Understanding the impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity: protocol for a mixed methods study

BACKGROUND

Primary care and other health services have been disrupted during the COVID-19 pandemic, yet the consequences of these service disruptions on patients' care experiences remain largely unstudied. People with mental-physical multimorbidity are vulnerable to the effects of the pandemic, and to sudden service disruptions. It is thus essential to better understand how their care experiences have been impacted by the current pandemic. This study aims to improve understanding of the care experiences of people with mental-physical multimorbidity during the pandemic and identify strategies to enhance these experiences.

METHODS

We will conduct a mixed-methods study with multi-phase approach involving four distinct phases. Phase 1 will be a qualitative descriptive study in which we interview individuals with mental-physical multimorbidity and health professionals in order to explore the impacts of the pandemic on care experiences, as well as their perspectives on how care can be improved. The results of this phase will inform the design of study phases 2 and 3. Phase 2 will involve journey mapping exercises with a sub-group of participants with mental-physical multimorbidity to visually map out their care interactions and experiences over time and the critical moments that shaped their experiences. Phase 3 will involve an online, cross-sectional survey of care experiences administered to a larger group of people with mental disorders and/or chronic physical conditions. In phase 4, deliberative dialogues will be held with key partners to discuss and plan strategies for improving the delivery of care to people with mental-physical multimorbidity. Pre-dialogue workshops will enable us to synthesize an prepare the results from the previous three study phases.

DISCUSSION

Our study results will generate much needed evidence of the positive and negative impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity and shed light on strategies that could improve care quality and experiences.

[Quality indicators of person-centred and recovery-oriented care for mental health issues]

Objective Meeting the mental health needs of the population is a priority of the Quebec government. To do so, it is important to evaluate and improve the quality of mental health care in primary and community care settings, particularly with respect to person-centred and recovery-oriented care. The purpose of this study is to identify existing quality indicators that measure these dimensions, and to report on their strengths and weaknesses. Method A review of systematic reviews was conducted in MEDLINE, EMBASE, PsycINFO and CINAHL, using combinations of search terms related to the concepts of "mental disorders," "primary care," "health care quality," and "review." The review of titles and abstracts review was completed by single reviewers and full-text review by pairs of reviewers working independently. Consultation with an expert in mental health care quality and a hand search of the references of identified articles finalized the search. A review of the grey literature, including the reports and websites of Canadian or international organizations, was also conducted. Results From 2837 initial references, the review of systematic reviews led to the inclusion of 6 systematic reviews. For the grey literature, relevant indicators were found on the websites of 13 organizations, including 7 international and 6 Canadian ones, from 25 organizations consulted. A total of 106 indicators were retrieved, including 91 for person-centred care approaches and 15 for recovery-oriented approaches. Among the indicators for person-centred care, two levels emerged: the organizational level, focusing mainly on continuity issues, and the practice level, focusing on processes related to the care providers or the individual. For recovery-oriented approaches to care, four categories emerged: community connections, discrimination and stigma, social roles, and social support. Conclusion Evaluating person-centered, recovery-oriented care for people with mental disorders based on robust quality indicators poses a major challenge and our review revealed several limitations related to the current set of indicators that exist to measure these approaches. Further efforts must be made to improve the measurement of quality of mental health care in terms of person-centred and recovery-oriented care, so that the governmental and clinical strategies currently in place, such as the Programme Québécois pour les Troubles Mentaux (PQPTM), can achieve their goals.

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