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Fleury MJ, Imboua A, Grenier G. Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation. Community Ment Health J 2024; 60:869-884. [PMID: 38383882 DOI: 10.1007/s10597-024-01239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results highlighted insufficient access to and inadequacy of outpatient care. While some patients were quite satisfied with ED care, most criticized the lack of referrals or follow-up care. Patient profiles justifying high ED use were strongly associated with health and social issues perceived as needing immediate care. The main barriers in professional practice involved lack of MD expertise among primary care clinicians, and insufficient follow-up by psychiatrists in response to patient needs. Collaboration with outpatient care may be prioritized to reduce high ED use and improve ED interventions by strengthening the discharge process, and increasing access to outpatient care.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Armelle Imboua
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
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2
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Duncan A, Dainty KN, Kirst M, Stergiopoulos V, Wodchis WP. Service Needs of Clients Before and After Short Term Community Mental Health Case Management. Community Ment Health J 2023; 59:325-334. [PMID: 35908257 DOI: 10.1007/s10597-022-01010-z] [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] [Received: 12/16/2021] [Accepted: 07/12/2022] [Indexed: 01/25/2023]
Abstract
This study evaluated level of service need before and after a short-term community mental health case management intervention from the perspective of both clients and case managers. Ontario Common Assessment of Need data were used to describe client needs. McNemar's test was applied to assess differences in pre- and post- need scores. Psychological distress, company, daytime activities, and physical health were most commonly rated by clients as unmet needs at enrolment. At discharge, there was a significant change in psychological distress from the perspective of clients, and in psychological distress and daytime activities from the perspective of case managers. Statistically significant changes were observed for Total Need, Total Unmet Need and Met Need scores from the perspective of case managers. While both clients and case managers reported changes in total service needs between admission and discharge from short-term case management, clients were less likely to report a difference in needs.
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Affiliation(s)
- Andrea Duncan
- Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
| | - Katie N Dainty
- Patient-Centred Outcomes, Research Chair North York General Hospital, 4001 Leslie Street, Toronto, ON, M2K 1E1, Canada
| | - Maritt Kirst
- Department of Psychology, Community Psychology Program, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, N2L 3C5, Canada
| | - Vicky Stergiopoulos
- Physician in Chief, Center for Addiction and Mental Health, 1001, 1025, 1051 Queen Street West, Toronto, ON, M6J 1H4, Canada
| | - Walter P Wodchis
- Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.,Research Chair, Implementation and Evaluation Science, Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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Li H, Glecia A, Arisman K, Peternelj-Taylor C, Holtslander L, Leidl D. Mental Health and Addiction Related Emergency Department Visits: A Systematic Review of Qualitative Studies. Community Ment Health J 2022; 58:553-577. [PMID: 34075518 DOI: 10.1007/s10597-021-00854-1] [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] [Received: 03/06/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022]
Abstract
Mental health and addiction (MHA) related Emergency Department (ED) visits have increased significantly in recent years. Studies identified that a small subgroup of patients constitutes a disproportionally large number of visits. However, there is limited qualitative research exploring the phenomenon from the perspectives of patients who visited ED frequently for MHA reasons, and healthcare providers who provide care to the patients since the overwhelming majority of studies were quantitative based on clinical records. Without input from patients and healthcare providers, policymakers have inadequate information for designing and implementing programs. The purpose of this study was to systematically review the literature of qualitative research on frequent MHA related ED visits. The findings of the review revealed that a lack of community resources and existing community resources not meeting the needs of patients were critical contributing factors for frequent MHA related ED visits.
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Affiliation(s)
- Hua Li
- College of Nursing, University of Saskatchewan, Health Sciences Building, E-Wing, Room 4248, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.
| | - Alana Glecia
- Department of Sociology, University of Saskatchewan, Arts Building, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada
| | - Kayla Arisman
- Department of Sociology, University of Saskatchewan, Arts Building, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada
| | - Cindy Peternelj-Taylor
- Department of Sociology, University of Saskatchewan, Arts Building, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada
| | - Lorraine Holtslander
- College of Nursing, University of Saskatchewan, Health Sciences Building, 1A10.14, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.,College of Nursing, University of Saskatchewan, Health Sciences Building, E-Wing, Room 4252, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Donald Leidl
- College of Nursing, University of Saskatchewan, Health Sciences Building, E-Wing, Room 4234, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
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Guthrie E, Romeu D, Czoski-Murray C, Relton S, Walker A, Trigwell P, Hewison J, West R, Fossey M, Hulme C, House A. Experiences of people seen in an acute hospital setting by a liaison mental health service: responses from an online survey. BMC Health Serv Res 2021; 21:1050. [PMID: 34610845 PMCID: PMC8493711 DOI: 10.1186/s12913-021-06974-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/18/2021] [Indexed: 11/22/2022] Open
Abstract
Background In recent years the UK has expanded the provision of liaison mental health services (LMHS). Little work has been undertaken to explore first-hand experiences of them. Aims The aim of this study was to gain insights into the experiences of users of LMHS in both emergency departments and acute inpatient wards in the UK. Methods This cross-sectional internet survey was initially advertised from May-July 2017 using the social media platform Facebook. Due to a paucity of male respondents, it was re-run from November 2017-February 2018, specifically targeting male respondents. The survey featured a structured questionnaire divided into three categories: the profile of the respondent, perceived professionalism of LMHS and overall opinion of the service. Analysis Responses to the structured questionnaire were analysed using descriptive statistics and latent class analysis. Free-text responses were transcribed verbatim and interpreted using thematic analysis. Results 184 people responded to the survey. 147 were service users and 37 were partners, friends or family members of service users. Only 31% of service users and 27% of close others found their overall contact helpful. Latent class analysis identified three clusters − 46% of service users generally disliked their contact, 36% had an overall positive experience, and 18% did not answer most questions about helpfulness or usefulness. Features most frequently identified as important were the provision of a 24/7 service, assessment by a variety of healthcare professionals and national standardisation of services. Respondents indicated that the least important feature was the provision of a separate service for older people. They desired faster assessments following referral from the parent team, clearer communication about next steps and greater knowledge of local services and third sector organisations. Conclusions This survey identified mixed responses, but overall experiences were more negative than indicated in the limited previous research. The evaluation and adaptation of LMHS along the lines suggested in our survey should be prioritised to enhance their inherent therapeutic value and to improve engagement with treatment and future psychiatric care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06974-4.
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Affiliation(s)
- Elspeth Guthrie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Daniel Romeu
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK. .,Leeds and York Partnership NHS Foundation Trust, Leeds, UK.
| | | | - Samuel Relton
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andrew Walker
- Clinical Research Network National Coordinating Centre, National Institute of Health Research Clinical Research Network, Leeds, UK
| | - Peter Trigwell
- National Inpatient Centre for Psychological Medicine, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matt Fossey
- Veterans and Families Institute for Military Research, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Gomez-Sanchez-Lafuente C, Guzman-Parra J, Lopez-Zambrano MA, Moreno-Kustner B, Mayoral-Cleries F. Met and Unmet Needs in an Inpatient Psychiatry Setting in Spain. Neuropsychiatr Dis Treat 2021; 17:1859-1868. [PMID: 34135587 PMCID: PMC8197593 DOI: 10.2147/ndt.s307394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patients with severe mental disorder have health and social needs that require care. The aim of the study was to determine the main areas of perceived needs among inpatients with severe mental disorders and to identify risk factors of the group of patients with the greatest unmet needs. PATIENTS AND METHODS A total of 150 patients with severe mental illness were assessed during admission prior to discharge from the hospital. Camberwell Assessment of Needs was used as evaluation measure, in addition to clinical status (The Brief Psychiatric Rating Scale), social functioning (Personal and Social Performance) and sociodemographic variables. A descriptive and a multivariate logistic regression analysis were used to analyse variables related to the group of patients with the highest number of unmet needs (≥3). RESULTS Mean number of needs was 7.93, being 4.61 the mean number of needs met and 3.32 the needs unmet. The highest proportion of unmet needs were intimate relationships (44.0%), company (40.7%) and daytime activities (38.7%). A relationship was also found between the presence of three or more unmet needs and the following variables: Brief Psychiatric Rating Scale score (p=0.004), Personal and Social Performance score (p = 0.013), marital status (p=0.018), employment status (p=0.009) and voluntary admission (p=0.032). The multivariate model explained 29.5% of the variance (Nagelkerke's R2: 0.295). CONCLUSION Treatments aimed at improving social relationships and daytime activities could be a good option for inpatients with many unmet needs.
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Affiliation(s)
- Carlos Gomez-Sanchez-Lafuente
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, 29010, Spain.,Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, 29071, Spain
| | - Jose Guzman-Parra
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, 29010, Spain
| | - Maria Alejandra Lopez-Zambrano
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, 29010, Spain
| | - Berta Moreno-Kustner
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, 29071, Spain
| | - Fermin Mayoral-Cleries
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, 29010, Spain
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Schmidt M, Uman T. Experiences of acute care by persons with mental health problems: An integrative literature review. J Psychiatr Ment Health Nurs 2020; 27:789-806. [PMID: 32083776 DOI: 10.1111/jpm.12624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 01/31/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Understanding experiences of acute care by persons with mental health problems is vital for improving these experiences through the development of different parts of the care delivery and its facilities. Literature has extensively addressed experiences of persons with mental health problems in acute care settings. Yet, there is a paucity of studies that aggregate and organize these findings in presenting development-oriented solutions for the improvements of these experiences. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Acute care can be understood through patients' experiences of structure (such as setting, staff and resources); process (such as communication and interpersonal relations); and outcome (such as satisfaction and post-discharge well-being and health) and suggests improvements in these domains. The paper illuminates that previous literature has mainly captured negative experiences of acute care by persons with mental health problems, and suggests diverting the focus to the best practices and to seek inspiration from other fields of research. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Attending to the improvement and development of different parts of the acute care might be an important step in improving experiences of persons with mental health problems. For example, improving resource allocation systems and facilities, emphasizing professionalism in encounters with these patients and systematically assessing patient satisfaction during and after visits are important areas that require attention. ABSTRACT: Aim The provision of acute care to persons with mental health problems is challenging due to difficulties in encountering this group and the vulnerability of these persons. Understanding this group's experiences with acute care is thus an important endeavour. The purpose of this review was to critically and systematically identify and assess previous research on experiences of acute care by persons with mental health problems, guided by Donabedian's structure-process-outcome framework (Prospero ID: CRD42019116652). Method and results An integrative literature review was performed, resulting in the identification of 43 studies. The search was conducted using five electronic databases: Web of Science Core, PubMed, MEDLINE, CINAHL and PsycINFO. Discussion The review revealed that patients experienced structure components such as setting, staff and resources in a predominantly negative way. A predominately negative picture also emerged of the process components, where, for example, communication and interpersonal relations were represented by negative experiences, with limited positive experiences reported. The outcome components, related to patients' satisfaction and their well-being after discharge, were also predominantly experienced negatively. Implications for practice Using Donabedian's framework of structure, process and outcome allowed us to systematize the literature reviewed, to identify the research gaps and to suggest ways forward for the field's development.
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Affiliation(s)
- Manuela Schmidt
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Timur Uman
- Jönköping International Business School, Jönköping University, Jönköping, Sweden
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Schmidt M, Garmy P, Stjernswärd S, Janlöv AC. Professionals' Perspective on Needs of Persons Who Frequently Use Psychiatric Emergency Services. Issues Ment Health Nurs 2020; 41:182-193. [PMID: 31930924 DOI: 10.1080/01612840.2019.1663565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study explores how professionals experience persons who frequently use psychiatric emergency services (PES) in terms of their needs in Sweden. The data comprise 19 semi-structured individual interviews and one focus group interview with healthcare professionals (i.e., assistant nurses, psychiatric nurses, intern physicians, and resident physicians), which are analyzed using qualitative content analysis. The overall findings suggest that persons who frequently use PES suffer from illness, unfavorable life circumstances, and inadequate care, which together emphasize the need for more sustainable support. The findings indicate that the professionals saw beyond illness-related needs and could also acknowledge patients' needs originating from social, existential, and care- and support-related aspects of life.
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Affiliation(s)
- Manuela Schmidt
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Pernilla Garmy
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
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Encounters with Persons Who Frequently Use Psychiatric Emergency Services: Healthcare Professionals' Views. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031012. [PMID: 32033481 PMCID: PMC7037678 DOI: 10.3390/ijerph17031012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/25/2020] [Accepted: 02/04/2020] [Indexed: 11/16/2022]
Abstract
Encounters and interactions between healthcare professionals and patients are central in healthcare services and delivery. Encountering persons who frequently use psychiatric emergency services (PES), a complex patient group in a complex context, may be particularly challenging for healthcare professionals. The aim of the study was to explore healthcare professionals’ experiences of such encounters. Data were collected via individual interviews (N = 19) and a focus group interview with healthcare professionals consisting of psychiatric nurses, assistant nurses, and physicians. The data were analyzed with qualitative content analysis. This study focused on the latent content of the interview data to gain a rich understanding of the professionals’ experiences of the encounters. Two themes were identified: “Nurturing the encounter with oneself and colleagues for continuous, professional improvement” and “Striving for a meaningful connection with the patient”. The professionals experienced their encounters with persons who frequently use PES as caring, professional, and humane processes. Prerequisites to those encounters were knowing and understanding oneself, having self-acceptance and self-compassion, and working within person-centered cultures and care environments.
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