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Chisholm A, Russolillo A, Carter M, Steinberg M, Lambert L, Knox A, Black A. Advancing evidence-based practice through the Knowledge Translation Challenge: Nurses' important roles in research, implementation science and practice change. J Adv Nurs 2024. [PMID: 39087775 DOI: 10.1111/jan.16362] [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: 12/01/2023] [Revised: 06/04/2024] [Accepted: 07/19/2024] [Indexed: 08/02/2024]
Abstract
AIM To describe a knowledge translation capacity-building initiative and illustrate the roles of nurses in practice change using an exemplar case study. DESIGN The report uses observational methods and reflection. METHODS The Knowledge Translation Challenge program involves a multi-component intervention across several sites. The advisory committee invited eligible teams to attend capacity-building workshops. Implementation plans were developed, and successful teams receive funding for a 2 year period. Evaluation involved collecting data on program uptake and impact on practice change. Data has been collected from five cohorts. The exemplar case study employed an action-research framework. RESULTS Four nurse-led teams have demonstrated successful implementation of their practice change. The case study on implementing a clinical toolkit for clozapine management further illustrates a thoughtful planning process, and implementation journey and learnings by a team of nurses. CONCLUSION The Knowledge Translation Challenge program empowers nurses to use implementation science practices to enhance the quality and effectiveness of healthcare services. Success of this initiative serves as a model for addressing the persistent gap between knowledge and practice in clinical settings and the value of activating nurses to help close this gap. IMPLICATIONS As the most trusted and numerous profession, it is vital that nurses contribute to efforts to translate research evidence into clinical practice. The Knowledge Translation Challenge program supports nurses to lead practice change. IMPACT The Knowledge Translation Challenge program successfully equips nurses and other health care providers with the knowledge, skills and resources to implement practice improvements which enhance the quality and effectiveness of healthcare services and nursing practice. PATIENT OR PUBLIC CONTRIBUTION The Knowledge Translation Challenge advisory committee has three patient-public partners that support teams to develop a patient-oriented approach for their projects by providing feedback on the implementation plans. Each team was also supported to include patient-public partners on their project.
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Affiliation(s)
- Amanda Chisholm
- Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | | | | | - Marla Steinberg
- Evaluation & KT Consultant and Educator, Victoria, British Columbia, Canada
| | | | - Andrea Knox
- BC Cancer, Vancouver, British Columbia, Canada
| | - Agnes Black
- Providence Health Care, Vancouver, British Columbia, Canada
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Matias MA, Jacobs R, Aragón MJ, Fernandes L, Gutacker N, Siddiqi N, Kasteridis P. Assessing the uptake of incentivised physical health checks for people with serious mental illness: a cohort study in primary care. Br J Gen Pract 2024; 74:e449-e455. [PMID: 38914479 PMCID: PMC11221420 DOI: 10.3399/bjgp.2023.0532] [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: 10/16/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND People with serious mental illness are more likely to experience physical illnesses. The onset of many of these illnesses can be prevented if detected early. Physical health screening for people with serious mental illness is incentivised in primary care in England through the Quality and Outcomes Framework (QOF). GPs are paid to conduct annual physical health checks on patients with serious mental illness, including checks of body mass index (BMI), cholesterol, and alcohol consumption. AIM To assess the impact of removing and reintroducing QOF financial incentives on uptake of three physical health checks (BMI, cholesterol, and alcohol consumption) for patients with serious mental illness. DESIGN AND SETTING Cohort study using UK primary care data from the Clinical Practice Research Datalink between April 2011 and March 2020. METHOD A difference-in-difference analysis was employed to compare differences in the uptake of physical health checks before and after the intervention, accounting for relevant observed and unobserved confounders. RESULTS An immediate change was found in uptake after physical health checks were removed from, and after they were added back to, the QOF list. For BMI, cholesterol, and alcohol checks, the overall impact of removal was a reduction in uptake of 14.3, 6.8, and 11.9 percentage points, respectively. The reintroduction of BMI screening in the QOF increased the uptake by 10.2 percentage points. CONCLUSION This analysis supports the hypothesis that QOF incentives lead to better uptake of physical health checks.
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Affiliation(s)
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | - María José Aragón
- Centre for Health Economics, University of York, York, UK; HCD Economics, Las Palmas de Gran Canaria, Spain
| | - Luis Fernandes
- Centre for Health Economics, University of York, York, UK; Janssen Pharmaceutica NV, Beerse, Belgium
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK; Hull York Medical School, York, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
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Jønsson ABR, Martiny FHJ, Søndergaard MK, Brodersen JB, Due TD, Nielsen MH, Bakkedal C, Bardram JE, Bissenbakker K, Christensen I, Doherty K, Kjellberg P, Mercer SW, Reventlow S, Rozing MP, Møller A. Introducing extended consultations for patients with severe mental illness in general practice: Results from the SOFIA feasibility study. BMC PRIMARY CARE 2023; 24:206. [PMID: 37798651 PMCID: PMC10552249 DOI: 10.1186/s12875-023-02152-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/05/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND People with a severe mental illness (SMI) have shorter life expectancy and poorer quality of life compared to the general population. Most years lost are due to cardiovascular disease, respiratory disease, and various types of cancer. We co-designed an intervention to mitigate this health problem with key stakeholders in the area, which centred on an extended consultations for people with SMI in general practice. This study aimed to1) investigate general practitioners' (GPs) experience of the feasibility of introducing extended consultations for patients with SMI, 2) assess the clinical content of extended consultations and how these were experienced by patients, and 3) investigate the feasibility of identification, eligibility screening, and recruitment of patients with SMI. METHODS The study was a one-armed feasibility study. We planned that seven general practices in northern Denmark would introduce extended consultations with their patients with SMI for 6 months. Patients with SMI were identified using practice medical records and screened for eligibility by the patients' GP. Data were collected using case report forms filled out by practice personnel and via qualitative methods, including observations of consultations, individual semi-structured interviews, a focus group with GPs, and informal conversations with patients and general practice staff. RESULTS Five general practices employing seven GPs participated in the study, which was terminated 3 ½ month ahead of schedule due to the COVID-19 pandemic. General practices attempted to contact 57 patients with SMI. Of these, 38 patients (67%) attended an extended consultation, which led to changes in the somatic health care plan for 82% of patients. Conduct of the extended consultations varied between GPs and diverged from the intended conduct. Nonetheless, GPs found the extended consultations feasible and, in most cases, beneficial for the patient group. In interviews, most patients recounted the extended consultation as beneficial. DISCUSSION Our findings suggest that it is feasible to introduce extended consultations for patients with SMI in general practice, which were also found to be well-suited for eliciting patients' values and preferences. Larger studies with a longer follow-up period could help to assess the long-term effects and the best implementation strategies of these consultations.
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Affiliation(s)
- A B R Jønsson
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Health and Society, Department of People and Technology, Roskilde University, Roskilde, Denmark
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - F H J Martiny
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
- Center for Social Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | - M K Søndergaard
- The Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
| | - J B Brodersen
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
- Primary Health Care, Region Zealand, Denmark
| | - T D Due
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M H Nielsen
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C Bakkedal
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J E Bardram
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - K Bissenbakker
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - I Christensen
- The Danish Centre for Social Science Research, Copenhagen, Denmark
| | - K Doherty
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - P Kjellberg
- The Danish Centre for Social Science Research, Copenhagen, Denmark
| | - S W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Denmark
| | - S Reventlow
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M P Rozing
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Møller
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Bradley ER, Delaffon V. Diabetic retinopathy screening in persons with mental illness: a literature review. BMJ Open Ophthalmol 2020; 5:e000437. [PMID: 32885049 PMCID: PMC7451277 DOI: 10.1136/bmjophth-2020-000437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
People living with severe mental illness (SMI) have an increased risk of developing diabetes and are less likely to spontaneously report physical health concerns; they may therefore derive greater benefit from attending screening to prevent diabetic retinopathy. We conducted a literature review to consider the uptake of diabetic retinopathy screening (DRS) in people with mental illness. People with a diagnosis of SMI and those with self-reported mental ill-health have reduced attendance at DRS, within the context of poorer compliance with general diabetic care. Anxiety and depression were noted as barriers in attending DRS. People living with SMI require additional support to benefit from preventative health programmes such as DRS. Further research could support a better understanding of barriers to attendance, allowing effective support systems to be developed.
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Affiliation(s)
- Elinor Rhian Bradley
- Ashford Community Mental Health Trust, Kent and Medway NHS and Social Care Partnership Trust, Ashford, UK
| | - Vijay Delaffon
- Willow Suite, Kent and Medway NHS and Social Care Partnership Trust, Dartford, UK
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Jacobs R, Aylott L, Dare C, Doran T, Gilbody S, Goddard M, Gravelle H, Gutacker N, Kasteridis P, Kendrick T, Mason A, Rice N, Ride J, Siddiqi N, Williams R. The association between primary care quality and health-care use, costs and outcomes for people with serious mental illness: a retrospective observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background
Serious mental illness, including schizophrenia, bipolar disorder and other psychoses, is linked with high disease burden, poor outcomes, high treatment costs and lower life expectancy. In the UK, most people with serious mental illness are treated in primary care by general practitioners, who are financially incentivised to meet quality targets for patients with chronic conditions, including serious mental illness, under the Quality and Outcomes Framework. The Quality and Outcomes Framework, however, omits important aspects of quality.
Objectives
We examined whether or not better quality of primary care for people with serious mental illness improved a range of outcomes.
Design and setting
We used administrative data from English primary care practices that contribute to the Clinical Practice Research Datalink GOLD database, linked to Hospital Episode Statistics, accident and emergency attendances, Office for National Statistics mortality data and community mental health records in the Mental Health Minimum Data Set. We used survival analysis to estimate whether or not selected quality indicators affect the time until patients experience an outcome.
Participants
Four cohorts of people with serious mental illness, depending on the outcomes examined and inclusion criteria.
Interventions
Quality of care was measured with (1) Quality and Outcomes Framework indicators (care plans and annual physical reviews) and (2) non-Quality and Outcomes Framework indicators identified through a systematic review (antipsychotic polypharmacy and continuity of care provided by general practitioners).
Main outcome measures
Several outcomes were examined: emergency admissions for serious mental illness and ambulatory care sensitive conditions; all unplanned admissions; accident and emergency attendances; mortality; re-entry into specialist mental health services; and costs attributed to primary, secondary and community mental health care.
Results
Care plans were associated with lower risk of accident and emergency attendance (hazard ratio 0.74, 95% confidence interval 0.69 to 0.80), serious mental illness admission (hazard ratio 0.67, 95% confidence interval 0.59 to 0.75), ambulatory care sensitive condition admission (hazard ratio 0.73, 95% confidence interval 0.64 to 0.83), and lower overall health-care (£53), primary care (£9), hospital (£26) and mental health-care costs (£12). Annual reviews were associated with reduced risk of accident and emergency attendance (hazard ratio 0.80, 95% confidence interval 0.76 to 0.85), serious mental illness admission (hazard ratio 0.75, 95% confidence interval 0.67 to 0.84), ambulatory care sensitive condition admission (hazard ratio 0.76, 95% confidence interval 0.67 to 0.87), and lower overall health-care (£34), primary care (£9) and mental health-care costs (£30). Higher general practitioner continuity was associated with lower risk of accident and emergency presentation (hazard ratio 0.89, 95% confidence interval 0.83 to 0.97) and ambulatory care sensitive condition admission (hazard ratio 0.77, 95% confidence interval 0.65 to 0.92), but not with serious mental illness admission. High continuity was associated with lower primary care costs (£3). Antipsychotic polypharmacy was not statistically significantly associated with the risk of unplanned admission, death or accident and emergency presentation. None of the quality measures was statistically significantly associated with risk of re-entry into specialist mental health care.
Limitations
There is risk of bias from unobserved factors. To mitigate this, we controlled for observed patient characteristics at baseline and adjusted for the influence of time-invariant unobserved patient differences.
Conclusions
Better performance on Quality and Outcomes Framework measures and continuity of care are associated with better outcomes and lower resource utilisation, and could generate moderate cost savings.
Future work
Future research should examine the impact of primary care quality on measures that capture broader aspects of health and functioning.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | - Lauren Aylott
- Expert by experience
- Hull York Medical School, York, UK
| | | | | | - Simon Gilbody
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | | | - Tony Kendrick
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Anne Mason
- Centre for Health Economics, University of York, York, UK
| | - Nigel Rice
- Centre for Health Economics, University of York, York, UK
| | - Jemimah Ride
- Centre for Health Economics, University of York, York, UK
| | - Najma Siddiqi
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Rachael Williams
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
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Travers JL, Le C, Desai MM, Merrill JA. Factors Associated with Dissatisfaction in Medical Care Quality among Older Medicare Beneficiaries Suffering from Mental Illness. J Aging Soc Policy 2019; 33:51-66. [DOI: 10.1080/08959420.2019.1628624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jasmine L. Travers
- Postdoctoral Fellow, National Clinician Scholars Program, Yale Schools of Medicine and Nursing, New Haven, Connecticut, USA
| | - Cindy Le
- MPH Candidate, Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
| | - Mayur M. Desai
- Associate Professor of Epidemiology, Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jacqueline A. Merrill
- Professor of Nursing,Department of Biomedical Informatics at Columbia University Medical Center, Columbia University School of Nursing, New York, New York, USA
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Jayatilleke N, Hayes RD, Chang CK, Stewart R. Acute general hospital admissions in people with serious mental illness. Psychol Med 2018; 48:2676-2683. [PMID: 29486806 PMCID: PMC6236443 DOI: 10.1017/s0033291718000284] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 01/19/2018] [Accepted: 01/23/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Serious mental illness (SMI, including schizophrenia, schizoaffective disorder, and bipolar disorder) is associated with worse general health. However, admissions to general hospitals have received little investigation. We sought to delineate frequencies of and causes for non-psychiatric hospital admissions in SMI and compare with the general population in the same area. METHODS Records of 18 380 individuals with SMI aged ⩾20 years in southeast London were linked to hospitalisation data. Age- and gender-standardised admission ratios (SARs) were calculated by primary discharge diagnoses in the 10th edition of the World Health Organization International Classification of Diseases (ICD-10) codes, referencing geographic catchment data. RESULTS Commonest discharge diagnosis categories in the SMI cohort were urinary conditions, digestive conditions, unclassified symptoms, neoplasms, and respiratory conditions. SARs were raised for most major categories, except neoplasms for a significantly lower risk. Hospitalisation risks were specifically higher for poisoning and external causes, injury, endocrine/metabolic conditions, haematological, neurological, dermatological, infectious and non-specific ('Z-code') causes. The five commonest specific ICD-10 diagnoses at discharge were 'chronic renal failure' (N18), a non-specific code (Z04), 'dental caries' (K02), 'other disorders of the urinary system' (N39), and 'pain in throat and chest' (R07), all of which were higher than expected (SARs ranging 1.57-6.66). CONCLUSION A range of reasons for non-psychiatric hospitalisation in SMI is apparent, with self-harm, self-neglect and/or reduced healthcare access, and medically unexplained symptoms as potential underlying explanations.
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Affiliation(s)
| | - Richard D. Hayes
- King's College London (Institute of Psychiatry, Psychology, and Neuroscience), UK
- Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Health and Welfare, University of Taipei, Taipei City, Taiwan
| | - Robert Stewart
- King's College London (Institute of Psychiatry, Psychology, and Neuroscience), UK
- Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London, UK
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Identifying primary care quality indicators for people with serious mental illness: a systematic review. Br J Gen Pract 2017; 67:e519-e530. [PMID: 28673958 PMCID: PMC5519123 DOI: 10.3399/bjgp17x691721] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/08/2017] [Indexed: 01/24/2023] Open
Abstract
Background Serious mental illness (SMI) — which comprises long-term conditions such as schizophrenia, bipolar disorder, and other psychoses — has enormous costs for patients and society. In many countries, people with SMI are treated solely in primary care, and have particular needs for physical care. Aim The objective of this study was to systematically review the literature to create a list of quality indicators relevant to patients with SMI that could be captured using routine data, and which could be used to monitor or incentivise better-quality primary care. Design and setting A systematic literature review, combined with a search of quality indicator databases and guidelines. Method The authors assessed whether indicators could be measured from routine data and the quality of the evidence. Results Out of 1847 papers and quality indicator databases identified, 27 were included, from which 59 quality indicators were identified, covering six domains. Of the 59 indicators, 52 could be assessed using routine data. The evidence base underpinning these indicators was relatively weak, and was primarily based on expert opinion rather than trial evidence. Conclusion With appropriate adaptation for different contexts, and in line with the relative responsibilities of primary and secondary care, use of the quality indicators has the potential to improve care and to improve the physical and mental health of people with SMI. However, before the indicators can be used to monitor or incentivise primary care quality, more robust links need to be established, with improved patient outcomes.
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The effect of context in rural mental health care: Understanding integrated services in a small town. Health Place 2017; 45:70-76. [PMID: 28288445 DOI: 10.1016/j.healthplace.2017.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/05/2017] [Accepted: 03/05/2017] [Indexed: 11/20/2022]
Abstract
Unequal health care outcomes for those with mental illness mean that access to integrated models is critical to supporting good physical and mental health care. This is especially so in rural areas where geographic and structural issues constrain the provision of health services. Guided by a conceptual framework about rural and remote health, this study draws on interviews with health providers and other staff and examines the dynamics of integrated primary and community-based specialist care for people with severe and persistent mental illnesses living in rural Australia. Findings show that the facilitation of sustainable linkages between general practice and community mental health requires the skilful exercise of power, knowledge, and resources by partners in order to address the social and structural factors that influence local health situations. These findings suggest that incremental processes of integration that are responsive to patients' and stakeholders' needs and that build on success and increased trust may be more effective than those imposed from the 'top down' that pay insufficient attention to local contexts.
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Patterson S, Freshwater K, Goulter N, Ewing J, Leamon B, Choudhary A, Moudgil V, Emmerson B. Psychiatrists' follow-up of identified metabolic risk: a mixed-method analysis of outcomes and influences on practice. BJPsych Bull 2016; 40:249-255. [PMID: 27752343 PMCID: PMC5046783 DOI: 10.1192/pb.bp.114.049379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aims and method To describe and explain psychiatrists' responses to metabolic abnormalities identified during screening. We carried out an audit of clinical records to assess rates of monitoring and follow-up practice. Semi-structured interviews with 36 psychiatrists followed by descriptive and thematic analyses were conducted. Results Metabolic abnormalities were identified in 76% of eligible patients screened. Follow-up, recorded for 59%, was variable but more likely with four or more abnormalities. Psychiatrists endorse guidelines but ambivalence about responsibility, professional norms, resource constraints and skills deficits as well as patient factors influences practice. Therapeutic optimism and desire to be a 'good doctor' supported comprehensive follow-up. Clinical implications Psychiatrists are willing to attend to physical healthcare, and obstacles to recommended practice are surmountable. Psychiatrists seek consensus among stakeholders about responsibilities and a systemic approach addressing the social determinants of health inequities. Understanding patients' expectations is critical to promoting best practice.
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Affiliation(s)
- Sue Patterson
- Metro North Mental Health, Queensland, Australia; Griffith University, Queensland, Australia
| | | | - Nicole Goulter
- Queensland University of Technology, Queensland, Australia
| | - Julie Ewing
- Metro North Mental Health, Queensland, Australia
| | - Boyd Leamon
- Metro North Mental Health, Queensland, Australia
| | | | | | - Brett Emmerson
- Metro North Mental Health, Queensland, Australia; The University of Queensland, Australia
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Medical-Surgical Nurses' Perceptions of Psychiatric Patients: A Review of the Literature With Clinical and Practice Applications. Arch Psychiatr Nurs 2016; 30:262-70. [PMID: 26992881 DOI: 10.1016/j.apnu.2015.06.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 06/28/2015] [Indexed: 11/21/2022]
Abstract
The literature consistently shows that medical-surgical nurses frequently lack the knowledge, skills, and attitudes necessary to render holistic nursing care to patients with severe mental illness (SMI). The negative perceptions often portrayed by medical-surgical nurses towards SMI patients with comorbid medical-surgical disorders must be addressed in order to ameliorate treatment gaps. Current concepts, issues, and challenges associated with the perceptions of nurses who care for patients with (SMI) in medical-surgical settings can prove overwhelming to both nurses and patients, and can result in concerning practice gaps. In accordance with a contemporary model of patient-centered care, it is imperative that medical-surgical nurses acquire the knowledge, skills, and attitudes necessary to work with this high-risk population. Cultivating an environment that promotes apposite attitudes along with effective training programs for medical-surgical nurses, may shift negative perceptions and ultimately meet best practice standards and improve outcomes for patients with SMI.
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