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Darker CD, Nicolson G, Reddon H, O'Connor K, Jennings R, O'Connell N. Monthly engagement with EIP keyworkers was associated with a five-fold increase in the odds of engagement with psychosocial interventions. BMC Psychiatry 2024; 24:96. [PMID: 38317157 PMCID: PMC10840293 DOI: 10.1186/s12888-024-05577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) supports people who are experiencing their first episode of psychosis (FEP). A new Model of Care (MoC) for EIP services was launched in Ireland in 2019. Three EIP demonstration sites were chosen to test this MoC through a 'hub and spoke' approach. These services were a new way of organising care for people experiencing FEP, based upon a recovery model of care, and which sought to standardise care, improve access by clinically led multidisciplinary teams. This included newly created EIP keyworker roles whereby keyworkers assumed responsibilities regarding assessment, comprehensive individual care planning and coordination of care. METHODS A mixed methods design utilising the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were utilised. Descriptive analyses and logistic regression were performed to examine how increased keyworker engagement influenced the use of other psychosocial interventions within the EIP demonstration sites. Thematic analyses was used for qualitative data. RESULTS There was a strong positive relationship between keyworker contacts and psychosocial interventions offered. Specifically, the odds of achieving at least monthly engagement with cognitive behavioural therapy for psychosis (CBTp; (5.76 (2.43-13.64), p < 0.001), and behavioural family therapy (BFT; (5.52(1.63-18.69, p < 0.006)) increased by fivefold with each additional monthly keyworker contact. For individual placement support (IPS) each additional monthly keyworker contact was associated with a three-fold increase in the odds of achieving monthly attendance with IPS (3.73 (1.64-8.48), p < 0.002). Qualitative results found that the EIP keyworker role as viewed by both service users and staff as a valuable nodal point, with a particular emphasis on care coordination and effective communication. CONCLUSIONS This study advances the understanding of keyworker effects through qualitative evidence of keyworkers functioning as a "linchpin" to the service, while the positive response association between keyworker contacts and engagement with other services provides quantitative support for keyworkers reducing the organisational or structural barriers to service access. Given the importance of these positions, health systems should ensure that EIP programmes identify qualified and experienced staff to fill these roles, as well as allocate the appropriate funding and protected time to support keyworker engagement and impact.
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Affiliation(s)
- C D Darker
- Discipline of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - G Nicolson
- Health Promotion and Improvement Department, HSE Health and Wellbeing, 1st Floor Old National Ambulance Training Building, St Marys Hospital Campus, Phoenix Park, Dublin 20, Chapelizod, D20 TY72, Ireland
| | - H Reddon
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - K O'Connor
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
| | - R Jennings
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - N O'Connell
- Sexual Health and Crisis Pregnancy Programme, HSE Health and Wellbeing, Strategy and Research, 89-94 Capel St, Dublin 1, Dublin, D01 P281, Ireland
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Walton H, Ng PL, Simpson A, Bloom L, Chitty LS, Fulop NJ, Hunter A, Jones J, Kai J, Kerecuk L, Kokocinska M, Leeson-Beevers K, Parkes S, Ramsay AIG, Sutcliffe A, Taylor C, Morris S. Experiences of coordinated care for people in the UK affected by rare diseases: cross-sectional survey of patients, carers, and healthcare professionals. Orphanet J Rare Dis 2023; 18:364. [PMID: 37996938 PMCID: PMC10668407 DOI: 10.1186/s13023-023-02934-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Poorly coordinated care can have major impacts on patients and families affected by rare conditions, with negative physical health, psychosocial and financial consequences. This study aimed to understand how care is coordinated for rare diseases in the United Kingdom. METHODS We undertook a national survey in the UK involving 760 adults affected by rare diseases, 446 parents/carers of people affected by rare diseases, and 251 healthcare professionals who care for people affected by rare diseases. RESULTS Findings suggested that a wide range of patients, parents and carers do not have coordinated care. For example, few participants reported having a care coordinator (12% patients, 14% parents/carers), attending a specialist centre (32% patients, 33% parents/carers) or having a care plan (10% patients, 44% parents/carers). A very small number of patients (2%) and parents/carers (5%) had access to all three-a care coordinator, specialist centre and care plan. Fifty four percent of patients and 33% of parents/carers reported access to none of these. On the other hand, a higher proportion of healthcare professionals reported that families with rare conditions had access to care coordinators (35%), specialist centres (60%) and care plans (40%). CONCLUSIONS Care for families with rare conditions is generally not well coordinated in the UK, with findings indicating limited access to care coordinators, specialist centres and care plans. Better understanding of these issues can inform how care coordination might be improved and embrace the needs and preferences of patients and families affected by rare conditions.
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Affiliation(s)
- Holly Walton
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Pei Li Ng
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | - Amy Simpson
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
- Genetic Alliance UK, Creative Works, 7 Blackhorse Lane, London, E17 6DS, UK
| | - Lara Bloom
- The Ehlers-Danlos Society and Academic Affiliate Professor of Practice in Patient Engagement and Global Collaboration (Penn State College of Medicine), Hershey, USA
| | - Lyn S Chitty
- North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | - Amy Hunter
- Genetic Alliance UK, Creative Works, 7 Blackhorse Lane, London, E17 6DS, UK
| | - Jennifer Jones
- Genetic Alliance UK, Creative Works, 7 Blackhorse Lane, London, E17 6DS, UK
| | - Joe Kai
- Division of Primary Care, Centre for Academic Primary Care, NIHR School for Primary Care Research, University of Nottingham, Floors 13-15, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - Larissa Kerecuk
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- NIHR Clinical Research Network West Midlands, Birmingham, UK
| | - Maria Kokocinska
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Sharon Parkes
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angus I G Ramsay
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | - Alastair Sutcliffe
- UCL and Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Christine Taylor
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Cipta DA, Kusumadewi I, Siste K, Werdhani RA, Diatri H. Factors associated with Indonesian family physicians' knowledge of depression: A cross-sectional study. Malays Fam Physician 2023; 18:18. [PMID: 37139475 PMCID: PMC10150326 DOI: 10.51866/oa.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Introduction Depression is a common mental disorder in primary care settings both globally and locally. Even with considerable impacts on patients' quality of life and public healthcare costs, most people with depression do not receive evidence-based treatment. Integrating mental healthcare services into primary care is essential to address the treatment gap for depression. As counsellors and care coordinators, family physicians have a vital role in providing primary mental healthcare services. This study aims to assess Indonesian family physicians' knowledge of depression and identify the associated factors. Method This cross-sectional observational study included a total of 83 family physicians from the Association of Indonesian Family Physicians. Data were collected using online questionnaires, including demographic and knowledge assessment instruments and the Care Coordinator Scale (CCS). Descriptive and multiple linear regression analyses were performed. Results The knowledge of depression, particularly in terms of prevention, diagnosis, pharmacological treatment, and post-referral treatment, was insufficient among the family physicians. The medication education (P=0.006) and follow-up care plan (P=0.04) domains of the CCS were associated with the family physicians' knowledge of the management of depression in the linear regression analysis (R2=0.077). Conclusion Interventions to improve Indonesian family physicians' knowledge of depression, focusing on medication/pharmacological treatment and considering them as care coordinators, are essential.
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Affiliation(s)
- Darien Alfa Cipta
- MD, MSc, Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo General Hospital, Jalan Pangeran Diponegoro, Jakarta, Indonesia.
| | - Irmia Kusumadewi
- MD, Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo General Hospital, Jalan Pangeran Diponegoro, Jakarta, Indonesia
| | - Kristiana Siste
- MD, PhD, Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo General Hospital, Jalan Pangeran Diponegoro, Jakarta, Indonesia
| | - Retno Asti Werdhani
- MD, PhD, Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jalan Pegangsaan Timur, Jakarta, Indonesia
| | - Hervita Diatri
- MD, PhD, Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo General Hospital, Jalan Pangeran Diponegoro, Jakarta, Indonesia
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Côté-Arsenault D, Denney-Koelsch E, Elliott G. 'Creating a safe space': how perinatal palliative care coordinators navigate care and support for families. Int J Palliat Nurs 2021; 27:386-400. [PMID: 34672781 DOI: 10.12968/ijpn.2021.27.8.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Families who learn that their unborn baby has a life-limiting fetal condition are often overwhelmed by this news, alongside navigating an unfamiliar healthcare system. A skilled perinatal palliative care coordinator (PPCC) can help these families, yet little is known about their function and roles. AIMS This study sought to describe the PPCC's approach to care, their guiding principles and the roles, knowledge and skills that enable them to provide exemplary care. METHODS This qualitative descriptive study included interviews of 12 expert PPCCs. Directed content analysis was used to identify major codes. Iterative analysis led to theme identification. FINDINGS Findings include the PPCC's position within the healthcare system, guiding principles, goals, roles and responsibilities, and knowledge and skills. Two figures enhance the understanding of the PPCCs approach to creating a safe space for the family, supporting the interdisciplinary team and facilitating coordinated birth planning. CONCLUSIONS Every perinatal palliative care programme should include a PPCC. Future research on clinical training could examine the effectiveness of an educational intervention, using the detailed knowledge and skills learned in this study as a curriculum.
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Affiliation(s)
- Denise Côté-Arsenault
- Professor of Maternal Child Nursing, Trudy Busch Valentine School of Nursing, St. Louis University, St. Louis, MO, US
| | - Erin Denney-Koelsch
- Associate Professor, Division of Palliative Care, University of Rochester Medical Center, Rochester, NY, US
| | - Gail Elliott
- Assistant Professor of Nursing at Western Carolina University, US
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Sheftall AH, Chisolm DJ, Alexy ER, Chavez LJ, Mangione-Smith RM, Ferrari RM, Song PH. Satisfaction With Care Coordination for Families of Children With Disabilities. J Pediatr Health Care 2019; 33:255-262. [PMID: 30449647 DOI: 10.1016/j.pedhc.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/03/2018] [Accepted: 08/19/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Children with disabilities have significant health care needs, and receipt of care coordinator services may reduce caregiver burdens. The present study assessed caregivers' experience and satisfaction with care coordination. METHOD Caregivers of Medicaid-enrolled children with disabilities (n = 2,061) completed a survey (online or by telephone) collecting information on the caregivers' experiences and satisfaction with care coordination using the Family Experiences with Coordination of Care questionnaire. RESULTS Eighty percent of caregivers with a care coordinator reported receiving help making specialist appointments, and 71% reported help obtaining community services. Caregivers who reported that the care coordinator helped with specialist appointments or was knowledgeable, supportive, and advocating for children had increased odds of satisfaction (odds ratio = 3.46, 95% confidence interval = [1.01, 11.77] and odds ratio = 1.07, 95% confidence interval = [1.03, 1.11], respectively). DISCUSSION Findings show opportunities for improving care coordination in Medicaid-enrolled children with disabilities and that some specific elements of care coordination may enhance caregiver satisfaction with care.
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Kotte A, Hill KA, Mah AC, Korathu-Larson PA, Au JR, Izmirian S, Keir SS, Nakamura BJ, Higa-McMillan CK. Facilitators and Barriers of Implementing a Measurement Feedback System in Public Youth Mental Health. Adm Policy Ment Health 2016; 43:861-78. [PMID: 27000148 DOI: 10.1007/s10488-016-0729-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examines implementation facilitators and barriers of a statewide roll-out of a measurement feedback system (MFS) in a youth public mental health system. 76 % of all state care coordinators (N = 47) completed interviews, which were coded via content analysis until saturation. Facilitators (e.g., recognition of the MFS's clinical utility) and barriers (e.g., MFS's reliability and validity) emerged paralleling the Exploration, Adoption/Preparation, Implementation, and Sustainment framework outlined by Aarons et al. (Adm Policy Mental Health Mental Health Serv Res, 38:4-23, 2011). Sustainment efforts may leverage innovation fit, individual adopter, and system related facilitators.
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Abstract
Health care is continuously undergoing evolutionary changes. These changes have been very dramatic for the end users. Instead of simple physician office visits and lengthy hospital stays, we are now faced with short hospital stays, office visits to different specialty providers, and an array of choices around them. With the present highway of choices between illness and wellness, it is important for transitions between these two to be affordable, advantageous to patients, and uncomplicated. This article discusses the choices patients and health care providers must make as the number of care options increase along with the risks and benefits.
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