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Tops L, Coteur K, Vermandere M. Defining Vision and Mission of a Medical Psychiatry Unit (MPU) for Older Adults: A Focus Group Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241236038. [PMID: 38465594 PMCID: PMC10929058 DOI: 10.1177/00469580241236038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/12/2024] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Abstract
This study aims to determine the vision and mission of an academic hospital's medical psychiatry unit (MPU) that exclusively treats geriatric patients. All healthcare providers working at an academic hospital's geriatric MPU were invited to reflect on formulate the vision and mission of this ward. Twenty-two of them took part in the focus group interviews. The interviews focused on defining the MPU's functioning, its objectives, how it will reach these objectives, and where the MPU aspires to go. The interviews were transcribed verbatim and analyzed according to the QUAGOL guide. The themes from the analysis emerged from these group discussions. The participants defined the MPU's vision as to excel in integrated mental and physical geriatric inpatient healthcare, inspiring others to shed the stigma related to this vulnerable patient population. The mission that emerged from the focus group discussions is to provide patient-centered, integrated healthcare for older adults with combined mental and physical disorders. To achieve this, involving the patient's network, interdisciplinarity, shared decision-making, clear communication between all stakeholders, and reintegration of patients into their communities emerged as important themes. This study provides a vision and mission of a geriatric MPU in an academic psychiatric hospital. Since there is no consensus in the literature about the characteristics of MPUs despite the international call for integrated care for older persons with combined mental and physical disorders, these vision and mission statements can feed the discussion on how to install excellent healthcare for this vulnerable patient population.
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Affiliation(s)
- Laura Tops
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Kristien Coteur
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Mieke Vermandere
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
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Zipp JS, Mete M, Miller KE, Knauff AE, Beaty DL, Kverno KS, Shaya EK. Assessment of a Unit-Level Acuity Tool in Inpatient Psychiatry. J Psychosoc Nurs Ment Health Serv 2024; 62:13-18. [PMID: 37379120 DOI: 10.3928/02793695-20230623-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Assessing acuity is deemed essential to staffing in intensive care nursing; however, it has not received sufficient attention in inpatient psychiatry, where acuity can fluctuate greatly within shifts. Staffing and admission decisions rely on the accuracy of this information. The current mixed methods study surveyed nurses from two hospitals within the same hospital system: one using an acuity tool and one naïve to acuity tools. The survey was followed by a focus group on the specific factors influencing acuity and nurses' assessment of needs. Results suggest that the current tool is not satisfactory for nurses who use it to help with staffing or admission decisions and it is not user-friendly. Most nurses from both hospitals indicated they would prefer an electronic version with automated features reflecting up-to-date patient and unit acuity that would assist in interprofessional collaborative admissions decisions and staffing. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 13-18.].
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Rocliffe P, O’ Keeffe BT, Sherwin I, Mannix-McNamara P, MacDonncha C. School-based physical education, physical activity and sports provision: A concept mapping framework for evaluation. PLoS One 2023; 18:e0287505. [PMID: 37352181 PMCID: PMC10289340 DOI: 10.1371/journal.pone.0287505] [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: 05/28/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE Physical education, physical activity and sports provision are important factors in whole school health promotion, however, a standardised evaluation framework to evaluate the contribution of these components is lacking. A framework that accounts for the distinct structures and associated factors, that impact upon provision would facilitate a more coherent evaluation. METHODS A concept mapping methodology, involving the generation of factors relevant to school physical education, physical activity and sports provision and their subsequent thematic and numeric rating and sorting was utilised. Concept mapping effectively gathers, integrates, and visually and numerically represents the composite thinking of a group of relevant and expert stakeholders around a complex social phenomenon. Following a review of the extant literature and synthesis among 20 expert stakeholders, a list of 95 factor statements relevant to school physical education, physical activity and sports provision were developed. RESULTS Each factor statement was rated and sorted by 197 multi-disciplinary participants. An eight-cluster framework that demonstrated good validity (stress value: 0.266), was derived from the data based on: 1. Partnerships and Pupil Centered Physical Education; 2. Physical Activity and Sports; 3. School Demographics; 4. Equipment, Facilities and Budget; 5. Extra Costs; 6. Curriculum and Policy; 7. School Management and 8. Timetable. Statements within the cluster on school management received the highest mean importance and modifiability ratings while statements within the cluster on school demographics received the lowest mean importance and modifiability ratings. CONCLUSIONS Eight overarching structures which account for school physical education, physical activity and sports provision have been identified. Within each of these, structures and overall factors of greatest importance and modifiability have been illuminated. Findings stemming from this rigorous methodology, provide the foundation for the development of a national provision evaluation index to inform both school-level and national policy and actions. It is recommended the current methodology is replicated in other nations to gain corresponding insights.
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Affiliation(s)
- Padraic Rocliffe
- Department of Physical Education and Sports Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Brendan T. O’ Keeffe
- Department of Physical Education and Sports Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ian Sherwin
- Department of Physical Education and Sports Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Ciaran MacDonncha
- Department of Physical Education and Sports Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
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Köbler P, Krauss-Köstler EK, Stein B, Ficker JH, Wilhelm M, Dechêne A, Waller C. Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units-A Pilot Study. Front Public Health 2022; 10:844874. [PMID: 35493384 PMCID: PMC9039260 DOI: 10.3389/fpubh.2022.844874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Specialized biopsychosocial care concepts are necessary to overcome the dualism between physical and psychosocial treatment in acute care hospitals. For patients with complex and chronic comorbid physical and mental health problems, neither standardized psychiatric/psychosomatic nor somatic care units alone are appropriate to their needs. The “Nuremberg Integrated Psychosomatic Acute Unit” (NIPA) has been developed to integrate treatment of both, psychosocial and physical impairments, in an acute somatic care setting. Method NIPA has been established in inpatient internal medical wards for respiratory medicine, oncology and gastroenterology. One to two patients per ward are regularly enrolled in the NIPA treatment while remaining in the same inpatient bed after completion of the somatic care. In a naturalistic study design, we evaluated treatment effects by assessment of symptom load at admission and at discharge using the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder Scale-7 (GAD-7). Furthermore, we assessed the severity of morbidity using diagnosis data during treatment. At discharge, we measured satisfaction with treatment through the Patient Satisfaction Questionnaire (ZUF-8). Results Data from 41 NIPA patients were analyzed (18–87 years, 76% female). Seventy-eight percent suffered from at least moderate depression and 49% from anxiety disorders. Other diagnoses were somatoform pain disorder, somatoform autonomic dysfunction, eating disorder and posttraumatic stress disorder. Hypertension, chronic lung diseases and musculoskeletal disorders as well as chronic oncological and cardiac diseases were the most common somatic comorbidities. Treatment resulted in a significant reduction of depressive mood (admission: M = 10.9, SD = 6.1, discharge: M = 7.6, SD = 5.3, d = 0.58, p = 0.001), anxiety (admission: M = 10.6, SD = 4.9, discharge: M = 7.3, SD = 4.1, d = 0.65, p< 0.001) and stress (admission: M = 6.0, SD = 3.6, discharge: M = 4.1, SD = 2.5, d = 0.70, p< 0.001). Somatic symptom burden was reduced by NIPA treatment (admission: M = 10.9, SD = 5.8, discharge: M = 9.6, SD = 5.5, d = 0.30), albeit not statistically significant (p = 0.073) ZUF-8 revealed that 89% reported large or full satisfaction and 11% partial dissatisfaction with treatment. Discussion NIPA acute care is bridging the gap for patients in need of psychosocial treatment with complex somatic comorbidity. Further long-term evaluation will show whether psychosocial NIPA care is able to reduce the course of physical illness and hospital costs by preventing hospitalization and short-term inpatient re-admissions.
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Affiliation(s)
- Paul Köbler
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Eva K Krauss-Köstler
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Joachim H Ficker
- Department of Internal Medicine 3, Respiratory Medicine, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Martin Wilhelm
- Department of Internal Medicine 5, Oncology/Hematology, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Alexander Dechêne
- Department of Internal Medicine 6, Gastroenterology, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
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van Schijndel MA, van Wijngaarden JDH, van de Klundert JJ. Organization and Outcomes of Integrated Inpatient Medical and Psychiatric Care Units: A Systematic Review. Psychiatr Serv 2022; 73:64-76. [PMID: 34407632 DOI: 10.1176/appi.ps.202000416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of this review was to assess the relationships among aims, designs, and outcomes of integrated inpatient medical and psychiatric care units (IMPUs) and gather the evidence base on the effectiveness of these units. METHODS Using online searches of Embase, Medline, Web of Science, PsycINFO, Scopus, CINAHL, Cochrane, and Google Scholar, the authors identified and reviewed literature describing the aims and outcomes of specific IMPU designs. RESULTS The search yielded 55 studies, in which the authors identified 39 IMPUs that focused on patients with mood, psychotic, somatic symptom, substance use, organic, and personality disorders and a broad array of medical diagnoses. Most units were psychiatric-medical units and had medium medical and psychiatric acuity capabilities. The studies reviewed provided little information on the cost-effectiveness of various IMPU designs. Although some comparative studies indicated reductions in hospital length of stay (LOS), these studies were generally of low quality and rarely reported other intended outcomes. CONCLUSIONS IMPUs may help shorten LOS. IMPUs should focus care on patients with complex conditions and high acuity to maximize health system value. Implementing compulsory admission facilities; qualified psychiatric, medical, and nursing staff involvement; and cross-disciplinary training may improve IMPUs' capacity to treat high-acuity patients. Future research should relate IMPU designs to intended outcomes.
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Affiliation(s)
- Maarten A van Schijndel
- Rijnstate Hospital, Arnhem, the Netherlands (van Schijndel); Erasmus MC, University Medical Center, Rotterdam, the Netherlands (van Schijndel); Erasmus School of Health Policy and Management, Rotterdam, the Netherlands (van Wijngaarden, van de Klundert); Prince Mohammed Bin Salman College of Business and Entrepreneurship, King Abdullah Economic City, Saudi Arabia (van de Klundert)
| | - Jeroen D H van Wijngaarden
- Rijnstate Hospital, Arnhem, the Netherlands (van Schijndel); Erasmus MC, University Medical Center, Rotterdam, the Netherlands (van Schijndel); Erasmus School of Health Policy and Management, Rotterdam, the Netherlands (van Wijngaarden, van de Klundert); Prince Mohammed Bin Salman College of Business and Entrepreneurship, King Abdullah Economic City, Saudi Arabia (van de Klundert)
| | - Joris J van de Klundert
- Rijnstate Hospital, Arnhem, the Netherlands (van Schijndel); Erasmus MC, University Medical Center, Rotterdam, the Netherlands (van Schijndel); Erasmus School of Health Policy and Management, Rotterdam, the Netherlands (van Wijngaarden, van de Klundert); Prince Mohammed Bin Salman College of Business and Entrepreneurship, King Abdullah Economic City, Saudi Arabia (van de Klundert)
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Valdés-Stauber J, Kendel U. The differences between referred and non-referred patients to a psychiatric consultation-liaison service in a general hospital. Int J Psychiatry Med 2021; 56:389-407. [PMID: 33327843 DOI: 10.1177/0091217420982102] [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: 11/16/2022]
Abstract
OBJECTIVE The primary aim of this study was to investigate whether there are clinical differences between patients who are referred or not referred for psychiatric consultation and liaison service. The secondary aim was to compare the perspectives of doctors, nurses and patients. METHODS This naturalistic, prospective and comparative study (N = 294) utilised a control sample of non-referrals (n = 177, consenting 81) and referrals (n = 177, consenting 49). The normality of the data was examined with the Shapiro-Wilk test; bivariate group comparisons were made using Mann-Whitney, Wilcoxon tests and bivariate regression analyses. Statistically adjusted group comparisons were performed with multivariate median regressions. RESULTS The sample presented limited representativeness. Referred patients were predominantly women, mostly living alone and not working. Compared to the non-referred patients, their disease episode and length of hospital stay were significantly longer, self-efficacy and quality of life lower and psychological stress was higher. For referred patients, there were no differences between the estimations of mental burden and the need for care among doctors, nurses and patients. Self-efficacy and appraisal of one's own burden were the best predictors of the extent of mental symptoms. DISCUSSION Patients in an admission ward for internal medicine referred to a psychiatric consultation-liaison service displayed a more adverse psychosocial profile and were more psychologically burdened than non-referred patients, but they are also relevantly subsyndromal burdened. Identifying and supporting burdened patients is an endeavour that requires collaborative care, especially in the transition to specialised mental health and to primary care.
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Affiliation(s)
- Juan Valdés-Stauber
- Department of Psychiatry and Psychotherapy I, Südwürttemberg's Center of Psychiatry, University of Ulm, Ulm, Germany
| | - Ulrich Kendel
- Department of Psychosomatics, Südwürttemberg's Center of Psychiatry, Friedrichshafen, Germany
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O'Cionnaith C, Wand APF, Peisah C. Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness. Clin Interv Aging 2021; 16:1315-1325. [PMID: 34285476 PMCID: PMC8285123 DOI: 10.2147/cia.s311773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this case series is to illustrate the complexity of considerations across health (physical and mental), ethical, human rights and practical domains when an older adult with chronic symptoms of mental illness refuses treatment for a serious medical comorbidity. A broad understanding of these considerations may assist health care professionals in navigating this challenging but common aspect of clinical practice. Case Presentation Three detailed case reports are described. Participants were older adults with an acute presentation of a chronic mental illness, admitted to a specialized older persons mental health inpatient unit (OPMHU) in an Australian metropolitan hospital. Significant comorbid medical issues were detected or arose during the admission and the patient refused the recommended medical intervention. Data extracted from patients' medical records were analyzed and synthesized into detailed case reports using descriptive techniques. Each patient was assessed as lacking capacity for healthcare and treatment consent and did not have relatives or friends to assist with supported decision-making. Multifaceted aspects of decision-making and management are highlighted. Conclusion There are multiple complex issues to consider when an older adult with chronic symptoms of mental illness refuses treatment for serious comorbid medical conditions. In addition to optimizing management of the underlying mental illness (which may be impairing capacity to make healthcare decisions), clinicians should adopt a role of advocacy for their patients in considering the potential impact of ageism and stigma on management plans and inequities in physical healthcare. Consultation with specialist medical teams should incorporate multifaceted considerations such as potentially inappropriate treatment and optimum setting of care. Equally important is reflective practice; considering whether treatment decisions may infringe upon human rights or cause trauma.
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Affiliation(s)
- Cathal O'Cionnaith
- Older Persons Mental Health Service, Jara Unit, Concord Centre for Mental Health, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Anne P F Wand
- Older Persons Mental Health Service, Jara Unit, Concord Centre for Mental Health, Concord Repatriation General Hospital, Concord, NSW, Australia.,Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Capacity Australia, Crows Nest, NSW, Australia
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Dawoodbhoy FM, Delaney J, Cecula P, Yu J, Peacock I, Tan J, Cox B. AI in patient flow: applications of artificial intelligence to improve patient flow in NHS acute mental health inpatient units. Heliyon 2021; 7:e06993. [PMID: 34036191 PMCID: PMC8134991 DOI: 10.1016/j.heliyon.2021.e06993] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Growing demand for mental health services, coupled with funding and resource limitations, creates an opportunity for novel technological solutions including artificial intelligence (AI). This study aims to identify issues in patient flow on mental health units and align them with potential AI solutions, ultimately devising a model for their integration at service level. Method Following a narrative literature review and pilot interview, 20 semi-structured interviews were conducted with AI and mental health experts. Thematic analysis was then used to analyse and synthesise gathered data and construct an enhanced model. Results Predictive variables for length-of-stay and readmission rate are not consistent in the literature. There are, however, common themes in patient flow issues. An analysis identified several potential areas for AI-enhanced patient flow. Firstly, AI could improve patient flow by streamlining administrative tasks and optimising allocation of resources. Secondly, real-time data analytics systems could support clinician decision-making in triage, discharge, diagnosis and treatment stages. Finally, longer-term, development of solutions such as digital phenotyping could help transform mental health care to a more preventative, personalised model. Conclusions Recommendations were formulated for NHS trusts open to adopting AI patient flow enhancements. Although AI offers many promising use-cases, greater collaborative investment and infrastructure are needed to deliver clinically validated improvements. Concerns around data-use, regulation and transparency remain, and hospitals must continue to balance guidelines with stakeholder priorities. Further research is needed to connect existing case studies and develop a framework for their evaluation.
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Affiliation(s)
- Fatema Mustansir Dawoodbhoy
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Jack Delaney
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Paulina Cecula
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Jiakun Yu
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Iain Peacock
- Imperial College London Business School, London, UK.,Brighton and Sussex Medical School, Brighton, East Sussex, BN1 9PX, UK
| | - Joseph Tan
- Imperial College London Business School, London, UK.,Brighton and Sussex Medical School, Brighton, East Sussex, BN1 9PX, UK
| | - Benita Cox
- Imperial College London Business School, London, UK
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