Wolff J, McCrone P, Koeser L, Normann C, Patel A. Cost drivers of inpatient mental health care: a systematic review. Epidemiol Psychiatr Sci 2015; 24:78-89. [PMID: 24330922 PMCID: PMC6998131 DOI: 10.1017/s204579601300067x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 11/07/2022] Open
Abstract
Aims. New reimbursement schemes for inpatient mental health care are imminent in the UK and Germany. The shared intention is to reflect cost differences between patients in reimbursement rates. This requires understanding of patient characteristics that influence hospital resource use. The aim of this review was to show which associations between mental health care per diem hospital costs and patient characteristics are supported by current evidence. Methods. A systematic review of the literature published between 1980 and 2012 was carried out. The search strategy included electronic databases and hand-searching. Furthermore, reference lists, citing articles and related publications were screened and experts were contacted. Results. The search found eight studies. Dispersion in per diem costs was moderate, as was the ability to explain it with patient characteristics. Six patient characteristics were identified as the most relevant variables. These were (1) age, (2) major diagnostic group, (3) risk, (4) legal problems, (5) the ability to perform activities of daily living and (6) presence of psychotic or affective symptoms. Two non-patient-related factors were identified. These were (1) day of stay and (2) treatment site. Conclusions. Idiosyncrasies of mental health care complicated the prediction of per diem hospital costs. More research is required in European settings since transferability of results is unlikely.
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Affiliation(s)
- J. Wolff
- King's College London, Institute of Psychiatry, Health Service and Population Research, CEMPH, London, UK
- Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Freiburg im Breisgau, Germany
| | - P. McCrone
- King's College London, Institute of Psychiatry, Health Service and Population Research, CEMPH, London, UK
| | - L. Koeser
- King's College London, Institute of Psychiatry, Health Service and Population Research, CEMPH, London, UK
| | - C. Normann
- Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Freiburg im Breisgau, Germany
| | - A. Patel
- King's College London, Institute of Psychiatry, Health Service and Population Research, CEMPH, London, UK
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Mas-Expósito L, Amador-Campos JA, Gómez-Benito J, Mauri-Mas L, Lalucat-Jo L. Clinical case management for patients with schizophrenia with high care needs. Community Ment Health J 2015; 51:165-70. [PMID: 24972907 DOI: 10.1007/s10597-014-9741-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 06/16/2014] [Indexed: 11/25/2022]
Abstract
The aim of this study is to establish the effectiveness of a clinical case management (CM) programme compared to a standard treatment programme (STP) in patients with schizophrenia. Patients for the CM programme were consecutively selected among patients in the STP with schizophrenia who had poor functioning. Seventy-five patients were admitted to the CM programme and were matched to 75 patients in the STP. Patients were evaluated at baseline and at 1 year follow-up. At baseline, patients in the CM programme showed lower levels of clinical and psychosocial functioning and more care needs than patients in the STP. Both treatment programmes were effective in maintaining contact with services but the CM programme did not show advantages over the STP on outcomes. Differences between groups at baseline may be masking the effects of CM at one year follow-up. A longer follow-up may be required to evaluate the real CM practices effects.
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Affiliation(s)
- Laia Mas-Expósito
- Department of Research, Centre d'Higiene Mental Les Corts, Barcelona, Spain
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Fleischhacker WW, Arango C, Arteel P, Barnes TRE, Carpenter W, Duckworth K, Galderisi S, Halpern L, Knapp M, Marder SR, Moller M, Sartorius N, Woodruff P. Schizophrenia--time to commit to policy change. Schizophr Bull 2014; 40 Suppl 3:S165-94. [PMID: 24778411 PMCID: PMC4002061 DOI: 10.1093/schbul/sbu006] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Care and outcomes for people with schizophrenia have improved in recent years, but further progress is needed to help more individuals achieve an independent and fulfilled life. This report sets out the current need, informs policy makers and all relevant stakeholders who influence care quality, and supports their commitment to creating a better future. The authors recommend the following policy actions, based on research evidence, stakeholder consultation, and examples of best practice worldwide. (1) Provide an evidence-based, integrated care package for people with schizophrenia that addresses their mental and physical health needs. (2) Provide support for people with schizophrenia to enter and to remain in their community, and develop mechanisms to help guide them through the complex benefit and employment systems. (3) Provide concrete support, information, and educational programs to families and carers on how to enhance care for an individual living with schizophrenia in a manner that entails minimal disruption to their lives. (4) All stakeholders, including organizations that support people living with schizophrenia, should be consulted to regularly revise, update, and improve policy on the management of schizophrenia. (5) Provide support, which is proportionate to the impact of the disease, for research and development of new treatments. (6) Establish adequately funded, ongoing, and regular awareness-raising campaigns that form an integral part of routine plans of action. Implementation of the above recommendations will require engagement by every stakeholder, but with commitment from all, change can be achieved.
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Affiliation(s)
- W. Wolfgang Fleischhacker
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria;,*To whom correspondence should be addressed; Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria; tel: +43-512-504-23669, fax: +43-512-504-25267, e-mail:
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, CIBERSAM, Madrid, Spain
| | | | - Thomas R. E. Barnes
- Imperial College Centre for Mental Health, Faculty of Medicine, Imperial College London and West London Mental Health NHS Trust, London, UK
| | - William Carpenter
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | | | - Silvana Galderisi
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | | | - Martin Knapp
- London School of Economics and the Institute of Psychiatry, King’s College London, London, UK
| | - Stephen R. Marder
- Semel Institute, UCLA, VA Desert Pacific Mental Illness Research Education and Clinical Center, Los Angeles, CA
| | - Mary Moller
- Past President, American Psychiatric Nurses Association, Yale School of Nursing, New Haven, CT
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Peter Woodruff
- Academic Faculty, Royal College of Psychiatrists, London, UK
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13
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Mas-Expósito L, Amador-Campos JA, Gómez-Benito J, Lalucat-Jo L. Considering variables for the assignment of patients with schizophrenia to a case management programme. Community Ment Health J 2013; 49:831-40. [PMID: 23775241 DOI: 10.1007/s10597-013-9621-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 06/03/2013] [Indexed: 12/16/2022]
Abstract
The elements and intensity of case management (CM) practices should be established according to patients' needs. Therefore, greater understanding of patients' needs in such community-based programmes is essential. This paper addresses this issue by characterizing two groups of patients receiving CM or a standard treatment programme (STP) and identifying the characteristics of patients receiving CM services. We recruited 241 patients with schizophrenia from 10 Adult Mental Health Centres in Barcelona (Catalonia, Spain). We analyzed the profile of new patients included in a clinical, non-intensive CM program against that of patients in a STP. CM patients, compared with STP patients, have a lower educational level and quality of life; greater use of health care services, and higher levels of psychiatric symptoms, disability and unmet needs. Community psychiatric visits, social services, education, physical health and needs were significantly associated with CM services. This study may help in identifying patients' needs and strengthening the CM programme.
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Affiliation(s)
- Laia Mas-Expósito
- Department of Research, Centre d'Higiene Mental Les Corts, c/Numància 103-105 baixos, 08029, Barcelona, Spain
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Integrated care in patients with schizophrenia: results of trials published between 2011 and 2013 focusing on effectiveness and efficiency. Curr Opin Psychiatry 2013; 26:384-408. [PMID: 23722100 DOI: 10.1097/yco.0b013e328361ec3b] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Overview on integrated care trials focusing on effectiveness and efficiency published from 2011 to 2013. RECENT FINDINGS Eight randomized controlled trials (RCTs) and 21 non-RCT studies were published from 2011 to 2013. Studies differed in several methodological aspects such as study population, psychotherapeutic approaches used, outcome parameters, follow-up times, fidelities, and implementation of the integrated care model and the nation-specific healthcare context with different control conditions. This makes it difficult to draw firm conclusions. Most studies demonstrated relevant improvements regarding symptoms (P=0.001) and functioning (P=0.01), quality of life (P=0.01), adherence (P<.05) and patient's satisfaction (P=0.01), and reduction of caregiver's stress (P<0.05). Mean total costs were favoring or at least equalizing costs but with positive effects found on subjective health favoring integrated care models. SUMMARY There is an increasing interest in the effectiveness and efficiency of integrated care models in patients with mental disorders, specifically in those with severe and persistent mental illness. To increase generalizability, future trials should exactly describe rationales and content of integrated care model and control conditions.
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Continuity of care for recently released prisoners with mental illness: a pilot randomised controlled trial testing the feasibility of a Critical Time Intervention. Epidemiol Psychiatr Sci 2012; 21:187-93. [PMID: 22789168 DOI: 10.1017/s2045796011000783] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS Prisoners with mental illness on release from prison often face complex challenges with little support, leading to poor clinical and social outcomes. This feasibility study aimed to see whether a Critical Time Intervention (CTI) in the first weeks post-release effectively connects mentally ill prisoners with social, clinical, housing, and welfare services on leaving prison. The study took place in 2007 and involved local prisons in London and Manchester. METHODS A pilot randomised controlled trial in which CTI was compared to Treatment as Usual (TAU). RESULTS Sixty prisoners were randomised in the trial, with outcome measures completed on 23. A higher proportion of prisoners in CTI group were in contact with services at follow-up than those receiving TAU. CTI prisoners were significantly more likely to be receiving medication, and be registered with a General Practitioner (GP) than those in the TAU group. CONCLUSIONS Continuity of care for prisoners with severe mental illness can be improved by working with them to identify their needs prior to release, and by assisting them to engage effectively to the necessary agencies in the community.
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