1
|
Kealy-Bateman W, Christian N, Wetton R, Bruce BJ, Rowe D, McIntyre S. Use of a quality improvement strategy to increase drug and alcohol consultation and care opportunities for mental health inpatients in rural and remote New South Wales. Aust J Rural Health 2021; 29:586-590. [PMID: 34148275 PMCID: PMC8453571 DOI: 10.1111/ajr.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/30/2022] Open
Abstract
PROBLEM Mental health inpatients have high rates of co-morbid substance use disorders which may exceed 50% in addition to the presenting complaint(s). Treating teams may prioritise, and substance use disorders are often not addressed. SETTING Dubbo inpatient mental health units. KEY MEASURES FOR IMPROVEMENT Rates of drug and alcohol consult of inpatients. DESIGN Retrospective audit of all inpatient records for mental health units at Dubbo Hospital (May-October period 2018 and 2019) following the intervention. Qualitative reflections of clinical staff were also included. STRATEGIES FOR CHANGE From early 2019, the problem was communicated with staff via education and open discussion. Modelling of the expected numbers of referral was understood as manageable within existing resources. The agenda of the morning meeting then always included an item that asked all team members to identify and refer a person if they needed drug and alcohol care. EFFECT OF CHANGE Consultation by the drug and alcohol clinical nurse consultant increased from 48 of 228 (21%) patients in the 2018 period to 83 of 232 (35.8%) patients in the 2019 period. LESSONS LEARNT The community and inpatient multidisciplinary team can correctly inform and increase drug and alcohol referral for mental health inpatients.
Collapse
Affiliation(s)
- Warren Kealy-Bateman
- Western NSW Local Health District, Dubbo, NSW, Australia.,School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | | | - Rebecca Wetton
- Western NSW Local Health District, Dubbo, NSW, Australia
| | - Billy-Jo Bruce
- Western NSW Local Health District, Dubbo, NSW, Australia
| | - Deborah Rowe
- Western NSW Local Health District, Dubbo, NSW, Australia
| | | |
Collapse
|
2
|
MacLeay E, Fry M, Roche MA, Montilla T. Care planning and nonpharmacological interventions in a metropolitan inpatient dual diagnosis service: A retrospective exploratory study. Int J Ment Health Nurs 2020; 29:856-867. [PMID: 32243035 DOI: 10.1111/inm.12719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/22/2020] [Accepted: 02/23/2020] [Indexed: 11/30/2022]
Abstract
In Australia, the terms dual diagnosis and comorbidity are commonly used, often interchangeably, to describe the experience of consumers with both mental health difficulties and difficulties with alcohol and other drug use. Consumers with comorbidity often have complex needs that require comprehensive assessment, multidisciplinary team support, and trauma-focused management. More information about the demographics of consumers admitted with comorbidity, and the documented assessed needs, care, and interventions provided, would provide the foundations for working towards improved quality and continuity of care. Therefore, the aim of this study was to explore the documentation of inpatient assessment, care, and interventions provided to people with comorbidity. The research design was a retrospective exploratory study, and data collection involved a 12-month healthcare record audit. Forty-one records were screened, and 36 consumer healthcare records were identified as eligible for inclusion in the study. Most consumers (n = 34, 94%) were admitted on an involuntary basis, and 8 (22.2%) were female. Consumers had a median length of stay of almost six months. In most healthcare records, there was no documented evidence of care planning involvement by consumers or the multidisciplinary team. There was great variance in the delivery of nonpharmacological interventions. Most consumers did not receive trauma-focused assessment or intervention, and assessment tools were often incomplete with outcome measures poorly documented. This study has demonstrated significant gaps in consumer and multidisciplinary engagement with care planning and goal setting. There was poor documentation of comprehensive assessment and nonpharmacological interventions.
Collapse
Affiliation(s)
- Euan MacLeay
- Mental Health Drug and Alcohol, Northern Sydney Local Health Service, Sydney, New South Wales, Australia.,UTS: School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Macquarie Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Margaret Fry
- UTS: School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,NSLHD Research and Practice Development, Nursing and Midwifery Directorate, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Michael Anthony Roche
- Mental Health Drug and Alcohol, Northern Sydney Local Health Service, Sydney, New South Wales, Australia.,UTS: School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Tim Montilla
- Mental Health Drug and Alcohol, Northern Sydney Local Health Service, Sydney, New South Wales, Australia.,UTS: School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| |
Collapse
|
3
|
Psychiatric Disorders and Alcohol Consumption Among Low-Income African Americans:Gender Differences. Brain Sci 2019; 9:brainsci9040086. [PMID: 31003459 PMCID: PMC6523251 DOI: 10.3390/brainsci9040086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Although cooccurrence of nonsubstance use disorders (non-SUDs) and substance use is well-established in the literature, most of what we know in this regard is derived from studies that have recruited predominantly White sample populations. As a result, there is a gap in knowledge on this link among low-income African Americans (AAs). There is also a need to understand how low-income AA men and women differ in these associations. Objective: To study whether there is an association between number of non-SUDs and amount of alcohol consumption by AA adults, and whether this association varies between AA men and women. Methods: This cross-sectional study recruited a nonrandom sample of 150 AA adults with non-SUDs (i.e., major depression, bipolar disorders, obsessive–compulsive disorder, paranoid disorder, panic disorder, posttraumatic stress disorder (PTSD), and schizoaffective disorder). The independent variable was the number of non-SUDs. The dependent variable was the amount of alcohol consumption. Age, socioeconomic status (educational attainment and household income), and self-rated health were covariates. Gender was the moderator. Linear regression models were used to analyze the data. Results: A higher number of non-SUDs was not associated with a higher amount of alcohol use in the pooled sample of AA adults. We, however, found a significant interaction between gender and number of non-SUDs on the amount of alcohol use, suggesting a stronger effect of non-SUDs on alcohol consumption in AA men than in AA women. Gender-stratified linear regression models showed a positive association between number of non-SUDs and amount of alcohol consumption in AA men but not in AA women. Conclusion: Non-SUDs impact alcohol use of AA men but not women. Future research should test whether AA men may have a higher tendency to turn to alcohol to regulate their emotions and cope with psychological pain due to multiple non-SUDs. The results also suggest that integration of services for SUDs and non-SUDs may be more relevant to provision of mental health services for AA men than AA women.
Collapse
|