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Background
In Europe, at discharge from a psychiatric hospital, patients with severe mental illness may be exposed to one of two main care approaches: personal continuity, where one clinician is responsible for in- and outpatient care, and specialisation, where various clinicians are. Such exposure is decided through patient-clinician agreement or...
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Citations
... In addition, hospital staff needs to be encouraged to implement such programs to achieve continuity of care (Smith et al. 2019). Another study suggested that adherence and continuity of treatment are multidimensional issues related to many factors such as age, sex, occupation, underlying disease, and education (Bindman et al. 2000). ...
Continuity of care has been considered, as a key component of the treatment process, especially after discharge from the hospital. Establishing treatment continuity is critical to achieving successful treatment outcomes. Roozbeh Home Care Program was developed to ensure the continuity of care in patients with severe mental illness. This study aims to investigate the consequences of discontinuing a home care service including; relapse, readmission, service satisfaction, severity and disability, in patients with severe mental illness in Iran. Forty-three patients who received home care service for more than 6 months were included. They were assessed 3 and 6 months after receiving the service; and 12 months after the program discontinuation. There was a significant difference between the hospitalization rate during (0.42 ± 0.64) and 1 year after the program's discontinuation (0.65 ± 1.46). The majority of the caregivers (70%) were highly satisfied with the home care services. Among the patients who received the homecare services, 40.4% were highly satisfied; and 21.2% were moderately satisfied. There was no significant difference between disability (as measured by World Health Organization Disability Assessment Schedule), clinical improvement (as measured by Clinical Global Impression-Improvement Scale), or severity of illness (as measured by Clinical Global Impression Severity of the Illness Scale) during and 1 year after program's discontinuation. During the time of receiving the service, hospitalization rate was reduced. Patients and caregivers were satisfied with the service. Providing psychiatric services at home should be considered as a solution to maintain the continuity of care.
... The objective of this study was not to make cross-country comparisons. In view of the differences between countries in terms of length of stay, mental health care, and social integration policies, however, further research might compare the association between long LoS or readmissions in psychiatric wards and the social integration of psychiatric patients in different countries [32,78,79]. Finally, a oneyear follow-up period is relatively short to detect significant and meaningful changes in the social integration of individuals. ...
PurposeLong lengths of stay (LoS) in psychiatric hospitals or repeated admission may affect the social integration of patients with psychiatric disorders. So far, however, studies have been inconclusive. This study aimed to analyse whether long LoS or repeated admissions in psychiatric wards were associated in different ways with changes in the social integration of patients.Methods
Within a prospective cohort study, data were collected on 2181 patients with a main ICD-10 diagnosis of psychotic, affective, or anxiety disorder, hospitalised in the UK, Italy, Germany, Poland, and Belgium in 2015. Social integration was measured at baseline and 1 year after admission using the SIX index, which includes four dimensions: employment, housing, family situation, and friendship. Regression models were performed to test the association between LoS, the number of admissions, and the change in social integration over the study period, controlling for patients’ characteristics (trial registration ISRCTN40256812).ResultsA longer LoS was significantly associated with a decrease in social integration (β = − 0.23, 95%CI − 0.32 to − 0.14, p = 0.03), particularly regarding employment (OR = 2.21, 95%CI 1.18–3.24, p = 0.02), housing (OR = 3.45, 95%CI 1.74–5.16, p < 0.001), and family situation (OR = 1.94, 95%CI 1.10–2.78, p = 0.04). In contrast, repeated admissions were only associated with a decrease in friendship contacts (OR = 1.15, 95CI% 1.08–1.22, p = 0.03).Conclusions
Results suggest that a longer hospital LoS is more strongly associated with a decrease in patients’ social integration than repeated admissions. Special attention should be paid to helping patients to find and retain housing and employment while hospitalised for long periods.
... After discharge from a hospital psychiatric ward, or emergency room, patients expressing suicidal behaviour may be referred to primary care or mental health units, and thus become integrated into the system through continuity of care (Omer, Priebe, & Giacco, 2015). Over the past decade, several international studies have researched the relevance of the continuity of mental health care model (Omer et al., 2015;Smith et al., 2019). This model takes a comprehensive and user-centered approach to complex healthcare needs (Youssef et al., 2017). ...
... This model takes a comprehensive and user-centered approach to complex healthcare needs (Youssef et al., 2017). Several studies have shown that continuity of care facilitates a faster and more flexible transition between services, favours a reduction in the number of hospitalisations, hospital stay lengths, and healthcare consumption, as well as an improvement in user satisfaction and quality of care (Nutting, Goodwin, Flocke, Zyzanski &, Stange, 2003;Smith et al., 2019). However, the Spanish organisational model is not well suited to the needs of patients at risk of suicide since has no continuity of mental health care model. ...
Poor coordination between different healthcare services means that the proper follow-up of patients cannot be guaranteed, thus increasing the risk of relapse in cases of attempted suicide. This study describes the sociodemographic variables related to suicidal behaviour in a Spanish sample and analyses how the use of a continued nursing care protocol influences the follow-up of patients who have shown suicidal behaviour. A cohort of 213 patient was identified from the emergency department medical records because of suicide attempters during 2011; 51.6% were included in the intervention group (n = 110) and 48.4% (n = 103) in the control group. We used a specific continuity of care chain protocol with the patients in the intervention group. More than half of all the initial suicide attempts were made by women; 80.3% had a previous history of a mental disorder and 65.7% of the attempts were made by ingesting medications. Significantly more patients in the intervention group attended their first follow-up visit. This study highlights the need to implement protocols that favour the continuity of mental health care processes—especially those designed to treat individuals expressing suicidal behaviour—with the aim of reducing the risk of suicide in them by intensifying their monitoring.
... Leider sind diese Programme nur wenigen Patienten zugänglich, sodass neue Ansätze zur Überwindung von Sektorengrenzen und klinikinterner Fragmentierung notwendig sind. Die Behandlerkontinuität, insbesondere beim Übergang vom stationären in den ambulanten Sektor, wird in verschiedenen europäischen Ländern eher durch die Organisation des aufnehmenden Krankenhauses als durch Patientenmerkmale bestimmt [4]. ...
Die Rahmenbedingungen für die Behandlung von Menschen mit psychiatrischen Erkrankungen haben sich verändert und stellen neue Anforderungen an Therapiekonzepte und -abläufe. Dies betrifft die rechtlichen Bedingungen der Behandlung, aber auch die inhaltlichen und ökonomischen Voraussetzungen für eine patientenorientierte Diagnostik und Therapie. Das Zentralinstitut (ZI) für Seelische Gesundheit in Mannheim setzt aktuell ein Track-Konzept um, das diesen Veränderungen Rechnung trägt und darauf abzielt, Sektorengrenzen zugunsten von Behandlungskontinuität zu überwinden.
