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Fayyaz S, Nkire N, Nwosu B, Amjad N, Kinsella A, Gill M, McDonough C, Russell V, Waddington JL. Carepath for overcoming psychosis early (COPE): first 5 years of clinical operation and prospective research in the Cavan-Monaghan early intervention service. Ir J Psychol Med 2024; 41:23-36. [PMID: 34353408 DOI: 10.1017/ipm.2021.54] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan-Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation. METHODS COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016. RESULTS During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder. CONCLUSIONS COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.
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Affiliation(s)
- S Fayyaz
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
| | - N Nkire
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B Nwosu
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
| | - N Amjad
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
| | - A Kinsella
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Gill
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - C McDonough
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- Louth Mental Health Service, St. Brigid's Hospital, Ardee, Ireland
| | - V Russell
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - J L Waddington
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Pereira J, Klinger C, Seow H, Marshall D, Herx L. Are We Consulting, Sharing Care, or Taking Over? A Conceptual Framework. Palliat Med Rep 2024; 5:104-115. [PMID: 38415077 PMCID: PMC10898231 DOI: 10.1089/pmr.2023.0079] [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] [Accepted: 01/09/2024] [Indexed: 02/29/2024] Open
Abstract
Background Primary- and specialist-level palliative care services are needed. They should work collaboratively and synergistically. Although several service models have been described, these remain open to different interpretations and deployment. Aim This article describes a conceptual framework, the Consultation-Shared Care-Takeover (C-S-T) Framework, its evolution and its applications. Design An iterative process informed the development of the Framework. This included a symposium, literature searches, results from three studies, and real-life applications. Results The C-S-T Framework represents a spectrum anchored by the Consultation model at one end, the Takeover model at the other end, and the Shared Care model in the center. Indicators, divided into five domains, help differentiate one model from the other. The domains are (1) Scope (What aspects of care are addressed by the palliative care clinician?); (2) Prescriber (Who prescribes the treatments?); (3) Communication (What communication occurs between the palliative care clinician and the patient's attending clinician?); (4) Follow-up (Who provides the follow-up visits and what is their frequency?); and (5) Most responsible practitioner (MRP) (Who is identified as MRP?). Each model demonstrates strengths, limitations, uses, and roles. Conclusions The C-S-T Framework can be used to better describe, understand, assess, and monitor models being used by specialist palliative care teams in their interactions with primary care providers and other specialist services. Large studies are needed to test the application of the Framework on a broader scale in health care systems.
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Affiliation(s)
- José Pereira
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Faculty of Medicine, University of Navarra, Pamplona, Navarra, Spain
- Pallium Canada, Ottawa, Ontario, Canada
| | - Christopher Klinger
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Pallium Canada, Ottawa, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Denise Marshall
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Leonie Herx
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Penno KA, Zakis JA. Exploring Hearing Care Technology from Clinic to Capability. Semin Hear 2023; 44:287-301. [PMID: 37484987 PMCID: PMC10361792 DOI: 10.1055/s-0043-1769741] [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: 07/25/2023] Open
Abstract
Healthcare systems are traditionally a clinician-led and reactive structure that does not promote clients managing their health issues or concerns from an early stage. However, when clients are proactive in starting their healthcare earlier than later, they can achieve better outcomes and quality of life. Hearing healthcare and the rehabilitation journey currently fit into this reactive and traditional model of care. With the development of service delivery models evolving to offer services to the consumer online and where they are predominately getting their healthcare information from the internet and the advancement of digital applications and hearing devices beyond traditional hearing aid structures, we are seeing a change in how consumers engage in hearing care. Similarly, as the range of hearing devices evolves with increasingly blended and standard levels of technology across consumer earbuds/headphones and medical grade hearing aids, we are seeing a convergence of consumers engaging earlier and becoming increasingly aware of hearing health needs. This article will discuss how the channels, service, and technology are coming together to reform traditionally clinician-led healthcare models to an earlier consumer-led model and the benefits and limitations associated with it. Additionally, we look to explore advances in hearing technologies and services, and if these will or can contribute to a behavioral change in the hearing healthcare journey of consumers.
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Affiliation(s)
- Kathryn A. Penno
- Department of Anatomy, Physiology & Human Biology, School of Human Science, University of Western Australia, Perth, Western Australia, Australia
- Nuheara, Perth, Western Australia, Australia
| | - Justin A. Zakis
- Sonova Audiological Care Australia, Melbourne, Victoria, Australia
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Stockton DA, Fowler C, Debono D, Travaglia J. Adapting community child and family health service models for rural and other diverse settings: A modified Delphi study to identify key elements. Health Soc Care Community 2022; 30:e6145-e6162. [PMID: 36195997 PMCID: PMC10092049 DOI: 10.1111/hsc.14052] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 06/29/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Inequity in health outcomes is pervasive, with poorer health outcomes identified in rural, regional and remote communities. An international call to action emphasises the need for service models adapted for less well-resourced settings. The aim of this study was to identify key elements of a framework for the adaptation of specialist community-based child and family health (CFH) service models for rural and other under-resourced settings. A modified Delphi study was undertaken with a 12-person expert panel in CFH including Australian and international professionals and parents from rural and remote communities. The study was informed by the WHO Framework for Strengthening Health Service Systems building blocks, the outcomes of an integrative review of literature and a Participatory Action Research study. Experts assessed 107 potential elements for service model development and rated them for importance when adapting service models for different contexts. Round 1 of the Delphi generated considerable consensus with 80 of the 107 potential elements identified as necessary for the service model adaptation framework. A further 17 elements for CFH service models were added in round 2. While multiple varied elements are important for adapting CFH service models for diverse settings, some elements had common themes. Experts highlighted the importance of community engagement and participation; utilising both data and local knowledge to develop a robust understanding of the community context; and the need for a flexible approach to funding and modes of service delivery to address barriers to implementation and access.
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Affiliation(s)
- Deborah A. Stockton
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Cathrine Fowler
- School of Nursing and MidwiferyUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Joanne Travaglia
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
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Page IS, Leitch E, Gossip K, Charlson F, Comben C, Diminic S. Modelling mental health service needs of Aboriginal and Torres Strait Islander peoples: a review of existing evidence and expert consensus. Aust N Z J Public Health 2022; 46:177-185. [PMID: 34978362 DOI: 10.1111/1753-6405.13202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To identify key mental health service components required for Aboriginal and Torres Strait Islander peoples and develop proposed modelling to modify the National Mental Health Service Planning Framework to account for the unique needs of these populations. METHODS Service areas and corresponding modelling rules were informed by a review and analysis of literature and data (on existing service models and policy directions) and expert group discussions on the important aspects of mental health care for Aboriginal and Torres Strait Islander peoples. RESULTS Eight key service areas were identified and translated into proposed modelling rules for service planning: culturally appropriate assessment; increased care coordination; more family and carer involvement and support; specified workforce; holistic primary care teams; enhanced staffing for inpatient care; integrating culture; and earlier support for behavioural and psychological symptoms of dementia. CONCLUSIONS This study provides a consolidated framework and implementation guidance to support more effective mental health service planning for Aboriginal and Torres Strait Islander peoples. Implications for public health: Better supporting planners to make informed decisions regarding mental health service provision for Aboriginal and Torres Strait Islander peoples will assist in a nationally coordinated approach to closing the mental health gap between Indigenous and non-Indigenous peoples.
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Affiliation(s)
- Imogen S Page
- School of Public Health, University of Queensland, Brisbane, Queensland.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland
| | - Elizabeth Leitch
- School of Public Health, University of Queensland, Brisbane, Queensland.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland
| | - Kate Gossip
- School of Public Health, University of Queensland, Brisbane, Queensland.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland
| | - Fiona Charlson
- School of Public Health, University of Queensland, Brisbane, Queensland.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland
| | - Charlotte Comben
- School of Public Health, University of Queensland, Brisbane, Queensland.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland
| | - Sandra Diminic
- School of Public Health, University of Queensland, Brisbane, Queensland.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland
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Stockton DA, Fowler C, Debono D, Travaglia J. World Health Organization building blocks in rural community health services: An integrative review. Health Sci Rep 2021; 4:e254. [PMID: 33732894 PMCID: PMC7942400 DOI: 10.1002/hsr2.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Developing and adapting health service models to effectively meet the needs of rural and remote communities is an international priority given inequities in health outcomes compared with metropolitan counterparts. This integrative review aims to inform rural and remote health service delivery systems by drawing on the WHO Framework building blocks to identify lessons learned from the literature describing experiences of rural and remote community health service planning and implementation; and inform recommendations to strengthen often disadvantaged rural and remote health systems for policy makers, health service managers, and those implementing international healthcare initiatives within these contexts. METHODS The integrative review examined the literature reporting rural and remote community health service delivery published from 2007 to 2017 (the decade following the release of the WHO Framework). Using an analytic frame, a structured template was developed to extract data and categorized against the WHO building blocks, followed by a synthesis of the key findings. RESULTS This integrative review identified that WHO Framework building blocks such as "Service Delivery" and "Health Workforce" are commonly reflected in rural and remote community health service delivery literature in the decade since the Framework's release. However, others such as "Sustainable Funding and Social Protection" are less commonly reported in the literature despite these elements being identified by the WHO as being integral to successful, sustainable health service delivery systems. CONCLUSIONS We found that collaboration across the health system governance continuum from local to policy level is an essential enabler for rural and remote health service delivery. Community-based participatory action research provides an opportunity to learn from one another, build capacity, optimize service model suitability, and promotes cultural safety by demonstrating respect and inclusivity in decision-making. Policy makers and funders need to acknowledge the time and resources required to build trust and community coalitions to inform effective planning and implementation.
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Affiliation(s)
- Deborah A. Stockton
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Cathrine Fowler
- School of Nursing and MidwiferyUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Joanne Travaglia
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
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Dolan E, Allott K, Proposch A, Hamilton M, Killackey E. Youth access clinics in Gippsland: Barriers and enablers to service accessibility in rural settings. Early Interv Psychiatry 2020; 14:734-740. [PMID: 32056366 DOI: 10.1111/eip.12949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 11/30/2022]
Abstract
AIM Approximately 15 years ago, four youth access clinics (YACs) were established in the Gippsland region to improve mental and general healthcare for young people living in the region. The aim of the study was to examine the barriers and enablers for young people accessing the YACs in Gippsland. METHODS Using qualitative methodology, nine female YAC staff members and seven youth YAC consumers were interviewed. Thematic analysis was utilized to identify important and consistent themes in the data derived through the consultation process. RESULTS Barriers under four themes were identified: environmental (eg, limited transport); service (ie, limited opening hours); client (eg, parent permission) and staff (ie, retention of staff). Enablers were identified as environmental (ie, high social proximity), service (eg, funding), client (ie, awareness of service) and staff (eg, champion staff). CONCLUSION The success of new rural service models will likely depend on learning from what has already worked in some of the many small communities in this region. Beyond learning, further success and uptake of new service offerings will be enhanced through understanding community needs, obtaining community support and enhancing high social proximity.
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Affiliation(s)
- Erin Dolan
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Kelly Allott
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Amanda Proposch
- Primary Health Network Gippsland, Traralgon, Victoria, Australia
| | - Matthew Hamilton
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Eóin Killackey
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Gonzales S, O'Keefe L, Gutzman K, Viger G, Wescott AB, Farrow B, Heath AP, Kim MC, Taylor D, Champieux R, Yen PY, Holmes K. Translational Personas and Hospital Library Services. J Hosp Librariansh 2020; 20:204-216. [PMID: 33727894 PMCID: PMC7959110 DOI: 10.1080/15323269.2020.1778983] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/16/2020] [Indexed: 06/12/2023]
Abstract
Academic health centers, CTSA hubs, and hospital libraries experience similar funding challenges and charges to do more with less. In recent years academic health center and hospital librarians have risen to these challenges by examining their service models, and beyond that, examining their patron base and users' needs. To meet the needs of employees, patients, and those who assist patients, hospital librarians can employ the CTS Personas, a project of the Clinical and Translational Science Awards (CTSA) Program National Center for Data to Health. The Persona profiles, which outline the motivations, goals, pain points, wants, and needs of twelve employees and two patients in translational science, provide vital information and insights that can inform everything from designing software tools and educational services, to advertising these services, to designing impactful and collaborative library spaces.
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Affiliation(s)
- Sara Gonzales
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lisa O'Keefe
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Karen Gutzman
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Guillaume Viger
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Annie B Wescott
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bailey Farrow
- Center for Data-Driven Discovery in Biomedicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Allison P Heath
- Center for Data-Driven Discovery in Biomedicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Meen Chul Kim
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Deanne Taylor
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and the Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robin Champieux
- The Oregon Health & Science University Library, Oregon Health & Science University, Portland, OR
| | - Po-Yin Yen
- Institute for Informatics, Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO. And Goldfarb School of Nursing, Barnes-Jewish College, BJC HealthCare, St. Louis, MO
| | - Kristi Holmes
- Department of Preventive Medicine, Division of Health and Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, IL
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Abstract
At an academic health science center, librarians identified problems, weaknesses, and strengths in reference services. The on-call reference schedule was discontinued and a question flowchart was developed for circulation staff. Only research questions were referred to librarians, who would respond if available. Circulation staff perceived the unscheduled, voluntary model was not working well for the patrons or the staff. After two months, the schedule was reinstated with a hybrid version of the previous on-call format. In the process of changing the service model, the library staff also underwent a cultural change.
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Affiliation(s)
- Jonquil D Feldman
- a Dolph Briscoe, Jr. Library, The University of Texas Health Science Center at San Antonio , San Antonio , Texas , USA
| | - Emme Lopez
- a Dolph Briscoe, Jr. Library, The University of Texas Health Science Center at San Antonio , San Antonio , Texas , USA
| | - Christine S Gaspard
- a Dolph Briscoe, Jr. Library, The University of Texas Health Science Center at San Antonio , San Antonio , Texas , USA
| | - Karen D Barton
- a Dolph Briscoe, Jr. Library, The University of Texas Health Science Center at San Antonio , San Antonio , Texas , USA
| | - Luis F Barcenes
- a Dolph Briscoe, Jr. Library, The University of Texas Health Science Center at San Antonio , San Antonio , Texas , USA
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Myklebust LH, Olstad R, Bjorbekkmo S, Eisemann M, Wynn R, Sørgaard K. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway. Int J Integr Care 2011; 11:e142. [PMID: 22359521 PMCID: PMC3280921 DOI: 10.5334/ijic.674] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 09/16/2011] [Accepted: 10/18/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention. AIMS To study whether inpatients' utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model. METHOD The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. RESULTS Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients' utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. CONCLUSION Inpatients' utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a favourable alternative to traditional central psychiatric hospitals.
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Affiliation(s)
- Lars Henrik Myklebust
- Psychiatric Research Centre of North Norway, Nordland Hospital Trust, N-8092 Bodø, Norway
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