Experienced continuity of care in patients at risk for depression in primary care

Continuity of care in suicide prevention: current status and future directions

Introduction

Continuity of Care (CoC) is central to suicide prevention. The present study aims to review contemporary definitions, operationalization in research, and key components of CoC in the prevention of suicide.

Methods

The present study is a narrative review. A thorough search of available literature on CoC and suicidality was conducted. Studies published between 1995 and 2021 were reviewed and selected based on relevance to CoC and suicidality. Selected research was subsequently summarized to outline definitions of CoC, its operationalization in research, and key components for suicide prevention.

Results

The definition, measurement, and operationalization of CoC in suicide prevention varies tremendously, derailing clinical practice. Key elements of CoC identified across the literature include (1) CoC across multiple levels of care, (2) the role of primary care providers and case managers in CoC of suicidal patients, (3) the importance of follow up contact with suicidal patients post-treatment, and (4) the role of national and institutional guidelines for CoC of suicidal patients. Limitations: There is a dearth of randomized controlled trials and insufficient evidence on specific populations.

Conclusion

CoC refers to a wide, complex concept that must be broken down into specific categories that can provide more nuanced guidance of research and clinical implications.

A named General Practitioner (GP) is associated with an increase of hospital days in a single predictor analysis: a follow-up of 15 years

BACKGROUND

Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system.

OBJECTIVES

The aim of the study was to determine whether having a named GP is associated with hospital service use.

METHODS

The data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 (n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 (n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register).

RESULTS

A named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis.

CONCLUSION

A named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized.

The effect of team collaboration and continuity of care on health and disability among rehabilitation patients: a longitudinal survey-based study from western Norway

PURPOSE

The purpose of this study was to investigate how changes in patient-rated health and disability from baseline to after rehabilitation were associated with communication and relationships in rehabilitation teams and patient-rated continuity of care.

METHODS

Linear models were used to assess the associations between relational coordination [RC] and Nijmegen Continuity Questionnaire-Norwegian version [NCQ-N] with changes in the World Health Association Disability Assessment Schedule 2.0 [WHODAS 2.0] and EuroQol EQ-VAS [EQ-VAS]. To express change in WHODAS 2.0 and EQ-VAS, the model was adjusted for WHODAS 2.0 and EQ-VAS baseline scores. Analyses for possible slopes for the various diagnosis groups were performed.

RESULTS

A sample of 701 patients were included in the patient cohort, followed from before rehabilitation to 1 year after a rehabilitation stay involving treatment by 15 different interprofessional teams. The analyses revealed associations between continuity of care and changes in patient-rated health, measured with EQ-VAS (all p values < 0.01). RC communication was associated with more improvement in functioning in neoplasms patient group, compared to improvement of health among included patient groups. The results revealed no associations between NCQ-N and WHODAS 2.0 global score, or between RC in the rehabilitation teams treating the patients and changes in WHODAS 2.0 global score.

CONCLUSION

The current results revealed that better personal, team and cross-boundary continuity of rehabilitation care was associated with better patient health after rehabilitation at 1-year follow-up. Measures of patient experiences with different types of continuity of care may provide a promising indicator of the quality of rehabilitation care.

Association between continuity of care and subsequent hospitalization and mortality in patients with mood disorders: Results from the Korea National Health Insurance cohort

Concerns have been raised about the loss of treatment continuity in unipolar and bipolar depressive disorder patients as continuity of care (COC) may be associated with patient outcomes. This study aimed to examine the relationship between COC and subsequent hospitalization, all-cause mortality, and suicide mortality in individuals with unipolar and bipolar disorder. Data were from the National Health Insurance (NHI) cohort, 2002 to 2013. Study participants included individuals first diagnosed with unipolar depressive disorder or bipolar affective disorder. The independent variable was COC for the first year of outpatient visits after diagnosis, measured using the usual provider of care (UPC) index. The dependent variables were hospitalization in the year after COC measurement, all-cause mortality, and suicide mortality. Analysis was conducted using logistic regression and Cox proportional hazards survival regression. A total of 48,558 individuals were analyzed for hospitalization and 48,947 for all-cause and suicide mortality. Compared to the low COC group, the medium [odds ratio (OR) 0.30, 95 percent confidence interval (95% CI) 0.19–0.47] and the high COC group (OR 0.14, 95% CI 0.09–0.21) showed statistically significant decreased odds of hospitalization. Additionally, lower likelihoods of suicide death were found in the high (HR 0.35, 95% CI 0.16–0.74) compared to the low COC group. The results infer an association between COC after first diagnosis of unipolar or bipolar depressive disorder and hospitalization and suicide mortality, suggesting the potential importance of treatment continuity in improving patient outcomes.

Questionnaires that measure the quality of relationships between patients and primary care providers: a systematic review

Background

International guidance on models of care stress the importance of good quality, continuous patient-provider relationships to support high quality and efficient care and hospital avoidance. However, assessing the quality of patient-provider relationships is challenging due to its experiential nature. The aim of this study was to undertake a systematic review to identify questionnaires previously developed or used to assess the quality of continuous relationships between patients and their provider in primary care.

Methods

MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and SCOPUS databases were searched for English language studies published between 2009 and 2017. Key terms used identified studies conducted in the primary care setting examining relationships between patients and providers. Studies that focused on the conceptualisation, development, testing or review of a questionnaire, or studies that used a questionnaire for assessing the quality of continuous relationships between patients and providers were eligible. Studies that did not assess quality via a questionnaire, only assessed single aspects of relationships, only assessed single encounters, assessed transitions between settings or assessed relationships using an index were excluded. Information on validity testing of each relevant questionnaire identified from articles was reviewed to inform recommendations for future research and evaluation.

Results

Twenty-seven studies met the eligibility criteria, including 14 unique questionnaires. The questionnaires were diverse in length, scope, focus and level of validity testing. Five questionnaires were considered not feasible for future use due to size and lack of development work. Three questionnaires were considered strongest candidates for use in future work based on being relevant to the topic and primary care setting, freely available in English and not needing additional pilot work prior to use. These three questionnaires were the Care Continuity Across Levels of Care Scale, the Nijmegan Continuity Questionnaire and the Patient-Doctor Depth of Relationship Tool.

Conclusions

This study provides an overview of 14 unique questionnaires that have been used to assess the quality of continuous relationships between patients and primary care providers. The decision to use one of the questionnaires in future work requires careful consideration, including the scope, length, validation testing, accessibility of the questionnaires and their alignment with the initiative being evaluated.

Relational coordination in interprofessional teams and its effect on patient-reported benefit and continuity of care: a prospective cohort study from rehabilitation centres in Western Norway

Background

Rehabilitation services depend on competent professionals who collaborate effectively. Well-functioning interprofessional teams are expected to positively impact continuity of care. Key factors in continuity of care are communication and collaboration among health care professionals in a team and their patients. This study assessed the associations between team functioning and patient-reported benefits and continuity of care in somatic rehabilitation centres.

Methods

This prospective cohort study uses survey data from 984 patients and from health care professionals in 15 teams in seven somatic rehabilitation centres in Western Norway. Linear mixed effect models were used to investigate associations between the interprofessional team communication and relationship scores (measured by the Relational Coordination [RC] Survey and patient-reported benefit and personal-, team- and cross-boundary continuity of care. Patient-reported continuity of care was measured using the Norwegian version of the Nijmegen Continuity Questionnaire.

Results

The mean communication score for healthcare teams was 3.9 (standard deviation [SD] = 0.63, 95% confidence interval [CI] = 3.78, 4.00), and the mean relationship score was 4.1 (SD = 0.56, 95% CI = 3.97, 4.18). Communication scores in rehabilitation teams varied from 3.4–4.3 and relationship scores from 3.6–4.5. Patients treated by teams with higher relationship scores experienced better continuity between health care professionals in the team at the rehabilitation centre (b = 0.36, 95% CI = 0.05, 0.68; p = 0.024). There was a positive association between RC communication in the team the patient was treated by and patient-reported activities of daily living benefit score; all other associations between RC scores and rehabilitation benefit scores were not significant.

Conclusion

Team function is associated with better patient-reported continuity of care and higher ADL-benefit scores among patients after rehabilitation. These findings indicate that interprofessional teams’ RC scores may predict rehabilitation outcomes, but further studies are needed before RC scores can be used as a quality indicator in somatic rehabilitation.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3536-5) contains supplementary material, which is available to authorized users.

Concepts, models and measurement of continuity of care in mental health services: A systematic appraisal of the literature

WHAT IS KNOWN ON THE SUBJECT?: Care continuity is considered to be a cornerstone of modern mental health care. As community mental health services have become increasingly fragmented and complex, the crucial criterion for best quality care has become the degree to which treatment delivered by separate services and professionals is continuous and well coordinated. However, clarification of the key elements of continuity has proved challenging and a consensus has not been reached. Recent research has shown significant levels of variation in the quality of care coordination across England and Wales, with potentially detrimental consequences for individuals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Studies on care continuity identified in this review are grouped into three categories: studies defining concepts of care continuity, studies providing models of continuity and studies describing development of questionnaires about care continuity. There are many similarities and parallels between concepts of continuity described in the studies under review. Therefore, there is potential for developing a consensus on the nature of care continuity as a multidimensional concept. The priority placed upon the patient's experience of care continuity is identified as a major focus in these studies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A consensus on the nature of care continuity would benefit both theory and practice in mental health nursing. It would provide a firmer foundation for new research seeking to improve continuity for people using services, and enable mental health nurses working as care coordinators to have a better understanding of the elements of their role that are most effective.

ABSTRACT

Introduction The increased complexity of community mental health services, and associated fragmentation of traditional dividing lines between services, has underscored the centrality of care continuity and coordination in modern mental health care. However, clarification of the key features of the care continuity concept has proved difficult and a consensus has not been reached. Aim/Question This review draws together and critically examines latest evidence concerning concepts, models and scales based on a multidimensional understanding of care continuity. Method Databases ASSIA, PubMed, MEDLINE and Cochrane were searched for papers dating from January 2005 to July 2016, of which 21 articles met the inclusion criteria. These were subjected to quality appraisal based on CASP and COSMIN checklists. Studies were grouped into three thematic categories describing concepts, models and scales of care continuity. Results/Discussion Synthesis indicated correspondence between independent, multidimensional models of care continuity, providing greater clarity regarding the essential features of the concept. Association, although not causation, between care continuity factors and health outcomes is supported by current evidence. Implications for practice Clarification of care continuity in mental health services may enable nurses working as care coordinators to develop a better understanding of key elements of their role, and provide guidance for future service development.

Aspects and Intensity of Pediatric Palliative Case Management Provided by a Hospital-Based Case Management Team: A Comparative Study Between Children With Malignant and Nonmalignant Disease

OBJECTIVES

Anticipating case management is considered crucial in pediatric palliative care. In 2012, our children's university hospital initiated a specialized pediatric palliative care team (PPCT) to deliver inbound and outbound case management for children with life-shortening disease. The aim of this report is to gain insight in the first 9 months of this PPCT.

METHODS

Aspects of care during the first 9 months of the PPCT are presented, and comparison is made between patients with malignant disease (MD) and nonmalignant disease (NMD) in a retrospective study design. Insight in the aspects of care of all patients with a life-shortening disease was retrieved from web-based files and the hour registrations from the PPCT.

RESULTS

Forty-three children were supported by the PPCT during the first 9 months: 22 with MD with a median of 50 (1-267) days and 29 minutes (4-615) of case management per patient per day and 21 patients with NMD with a median of 79.5 (5-211) days and 16 minutes of case management per day (6-64). Our data show significantly more interprofessional contacts for patients with MD and more in-hospital contacts for patients with NMD. The median number of admission days per patient was 11 (0-22) for MD (44% for anticancer therapy) and 44 (0-303) for NMD (36% for infectious diseases).

SIGNIFICANCE OF RESULTS

This overview of aspects of pediatric palliative case management shows shorter but more intensive case management for MD in comparison with NMD. This insight in palliative case management guides the design of a PPCT.

Developing IntegRATE: a fast and frugal patient-reported measure of integration in health care delivery

BACKGROUND

Efforts have been made to measure integration in health care delivery, but few existing instruments have adopted a patient perspective, and none is sufficiently generic and brief for administration at scale. We sought to develop a brief and generic patient-reported measure of integration in health care delivery.

METHODS

Drawing on both existing conceptualisations of integrated care and research on patients' perspectives, we chose to focus on four distinct domains of integration: information sharing, consistent advice, mutual respect and role clarity. We formulated candidate items and conducted cognitive interviews with end users to further develop and refine the items. We then pilot-tested the measure.

RESULTS

Four rounds of cognitive interviews were conducted (n = 14) and resulted in a four-item measure that was both relevant and understandable to end users. The pilot administration of the measure (n = 15) further confirmed the relevance and interpretability of items and demonstrated that the measure could be completed in less than one minute.

CONCLUSIONS

This new measure, IntegRATE, represents a patient-reported measure of integration in health care delivery that is conducive to use in both routine performance monitoring and research. The psychometric properties of the measure will be assessed in the next stage of development.