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Stubbs JM, Chong S, Achat HM. Identifying Patients at Risk of Not Receiving Timely Community Mental Health Follow-Up After Psychiatric Hospitalisation Using Linked Routinely Collected Data. J Behav Health Serv Res 2024:10.1007/s11414-024-09910-6. [PMID: 39317857 DOI: 10.1007/s11414-024-09910-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2024] [Indexed: 09/26/2024]
Abstract
Timely receipt of community-based follow-up after inpatient psychiatric discharge is associated with positive outcomes. This retrospective cross-sectional study aimed to identify socio-demographic and clinical factors associated with failure to receive community mental health follow-up within 7 days. Routinely collected hospital and community mental health data were linked for all inpatients discharged with a mental health condition in 2017 to 2019 in a local health district in New South Wales, Australia. Of the 8780 patients discharged, 28% (n = 2466) did not have 7-day follow-up. Males were significantly more likely than females to fail follow-up. Adjusted logistic regression analyses revealed that both male and female patients aged 65 years and older were generally less likely to fail follow-up than those who were younger; conversely, patients referred to a hospital by a law enforcement agency and those who left the hospital at their own risk were more likely to fail follow-up. Other factors significantly related to failure to follow-up varied between the sexes. Improved outcomes may be achieved by enhancing the transition from inpatient to outpatient care through targeted strategies aimed at patients who are more likely to disengage with care.
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Affiliation(s)
- Joanne M Stubbs
- Epidemiology and Health Analytics, Research and Education Network, Western Sydney Local Health District, New South Wales, 5 Fleet Street, North Parramatta, 2151, Australia.
| | - Shanley Chong
- Epidemiology and Health Analytics, Research and Education Network, Western Sydney Local Health District, New South Wales, 5 Fleet Street, North Parramatta, 2151, Australia
| | - Helen M Achat
- Epidemiology and Health Analytics, Research and Education Network, Western Sydney Local Health District, New South Wales, 5 Fleet Street, North Parramatta, 2151, Australia
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2
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Savaglio M, Vincent A, Bentley M, Gaul J, Poke S, Watson N, Skouteris H. A Controlled Evaluation of a Psychosocial Outreach Support Program for Adults with Severe Mental Illness. PSYCHOSOCIAL INTERVENTION 2024; 33:179-185. [PMID: 39234360 PMCID: PMC11370126 DOI: 10.5093/pi2024a12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/05/2024] [Indexed: 09/06/2024]
Abstract
Objective: Serious mental illness (SMI) remains a leading cause of disability worldwide. However, there is limited Australian evidence of community-based programs to enhance the psychosocial wellbeing of adults experiencing SMI. Foundations is a long-term community-based psychosocial outreach support program delivered in Tasmania, Australia. A longitudinal non-randomised controlled trial was conducted to examine the effectiveness of the Foundations program on adults' psychosocial functioning, clinical symptomology, and hospital readmissions, in comparison to standard care only. Method: Participants were adults aged 18-64 years experiencing SMI. Control participants received standard clinical care only. Intervention participants were engaged in the Foundations program in addition to standard care. Data were collected at program commencement, midpoint, closure, and six-months post-closure. Linear mixed modelling was used to examine differences between groups. Results: Intervention participants achieved better psychosocial functioning in comparison to the control group by program closure and at six-month follow-up. No significant differences were observed for clinical mental health symptomology or hospital readmission rates. Length of readmission stay was significantly shorter for intervention participants. Conclusions: The findings highlight the additional value of community-based, recovery-oriented, psychosocial outreach support alongside clinical mental health care to enhance the psychosocial wellbeing of adults experiencing SMI.
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Affiliation(s)
- Melissa Savaglio
- Monash UniversitySchool of Public Health and Preventive MedicineHealth and Social Care UnitMelbourneVictoriaAustraliaHealth and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;
| | - Ash Vincent
- BaptcareTasmaniaAustraliaBaptcare, Tasmania, Australia;
| | | | - Jasmine Gaul
- BaptcareTasmaniaAustraliaBaptcare, Tasmania, Australia;
| | - Stuart Poke
- BaptcareTasmaniaAustraliaBaptcare, Tasmania, Australia;
| | - Nicole Watson
- BaptcareTasmaniaAustraliaBaptcare, Tasmania, Australia;
| | - Helen Skouteris
- Monash UniversitySchool of Public Health and Preventive MedicineHealth and Social Care UnitMelbourneVictoriaAustraliaHealth and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;
- University of WarwickWarwick Business SchoolCoventryUnited KingdomWarwick Business School, University of Warwick, Coventry, United Kingdom
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3
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Hou M, Wu Y, Xue J, Chen Q, Zhang Y, Zhang R, Yu L, Wang J, Zhou Z, Li X. A predictive model for readmission within 1-year post-discharge in patients with schizophrenia. BMC Psychiatry 2024; 24:573. [PMID: 39174919 PMCID: PMC11340171 DOI: 10.1186/s12888-024-06024-3] [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] [Received: 03/28/2024] [Accepted: 08/16/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Schizophrenia is a pervasive and severe mental disorder characterized by significant disability and high rates of recurrence. The persistently high rates of readmission after discharge present a serious challenge and source of stress in treating this population. Early identification of this risk is critical for implementing targeted interventions. The present study aimed to develop an easy-to-use predictive instrument for identifying the risk of readmission within 1-year post-discharge among schizophrenia patients in China. METHODS A prediction model, based on static factors, was developed using data from 247 schizophrenia inpatients admitted to the Mental Health Center in Wuxi, China, from July 1 to December 31, 2020. For internal validation, an additional 106 patients were included. Multivariate Cox regression was applied to identify independent predictors and to create a nomogram for predicting the likelihood of readmission within 1-year post-discharge. The model's performance in terms of discrimination and calibration was evaluated using bootstrapping with 1000 resamples. RESULTS Multivariate cox regression demonstrated that involuntary admission (adjusted hazard ratio [aHR] 4.35, 95% confidence interval [CI] 2.13-8.86), repeat admissions (aHR 3.49, 95% CI 2.08-5.85), the prescription of antipsychotic polypharmacy (aHR 2.16, 95% CI 1.34-3.48), and a course of disease ≥ 20 years (aHR 1.80, 95% CI 1.04-3.12) were independent predictors for the readmission of schizophrenia patients within 1-year post-discharge. The area under the curve (AUC) and concordance index (C-index) of the nomogram constructed from these four factors were 0.820 and 0.780 in the training set, and 0.846 and 0.796 for the validation set, respectively. Furthermore, the calibration curves of the nomogram for both the training and validation sets closely approximated the ideal diagonal line. Additionally, decision curve analyses (DCAs) demonstrated a significantly better net benefit with this model. CONCLUSIONS A nomogram, developed using pre-discharge static factors, was designed to predict the likelihood of readmission within 1-year post-discharge for patients with schizophrenia. This tool may offer clinicians an accurate and effective way for the timely prediction and early management of psychiatric readmissions.
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Affiliation(s)
- Mingru Hou
- Department of General Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China
| | - Yuqing Wu
- Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China
| | - Jianhua Xue
- Health Screening Center, Shanghai Health and Medical Center, Wuxi, Jiangsu, 214065, China
| | - Qiongni Chen
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Yan Zhang
- Department of Nursing, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China
| | - Ruifen Zhang
- Department of Geriatric Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China
| | - Libo Yu
- Department of Substance Dependence, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China
| | - Jun Wang
- Department of Clinical Psychology, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China.
| | - Zhenhe Zhou
- Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China.
| | - Xianwen Li
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, 211166, China.
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Chong S, Achat HM, Stubbs JM, Murphy M. Factors associated with mental health representations to the emergency department within six months. Int Emerg Nurs 2024; 75:101480. [PMID: 38936272 DOI: 10.1016/j.ienj.2024.101480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 04/24/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND/OBJECTIVE ED representation places a tremendous drain on resources with mental health (MH) representation among the most common. This study aimed to identify patient and clinical factors associated with 28-day and six-month ED MH representation of an index MH ED presentation. METHOD All MH related ED presentations from 1 January 2017 to 30 June 2019 were extracted from routinely collected administrative data. Cox regression and multinomial logistic regression models tested associations between patient characteristics and risk of representation. RESULTS For the 8,010 patients, 28-day and six-month representations were 8 % and 16 % respectively. Self-identifying with a MH problem at index presentation (28-day hazard ratio (HR) = 1.48, 95 % CI = 1.19-1.84; six-month HR = 1.52, 95 % CI = 1.29-1.78), leaving ED before completing treatment (28-day HR = 4.13, 95 % CI = 3.36-5.08; six-month HR = 2.52, 95 % CI = 2.12-2.99), no private health insurance (six-month HR = 1.34, 95 % CI = 1.08-1.66), and hospital admission within one year prior to index (six month MH-related admission vs non-MH, HR = 1.59, 95 % CI = 1.19-2.13) were associated with increased risk of representation. Being uninsured was associated with frequent six-month representation among adults aged 16-39 years (OR = 3.16, 95 %CI = 1.59-6.25). CONCLUSION Self-identifying with a MH problem, leaving ED prematurely, being uninsured and prior hospitalisation are areas for in-depth investigation for improved understanding of unplanned representations.
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Affiliation(s)
- Shanley Chong
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Helen M Achat
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Joanne M Stubbs
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Margaret Murphy
- Western Sydney Local Health District Emergency Services, Westmead, NSW, Australia.
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Agudelo-Hernández F, Guapacha-Montoya M, Rojas-Andrade R. Mutual Aid Groups for Loneliness, Psychosocial Disability, and Continuity of Care. Community Ment Health J 2024; 60:608-619. [PMID: 38194119 DOI: 10.1007/s10597-023-01216-9] [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: 09/22/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024]
Abstract
The objective of the present study was to evaluate the effectiveness of mutual help groups in continuity of care, loneliness and psychosocial disability in a Colombian context. For this, a quasi-experimental design is used, with pre- and post-intervention assessments due to non-randomized participant allocation. The study involved 131 individuals with mental disorders. The Psychosocial Disability Scale, The Alberta Scale of Continuity of Services in Mental Health, the UCLA Scale and the Zarit Caregiver Burden Scale were employed. The intervention was based on the core components of mutual aid groups. Significant differences (p < 0.001) were observed for the study variables, particularly in Loneliness, Continuity of Care, and various domains of psychosocial disability. A large effect size was found for these variables after the intervention. Most variables exhibited a moderate to large effect. This study demonstrates the effectiveness of mutual groups facilitated by mental health personnel at the primary care level.
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Stewart K, Hancock N, Chapparo C, Stancliffe ERJ. Supports that help me to live well in the community: experiences of people living with schizophrenia. Aust Occup Ther J 2024; 71:340-351. [PMID: 38151285 DOI: 10.1111/1440-1630.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 10/05/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION People with schizophrenia are more likely to be hospitalised than any other psychiatric diagnosis. Occupational therapists working in mental health are often required to assess and recommend supports that will assist people with schizophrenia to live successfully in the community. There is little research exploring consumer perspectives regarding the support they find useful to stay out of the hospital. The aim of this study was to explore what supports people living with schizophrenia identify as helping them to live in the community and stay out of the hospital. METHOD Qualitative data were collected via semi-structured interviews with adult consumers (N = 18) diagnosed with schizophrenia. Data were thematically analysed using constant comparative analysis methods. Inductive analysis was followed by a deductive phase of analysis. FINDINGS Participants highlighted personal-, occupational- and environmental-focused supports. Person-focused supports addressed cognitive and psychological needs. Occupation-focused supports included assisting people to manage daily life with a mental illness; engage in social activities; and engage in meaningful activities. Environment-focused supports included access to financial security; accommodation security; and community of choice. In addition to types of support, participants highlighted the importance of quality of support including the need for flexible; timely; and non-judgemental support. CONCLUSION These results emphasise the multifaceted nature of support required by people living with schizophrenia to stay out of the hospital. Both type and quality of support are important. People in this study were able to clearly articulate the types and qualities of support that were important to them. Occupational therapists may benefit from greater collaboration with consumers during assessments of support needs and the development of recommendations. Further exploration of how occupational therapists identify people's multifaceted support needs is required.
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Affiliation(s)
- Kylie Stewart
- The University of Sydney, Faculty of Health Sciences, Centre for Disability Research and Policy, Sydney, Australia
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nicola Hancock
- The University of Sydney, Faculty of Health Sciences, Centre for Disability Research and Policy, Sydney, Australia
| | - Christine Chapparo
- The University of Sydney, Faculty of Health Sciences, Centre for Disability Research and Policy, Sydney, Australia
| | - Emeritus Roger J Stancliffe
- The University of Sydney, Faculty of Health Sciences, Centre for Disability Research and Policy, Sydney, Australia
- University of Minnesota, Institute of Community Integration, Minneapolis, Minnesota, USA
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Baune BT. Aripiprazole 2-month ready-to-use 960 mg (Ari 2MRTU): review of its possible role in schizophrenia therapy. Curr Med Res Opin 2024; 40:87-96. [PMID: 37999650 DOI: 10.1080/03007995.2023.2287612] [Citation(s) in RCA: 1] [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: 10/09/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023]
Abstract
Most patients with schizophrenia need life-long treatment. There is therefore a continued need for effective and tolerable treatment options. A 2-monthly LAI formulation of aripiprazole, Aripiprazole 2-Month Ready-to-Use 960 mg (Ari 2MRTU 960) has recently been approved in the US. Here, the possible role in therapy for this new treatment option is discussed in a narrative review. PubMed was searched for literature on long-acting injectables with a focus on patient-reported outcomes and real-world evidence on extended injection intervals (2-3 months). Dopamine D2 partial agonists, one of which is aripiprazole, exhibit favorable tolerability and safety properties. Additionally, there are many advantages in using long-acting injectable formulations such as enhanced treatment persistence and stability of patients as well as reduced rates of relapses, hospitalizations, and death. Some of these advantages become more pronounced with longer injection intervals. Additional advantages of longer injection intervals are more room for non-medication-related communication between healthcare professionals and patients, patient and physician preferences, reduced caregiver burden, and easier transitioning from inpatient to outpatient treatment. Taken together, since aripiprazole may be a good treatment choice for many patients based on its favorable safety and tolerability profile, and given the advantages of LAI treatment over oral treatment and the advantages of reduced dosing frequency, Ari 2MRTU 960 may become an important treatment option for many clinically stable patients with schizophrenia.
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Affiliation(s)
- Bernhard T Baune
- Department of Psychiatry, University Hospital of Münster, Münster, Germany
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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Mao W, Shalaby R, Owusu E, Elgendy H, Shalaby N, Agyapong B, Nichols A, Eboreime E, Nkire N, Agyapong VIO. Status after Hospital Discharge: An Observational Study of the Progression of Patients' Mental Health Symptoms Six Weeks after Hospital Discharge. J Clin Med 2023; 12:7559. [PMID: 38137628 PMCID: PMC10744019 DOI: 10.3390/jcm12247559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Transitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise. We collected data for this study as part of a pragmatic cluster-randomized, longitudinal approach in Alberta. As the first phase of the ongoing innovative supportive program, this paper assessed the progression of mental health symptoms in patients six weeks after hospital discharge. Factors that may contribute to the presence or absence of anxiety and depression symptoms, as well as well-being, following return to the community were investigated. This provides evidence and baseline data for future phases of the project. (2) Methods: An observational study design was adopted for this study. Data on a variety of sociodemographic and clinical factors were collected at discharge and six weeks after via REDCap. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5), respectively. Descriptive, chi-square, independent t-tests, and multivariate regression analyses were conducted. (3) Result: The survey was completed by 88 out of 306 participants (28.8% response rate). The chi-square/Fisher exact test and independent t-test revealed no significant change in the mental health conditions from baseline to six weeks after discharge. It was found that the only significant factor predicting symptoms six weeks after discharge from inpatient treatment was the baseline symptoms in all three logistic regression models. It was four times more likely for those who experienced anxiety and depression at baseline to experience anxiety and depression symptoms six weeks after discharge (OR = 4.27; 95% CI: 1.38-13.20) (OR = 4.04; 95% CI: 1.25-13.05). Those with poor baseline well-being were almost 12 times more likely to experience poor well-being six weeks after discharge (OR = 11.75; 95% CI: 3.21-42.99). (4) Conclusions: Study results found no significant change in mental health conditions in the short term following hospital discharge. It is essential that researchers and policymakers collaborate in order to implement effective interventions to support and maintain the mental health conditions of patients following discharge.
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Affiliation(s)
- Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Ernest Owusu
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Hossam Elgendy
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Nermin Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Angel Nichols
- Queen Elizabeth II Hospital, Alberta Health Services, Grande Prairie, AB T5J 3E4, Canada
| | - Ejemai Eboreime
- 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;
| | - Nnamdi Nkire
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
- 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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Gabet M, Armoon B, Meng X, Fleury MJ. Effectiveness of emergency department based interventions for frequent users with mental health issues: A systematic review. Am J Emerg Med 2023; 74:1-8. [PMID: 37717467 DOI: 10.1016/j.ajem.2023.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
Frequent emergency department (ED) users with mental health issues are particularly vulnerable patients, who often receive insufficient or inadequate outpatient care. This systematic review identified and evaluated studies on ED-based interventions to reduce acute care use by this population, while improving outpatient service use and patient outcomes. Searches were conducted in five databases for studies published between January 1, 2000, and April 30, 2022. Eligibility criteria included: patients with mental health issues who made 2+ ED visits in the previous 6 months or were high ED users (3+ visits/year), and who received ED-based interventions to reduce ED use. The review included 12 studies of 11,082 articles screened. Four intervention groups were identified: care plan (n = 4), case management (n = 4), peer-support (n = 2) and brief interventions (n = 2). The definitions of frequent users varied considerably, while the quality assessment rated studies from moderate to good and risk of bias from low to high. Eight studies used pre-post design, and four were randomized controlled trials. Ten studies assessed outcomes related to use of other services than ED, mainly hospitalizations, while five assessed patients' clinical conditions and three, social conditions (e.g., housing status). This review revealed that case management and care plan interventions, based in ED, decrease ED use among frequent users, while case management also showed promising results for outpatient service use and clinical and social outcomes. Thus, the results support continued deployment of intensive ED-based interventions for frequent ED users with mental health issues although firm conclusions regarding the effectiveness of these interventions, particularly outcomes related to services other than ED, require further investigation.
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Affiliation(s)
- Morgane Gabet
- Division of Mental Health & Society, Douglas Hospital Research Centre, Montreal, Canada; Département de Gestion, Evaluation et Politique de Santé, Université de Montréal, Montréal, Canada
| | - Bahram Armoon
- Division of Mental Health & Society, Douglas Hospital Research Centre, Montreal, Canada
| | - Xiangfei Meng
- Division of Mental Health & Society, Douglas Hospital Research Centre, Montreal, Canada
| | - Marie-Josée Fleury
- Division of Mental Health & Society, Douglas Hospital Research Centre, Montreal, Canada; Département de Gestion, Evaluation et Politique de Santé, Université de Montréal, Montréal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
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Tönnies J, Ayoub-Schreifeldt M, Schrader V, Hartmann M, Wild B, Friederich HC, Haun MW. From inpatient to outpatient mental health care: Protocol for a randomised feasibility trial of a care transition intervention for patients with depression and anxiety (the AMBITION-trial). PLoS One 2023; 18:e0291067. [PMID: 37922269 PMCID: PMC10624294 DOI: 10.1371/journal.pone.0291067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/17/2023] [Indexed: 11/05/2023] Open
Abstract
INTRODUCTION Despite guideline recommendations, inpatients with mental health disorders often do not receive appropriate treatment after discharge. This leads to high readmission rates, problems with medication adherence, increased risk of chronicity and suicide, and exclusion from the labour market accompanied by high individual and social costs. The causes are both system-related, such as limited treatment availability, and patient-related, such as ambivalent motivation to continue treatment and lack of information about available treatment options. The aim of this trial is to assess the feasibility of a Care Transition Intervention (CTI) which supports patients in the psychosocial follow-up treatment process after discharge from a psychotherapy ward. METHODS AND ANALYSIS Fifty patients with depression and/or anxiety who are treated as inpatients at a psychotherapy ward will be included and randomised into two groups with a 1:1 ratio. In the intervention group, patients will receive five CTI sessions with a Care Transition Navigator before and after discharge. The sessions will focus on individual patient support including a) identification and tackling of barriers to initiate follow-up treatment, b) reflection on the inpatient stay and individual progress, with focus on the helpful aspects and c) motivation of patients to organise and take up outpatient treatment. Patients in the control group will receive treatment-as-usual during discharge. We will evaluate the following outcomes: effectiveness of recruitment strategies, patient acceptance of randomisation, practicability of implemented workflows, feasibility of data collection, and clinical outcomes.
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Affiliation(s)
- Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Marayah Ayoub-Schreifeldt
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Viola Schrader
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Markus W. Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
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11
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Tyler N, Hodkinson A, Planner C, Angelakis I, Keyworth C, Hall A, Jones PP, Wright OG, Keers R, Blakeman T, Panagioti M. Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes: A Systematic Review and Network Meta-Analysis. JAMA Netw Open 2023; 6:e2344825. [PMID: 38032642 PMCID: PMC10690480 DOI: 10.1001/jamanetworkopen.2023.44825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Importance Discharge from the hospital to the community has been associated with serious patient risks and excess service costs. Objective To evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community. Data Sources CENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022. Study Selection Randomized clinical trials evaluating transitional care interventions from hospitals to the community were identified. Data Extraction and Synthesis At least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Main Outcomes and Measures The primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake. Results Overall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, -0.20; 95% CI, -0.38 to -0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits. Conclusions and Relevance These findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.
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Affiliation(s)
- Natasha Tyler
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Ioannis Angelakis
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Institute of Population Health, Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | | | - Alex Hall
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
| | | | | | - Richard Keers
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
- Pharmacy Department, Pennine Care NHS Foundation Trust, Aston-Under-Lyne, United Kingdom
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Tom Blakeman
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
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12
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Hackmann C, Komashie A, Handley M, Murdoch J, Wagner AP, Grünwald LM, Waller S, Kaminskiy E, Zeilig H, Jones J, Bray J, Bagge S, Simpson A, Dalkin SM, Clarkson J, Borghini G, Kipouros T, Rohricht F, Taousi Z, Haighton C, Rae S, Wilson J. Codesigning a systemic discharge intervention for inpatient mental health settings (MINDS): a protocol for integrating realist evaluation and an engineering-based systems approach. BMJ Open 2023; 13:e071272. [PMID: 37709323 PMCID: PMC10503342 DOI: 10.1136/bmjopen-2022-071272] [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] [Received: 12/21/2022] [Accepted: 04/26/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Transition following discharge from mental health hospital is high risk in terms of relapse, readmission and suicide. Discharge planning supports transition and reduces risk. It is a complex activity involving interacting systemic elements. The codesigning a systemic discharge intervention for inpatient mental health settings (MINDS) study aims to improve the process for people being discharged, their carers/supporters and staff who work in mental health services, by understanding, co-designing and evaluating implementation of a systemic approach to discharge planning. METHODS AND ANALYSIS The MINDS study integrates realist research and an engineering-informed systems approach across three stages. Stage 1 applies realist review and evaluation using a systems approach to develop programme theories of discharge planning. Stage 2 uses an Engineering Better Care framework to codesign a novel systemic discharge intervention, which will be subjected to process and economic evaluation in stage 3. The programme theories and resulting care planning approach will be refined throughout the study ready for a future clinical trial. MINDS is co-led by an expert by experience, with researchers with lived experience co-leading each stage. ETHICS AND DISSEMINATION MINDS stage 1 has received ethical approval from Yorkshire & The Humber-Bradford Leeds (Research Ethics Committee (22/YH/0122). Findings from MINDS will be disseminated via high-impact journal publications and conference presentations, including those with service user and mental health professional audiences. We will establish routes to engage with public and service user communities and National Health Service professionals including blogs, podcasts and short videos. TRIAL REGISTRATION NUMBER MINDS is funded by the National Institute of Health Research (NIHR 133013) https://fundingawards.nihr.ac.uk/award/NIHR133013. The realist review protocol is registered on PROSPERO. PROSPERO REGISTRATION NUMBER CRD42021293255.
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Affiliation(s)
- Corinna Hackmann
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
| | - Alexander Komashie
- Department of Enginering, University of Cambridge School of Technology, Cambridge, UK
| | - Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jamie Murdoch
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Adam P Wagner
- NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lisa Marie Grünwald
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Sam Waller
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Chelmsford, UK
| | - Hannah Zeilig
- London College of Fashion, University of the Arts London, London, UK
| | - Julia Jones
- Centre for Research in Primary & Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Sophie Bagge
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
| | - Sonia Michelle Dalkin
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - John Clarkson
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | | | | | - Frank Rohricht
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Zohra Taousi
- Hertfordshire and Peterborough NHS Foundation Trust, St Albans, UK
| | - Catherine Haighton
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Jon Wilson
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
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13
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Fonseca Barbosa J, Gama Marques J. The revolving door phenomenon in severe psychiatric disorders: A systematic review. Int J Soc Psychiatry 2023; 69:1075-1089. [PMID: 37209104 PMCID: PMC10338701 DOI: 10.1177/00207640221143282] [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] [Indexed: 05/22/2023]
Abstract
BACKGROUND The treatment of psychiatric patients has suffered a major change over the last decades, with long-term hospitalizations being replaced by short-term stays and appropriate aftercare in outpatient services. Some chronically ill patients exhibit a pattern of multiple hospitalizations, designated as the Revolving Door (RD) phenomenon. AIMS This review aims to analyse the existing literature regarding sociodemographic, clinical and other factors associated with multiple hospitalizations in psychiatric facilities. METHOD The search performed in the PubMed database for the terms revolving[Title] AND (psyc*[Title] OR schizo*[Title] OR mental[Title]) presented 30 citations, 8 of which met the eligibility criteria. Four other studies found in references of these articles were also included in the review. RESULTS Albeit the use of different criteria to define the RD phenomenon, it is more likely to be associated with patients who are younger, single, with low educational level, unemployed, diagnosed with a psychotic disorder, particularly schizophrenia, and with alcohol and/or substance use. It is also associated with a younger age on disease onset, suicidality, noncompliance and voluntary type of admission. CONCLUSION Recognizing patients with a RD pattern of admissions and prediction of rehospitalization can help the development of preventive intervention strategies and identify potential limitations in existing health care delivery systems.
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Affiliation(s)
- Joana Fonseca Barbosa
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Portugal
- Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Portugal
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14
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Patel C, Pilon D, Morrison L, Holiday C, Lafeuille MH, Lefebvre P, Benson C. Continuity of care among patients newly initiated on second-generation oral or long-acting injectable antipsychotics during a schizophrenia-related inpatient stay. Curr Med Res Opin 2023; 39:1157-1166. [PMID: 37461233 DOI: 10.1080/03007995.2023.2237833] [Citation(s) in RCA: 1] [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: 03/09/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Maintaining continuity of care after schizophrenia-related hospitalization is challenging for patients and healthcare providers and systems. Prior evidence suggests that second-generation long-acting injectable antipsychotics (SGLAIs) may reduce the risk of treatment nonadherence and readmission versus oral atypical antipsychotics (OAAs). Therefore, quality measures were compared between patients initiated on SGLAIs and OAAs in the United States. METHODS Adults newly initiated on an SGLAI or OAA during a schizophrenia-related inpatient stay were identified in HealthVerity databases (01/2015-12/2020); the index date was the hospital discharge date. Patients had continuous health insurance coverage for pharmacy and medical services for 6 months pre-admission and post-discharge from the inpatient stay and ≥1 pharmacy or medical claim (i.e. treatment as indicated by the observed insurance claims) for an antipsychotic other than the index SGLAI or OAA in the 6 months pre-admission. Antipsychotic use and adherence, and schizophrenia-related readmissions and outpatient visits were compared during the 6-month period post-discharge. Characteristics between cohorts were balanced using inverse probability weights. RESULTS Post-discharge, only 36.9% and 40.7% of weighted SGLAI (N = 466) and OAA (N = 517) patients had ≥1 pharmacy or medical claim for the antipsychotic initiated during the inpatient stay, among whom SGLAI patients were 4.4 times more likely to be adherent to that antipsychotic compared to OAA patients (p < .001). Additionally, SGLAI patients were 2.3 and 3.0 times more likely to have a pharmacy or medical claim for and be adherent to any antipsychotic relative to OAA patients (including index antipsychotic; all p < .001). Within 7 and 30 days post-discharge, 1.7% and 13.0% of SGLAI patients and 4.1% and 12.6% of OAA patients had a readmission. Further, SGLAI patients were 51% more likely to have an outpatient visit compared to OAA patients (p = .044). CONCLUSIONS Less than half of patients initiated on antipsychotics during a schizophrenia-related inpatient stay continued the same treatment post-discharge. However, SGLAI patients were more likely to be adherent to the initiated antipsychotic and to have an outpatient visit, which may suggest improved continuity of care post-discharge relative to OAA patients.
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Affiliation(s)
- Charmi Patel
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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15
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Muhammad N, Talpur S, Sangroula N, Washdave F. Independent Predictors of 30-Day Readmission to Acute Psychiatric Wards in Patients With Mental Disorders: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e42490. [PMID: 37637588 PMCID: PMC10453981 DOI: 10.7759/cureus.42490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Psychiatric readmissions have long been considered significant indicators for healthcare planning. The aim of this study was to identify factors influencing early (30-day) readmissions to acute psychiatric wards. A meta-analysis and systematic review were conducted according to Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Comprehensive database searching was conducted using online databases, including PubMed and Google Scholar, to search for articles identifying factors associated with early (30-day) readmissions to acute psychiatric wards. Keywords used to search for relevant articles included "Mental illness," "readmission," and factors along with their synonyms and Medical Subject Headings (MeSH) terms. The search included studies published between 2011 and June 2023. A total of 13 studies were included in this meta-analysis. The pooled rate of the 30-day readmission was 16% (95% confidence interval: 13%-20%). A pooled analysis showed that factors significantly associated with an unplanned hospital readmission included gender, length of stay, and insurance status as predictors of the unplanned hospital readmission among individuals with psychiatric illness. Additionally, we also found that the rate of 30-day unplanned admissions was greater in patients with schizophrenia, followed by personality disorder, bipolar disorder, depression, and substance use. This study highlights the importance of providing targeted interventions and support for individuals with these conditions to reduce the risk of readmissions.
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Affiliation(s)
- Nazar Muhammad
- Psychiatry, Cornerstone Family Healthcare, Binghamton, USA
| | - Saifullah Talpur
- Psychiatry, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | - Fnu Washdave
- Psychiatry, Children's Home of Wyoming Conference, Binghamton, USA
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16
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Cappo D, Mutamba B, Ayesiga K, Kebirungi E, Chelangat D, Fegan G, Jacob ST, Nsangi E, Ntabazi I, Nalubwama D, Nakasujja N, Odoki E, Odoi P, Mpairwe I, Verity F. YouBelong Home: A Ugandan Community Mental Health Intervention. Community Ment Health J 2023; 59:770-783. [PMID: 36477688 PMCID: PMC9734846 DOI: 10.1007/s10597-022-01058-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
In Uganda, low resources for mental health provision combine with disadvantage and inadequate supports for family and community-based care. Catalysed by the need to reduce overcrowded psychiatric hospital wards and frequent readmissions at Butabika National Referral Mental Hospital (BNRMH) in Kampala, the nongovernment organisation YouBelong Uganda (YBU) developed the YouBelong Home (YBH) intervention. YBH is a theoretically eclectic pre and post hospital discharge intervention. This paper reports on qualitative findings of the project Curtailing Hospital Readmissions for Patients with Severe Mental Illness in Africa (CHaRISMA), which explored how to refine the YBH intervention. The project was funded by a UK Joint Global Health Trials (JGHT) Development Grant. Data was collected through structured interviews with service users and caregivers, reflective practice by the YBH implementing team and a stakeholder focus group. A summary of refinements to the YBH intervention follows the TIDieR format (Template for Intervention Description and Replication).
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Affiliation(s)
- D Cappo
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - B Mutamba
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - K Ayesiga
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - E Kebirungi
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - D Chelangat
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - G Fegan
- Faculty of Medicine, Health and Life Science, Swansea University, Singleton, SA28PP, Swansea, Wales, UK
| | - S T Jacob
- Liverpool School of Tropical Medicine, Pembroke Pl, L3 5QA, Liverpool, United Kingdom
- Walimu, Plot 5-7, Coral Crescent, Kololo, P.O. Box 9924, Kampala, Uganda
| | - E Nsangi
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - I Ntabazi
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - D Nalubwama
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - N Nakasujja
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - E Odoki
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - P Odoi
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - I Mpairwe
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - F Verity
- Faculty of Medicine, Health and Life Science, Swansea University, Singleton, SA28PP, Swansea, Wales, UK.
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17
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Tyler N, Angelakis I, Keers RN, Planner C, Hodkinson A, Giles SJ, Grundy A, Kapur N, Armitage C, Blakeman T, Campbell SM, Robinson C, Leather J, Panagioti M. Evaluating a co-designed care bundle to improve patient safety at discharge from adult and adolescent mental health services (SAFER-MH and SAFER-YMH): protocol for a non-randomised feasibility study. BMJ Open 2023; 13:e069216. [PMID: 37041053 PMCID: PMC10106061 DOI: 10.1136/bmjopen-2022-069216] [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] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Patients being discharged from inpatient mental wards often describe safety risks in terms of inadequate information sharing and involvement in discharge decisions. Through stakeholder engagement, we co-designed, developed and adapted two versions of a care bundle intervention, the SAFER Mental Health care bundle for adult and youth inpatient mental health settings (SAFER-MH and SAFER-YMH, respectively), that look to address these concerns through the introduction of new or improved processes of care. METHODS AND ANALYSIS Two uncontrolled before-and-after feasibility studies, where all participants will receive the intervention. We will examine the feasibility and acceptability of the SAFER-MH in inpatient mental health settings in patients aged 18 years or older who are being discharged and the feasibility and acceptability of the SAFER-YMH intervention in inpatient mental health settings in patients aged between 14 and 18 years who are being discharged. The baseline period and intervention periods are both 6 weeks. SAFER-MH will be implemented in three wards and SAFER-YMH in one or two wards, ideally across different trusts within England. We will use quantitative (eg, questionnaires, completion forms) and qualitative (eg, interviews, process evaluation) methods to assess the acceptability and feasibility of the two versions of the intervention. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients/wards should be included. ETHICS AND DISSEMINATION Ethical approval was obtained from the National Health Service Cornwall and Plymouth Research Ethics Committee and Surrey Research Ethics Committee (reference: 22/SW/0096 and 22/LO/0404). Research findings will be disseminated with participating sites and shared in various ways to engage different audiences. We will present findings at international and national conferences, and publish in open-access, peer-reviewed journals.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Ioannis Angelakis
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Richard Neil Keers
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety Research, University of Manchester, Manchester, UK
| | - Claire Planner
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | | | - Sally J Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Andrew Grundy
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Navneet Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - Chris Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Tom Blakeman
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Catherine Robinson
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Jessica Leather
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
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Profiles, correlates, and risk of death among patients with mental disorders hospitalized for psychiatric reasons. Psychiatry Res 2023; 321:115093. [PMID: 36764119 DOI: 10.1016/j.psychres.2023.115093] [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] [Received: 05/03/2022] [Revised: 09/19/2022] [Accepted: 02/03/2023] [Indexed: 02/07/2023]
Abstract
This study identified profiles of hospitalized patients with mental disorders (MD) based on their 3-year hospitalization patterns and clinical characteristics and compared sociodemographic profiles and other service use correlates as well as risk of death within 12 months after hospitalization. Quebec (Canada) medical administrative databases were used to investigate a 5-year cohort of 4,400 patients hospitalized for psychiatric reasons. Latent class analysis, chi-square tests and survival analysis were produced. Three profiles of hospitalized patients were identified based on hospitalization patterns and other patient characteristics. Profile 3 patients had multiple hospitalizations and early readmissions, worst health and social conditions, and used the most outpatient services. Profiles 2 and 1 patients had only one hospitalization, of brief duration in the case of Profile 2 patients, who had mainly common MD and made least use of psychiatric care. All Profile 1 patients were hospitalized for serious MD but received least continuity of physician care and fewest biopsychosocial interventions. Risk of death was higher for Profiles 3 and 2 versus Profile 1 patients. Interventions like early follow-up care after hospitalization for Profile 3, collaborative care between general practitioners and psychiatrists for Profile 2, and continuous biopsychosocial care for Profile 1 could be greatly improved.
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19
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Raluthaga N, Shilubane HN, Lowane MP. Relapse among MHCUs after a Short-Term Admission in an Acute Psychiatric Unit: Primary Caregivers' Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1384. [PMID: 36674139 PMCID: PMC9859106 DOI: 10.3390/ijerph20021384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
South Africa has taken initiative to strengthen its mental health system, by improving the Mental Health Care Act 17 of 2002 which proclaims that mental healthcare users (MHCUs) can be treated in communities and homes. Due to short-term hospitalisations for acute MHCUs and advocacy for community-based care, families play a significant role in providing care to severe mental healthcare users. The objective of the study was to explore primary caregivers' perspective regarding the relapse of MHCUs following a short-term admission in acute psychiatric units. A qualitative explorative design was used. In-depth individual interviews were conducted with 18 primary caregivers whose family members were readmitted to four hospitals with units designated for acute MHCUs in Limpopo. NVivo computer software version 11 was used to analyse data. The findings are that MHCUs deny the mental health condition. Mental illness is considered a short illness that can be cured, which shows misconceptions about self-mental health conditions. Refusal of direct observed treatment support also emerged; hence, it is difficult for caregivers to identify if the patient is taking the correct doses or not taking the medication at all. Perceived wrong beliefs about mental illness can affect the patient's desire to seek proper management and it can be damaging in many ways. Drugs and alcohol abuse makes MHCUs display disruptive behaviours and contribute to treatment non-adherence resulting in caregivers becoming reluctant to be around them. In conclusion, mixing traditional and faith-based mental healthcare practices as reported by primary caregivers can mean that tailor-fabricated culture-specific mental healthcare is required.
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Affiliation(s)
- Nelson Raluthaga
- Department of Advanced Nursing Science, University of Venda, Private Bag X5050, Thohoyandou 0950, South Africa
| | - Hilda N. Shilubane
- Department of Advanced Nursing Science, University of Venda, Private Bag X5050, Thohoyandou 0950, South Africa
| | - Mygirl Pearl Lowane
- Department of Public Health, Sefako Makgatho Health Sciences University, P.O. Box 215, Medunsa, Pretoria 0204, South Africa
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20
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Effectiveness of a Community-Based Crisis Resolution Team for Patients with Severe Mental Illness in Greece: A Prospective Observational Study. Community Ment Health J 2023; 59:14-24. [PMID: 35588027 PMCID: PMC9118182 DOI: 10.1007/s10597-022-00983-1] [Citation(s) in RCA: 1] [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: 01/18/2022] [Revised: 04/16/2022] [Accepted: 05/02/2022] [Indexed: 01/07/2023]
Abstract
This prospective observational study evaluated the effectiveness of a crisis resolution team (CRT) for outpatient treatment of psychiatric patients experiencing an acute episode of severe mental disorder. The effectiveness of the CRT (n = 65) was assessed against the care-as-usual [CAU group (n = 65)]. Patients' clinical state, overall functioning, quality of life and satisfaction were respectively evaluated at baseline, post intervention and three-month post-intervention.CRT patients compared to the CAU group, had significantly improved outcomes concerning clinical state and patient satisfaction at post intervention phase. Statistically significant improvement was also recorded for the dimensions of environment, physical and psychological health related to quality of life. No significant differences were observed between the two groups regarding overall functioning.On the basis of these results, reforming of existing crisis-management services, in Greece, using the CRT model may improve substantially the services offered to psychiatric patients.
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Ladhar S, Dahri K, Inglis C, Sambrielaz A, Raza H, Legal M. Insights into British Columbian Hospital Pharmacists Perspectives on the Discharge Process. Innov Pharm 2022; 13:10.24926/iip.v13i4.5093. [PMID: 37305597 PMCID: PMC10256297 DOI: 10.24926/iip.v13i4.5093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background: Transitions of care represent a vulnerable time for patients where unintended therapeutic changes are common and inadequate communication of information frequently results in medication errors. Pharmacists have a large impact on the success of patients during these care transitions; however, their role and experiences are largely absent from the literature. Objectives: The purpose of this study was to gain a greater understanding of British Columbian hospital pharmacists' perceptions of the hospital discharge process and their role in it. Methods: A qualitative study utilizing focus groups and key informant interviews of British Columbian hospital pharmacists was conducted from April to May 2021. Questions asked during interviews were developed following a detailed literature search and included questions regarding the use of frequently studied interventions. Interview sessions were transcribed and then thematically analyzed using both NVivo software and manual coding. Results: Three focus groups with a total of 20 participants and one key informant interview were conducted. Six themes were identified through data analysis: (1) overall perspectives; (2) important roles of pharmacists in discharges; (3) patient education; (4) barriers to optimal discharges; (5) solutions to current barriers; and (6) prioritization. Conclusions and Relevance: Pharmacists play a vital role in patient discharges but due to limited resources and inadequate staffing models, they are often unable to be optimally involved. Understanding the thoughts and perceptions of pharmacists on the discharge process can help us better allocate limited resources to ensure patients receive optimal care.
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Affiliation(s)
- Simroop Ladhar
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Karen Dahri
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
- Lower Mainland Pharmacy Services, Lower Mainland, BC
| | - Colleen Inglis
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
- Island Health, Courtenay, BC
| | - Amanda Sambrielaz
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Haider Raza
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Michael Legal
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
- Lower Mainland Pharmacy Services, Lower Mainland, BC
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22
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Tomás MAR, Rebelo MTDS. Everyday Life after the First Psychiatric Admission: A Portuguese Phenomenological Research. J Pers Med 2022; 12:1938. [PMID: 36422114 PMCID: PMC9692884 DOI: 10.3390/jpm12111938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 01/14/2024] Open
Abstract
Returning to daily life after psychiatric admission can be difficult and complex. We aimed to explore, describe and interpret the lived experience of returning to everyday life after the first psychiatric admission. We designed this research as a qualitative study, using van Manen's phenomenology of practice. We collected experiential material through phenomenological interviews with 12 participants, from 5 June 2018 to 18 December 2018. From the thematic and hermeneutic analysis, we captured seven themes: (1) (un)veiling the imprint within the self; (2) the haunting memories within the self; (3) from disconnection to the assimilation of the medicated body in the self; (4) from recognition to overcoming the fragility within the self; (5) the relationship with health professionals: from expectation to response; (6) the relationship with others: reformulating the bonds of alterity; (7) the relationship with the world: reconnecting as a sense of self. The results allow us to establish the phenomenon as a difficult, complex, demanding and lengthily transitional event that calls into question the person's stability and ability for well-being and more-being. Thus, implementing structured transitional interventions by health services seems crucial. Mental health specialist nurses can present a pivotal role in establishing a helping relationship with recovery-oriented goals, coordinating patients' transitional care, and assuring continuity of care sensitive to the person's subjective experiences, volitions, and resources.
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Affiliation(s)
- Margarida Alexandra Rodrigues Tomás
- Escola Superior de Saúde Atlântica, 2730-036 Barcarena, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal
| | - Maria Teresa dos Santos Rebelo
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal
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Fleury MJ, Gentil L, Grenier G, Rahme E. The Impact of 90-day Physician Follow-up Care on the Risk of Readmission Following a Psychiatric Hospitalization. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:1047-1059. [PMID: 36125690 DOI: 10.1007/s10488-022-01216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
AIMS This study measures the impact of 90-day physician follow-up care after psychiatric hospitalization among 3,311 adults and youth, with risk of subsequent readmission within six months. METHODS A 5-year investigation was conducted based on Quebec (Canada) medical administrative databases. Cox proportional-hazards regression was performed, with 90-day follow-up care as the main independent variable, controlling for various sociodemographic, clinical, and other service use variables. RESULTS Within the 90-day follow-up period after patient discharge, or in the first 30 days, receiving at least one consultation per month as opposed to no consultation was associated with a reduced risk of psychiatric readmission. Women showed an increased readmission risk compared to men, while those living in less materially deprived areas a decreased risk as opposed to more deprived areas. Patients hospitalized for suicide attempt or schizophrenia spectrum and other psychotic disorders, and those with co-occurring mental and substance-related disorders or chronic physical illnesses, especially illnesses high on the severity index, also presented a heightened risk of hospitalization. Patients hospitalized for personality disorders or receiving a high continuity of physician care showed a reduced risk of readmission. CONCLUSION This study demonstrates that follow-up care, if provided within the first 30 days of discharge or monthly during the 90-day follow-up period, decreased the risk of readmission, as did having a high continuity of physician care prior to and within the 90-day follow-up period. However, few patients in this study had received such high-quality care, indicating that the Quebec system needs to considerably improve its discharge planning processes.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, H3A 1A1, Montreal, QC, Canada. .,Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, H4H 1R3, Montreal, QC, Canada.
| | - Lia Gentil
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, H3A 1A1, Montreal, QC, Canada.,Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, H4H 1R3, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, H4H 1R3, Montreal, QC, Canada
| | - Elham Rahme
- Department of Medicine, McGill University, 1033 Pine Avenue West, H3A 1A1, Montreal, QC, Canada
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A Psychoeducational Support Group Intervention for People Who Have Attempted Suicide: An Open Trial with Promising Preliminary Findings. Community Ment Health J 2022; 58:1621-1629. [PMID: 35635551 PMCID: PMC9150625 DOI: 10.1007/s10597-022-00978-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/20/2022] [Indexed: 01/27/2023]
Abstract
Psychoeducational groups have been used to address many health needs. Yet, there are few such options available for people who have attempted suicide. This study presents preliminary findings from an open trial of Eclipse, an 8-week closed, psychoeducational group for people who have attempted suicide. It examined the effectiveness of the Eclipse program in reducing suicidal ideation, depressive symptoms, perceived burdensomeness and thwarted belongingness, and increasing resilience and help-seeking. Results showed statistically significant improvements in depressive symptoms, perceived burdensomeness, resilience and help-seeking from baseline (T1) to immediate post-test (T2), and in perceived burdensomeness from T1 to 1-month follow-up (T3). A pervasiveness analysis showed that over half of the participants reported improvements in key study outcomes, respectively, as a result of participating in the Eclipse group. Psychoeducational support groups could provide broad application for those who have previously attempted suicide in decreasing severity of suicidal thinking by reductions in depressive symptoms, burdensomeness, and thwarted belongingness.
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25
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Birtwell K, Planner C, Hodkinson A, Hall A, Giles S, Campbell S, Tyler N, Panagioti M, Daker-White G. Transitional Care Interventions for Older Residents of Long-term Care Facilities: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2210192. [PMID: 35507344 PMCID: PMC9069255 DOI: 10.1001/jamanetworkopen.2022.10192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Residents of long-term care facilities (LTCFs) experience high hospitalization rates, yet little is known about the effects of transitional care interventions for these residents. OBJECTIVE To assess the association of transitional care interventions with readmission rates and other outcomes for residents of LTCFs who are 65 years and older and LTCF staff and to explore factors that potentially mitigate the association. DATA SOURCES MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature were searched for English-language studies published until July 21, 2021. Associated qualitative studies were identified using aspects of the CLUSTER (citations, lead authors, unpublished materials, searched Google Scholar, tracked theories, ancestry search for early examples, and follow-up of related projects) methodology. STUDY SELECTION Controlled design studies evaluating transitional care interventions for residents of LTCFs 65 years and older were included. Records were independently screened by 2 reviewers; disagreements were resolved through discussion and involvement of a third reviewer. From 14 538 records identified, 15 quantitative and 4 qualitative studies met the eligibility criteria. DATA EXTRACTION AND SYNTHESIS The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data were extracted by one reviewer and checked by a second reviewer. Fixed-effect and random-effects models were used according to the number of studies reporting the outcomes of interest. MAIN OUTCOMES AND MEASURES The primary outcome consisted of 30-, 60-, and 90-day readmission rates (hospital and emergency department [ED]). Other outcomes included length of stay, functional independence (Barthel score), and quality of life. The I2 statistic was used to quantify heterogeneity. RESULTS Of 14 538 records identified from searches, 15 quantitative studies (totaling 32 722 participants or records) and 4 qualitative studies were included. People allocated to transitional care interventions were 1.7 times less likely to be readmitted to the hospital or ED compared with those in control groups (14 studies; odds ratio, 1.66 [95% CI, 1.18-2.35]; I2 = 81% [95% CI, 70%-88%]). Length of stay in the ED was significantly decreased for intervention groups (3 studies; standardized mean difference, -3.00 [95% CI, -3.61 to -2.39]; I2 = 99% [95% CI, 98%-99%]). There were no significant differences for other outcomes. Factors associated with outcomes included communication and referral processes between health care professionals. CONCLUSIONS AND RELEVANCE Emerging evidence suggests that transitional care interventions are associated with lower readmissions for residents of LTCFs 65 years and older. Despite this and with aging populations, investment in such interventions has been remarkably low across most countries.
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Affiliation(s)
- Kelly Birtwell
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Alex Hall
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Natasha Tyler
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Gavin Daker-White
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
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Shalaby R, Vuong W, Eboreime E, Surood S, Greenshaw AJ, Agyapong VIO. Patients' Expectations and Experiences With a Mental Health-Focused Supportive Text Messaging Program: Mixed Methods Evaluation. JMIR Form Res 2022; 6:e33438. [PMID: 35014972 PMCID: PMC8790698 DOI: 10.2196/33438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/07/2021] [Accepted: 11/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Web-based services are an economical and easily scalable means of support that uses existing technology. Text4Support is a supportive, complementary text messaging service that supports people with different mental health conditions after they are discharged from inpatient psychiatric care. OBJECTIVE In this study, we aim to assess user satisfaction with the Text4Support service to gain a better understanding of subscribers' experiences. METHODS This was a mixed methods study using secondary data from a pilot observational controlled trial. The trial included 181 patients discharged from acute psychiatric care and distributed into 4 randomized groups. Out of the 4 study groups in the initial study, 2 groups who received supportive text messages (89/181, 49.2% of patients), either alone or alongside a peer support worker, were included. Thematic and descriptive analyses were also performed. Differences in feedback based on sex at birth and primary diagnosis were determined using univariate analysis. The study was registered with ClinicalTrials.gov (trial registration number: NCT03404882). RESULTS Out of 89 participants, 36 (40%) completed the follow-up survey. The principal findings were that Text4Support was well perceived with a high satisfaction rate either regarding the feedback of the messages or their perceived impact. Meanwhile, there was no statistically significant difference between satisfactory items based on the subscriber's sex at birth or primary diagnosis. The patients' initial expectations were either neutral or positive in relation to the expected nature or the impact of the text messages received on their mental well-being. In addition, the subscribers were satisfied with the frequency of the messages, which were received once daily for 6 consecutive months. The participants recommended more personalized messages or mutual interaction with health care personnel. CONCLUSIONS Text4Support was generally well perceived by patients after hospital discharge, regardless of their sex at birth or mental health diagnosis. Further personalization and interactive platforms were recommended by participants that may need to be considered when designing similar future services.
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Affiliation(s)
- Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Wesley Vuong
- Addiction and Mental Health, Alberta Health services, Edmonton, AB, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Shireen Surood
- Addiction and Mental Health, Alberta Health services, Edmonton, AB, Canada
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Johansen KK, Marcussen J, Hansen JP, Hounsgaard L, Fluttert F. Early recognition method for patients with schizophrenia or bipolar disorder in community mental health care: Illness insight, self-management and control. J Clin Nurs 2021; 31:3535-3549. [PMID: 34935221 DOI: 10.1111/jocn.16181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVE To investigate how participating in the early recognition method treatment strategy affect illness insight and management, in patients with schizophrenia or bipolar disorder in community mental healthcare. BACKGROUND The current practice in mental healthcare focus on shared decision-making and self-managing capacity, but poor insight is a predictor of poor adherence and dropout. Engagement in illness management and recovery predict the treatment response. DESIGN Semi-structured interviews with a phenomenological-hermeneutic approach. METHODS We conducted 36 semi-structured interviews with 26 patients. The interviews were conducted before and after participating in the intervention using the early recognition method strategy. The analysis was based on Ricoeur's theory of interpretation: Naive reading, structural analysis, interpretation and discussion. The COREQ checklist was used as reporting guideline. RESULTS The experience of participating in treatment as usual and early recognition method revealed two main themes. The first theme 'patient care' describes how dialogue and collaboration increase awareness of the illness and how to gain control. The second theme 'insight and experience' describes how illness affects personality and self-image, and how insight entails control and self-confidence. CONCLUSION Managing life with severe mental illness is complex and challenging. However, the experience of guidance, support and collaboration between patient and nurse are essential to improve these circumstances. RELEVANCE TO CLINICAL PRACTICE A systematic approach to the patient' symptoms, as in the early recognition method strategy, enhances knowledge of the individual patient' symptoms, both for nurse and patient. A knowledge that is significant for meeting individual treatment needs. Therefore, applying this strategy is likely to enhance collaboration and improve treatment outcome.
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Affiliation(s)
- Kirsten Kjaer Johansen
- Mental Health Department Esbjerg, University Clinic Region of Southern Denmark, Esbjerg N, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark, Aarhus C, Denmark
| | - Jette Marcussen
- OPEN, Institute of Clinical Research, University of Southern Denmark, Aarhus C, Denmark.,Department of Nursing and Health Sciences, University of Greenland, Nuuk, Greenland.,Faculty of Nursing, Health Science Research Center, University College Lillebaelt, Svendborg, Denmark
| | - Jens Peter Hansen
- Mental Health Department Esbjerg, University Clinic Region of Southern Denmark, Esbjerg N, Denmark.,Faculty of Health Sciences, CPS/Institute of Regional Health Research, University of Southern Denmark, Aarhus C, Denmark
| | - Lise Hounsgaard
- OPEN, Institute of Clinical Research, University of Southern Denmark, Aarhus C, Denmark.,Faculty of Health Sciences, CPS/Institute of Regional Health Research, University of Southern Denmark, Aarhus C, Denmark
| | - Frans Fluttert
- Faculty of Health Sciences, CPS/Institute of Regional Health Research, University of Southern Denmark, Aarhus C, Denmark.,FPC Dr. S. Van Mesdag, Groningen, The Netherlands.,Molde University College & Oslo University Hospital, Molde, Norway
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28
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Nikbakht Nasrabadi A, Mardanian Dehkordi L, Taleghani F. Nurses’ Experiences of Transitional Care in Multiple Chronic Conditions. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/10848223211002166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transitional care is a designed plan to ensure the continuity of care received by patients as they transfer between different locations or levels of care. The aim of this paper is to explore nurses’ experiences of transitional care in multiple chronic conditions. A qualitative method with a conventional content analysis approach was utilized. The study was conducted at university hospitals in 2 big cities (Isfahan and Tehran) of Iran. This study is performed from November 2018 to December 2019 using deep, semi-structured, and face-to-face interviews which are focused on nurses’ experiences of transitional care. Data collection continued until saturation was reached. Finally, 15 nurses take part in this study. Data collection and data analysis were conducted concurrently. Data were analyzed using Graneheim and Lundman’s techniques. Two main themes providing a descriptive summary of the major elements of transitional care identified: “threat to patient safety” and “Care breakdown”. Findings showed an exclusive image of unsafe transitional care which was done unplanned without appropriate delegating care to family and threat patient safety. There is still a gap in the transition from hospital to home. Nursing managers can address this issue by creating a culture of teamwork, training competent nurses by continuum education, and more supervision of nursing care. Policymakers can ensure continuity of care by developing policies and programs about transitional care.
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Affiliation(s)
| | - Leila Mardanian Dehkordi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Taleghani
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Tyler N, Wright N, Gregoriou K, Waring J. Improving mental health care transitions through information capture during admission to inpatient mental health services: a quality improvement study. BMC Health Serv Res 2021; 21:1132. [PMID: 34674690 PMCID: PMC8529804 DOI: 10.1186/s12913-021-07136-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Many interventions aim to improve the transition from ward to community at the time of discharge, with varying success. Guidelines suggest that discharge planning should begin at admission, but in reality this is ideal rather than standard practice. We aimed to develop a novel information capture tool during admission that facilitates and accelerates discharge. Methods A quality improvement study to develop, implement and evaluate a novel tool that improves information capture upon admission to acute mental health wards within a single English National Health Service (NHS) trust. We developed the tool by synthesising existing evidence and working with multi-agency and multi-disciplinary professionals in two co-design workshops. During implementation the tool was piloted on three wards. Ethnographic observations (145 h) and interviews (45) were used to evaluate the implementation of the tool across the three wards. Thematic synthesis was used to consolidate the findings. Results The tool developed considerably as the process evolved. The finished product is a list of 10 information categories that should be captured from external agencies upon admission to hospital to facilitate discharge planning to community settings. Reported advantages of the tool were: (1) facilitating confidence in junior staff to legitimately question the suitability of a patient for an acute ward (2) collecting and storing essential information in a single accessible place that can be used throughout the care pathway and (3) collecting information from the services/agencies to which patients will eventually be discharged. Conclusions Improving the quality of information at admission has the potential to facilitate and accelerate discharge. The novel tool provides a framework for capturing this information that can be incorporated into existing information systems. However, the introduction of the tool exacerbated complex, fragile distributed team dynamics, highlighting the importance of sociocultural context in information flow transitional interventions within distributed teams. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07136-2.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom.
| | - Nicola Wright
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | | | - Justin Waring
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom.,Health Services Management Centre, University of Birmingham, Birmingham, United Kingdom
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30
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Daley A, Scobie B, Shorey J, Breece J, Oxley S. Predicting 30-Day Readmissions: Evidence From a Small Rural Psychiatric Hospital. J Psychiatr Pract 2021; 27:346-360. [PMID: 34529601 DOI: 10.1097/pra.0000000000000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To improve quality of care and patient outcomes, and to reduce costs, hospitals in the United States are trying to mitigate readmissions that are potentially avoidable. By identifying high-risk patients, hospitals may be able to proactively adapt treatment and discharge planning to reduce the likelihood of readmission. Our objective in this study was to derive and validate a predictive model of 30-day readmissions for a small rural psychiatric hospital in the northeast. However, this model can be adapted by other rural psychiatric hospitals-a context that has been understudied in the literature. Our sample consisted of 1912 adult inpatients (1281 in the derivation cohort and 631 in the validation cohort), who were admitted between August 1, 2014, and July 31, 2016. We used deidentified data from the hospital's electronic medical record, including physician orders and discharge summaries. These data were merged with community-level variables that reflected the availability of care in the patients' zip codes. We first considered the correlates of 30-day readmission in a regression framework. We found that the probability of readmission increased with the number of previous admissions (vs. no readmissions). Moreover, the probability of readmission was much higher for patients with a depressive disorder (vs. no depressive disorder), with another mood disorder (vs. no other mood disorder), and/or with a psychotic disorder (vs. no psychotic disorder). We used these associations to derive a predictive model, in which we used the regression coefficients to construct a score for each patient. We then estimated the predicted probability of 30-day readmission on the basis of that score. After validating the model, we discuss the implications for clinical practice and the limitations of our approach.
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Blasi PR, Mettert KD, Coleman K, Lewis C, Wagner E, Coghill MN, Dang T, Richards JE. Transitioning patients from outpatient mental health services to primary care: A rapid literature review. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211041294. [PMID: 37089993 PMCID: PMC9981893 DOI: 10.1177/26334895211041294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background A lack of access to mental health services is a critical barrier to obtaining evidence-based care. One strategy to improve access is to transition stable patients out of mental health specialty services and into primary care, thus opening availability for new patients and those with acute mental health needs. To support these transitions, organizations might explore a range of new practices and implementation strategies. Methods We conducted a rapid literature review to summarize descriptions from the research literature about practices for transitioning stable patients from outpatient mental health services to primary care, as well as implementation strategies to enhance the adoption and sustainment of these practices. We searched PsycINFO and Cumulated Index to Nursing and Allied Health Literature (CINAHL) for articles published between January 2000 and August 2019. For articles meeting inclusion criteria, we abstracted data on study characteristics, transition practices, and implementation strategies. Results We included 11 articles representing diverse study designs, settings, and health care organizations. Across these articles, we identified six categories of commonly described transition practices, with patient engagement appearing the most frequently (10 articles), followed by shared treatment planning (eight articles), assessment of recovery and stability, care coordination, follow up and support, and medication management (seven articles each). Less frequently, articles included descriptions of implementation strategies, with five articles describing efforts to train and educate stakeholders and four articles describing the use of evaluative and iterative strategies. Conclusions We identified descriptions of several common practices to help patients transition from mental health specialty services to primary care, but there are opportunities for an increased focus on implementation strategies to enhance the adoption and sustainment of these transition practices. More research is needed to better understand the effectiveness of specific transition interventions and the feasibility of deploying these interventions in heterogeneous health care settings.
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Affiliation(s)
- Paula R. Blasi
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kayne D. Mettert
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Katie Coleman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Cara Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Edward Wagner
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Tobias Dang
- Kaiser Permanente Washington, Renton, WA, USA
| | - Julie E. Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
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Shalaby R, Hrabok M, Spurvey P, Abou El-Magd RM, Knox M, Rude R, Vuong W, Surood S, Urichuk L, Snaterse M, Greenshaw AJ, Li XM, Agyapong VIO. Recovery Following Peer and Text Messaging Support After Discharge From Acute Psychiatric Care in Edmonton, Alberta: Controlled Observational Study. JMIR Form Res 2021; 5:e27137. [PMID: 34477565 PMCID: PMC8449293 DOI: 10.2196/27137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/08/2021] [Accepted: 06/14/2021] [Indexed: 12/25/2022] Open
Abstract
Background Peer support is an emotional, social, and practical help provided by nonprofessionals to assist others in sustaining health behaviors. Peer support is valued in recovery-oriented models of mental health and is becoming increasingly implemented at the organizational level. Text messaging is a relatively low-cost, high-impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users. Objective This study aims to evaluate the effectiveness of an innovative peer support system plus a supportive text messaging program on the recovery of discharged patients from acute psychiatric care. Methods This prospective, rater blinded, controlled observational study included 181 patients who were discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages only, peer support only, or peer support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale [RAS]) was completed at baseline, 6 weeks, 3 months, and 6 months. Descriptive analysis, one-way analysis of variance, and repeated measures multivariate analysis of covariance were used to examine the changes in the RAS among the study groups and over the follow-up time points. Results A total of 65 patients completed the assessments at each time point. For the overall sample, higher scores were found for the peer support plus text message condition compared with the text message only and treatment as usual condition on several scales (ie, willingness to ask for help and personal confidence and hope) and total score on the RAS, after 6 months of intervention. Conclusions Peer support plus supportive text messaging seems to result in improved recovery compared with other interventions. It may be advisable to incorporate the two interventions as part of routine practice for patients with psychiatric disorders upon hospital discharge.
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Affiliation(s)
- Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Marianne Hrabok
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pamela Spurvey
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB, Canada
| | | | - Michelle Knox
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB, Canada
| | - Rebecca Rude
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB, Canada
| | - Wesley Vuong
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB, Canada
| | - Shireen Surood
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB, Canada
| | - Liana Urichuk
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB, Canada
| | - Mark Snaterse
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB, Canada
| | | | - Xin-Min Li
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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Tyler N, Daker-White G, Grundy A, Quinlivan L, Armitage C, Campbell S, Panagioti M. Effects of the first COVID-19 lockdown on quality and safety in mental healthcare transitions in England. BJPsych Open 2021; 7:e156. [PMID: 34493959 PMCID: PMC8410739 DOI: 10.1192/bjo.2021.996] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic forced the rapid implementation of changes to practice in mental health services, in particular transitions of care. Care transitions pose a particular threat to patient safety. AIMS This study aimed to understand the perspectives of different stakeholders about the impact of temporary changes in practice and policy of mental health transitions as a result of coronavirus disease 2019 (COVID-19) on perceived healthcare quality and safety. METHOD Thirty-four participants were interviewed about quality and safety in mental health transitions during May and June 2020 (the end of the first UK national lockdown). Semi-structured remote interviews were conducted to generate in-depth information pertaining to various stakeholders (patients, carers, healthcare professionals and key informants). Results were analysed thematically. RESULTS The qualitative data highlighted six overarching themes in relation to practice changes: (a) technology-enabled communication; (b) discharge planning and readiness; (c) community support and follow-up; (d) admissions; (e) adapting to new policy and guidelines; (f) health worker safety and well-being. The COVID-19 pandemic exacerbated some quality and safety concerns such as tensions between teams, reduced support in the community and increased threshold for admissions. Also, several improvement interventions previously recommended in the literature, were implemented locally. DISCUSSION The practice of mental health transitions has transformed during the COVID-19 pandemic, affecting quality and safety. National policies concerning mental health transitions should concentrate on converting the mostly local and temporary positive changes into sustainable service quality improvements and applying systematic corrective policies to prevent exacerbations of previous quality and safety concerns.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Gavin Daker-White
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Andrew Grundy
- School of Health Science, University of Nottingham, UK
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; and Centre for Mental Health and Safety, University of Manchester, UK
| | - Chris Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Manchester Centre for Health Psychology, University of Manchester, UK; and Manchester Academic Health Science Centre, Manchester University Foundation Trust, UK
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
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Castelpietra G, Guadagno S, Pischiutta L, Tossut D, Maso E, Albert U, Balestrieri M. Are patients improving during and after a psychiatric hospitalisation? Continuity of care outcomes of compulsory and voluntary admissions to an Italian psychiatric ward. J Public Health Res 2021; 11. [PMID: 34355553 PMCID: PMC8847955 DOI: 10.4081/jphr.2021.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background: To compare the characteristics of compulsory admissions (CAs) and voluntary admissions (VAs) in a General Hospital Psychiatric Unit (GHPU), and to assess whether CA and VA patients’ outcomes improved during hospitalisation and followup in mental health services (MHS) based on community continuity of care. Design and methods: Observational longitudinal study comparing 19 CAs and 83 VAs consecutively admitted to GHPU of Udine, Italy, and followed-up for six-months by MHS. Five psychometric scales assessed psychosocial and clinical characteristics for each patient at admission (T0), discharge (T1) and follow-up (T2). Statistical analyses were performed using: multivariate logistic regression for comparing CA and VA; Friedman χ2 and Mann-Whitney tests for outcomes’ improvement. Results: Being hospitalised for a psychotic crisis was the most significant predictor of CA (OR = 5.07). An outcomes’ improvement was observed from T0 to T1 in almost all psychometric tests, while from T1 to T2 only for PSP-A (useful social activities), CGI-S (severity of illness) and CGI-EI (drug’s efficacy related to side effects). CA was associated to lower performances in all scales at T0, in GAF and CGI-S at T1, while no difference with VA was observed at T2. Conclusions: CA and VA patients improved to a same extent during hospitalisation and follow-up, particularly in relation to social functioning. This fosters the hypothesis that communitybased MHS using a longitudinal continuity of care model might achieve recovery in a long-term perspective. Future research may benefit by considering patients’ subjective experiences and assessing long-term improvement in those who received personcentred interventions. Significance for public health This study demonstrates that patients voluntarily or involuntarily admitted to an inpatient psychiatric service improve to a same extent during hospitalisation, and this improvement is maintained during a six-month follow-up by outpatient mental health services. Moreover, the greatest improvement after discharge from hospital is observed in social functioning. To our knowledge, this is also the first study analysing psychiatric patients’ outcomes in a longitudinal continuity of care model, allowing preliminary scientific evidences valuable for mental health policy. The study also shed a light on the hypothesis that a mental health system strongly community-based and applying a whole-system continuity of care approach might achieve recovery in a long-term perspective, particularly with regard to psychosocial outcomes in more severely-ill patients.
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Affiliation(s)
- Giulio Castelpietra
- Outpatient and Inpatient Care Service, Central Health Directorate, Friuli Venezia Giulia Region, Trieste.
| | - Silvia Guadagno
- Udine Nord Community Mental Health Centre, Mental Health Department, Friuli Centrale Healthcare Agency, Udine.
| | - Livia Pischiutta
- Department of Medicine, Surgery and Health Sciences, University of Trieste.
| | - Davide Tossut
- Welfare Area, Giuliano Isontina Healthcare Agency, Palmanova (UD).
| | - Elisa Maso
- Psychiatric Unit, Mental Health Department, Friuli Centrale Healthcare Agency, Udine.
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste.
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Petkari E, Kaselionyte J, Altun S, Giacco D. Involvement of informal carers in discharge planning and transition between hospital and community mental health care: A systematic review. J Psychiatr Ment Health Nurs 2021; 28:521-530. [PMID: 33053271 DOI: 10.1111/jpm.12701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Family members and friends (informal carers) are very important for providing support to people with mental health difficulties. When these carers are included to care planning patients seem to benefit, as they are less likely to relapse. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE There are three types of interventions including carers in the patients'transition 1) programmes that offer education in hospital; 2) programmes that involve carers in planning the patients discharge; and 3) programmes that involve carers in hospital care, discharge planning and also follow-up in the community. Interventions including carers that take place both in the hospital and the community have the clearest evidence for benefit on relapse reduction. WHAT ARE THE IMPLICATIONS FOR PRACTICE Comprehensive interventions have the best evidence for effectiveness but challenges in their implementation and resourcing should be considered. It might worth trying to identify and test simpler interventions focusing on discharge planning that can be used in busy services and require more limited resources whilst providing opportunities for the participation of carers. ABSTRACT INTRODUCTION: Involving informal carers (family and friends of patients) in mental health interventions can lead to positive clinical and psychosocial outcomes such as relapse prevention or treatment adherence. AIM/QUESTION To explore the evidence on the effectiveness of different models that involve carers in the transition between hospital and community mental health care. METHODS Five electronic databases (PsycINFO, CINAHL, MEDLINE, Embase and Scopus) and Grey literature (Open Grey and Grey Literature report) were systematically searched. The results were analysed using a narrative synthesis. RESULTS Fourteen papers were identified. They described twelve interventions that were categorized into three groups: 1) purely educational programmes in preparation of discharge; 2) programmes that involved carers in planning the transition from the mental health inpatient treatment to community mental health services; and 3) programmes that bridged into the aftercare involving carers in community follow-up. The most comprehensive interventions, i.e. those including psychoeducation, care planning and aftercare follow-up were better evaluated and showed a clearer benefit in improving long-term outcomes and, in particular, reduce re-hospitalization. IMPLICATIONS FOR PRACTICE Comprehensive interventions showed the clearest benefit in improving long-term clinical outcomes of patients. Future research should explore implementation, costs and cost-effectiveness, as comprehensive interventions delivered across different settings are likely to require wide-ranging organizational changes and significant resources.
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Affiliation(s)
- Eleni Petkari
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Mary University of London, London, UK
| | - Justina Kaselionyte
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Mary University of London, London, UK
| | | | - Domenico Giacco
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Mary University of London, London, UK.,Warwick Medical School, University of Warwick, Coventry, UK
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Kidd SA, Mutschler C, Lichtenstein S, Yan S, Virdee G, Blair F, Mihalakakos G, McKinney C, Collins A, Guimond T, George TP, Davidson L, Velligan D, Voineskos A. Randomized trial of a brief peer support intervention for individuals with schizophrenia transitioning from hospital to community. Schizophr Res 2021; 231:214-220. [PMID: 33895598 DOI: 10.1016/j.schres.2021.03.019] [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: 09/28/2020] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
This phase 2 randomized trial examined the outcomes of a brief, transitional, peer support intervention designed to address the poor outcomes that are common for individuals with schizophrenia spectrum illnesses in the period immediately following hospitalization. In the context of treatment-as-usual, participants were provided with a peer support intervention, 'the Welcome Basket,' in which participants received 1-2 sessions of peer support in the two weeks before discharge and met weekly for a month post-discharge. The study also piloted a brief version of this intervention with only one community session post-discharge with the same pre-discharge process. It was hypothesized that the full intervention would improve community transition outcomes, with community functioning (Multnomah Community Ability Scale) being the primary measure and secondary measures including symptomatology, community integration, personal recovery, quality of life, and social support. The examination of the brief intervention was exploratory. Measures were completed at baseline, 1-month post-discharge, and follow-up at 6 months. A total of 110 participants were randomized to one of three interventions, with outcome data obtained from 82 and follow-up from 74. While feasible, we did not find that the Welcome Basket intervention was superior to treatment as usual for any of our primary or secondary outcome measures. Future work is needed to determine whether a more extended intervention is required and whether specific subgroups of patients may benefit (e.g. those without access to immediate psychiatric care or those better able to engage with a peer).
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Affiliation(s)
- Sean A Kidd
- University of Toronto Department of Psychiatry, Canada.
| | | | | | - Sandra Yan
- Centre for Addiction and Mental Health, Canada.
| | | | | | | | | | | | | | | | | | - Dawn Velligan
- University of Texas at San Antonio, Department of Psychiatry, United States.
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Tyler N, Wright N, Panagioti M, Grundy A, Waring J. What does safety in mental healthcare transitions mean for service users and other stakeholder groups: An open-ended questionnaire study. Health Expect 2021; 24 Suppl 1:185-194. [PMID: 33471958 PMCID: PMC8137494 DOI: 10.1111/hex.13190] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Historically, safety mental health research has tended to focus on risks of homicide, suicide and deaths. Although wider safety issues are now recognized in regards to mental health services, the safety of mental health transitions, a key research and policy priority according to World Health Organisation, has not been explored. OBJECTIVE The purpose of this study was to investigate perceptions of safety in mental health transitions (hospital to community) amongst five stakeholder groups. DESIGN AND SETTING An online, international cross-sectional, open-ended questionnaire. PARTICIPANTS There were five stakeholder participant groups: service users; families/carers; mental health-care professionals; researchers; and end users of research. RESULTS Ninety-three participants from 12 different countries responded. Three overarching themes emerged: 'individual/clinical', 'systems/services' and 'human, behavioural and social' elements of safe mental health transitions. Whilst there was a great focus on clinical elements from researchers and healthcare professionals, service users and carers considered safety in terms of human, behavioural and social elements of transitional safety (ie loneliness, emotional readiness for discharge) and systems/services (ie inter-professional communication). DISCUSSION Safety in mental health-care transitions is perceived differently by service users and families compared to healthcare professionals and researchers. Traditional safety indicators for care transitions such as suicide, self-harm and risk of adverse drug events are raised as important. However, service users and families in particular have a much wider perception of transitions safety. CONCLUSION Future quality and safety research and policy should consider including a service user voice and consider integration of psychosocial elements in discharge interventions.
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Affiliation(s)
- Natasha Tyler
- Faculty of Biology, Medicine and HealthNIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC)University of ManchesterManchesterUK
| | - Nicola Wright
- School of Health SciencesUniversity of NottinghamNottinghamUK
| | - Maria Panagioti
- NIHR Greater Manchester Patients Safety Translational Research CentreUniversity of ManchesterManchesterUK
| | | | - Justin Waring
- Health Services Management CentreUniversity of BirminghamBirminghamUK
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Maki S, Nagai K, Ando S, Tamakoshi K. Structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia in Japan: A cross-sectional study. PLoS One 2021; 16:e0250771. [PMID: 33930056 PMCID: PMC8087037 DOI: 10.1371/journal.pone.0250771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 04/13/2021] [Indexed: 12/02/2022] Open
Abstract
Schizophrenia is a disorder characterized by psychotic relapses. Globally, about 15%-30% of patients with schizophrenia discharged from inpatient psychiatric admissions are readmitted within 90 days due to exacerbation of symptoms that leads to self-harm, harm to others, or self-neglect. The purpose of this study was to investigate the structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. A new questionnaire was developed to assess the extent to which respondents delivered in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. This study adopted a cross-sectional research design. The survey was conducted with the new questionnaires. The participants were registered nurses working in psychiatric wards. Item analyses and exploratory factor analyses were performed using the new questionnaires to investigate the structure of in-hospital nursing care leading to reduction in early readmission. Stepwise regression analyses were conducted to examine the factors predicting in-hospital nursing care leading to reduction in early readmission. Data were collected from 724 registered nurses in Japan. In-hospital nursing care leading to reduction in early readmission was found to consist of five factors: promoting cognitive functioning and self-care, identifying reasons for readmission, establishing cooperative systems within the community, sharing goals about community life, and creating restful spaces. In-hospital nursing care leading to reduction in early readmission was predicted by the following variables: the score on the nursing excellence scale in clinical practice, the score on therapeutic hold, and the participation of community care providers in pre-discharge conferences. Japanese psychiatric nurses provide nursing care based on these five factors leading to reduction in early readmission. Such nursing care would be facilitated by not only nurses' excellence but also nurses' environmental factors, especially the therapeutic climate of the ward and the participation of community care providers in pre-discharge conferences.
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Affiliation(s)
- Shigeyoshi Maki
- Department of Nursing, School of Nursing, Sugiyama Jogakuen University, Nagoya, Aichi, Japan
| | - Kuniyoshi Nagai
- Department of Nursing, School of Nursing, Nagoya University of Arts and Sciences, Nagoya, Aichi, Japan
| | - Shoko Ando
- Department of Nursing, Nagoya University Graduate School of Medicine (Health Sciences), Nagoya, Aichi, Japan
| | - Koji Tamakoshi
- Department of Nursing, Nagoya University Graduate School of Medicine (Health Sciences), Nagoya, Aichi, Japan
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Litsou K, Graham C, Ingham R. Women in Relationships and Their Pornography Use: A Systematic Review and Thematic Synthesis. JOURNAL OF SEX & MARITAL THERAPY 2021; 47:381-413. [PMID: 33627043 DOI: 10.1080/0092623x.2021.1885532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A systematic review and thematic synthesis were conducted on the motivations, purposes, and influence of pornography use among women who are in committed relationships. Pornography use was identified as having both positive and negative outcomes for women's sexual and relationship lives. Women watched pornography for diverse reasons: to feel sexually empowered, to enhance sexual arousal, and for masturbation purposes. Shared use of pornography with partners provided variety in sexual activities, could aid communication about sexual issues and helped improve intimacy. Pornography use can help some women feel sexually empowered, relaxed and better able to enjoy their sexual lives.
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Affiliation(s)
- Katerina Litsou
- Centre for Sexual Health Research, School of Psychology, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Cynthia Graham
- Centre for Sexual Health Research, School of Psychology, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Roger Ingham
- Centre for Sexual Health Research, School of Psychology, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
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Tyler N, Planner C, Byrne M, Blakeman T, Keers RN, Wright O, Pascall Jones P, Giles S, Keyworth C, Hodkinson A, Taylor CDJ, Armitage CJ, Campbell S, Panagioti M. Developing Best Practice Guidance for Discharge Planning Using the RAND/UCLA Appropriateness Method. Front Psychiatry 2021; 12:789418. [PMID: 34925112 PMCID: PMC8680088 DOI: 10.3389/fpsyt.2021.789418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Discharge from acute mental health inpatient units is often a vulnerable period for patients. Multiple professionals and agencies are involved and processes and procedures are not standardized, often resulting in communication delays and co-ordination failures. Early and appropriate discharge planning and standardization of procedures could make inpatient care safer. Aim: To inform the development of a multi-component best practice guidance for discharge planning (including the 6 component SAFER patient flow bundle) to support safer patient transition from mental health hospitals to the community. Methods: Using the RAND/UCLA Appropriateness method, a panel of 10 professional stakeholders (psychiatrists, psychiatric nurses, clinical psychologists, pharmacists, academics, and policy makers) rated evidence-based statements. Six hundred and sixty-eight statements corresponding to 10 potential components of discharge planning best practice were rated on a 9-point integer scale for clarity, appropriateness and feasibility (median ≥ 7-9) using an online questionnaire then remote online face-to-face meetings. Results: Five of the six "SAFER" patient flow bundle components were appropriate and feasible for inpatient mental health. One component, "Early Flow," was rated inappropriate as mental health settings require more flexibility. Overall, 285 statements were rated as appropriate and feasible. Forty-four statements were considered appropriate but not feasible to implement. Discussion: This consensus study has identified components of a best practice guidance/intervention for discharge planning for UK mental health settings. Although some components describe processes that already happen in everyday clinical interactions (i.e., review by a senior clinician), standardizing such processes could have important safety benefits alongside a tailored and timely approach to post-discharge care.
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Affiliation(s)
- Natasha Tyler
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Matthew Byrne
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Thomas Blakeman
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Richard N Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Oliver Wright
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, United Kingdom
| | - Paul Pascall Jones
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, United Kingdom
| | - Sally Giles
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Chris Keyworth
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Christopher D J Taylor
- Secondary Care Psychological Therapies Service, Pennine Care National Health Service (NHS) Foundation Trust, Bury, United Kingdom.,Division of Psychology and Mental Health, Manchester Academic Health Science Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Christopher J Armitage
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom.,University National Health Service (NHS) Foundation Trust Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,National Institute of Health Research (NIHR) Manchester Biomedical Research Council, Manchester, United Kingdom
| | - Stephen Campbell
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Hattangadi N, Kurdyak P, Solomon R, Soklaridis S. Goals of care or goals of life? A qualitative study of clinicians' and patients' experiences of hospital discharge using Patient-Oriented Discharge Summaries (PODS). BMC Health Serv Res 2020; 20:687. [PMID: 32709233 PMCID: PMC7379793 DOI: 10.1186/s12913-020-05541-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/14/2020] [Indexed: 11/15/2022] Open
Abstract
Background Recognizing the need for improved communication with patients at the point of hospital discharge, a group of clinicians, patients, and designers in Toronto, Canada collaborated to develop a standardized tool known as the Patient-Oriented Discharge Summary (PODS). Although quantitative results suggest PODS helps mitigate gaps in knowledge, a qualitative inquiry from the clinician and patient perspective of psychiatric hospital discharge using PODS has not been widely explored. Our aim was to explore clinicians’ and patients’ experiences with PODS. Methods We used a qualitative thematic analysis to explore clinicians’ (n = 10) and patients’ (n = 6) experiences with PODS. We used convenience sampling to identify and invite potential participants at the Center for Addiction and Mental Health in Toronto, Canada to participate in semi-structured interviews between February 2019 and September 2019. Data were analyzed using a thematic analysis approach to develop descriptive themes. Results Emerging themes from the data between clinicians and patients were both different and complementary. Clinicians described PODS using the concept of “goals of care.” They relayed their experiences with PODS as a discrete event and emphasized its role in meeting their “goals of care” for discharge planning. Patients provided more of a “goals of life” perspective on recovery. They characterized PODS as only one facet of their recovery journey and not necessarily as a discrete or memorable event. Patients focused on their outcomes post-discharge and situated their experiences with PODS through its relation to their overall recovery. Conclusions PODS was experienced differently by clinicians and patients. Clinicians experienced PODS as helpful in orienting them to the fulfillment of goals of care. Patients did not experience PODS as a particularly memorable intervention. Due to the information advantage that clinicians have about PODS, it is not surprising that clinicians and patients experienced the PODS differently. This study expanded our understanding of hospital discharge from clinicians and patients perspectives, and suggests that there are additional areas that need improvement.
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Affiliation(s)
- Nayantara Hattangadi
- Center for Addiction and Mental Health, 33 Russell Street, 2nd floor, room 2059, Toronto, ON, Canada
| | - Paul Kurdyak
- Center for Addiction and Mental Health, 33 Russell Street, 2nd floor, room 2059, Toronto, ON, Canada
| | - Rachel Solomon
- The Hospital for Sick Children, Toronto, ON, M5S 1S2, Canada
| | - Sophie Soklaridis
- Center for Addiction and Mental Health, 33 Russell Street, 2nd floor, room 2059, Toronto, ON, Canada.
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Tyler N, Wright N, Grundy A, Waring J. Developing a core outcome set for interventions to improve discharge from mental health inpatient services: a survey, Delphi and consensus meeting with key stakeholder groups. BMJ Open 2020; 10:e034215. [PMID: 32404388 PMCID: PMC7228512 DOI: 10.1136/bmjopen-2019-034215] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/25/2020] [Accepted: 04/02/2020] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To develop a core set of outcomes to be used in all future studies into discharge from acute mental health services to increase homogeneity of outcome reporting. DESIGN We used a cross-sectional online survey with qualitative responses to derive a comprehensive list of outcomes, followed by two online Delphi rounds and a face-to-face consensus meeting. SETTING The setting the core outcome set applies to is acute adult mental health. PARTICIPANTS Participants were recruited from five stakeholder groups: service users, families and carers, researchers, healthcare professionals and policymakers. INTERVENTIONS The core outcome set is intended for all interventions that aim to improve discharge from acute mental health services to the community. RESULTS Ninety-three participants in total completed the questionnaire, 69 in Delphi round 1 and 68 in round 2, with relatively even representation of groups. Eleven participants attended the consensus meeting. Service users, healthcare professionals, researchers, carers/families and end-users of research agreed on a four-item core outcome set: readmission, suicide completed, service user-reported psychological distress and quality of life. CONCLUSION Implementation of the core outcome set in future trials research will provide a framework to achieve standardisation, facilitate selection of outcome measures, allow between-study comparisons and ultimately enhance the relevance of trial or research findings to healthcare professionals, researchers, policymakers and service users.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Nicola Wright
- Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Andrew Grundy
- Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Justin Waring
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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Tyler N, Wright N, Grundy A, Gregoriou K, Campbell S, Waring J. Codesigning a Mental Health Discharge and Transitions of Care Intervention: A Modified Nominal Group Technique. Front Psychiatry 2020; 11:328. [PMID: 32372990 PMCID: PMC7186904 DOI: 10.3389/fpsyt.2020.00328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/01/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Discharge from acute mental health services has long been associated with mortality, risk, and related adverse outcomes for patients. Many of the interventions that currently aim to reduce adverse outcomes focus on a single group of healthcare professionals within a single healthcare setting. A recent systematic review highlights very few robust interventions that specifically aim to improve communication across services. However the importance of promoting interagency working and improving information flow between services is continually highlighted as a key priority. METHODS Using a novel codesign and experience based approach we worked with a multistakeholder group to develop possible solutions to reduce the adverse outcomes commonly associated with discharge from acute mental health services. This utilized a modified Nominal Group Technique and creative problem solving method to follow a four-stage process: Problem Identification, Solution Generation, Decision-Making, Prioritization and Implementation. Thirty-two healthcare professionals and an expert by lived experienced engaged with the process that took place over two stakeholder events. RESULTS Stakeholders at the first event identified and agreed upon 24 potential ideas to improve discharge from acute mental health services. These were refined at the second event to four elements of an interagency intervention: a multiagency 'Discharge Team' (with designated discharge coordinator), inclusive technology enabled team meetings, universal documentation and a patient generated discharge plan. CONCLUSION This is the first study to codesign an interagency mental health discharge intervention based around a discharge team. We developed a model for working that places a greater focus on a patient generated discharge plan, interagency working, and information flow. A pilot of the proposed intervention is now needed to test the feasibility and effectiveness in reducing adverse outcomes.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Nicola Wright
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Grundy
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | | | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom.,NIHR School for Primary Care Research, Manchester Academic Health Science Centre, School for Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, United Kingdom
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