1
|
Brophy L, Fletcher J, Dawadi S, Reece J, Edan V, Enticott J, Farhall J, Fossey E, Hamilton B, Harvey C, Meadows G, Mihalopoulos C, Morrisroe E, Newton R, Palmer V, Vine R, Waks S, Pirkis J. A longitudinal study of the impacts of a stay in a Prevention and Recovery Care service in Victoria, Australia. Aust N Z J Psychiatry 2024; 58:615-626. [PMID: 38679852 PMCID: PMC11193319 DOI: 10.1177/00048674241242943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Prevention and Recovery Care services are residential sub-acute services in Victoria, Australia, guided by a commitment to recovery-oriented practice. The evidence regarding the effectiveness of this service model is limited, largely relying on small, localised evaluations. This study involved a state-wide investigation into the personal recovery, perceived needs for care, well-being and quality-of-life outcomes experienced by Prevention and Recovery Care services' consumers. METHODS A longitudinal cohort design examined the trajectory of self-reported personal recovery and other outcomes for consumers in 19 Victorian Prevention and Recovery Care services over 4 time points (T1 - 1 week after admission; T2 - within 1 week of discharge; T3 - 6 months after discharge; T4 - 12 months after discharge). T2-T4 time frames were extended by approximately 3 weeks due to recruitment challenges. The Questionnaire about the Process of Recovery was the primary outcome measure. RESULTS At T1, 298 consumers were recruited. By T4, 114 remained in the study. Participants scored higher on the Questionnaire about the Process of Recovery at all three time points after T1. There were also sustained improvements on all secondary outcome measures. Improvements were then sustained at each subsequent post-intervention time point. Community inclusion and having needs for care met also improved. CONCLUSION The findings provide a consistent picture of benefits for consumers using Prevention and Recovery Care services, with significant improvement in personal recovery, quality of life, mental health and well-being following an admission to a Prevention and Recovery Care service. Further attention needs to be given to how to sustain the gains made through a Prevention and Recovery Care service admission in the long term.
Collapse
Affiliation(s)
- Lisa Brophy
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, VIC, Australia
| | - Justine Fletcher
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, VIC, Australia
| | - Shrinkhala Dawadi
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, Australia
| | - John Reece
- Discipline of Psychological Sciences, Australian College of Applied Professions, Melbourne, VIC, Australia
| | - Vrinda Edan
- Centre for Mental Health Nursing, Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, Australia
| | - John Farhall
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Bridget Hamilton
- Centre for Mental Health Nursing, Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Carol Harvey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- North West Area Mental Health, Division of Mental Health, Northern Health, Melbourne, VIC, Australia
| | - Graham Meadows
- School of Psychology, Psychiatry and Psychological Medicine, Monash University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Emma Morrisroe
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Richard Newton
- Peninsula Mental Health Service, Melbourne, VIC, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Victoria Palmer
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, VIC, Australia
- Department of General Practice and Primary Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Ruth Vine
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Shifra Waks
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Chippendale, NSW, Australia
| | - Jane Pirkis
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
2
|
Coelho J, Sanchez-Ortuño MM, Martin VP, Gauld C, Richaud A, Lopez R, Pelou M, Abi-Saab P, Philip P, Geoffroy PA, Palagini L, Micoulaud-Franchi JA. Content analysis of insomnia questionnaires: A step to better evaluate the complex and multifaceted construct of insomnia disorder. Psychiatry Res 2023; 330:115584. [PMID: 37944205 DOI: 10.1016/j.psychres.2023.115584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
Insomnia disorder is a mental disorder that includes various types of symptoms (e.g., insomnia initiating, worries, mood disturbances) and impairments (e.g., distress related to sleep alterations). Self-report questionnaires are the most common method for assessing insomnia but no systematic quantified analysis of their content and overlap has been carried out. We used content analysis and a visualization method to better identify the different types of clinical manifestations that are investigated by nine commonly used insomnia questionnaires for adults and the Jaccard index to quantify the degree to which they overlap. Content analysis found and visualized 16 different clinical manifestations classified into five dimensions ("Insomnia symptoms", "Insomnia-related symptoms", "Daytime symptoms", "Insomnia-related impairments", "Sleep behaviors"). The average Jaccard Index was 0.409 (moderate overlap in content). There is a lack of distinction between symptoms and impairments, and the assessment of sleep duration and hyperarousal symptoms remains overlooked. This preliminary analysis makes it possible to visualize the content of each of the nine questionnaires and to select the most appropriate questionnaire based on the issue to be addressed. Suggestions are made regarding the development of future questionnaires to better distinguish symptoms and impairments, and the different phenotypes of insomnia disorder.
Collapse
Affiliation(s)
- Julien Coelho
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France.
| | - Maria Montserrat Sanchez-Ortuño
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; Department of Nursing, School of Nursing, University of Murcia, Murcia, Spain
| | - Vincent P Martin
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, Talence F-33400, France
| | - Christophe Gauld
- Service Psychopathologie du Développement de l'Enfant et de l'Adolescent, Hospices Civils de Lyon & Université de Lyon 1, France; Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS & Université Claude Bernard Lyon, France
| | - Alexandre Richaud
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France
| | - Régis Lopez
- Institut des Neurosciences de Montpellier (INM), University Montpellier, Montpellier 34000, France; Unité des Troubles du Sommeil, Département de Neurologie, CHU Montpellier, Montpellier 34000, France
| | - Marie Pelou
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France
| | - Poeiti Abi-Saab
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France
| | - Pierre Philip
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France
| | - Pierre-Alexis Geoffroy
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat-Claude Bernard, Paris 75018, France; GHU Paris-Psychiatry & Neurosciences, 1 Rue Cabanis, Université de Paris, NeuroDiderot, Inserm, Paris 75019, France
| | - Laura Palagini
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana AUOP, Pisa 56126, Italy; Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara 44121, Italy
| | - Jean-Arthur Micoulaud-Franchi
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France
| |
Collapse
|
3
|
Harvey C, Zirnsak TM, Brasier C, Ennals P, Fletcher J, Hamilton B, Killaspy H, McKenzie P, Kennedy H, Brophy L. Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis. Front Psychiatry 2023; 14:1259944. [PMID: 37779607 PMCID: PMC10539575 DOI: 10.3389/fpsyt.2023.1259944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Objective This study aims to assess the effectiveness of community-based models of care (MoCs) supporting the recovery of individuals who experience persistent and complex mental health needs. Method We conducted a systematic review and narrative synthesis of MoC studies reporting clinical, functional, or personal recovery from October 2016 to October 2021. Sources were Medline, EMBASE, PsycInfo, CINAHL, and Cochrane databases. Studies were grouped according to MoC features. The narrative synthesis was led by our researchers with lived experience. Results Beneficial MoCs ranged from well-established to novel and updated models and those explicitly addressing recovery goals and incorporating peer support: goal-focused; integrated community treatment; intensive case management; partners in recovery care coordination; rehabilitation and recovery-focused; social and community connection-focused; supported accommodation; and vocational support. None of our diverse group of MoCs supporting recovery warranted a rating of best practice. Established MoCs, such as intensive case management, are promising practices regarding clinical and functional recovery, with potential for enhancements to support personal recovery. Emerging practice models that support personal and functional recovery are those where consumer goals and priorities are central. Conclusion Evidence for established models of care shows that there is a need for inevitable evolution and adaptation. Considering the high importance of effective MoCs for people experiencing persistent and complex mental health needs, further attention to service innovation and research is required. Greater emphasis on the inclusion of lived and living experience in the design, delivery, implementation, and research of MoCs is needed, to enhance MOCs' relevance for achieving individual consumer recovery outcomes.
Collapse
Affiliation(s)
- Carol Harvey
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- North West Area Mental Health, Division of Mental Health, Northern Health, Melbourne, VIC, Australia
| | - Tessa-May Zirnsak
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
| | - Catherine Brasier
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
| | | | - Justine Fletcher
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Bridget Hamilton
- Centre for Mental Health Nursing, Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Helen Killaspy
- Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Peter McKenzie
- The Bouverie Centre, School of Psychology and Public Health, La Trobe University, Brunswick, VIC, Australia
| | - Hamilton Kennedy
- Centre for Mental Health Nursing, Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Lisa Brophy
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
| |
Collapse
|
4
|
Coleman M, Cuesta-Briand B, Ngo H, Bass R, Mills-Edward N, Ennals P. Developing fit-for-purpose funding models for rural settings: Lessons from the evaluation of a step-up/step-down service in regional Australia. Front Psychiatry 2023; 14:1036017. [PMID: 36778633 PMCID: PMC9911213 DOI: 10.3389/fpsyt.2023.1036017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Sub-acute mental health community services provide a bridging service between hospital and community care. There is limited understanding of the local factors that influence success, and of the funding implications of delivering services in rural areas. METHODS This paper draws from quantitative and qualitative evaluation data from a regional Western Australian service to explore these issues. RESULTS Consumers satisfaction with the service was high and, overall, admission to the service resulted in positive outcomes. High re-admission rates may be linked to limited community support services following discharge. DISCUSSION Our results suggest that outcomes may be enhanced by implementing flexible approaches that address the resource limitations of the rural context, and that the current funding model for sub-acute mental health services in rural Australian may not be fit for purpose. More needs to be understood about how these services can be better integrated with existing support services, and how they can be better funded.
Collapse
Affiliation(s)
- Mathew Coleman
- The Rural Clinical School of WA, The University of Western Australia, Albany, WA, Australia.,Great Southern Mental Health Service, WA Country Health Service, Albany, WA, Australia.,Telethon Kids Institute, Nedlands, WA, Australia
| | - Beatriz Cuesta-Briand
- The Rural Clinical School of WA, The University of Western Australia, Albany, WA, Australia
| | - Hanh Ngo
- The Rural Clinical School of WA, The University of Western Australia, Albany, WA, Australia
| | | | | | | |
Collapse
|
5
|
Vava Y, Koen L, Niehaus D, Botha HF, Botha U. Impact of completing a psychosocial rehabilitation programme on inpatient service utilisation in South Africa. S Afr J Psychiatr 2022; 28:1764. [PMID: 36340642 PMCID: PMC9634828 DOI: 10.4102/sajpsychiatry.v28i0.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 06/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background Deinstitutionalisation refers to the process of transferring most of the psychiatric care provision from inpatient state-run institutions to community-based care. However, it has proven difficult to implement and failed to reach its desired targets. New Beginnings (NB) is a transitional care facility that facilitates the transition from in- to outpatient care. To date, no data exist as to whether the intervention provided at NB is effective in reducing psychiatric readmissions. Aim To determine if completing a psychosocial rehabilitation (PSR) programme reduces acute inpatient service utilisation and if this is influenced by sociodemographic or clinic factors. Setting New Beginnings transitional care facility in South Africa. Methods A record review of all NB admissions between January 2011 and December 2015. Demographic and clinical data were collected, including readmissions and days-in-hospital (DIH), 36 months pre- and postindex admission. Patients were divided into a completer group (CG) and a noncompleter group (NCG) for the eight-week PSR programme, and comparative statistical analysis was performed. Results Completion of the 8-week voluntary inpatient PSR programme led to a significant decrease (p = 0.017) (CG vs. NCG) in DIH during the 36-month period postindex admission. In addition, both groups showed significantly decreased (p < 0.001) DIH postindex in comparison to pre-index admission. Conclusions This study’s findings support that transitional care facilities offering an inpatient PSR programme may reduce inpatient service utilisation for all attendees but especially for those who complete the program. This highlights the need for such facilities that offer interventions tailored for patients with mental illness. Contribution This is the first local study highlighting the potentially important role transitional care facilities could play in reducing readmissions.
Collapse
Affiliation(s)
- Yanga Vava
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liezl Koen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dana Niehaus
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Henmar F. Botha
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ulla Botha
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
6
|
Farhall J, Brophy L, Reece J, Tibble H, Le LKD, Mihalopoulos C, Fletcher J, Harvey C, Morrisroe E, Newton R, Sutherland G, Spittal MJ, Meadows G, Vine R, Pirkis J. Outcomes of Victorian Prevention and Recovery Care Services: A matched pairs comparison. Aust N Z J Psychiatry 2021; 55:1178-1190. [PMID: 33423519 DOI: 10.1177/0004867420983473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In Victoria, Prevention and Recovery Care Services have been established to provide a partial alternative to inpatient admissions through short-term residential mental health care in the community. This study set out to determine whether Prevention and Recovery Care Services are achieving their objectives in relation to reducing service use and costs, fostering least restrictive care and leading to positive clinical outcomes. METHODS We matched 621 consumers whose index admission in 2014 was to a Prevention and Recovery Care ('PARCS consumers') with 621 similar consumers whose index admission in the same year was to an acute inpatient unit and who had no Prevention and Recovery Care stays for the study period ('inpatient-only consumers'). We used routinely collected data to compare them on a range of outcomes. RESULTS Prevention and Recovery Care Services consumers made less subsequent use of acute inpatient services and, on balance, incurred costs that were similar to or lower than inpatient-only consumers. They were also less likely to spend time on an involuntary treatment order following their index admission. Prevention and Recovery Care Services consumers also experienced positive clinical outcomes over the course of their index admission, but the magnitude of this improvement was not as great as for inpatient-only consumers. This type of clinical improvement is important for Prevention and Recovery Care Services, but they may place greater emphasis on personal recovery as an outcome. CONCLUSION Prevention and Recovery Care Services can provide an alternative, less restrictive care option for eligible consumers who might otherwise be admitted to an acute inpatient unit and do so at no greater cost.
Collapse
Affiliation(s)
- John Farhall
- Department of Psychology and Counselling, School of Psychology & Public Health, La Trobe University, Bundoora, VIC, Australia.,Academic Psychology Unit, NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Lisa Brophy
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia.,Centre for Mental Health, Melbourne School of Population & Global Health, University of Melbourne, Carlton, VIC, Australia
| | - John Reece
- Discipline of Psychological Sciences, Australian College of Applied Psychology, Melbourne, VIC, Australia
| | - Holly Tibble
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Long Khanh-Dao Le
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Justine Fletcher
- Centre for Mental Health, Melbourne School of Population & Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Carol Harvey
- North West Area Mental Health Service, NorthWestern Mental Health, The Royal Melbourne Hospital, Coburg, VIC, Australia.,Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Emma Morrisroe
- Centre for Mental Health, Melbourne School of Population & Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Richard Newton
- Department of Psychiatry, Monash University, Peninsula Mental Health Service, Frankston, VIC, Australia
| | - Georgina Sutherland
- Centre for Health Equity, Melbourne School of Population & Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population & Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Graham Meadows
- Centre for Mental Health, Melbourne School of Population & Global Health, University of Melbourne, Carlton, VIC, Australia.,Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,Mental Health Program, Monash Health, Melbourne, VIC, Australia
| | - Ruth Vine
- Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.,NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population & Global Health, University of Melbourne, Carlton, VIC, Australia
| |
Collapse
|
7
|
Improvements in Hope, Engagement and Functioning Following a Recovery-Focused Sub-Acute Inpatient Intervention: a Six-Month Evaluation. Psychiatr Q 2021; 92:1611-1634. [PMID: 34125366 DOI: 10.1007/s11126-021-09934-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Few studies have examined the post-discharge benefits associated with recover-oriented programs delivered in inpatient and sub-acute mental health settings. The aim of this study was to evaluate the medium-term outcomes of a 6-week sub-acute inpatient intervention program for 27 service users with a diagnosis of serious mental illness (mean age = 33.22 years, 70.4% with a psychosis diagnosis). Recovery data were collected on admission, at discharge, and at 3- and 6-months post-discharge using self-report, collaborative and clinical measures. The three clinician-rated measures (assessing therapeutic engagement, functioning, and life skills) revealed linear improvements from admission to 6-month follow-up (with mean z-change ranging from 0.72 to 1.35), as did the self-reported social connection measure (Mental Health Recovery Star, MHRS; mean z-change: 1.05). There were also curvilinear improvements in self-determination and self-reported MHRS symptom management and functioning scores; however, only modest changes were detected in hope (Herth Hope Index) and MHRS self-belief scores. Change scores based on self-reported and clinician-rated measures tended to be uncorrelated. An exploration of client-level outcomes revealed three recovery trajectory subgroups: transient (21.7%), gradual (34.8%), or sustained (43.5%) improvement; with members of the latter group tending to have longer illness durations. The study's findings are encouraging, to the extent that they demonstrate recovery-focused sub-acute inpatient programs can promote clinical recovery and aspects of personal recovery. However, they also suggest that recovery perspectives differ between clients and clinicians, and that far more work is required to understand the psychological factors that generate and sustain the hope that recovery is possible.
Collapse
|
8
|
Sutherland G, Harvey C, Tibble H, Spittal MJ, Farhall J, Fletcher J, Meadows G, Newton JR, Vine R, Brophy L. Similarities and differences in people accessing prevention and recovery care services and inpatient units in Victoria, Australia. BMC Health Serv Res 2020; 20:542. [PMID: 32546224 PMCID: PMC7296697 DOI: 10.1186/s12913-020-05402-3] [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] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 06/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background There is an emerging international literature demonstrating clinical and cost-effectiveness of sub-acute residential mental health services. To date, however, there is limited information on the profile of consumers accessing these models of care. This study aimed to understand the profile of the population served by adult sub-acute residential mental health services in Victoria, Australia (known as Prevention and Recovery Care; PARC) and to compare PARC service consumers with consumers admitted to psychiatric inpatient units within public hospitals. Method Using 5 years (2012–2016) of a state-wide database of routinely collected individual level mental health service data, we describe the socio-demographic and clinical profile of PARC service consumers compared to consumers of psychiatric inpatient units including for primary diagnosis and illness severity. Using admissions as the unit of analysis, we identify the characteristics that distinguish PARC service admissions from psychiatric inpatient admissions. We also examine and compare length of stay for the different admission types. Results We analysed 78,264 admissions representing 34,906 individuals. The profile of PARC service consumers differed from those admitted to inpatient units including for sex, age, diagnosis and illness severity. The odds of an admission being to a PARC service was associated with several socio-demographic and clinical characteristics. Being male or in the youngest age grouping (< 20 years) significantly reduced the odds of admission to PARC services. The presence of primary diagnoses of schizophrenia and related disorders, mood, anxiety or personality disorders, all significantly increased the odds of admission to PARC services. Predictors of length of stay were consistent across PARC and inpatient admission types. Conclusions Our findings suggest PARC services may serve an overlapping but distinguishably different consumer group than inpatient psychiatric units. Future research on sub-acute mental health services should be cognizant of these consumer differences, particularly when assessing the long-term effectiveness of this service option.
Collapse
Affiliation(s)
- Georgina Sutherland
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Holly Tibble
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, VIC, Australia.,NorthWestern Mental Health, Parkville, VIC, Australia
| | - Justine Fletcher
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Graham Meadows
- Southern Synergy, Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, VIC, Australia
| | - J Richard Newton
- Dept of Psychiatry, Monash University, Peninsula Mental Health Service, Frankston, VIC, Australia
| | - Ruth Vine
- NorthWestern Mental Health, Parkville, VIC, Australia
| | - Lisa Brophy
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,School of Allied Health, Human Services and Sport, La Trobe University , Bundoora, VIC, Australia
| |
Collapse
|
9
|
Ngo H, Ennals P, Turut S, Geelhoed E, Celenza A, Wolstencroft K. Step-up, step-down mental health care service: evidence from Western Australia's first - a mixed-method cohort study. BMC Psychiatry 2020; 20:214. [PMID: 32393203 PMCID: PMC7216384 DOI: 10.1186/s12888-020-02609-w] [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: 09/18/2019] [Accepted: 04/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mental health Step-up, Step-down services (SUSD), also known as subacute services or Prevention and Recovery Services, have emerged to fill an identified gap between hospital-based inpatient care and clinical community-based mental health support. Evidence for the effectiveness of the SUSD service model is limited but growing. Accordingly, this study looked to add to the extant body of knowledge, by (i) assessing change outcomes in mental health and wellbeing, and predictors of these changes, for patients who accessed Western Australia's first SUSD service; and (ii) evaluating patients' satisfaction with service, and what patients value from their stay. METHODS This was a mixed-method retrospective cohort study. Participants comprised 382 patients who accessed a 22-bed Mental Health SUSD facility and incurred 551 episodes of care during the 01/07/2014-30/06/2016 period. Patients' change outcomes in psychological distress, general self-efficacy, and work and social adjustment from service entry to service exit were analyzed using generalized linear modeling. Simple Pearson's correlation coefficients were calculated for preliminary assessment of the associations between patients' service satisfaction and their change outcomes. Qualitative outcomes that patients valued from their stay were analyzed thematically according to a semi-grounded theoretical approach. RESULTS Significant improvements were observed in patients' self-reported psychological distress, self-efficacy, and work and social adjustment (all p < 0.0001). A strong and persistent baseline effect existed across the three measures. Older age, female gender, and having a dependent child in the same household were protective/enhancing factors for the patients' recovery. Satisfaction with service was high. Patients valued having the time and space to recuperate, gain insight, focus, and create changes in their lives. CONCLUSION The encouraging findings, regarding both patients' change outcomes and satisfaction with service, support the value of the SUSD service model for patients with mental illnesses. Strengths and limitations were discussed; ensued recommendations were offered to both service providers and researchers to enhance the robustness of future research findings, to help inform more effective policy and funding decisions related to mental health care.
Collapse
Affiliation(s)
- Hanh Ngo
- Division of Emergency Medicine, School of Medicine, The University of Western Australia (Internal Mail Code M516), 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | | | - Serhat Turut
- grid.477634.5Neami National, Melbourne, VIC Australia
| | - Elizabeth Geelhoed
- grid.1012.20000 0004 1936 7910School of Allied Health, The University of Western Australia, Perth, WA Australia
| | - Antonio Celenza
- grid.1012.20000 0004 1936 7910Division of Emergency Medicine, School of Medicine, The University of Western Australia (Internal Mail Code M516), 35 Stirling Highway, Crawley, WA 6009 Australia
| | | |
Collapse
|
10
|
Sly KA, Lewin TJ, Frost BG, Tirupati S, Turrell M, Conrad AM. Care pathways, engagement and outcomes associated with a recovery-oriented intermediate stay mental health program. Psychiatry Res 2020; 286:112889. [PMID: 32114210 DOI: 10.1016/j.psychres.2020.112889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 10/25/2022]
Abstract
This study examined care pathways, program engagement, and key outcomes associated with a sub-acute inpatient stay in a 20-bed stand-alone Intermediate Stay Mental Health Unit (ISMHU; NSW, Australia). A 6-week evidenced-based tailored intervention program was offered, utilizing a recovery-oriented model of care. Service data from multiple record systems were combined, including admissions and service contacts 2-years prior to and following the index admission. During the initial 16-months there were 146 index admissions with a length of stay greater than 7 days. The majority (75.3%) were transfers from acute-care, with an average ISMHU stay of 50.3 days. Service and clinical outcomes were examined in relation to care pathways, recovery needs, program engagement and benefits achieved. Substantial engagement was detected (e.g., 74.0% >10 intervention types), together with significant improvements on self-report and clinician rated measures (e.g., social connection, symptoms, and self-belief). Logistic regression analyses revealed that arrival category was the strongest outcome predictor, with community referrals experiencing the largest reduction in subsequent acute mental health admissions (58.3% to 16.7%), followed by involuntary inpatient referrals (80.3% to 60.7%). Potential recovery-focused benefits are not limited to community treatment settings, while pathways to care may help identify clients with differing needs and opportunities for treatment.
Collapse
Affiliation(s)
- Ketrina A Sly
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW 2300, Australia; Centre for Brain and Mental Health Research (CBMHR), The University of Newcastle, Callaghan, NSW 2308, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute (HMRI), New Lambton, NSW, 2305, Australia.
| | - Terry J Lewin
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW 2300, Australia; Centre for Brain and Mental Health Research (CBMHR), The University of Newcastle, Callaghan, NSW 2308, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute (HMRI), New Lambton, NSW, 2305, Australia.
| | - Barry G Frost
- Hunter Medical Research Institute (HMRI), New Lambton, NSW, 2305, Australia; School of Psychology, Faculty of Science and Technology, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Srinivasan Tirupati
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW 2300, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Megan Turrell
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW 2300, Australia.
| | - Agatha M Conrad
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW 2300, Australia; Centre for Brain and Mental Health Research (CBMHR), The University of Newcastle, Callaghan, NSW 2308, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute (HMRI), New Lambton, NSW, 2305, Australia.
| |
Collapse
|
11
|
Green R, Mitchell PF, Lee K, Svensson E, Toh JW, Barentsen C, Copeland M, Newton JR, Hawke KC, Brophy L. Key features of an innovative sub-acute residential service for young people experiencing mental ill health. BMC Psychiatry 2019; 19:311. [PMID: 31646990 PMCID: PMC6813091 DOI: 10.1186/s12888-019-2303-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies across international settings have highlighted a need to improve the appropriateness and continuity of services for young people experiencing mental ill health. This paper examines key features of a sub-acute youth mental health residential service model, Youth Prevention and Recovery Care (Y-PARC) service. Y-PARC provides up to 4 weeks care to 16 to 25 year-olds at risk of hospitalisation and to those transitioning out of hospital inpatient units. The research was conducted at one of three Y-PARCs located in Victoria, Australia. METHODS This paper presents findings from analysis of two data sources collected during evaluation of a Y-PARC service in 2015-17. Routinely collected administrative data of Y-PARC residents (n = 288) were analysed and semi-structured interviews were conducted with 38 participants: a) former residents (n = 14); b) family members of group a) (n = 5); key stakeholders (n = 9); and, Y-PARC staff (n = 10 respondents in 3 group interviews). Analysis of the qualitative data was thematic and structured by the interview guide, which covered the key service aims. RESULTS Consistent with the aims of the service, respondents described practice at Y-PARC that aligns with recovery-oriented care. Key features emphasised were: a safe and welcoming environment for residents and families; provision of person-centred care; promotion of autonomy and self-help; informal interactions with staff allowing for formation of naturalistic relationships; time spent with other young people with similar experiences; and, assurance upon exit that the 'door is always open.' High levels of satisfaction were reported. Outcomes described included: improved resilience; better understanding of mental health; the importance of seeking help; and, stronger connections to therapeutic services. Longer and multiple stays were associated with progressive and sustained change. Family members and stakeholders widely reported that the service fills a gap between community services and acute inpatient mental health hospital wards. Some challenging areas of practice identified included: integration of evidence-based psychosocial interventions; provision of care within a model that blends clinical and psychosocial support services; and, negotiation of family-inclusive practice. CONCLUSIONS The Y-PARC service model shows promise with young people experiencing mental ill health, particularly in improving the range and availability of options across a spectrum of need.
Collapse
Affiliation(s)
- Rachael Green
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
| | - Penelope Fay Mitchell
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
| | - Kira Lee
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
| | - Ella Svensson
- Orygen, the National Centre of Excellence in Youth Mental Health, 35 Poplar Roadd, Parkville, Victoria 3052 Australia
| | - Jia-Wern Toh
- Orygen, the National Centre of Excellence in Youth Mental Health, 35 Poplar Roadd, Parkville, Victoria 3052 Australia
| | - Carolyn Barentsen
- Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199 Australia
| | - Michala Copeland
- Mind Australia, 86-92 Mount Street, Heidelberg, Victoria 3084 Australia
| | - J. Richard Newton
- Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199 Australia
| | | | - Lisa Brophy
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
- Mind Australia, 86-92 Mount Street, Heidelberg, Victoria 3084 Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria Australia
| |
Collapse
|
12
|
Harvey C, Brophy L, Tibble H, Killaspy H, Spittal MJ, Hamilton B, Ennals P, Newton R, Cruickshank P, Hall T, Fletcher J. Prevention and Recovery Care Services in Australia: Developing a State-Wide Typology of a Subacute Residential Mental Health Service Model. Front Psychiatry 2019; 10:383. [PMID: 31244691 PMCID: PMC6580196 DOI: 10.3389/fpsyt.2019.00383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/15/2019] [Indexed: 01/15/2023] Open
Abstract
Aims: Community-based residential alternatives to hospitalization are an emerging service model. Evidence for their acceptability and effectiveness is promising but limited. Prevention and Recovery Care (PARC) services are one such residential model, offering short-term subacute treatment and care (usually between 7 and 28 days). PARC services in Victoria, Australia, are designed to support consumers with severe mental illness to either avoid a psychiatric hospital admission (step-up care) or transition from hospital back into the community (step-down care). As a precursor to a series of studies investigating the appropriateness, effectiveness and efficiency of PARC services, we aimed to investigate whether a typology of PARC services can be developed. Methods: A manager or other appropriately knowledgeable staff member from each of the 19 adult PARC services included in the study completed a tool based on PARC operational guidelines (the Victorian PARC service mapping questionnaire) and a validated instrument measuring the quality of care in residential mental health settings (the Quality Indicator for Rehabilitative Care, QuIRC). Thirty (of 42) stakeholders participated in a modified Delphi study to select 23 from the available 230 variables for entry into a hierarchical cluster analysis. Results: Cluster analysis produced three clusters of equal dissimilarity. At the 90% confidence level, there were four variables which were significantly different between clusters. These were the year the PARC was opened, the QuIRC Living Environment domain score, the proportion of all admissions that were a step-down admission from an inpatient unit, and how often families were invited to care meetings. Sensitivity analyses suggested the findings were robust to the method used to identify clusters. Conclusions: Although PARC services were broadly similar, their identified differences suggest there is variable model implementation across Victoria sufficient to generate a PARC service typology. This typology may prove important for interpreting differences in outcomes experienced by consumers and carers using PARC services, when applied in our analyses of service effectiveness. The value of conducting service mapping and typology studies is underscored. Further research to characterize subacute residential services, including recovery-promoting features of the built environment, is warranted.
Collapse
Affiliation(s)
- Carol Harvey
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
- Psychosocial Research Centre, NorthWestern Mental Health, Coburg, VIC, Australia
| | - Lisa Brophy
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Mind Australia Ltd, Heidelberg, VIC, Australia
- La Trobe University School of Allied Health, Human Services and Sport, Bundoora, VIC, Australia
| | - Holly Tibble
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom
| | - Matthew J. Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Bridget Hamilton
- School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | | | - Richard Newton
- Peninsula Mental Health Service, Frankston, VIC, Australia
| | | | - Teresa Hall
- Nossal Institute for Global Health, and Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Justine Fletcher
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
13
|
Di Lorenzo R, Olmi T, Rioli G, Galeazzi GM, Ferri P. Factors Associated with Long-Stays in an Italian Psychiatric Intensive Treatment Facility: 1-Year Retrospective Observational Analysis. Psychiatr Q 2019; 90:185-196. [PMID: 30488329 DOI: 10.1007/s11126-018-9616-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Psychiatric Intensive Treatment Facilities (PITF) are health inpatient settings for patients affected by sub-acute psychiatric disorders with impaired personal and social functioning. The aim of this study is to analyse the demographic and clinical variables related to long-stays in an Italian PITF in order to highlight the risk factors for stay lengthening. We retrospectively collected the selected variables from all patients and their stays in a PITF from 1 to 11-2016 to 31-10-2017. We divided the stays according to the median of duration, ≤29 and > 29 days, to compare selected variables in the two groups of stay length. Patients hospitalized for >29 days more frequently presented "Self-neglect", nursing diagnosis NANDA-I, and needed economic social service support. Multiple linear regression revealed that the presence of some variables as "many medical consultations", "economic social service support", "clinical interviews extended to institutional figures" were statistically significantly associated with an increased stay duration, suggesting that both clinical severity and difficult economic conditions were associated with the lengthening of stay. The knowledge of these factors can contribute to improve psychiatric treatments, reducing potential risk conditions for patient institutional dependence.
Collapse
Affiliation(s)
- Rosaria Di Lorenzo
- Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, AUSL Modena, 41122, Modena, Italy.
| | - Teresa Olmi
- School of Nursing, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Giulia Rioli
- Section of Clinical Neuroscience, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Gian Maria Galeazzi
- Section of Clinical Neuroscience, Department of Biomedical Metabolic and Neural Sciences. Department of Mental Health and Drug Abuse, AUSL Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Paola Ferri
- Section of Clinical Neuroscience, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124, Modena, Italy
| |
Collapse
|
14
|
Roos E, Bjerkeset O, Steinsbekk A. Health care utilization and cost after discharge from a mental health hospital; an RCT comparing community residential aftercare and treatment as usual. BMC Psychiatry 2018; 18:363. [PMID: 30419894 PMCID: PMC6233284 DOI: 10.1186/s12888-018-1941-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/24/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Community residential aftercare (step-down) services can ease the transition after a mental health hospital stay for patients with severe mental illness (SMI). AIMS To investigate use of community and specialised mental health care services and costs in patients with SMI the first 12 months after discharge from a mental health hospital (MHH), comparing community residential aftercare (CRA) and treatment as usual. METHODS An open parallel group randomised controlled trial with 41 participants. Data on use of specialist services (hospital, ambulant treatment and outpatient treatment) and community services (residential stays, home help, home care nursing, mental health consultation) were collected from specialist and community registers and health records. RESULTS For the primary outcome, utilisation of community mental health services, the intervention group used, on average, 29% fewer hours (mean differences - 21.6 h, 95% CI -93.1 to 44.9, p = .096) with a cost saving of 29% (mean differences - 1845 EUR, 95% CI -8267 to 4171, p = .102), but the estimates were imprecise. For the secondary outcome, the study groups had the same total number of inpatient days (66 days), but the intervention group had on average of 13.4 fewer inpatient days in the mental health hospital (95% CI -29.9 to 0.9. p = .008). The number of inpatient admissions (mean difference - 0.9 admissions, 95% CI -3.5 to 1.5, p = .224) and readmissions (- 0.8, 95% CI -2.5 to 0.9. p = .440) was lower in the intervention group. The intervention group had on average a total cost saving of 38.5% (mean differences - 23,071 EUR, 95% CI -45,450 to 3027. p = .057). A post hoc multivariable regression analysis controlling for baseline characteristics gave a reduction in total cost in favour of the intervention group of - 19,781 EUR (95% CI -44,072 to 4509, p=,107). CONCLUSION In this study, it was not possible to draw a definite conclusion about the effect, due to the small sample and imprecision of the estimates. The direction of the results and size of the point estimate, in addition to findings in other studies, indicates that transferring patients ready for discharge from mental hospital to community residential aftercare can have the potential to reduce total consumption of health services and costs without increased hospital admissions. TRIAL REGISTRATION Registered in clinicaltrials.gov ( NCT01719354 ).
Collapse
Affiliation(s)
- Eirik Roos
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491, Trondheim, Norway. .,Health and Welfare, Trondheim, Norway.
| | - Ottar Bjerkeset
- grid.465487.cFaculty of Nursing and Health Sciences, Nord University, Levanger, Norway ,0000 0001 1516 2393grid.5947.fDepartment of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aslak Steinsbekk
- 0000 0001 1516 2393grid.5947.fDepartment of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| |
Collapse
|
15
|
Roos E, Bjerkeset O, Svavarsdóttir MH, Steinsbekk A. Like a hotel, but boring: users' experience with short-time community-based residential aftercare. BMC Health Serv Res 2017; 17:832. [PMID: 29246222 PMCID: PMC5732432 DOI: 10.1186/s12913-017-2777-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022] Open
Abstract
Background The discharge process from hospital to home for patients with severe mental illness (SMI) is often complex, and most are in need of tailored and coordinated community services at home. One solution is to discharge patients to inpatient short-stay community residential aftercare (CRA). The aim of this study was to explore how patients with SMI experience a stay in CRA established in a City in Central Norway. Methods A descriptive qualitative study with individual interviews and a group interview with 13 persons. The CRA aims to improve the discharge process from hospital to independent supported living by facilitating the establishment of health and social services and preparing the patients. The philosophy is to help patients use community resources by e.g. not offering any organized in-house activities. The main question in the interviews was “How have you experienced the stay at the CRA?” The interviews were analyzed with a thematic approach using systematic text condensation. Results The participants experienced the stay at the CRA “Like a hotel” but also boring, due to the lack of organized in-house activities. The patients generally said they were not informed about the philosophy of the CRA before the stay. The participants had to come up with activities outside the CRA and said they got active help from the staff to do so; some experienced this as positive, whereas others wanted more organized in-house activities like they were used to from mental health hospital stays. Participants described the staff in the CRA to be helpful and forthcoming, but they did not notice the staff being active in organizing the aftercare. Conclusions The stay at the CRA was experienced as different from other services, with more freedom and focus on self-care, and lack of in-house activities. This led to increased self-activity among the patients, but some wanted more in-house activities. To prepare the patients better for the stay at the CRA, more information about the philosophy is needed in the pre-admission process. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2777-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eirik Roos
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway. .,, Municipality of Trondheim, Norway.
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Margrét Hrönn Svavarsdóttir
- Department of Health Sciences, Norwegian University of Sciences and Technology, Gjøvik, Norway.,School of Health Sciences, University of Akureyri, Akureyri, Iceland
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway
| |
Collapse
|