functional model : mind the gap - prize presentation
DESCRIPTION
Dr Ankush SinghalTRANSCRIPT
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Functional model: Mind the Gap
Dr Ankush Singhal MBBS, MD (AIIMS), MRCPsych
ST6 (General adult psychiatry)
BIPA Annual Conference 2010
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My ContributionConceived the idea and led the study.Literature review, the protocol and ethics
approval. Collected the data. Co-ordinated.Merged the data & analysed it.Prepared the manuscript and sent for publication. Revisions as first & corresponding author.Presented in RCPsych AGM, Liverpool and in my
Trust.
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BackgroundNWW: enabling consultant psychiatrists,
among others, to deliver effective and person-centred care.
Acute care pathway – CRHT + In-patient.Functional model.Acute in-patient psychiatry – a subspecialty?
Community consultant
In-patient consultant
Service user
Mind the gap
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AimTo investigate
health professionals’, service users’ and carers’
opinions about the provision of separate consultants
for in-patient settings and the community
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DesignMulticentre study : North Hertfordshire; the
south lakes region of Cumbria; and Winchester.
Tool semi-structured semi-qualitative questionnaire (paper and online version)
An information leaflet (without introducing any bias).
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Data CollectionPersonally, by post and online.
Through CMHTs, out-patient clinics, mental health wards and other places (e.g. the local centre of MIND).
Admitted patients were not invited.
Reminder - after a month.
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AnalysisQuantitative data – descriptive statistics.
Qualitative data – framework analysis.
Carers: too few to be included in the analysis.
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Results
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Quantitative: Service providers170/330 responded - response rate about
50%.
56 participants left after introductory questions.
72% participants having > 6 years experience in mental health.
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GPs
CPNs
Psych
iatr
ists SW
staff
nur
ses
Suppo
rt w
orke
rs
Man
ager
sOT
Psych
olog
ists
Oth
ers
3734
30
23
12
7 73 2
15
Distribution of respondents
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Distribution of Respondents
CMHT; 63
Primary care; 37
In-patient; 35
CRHT; 19
AOT; 10 Liaison; 2 Addiction; 2 Others; 2
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Results: contd...
Yes; 134
No; 36
Awareness
Yes; 47
No; 49
Need
No; 30
Yes; 66
Would it stay?
No; 88
Yes; 8
Subspecialty?
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Satisfaction of service providers
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Quantitative: Service users
20/43 respondents had a history of admission.
Duration of contact with mental health: 2-10 years.
Awareness: 16/43 (36%) aware
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Satisfaction of service users
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Qualitative resultsNeed of functional model:
Unaware; divided opinions.to save money and/or time to reduce workload on consultantsto improve patient care.Service need, no clinical need.
Long-term future:driven by financial issues, so will stay (2/3)would be reversed (1/3)
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Qualitative resultsAdvantages
1/3 : no advantages of this changeDisadvantagesIn-patient psychiatry – NOT a separate sub-
specialty.Skills Training
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Qualitative data
CONTINUITY/COMMUNICATION•Both consultants attend CPA•Care-coordinators•Shared electronic records
Functional Model:
Mind the Gap
DYNAMICS•Disagreements•ResponsibilitySuggestions:•Communication•Shared decisions PATIENT CARE
•Easily available consultant.•Time/cost efficient.•↓ trust.•Problems with discharge.Suggestion: Communication
SU’s SATISFACTION•Poor engagement•Repetition•2nd opinionSuggestion: Involve SU & C in service designing.
STRESS, SKILLS & TRAINING
•Less stress, more time.•De-skilling Vs specialisation,•Poor training.Suggestion: Rotation
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In their own words...Assessment tools & referral notes - not a
substitute for first hand knowledge of a patient and their circumstances.
......... a GP.
Smooth running of wards.Likely to improve in-patient and community care
individually but discontinuity will offset advantage.
.......... Mental health professionals.
The old system was on paper and we were seeing a different consultant every 3 months anyway.
.......... A service user
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DiscussionAwareness.Driving force for NWW.It would continue despite a high level of
dissatisfaction.The most consistent view - continuity of care,
the therapeutic alliance, the doctor-patient relationship and trust
Ensuring continuity of care was already a challenge
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Evidence basePioneering work at Guy’s hospital.East Suffolk (pilot in 2005).
A survey of psychiatrists (Dale & Milner, 2009) : Generally negative attitudes, particularly effect on patient care, the erosion of the professional role of the consultant and quality of work life.
Malik et al (2008) : the implications on training.
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StrengthsExplorative studyMulticentre Both service providers (primary and
secondary care, medical and non-medical) as well as service users included
Highly relevant and Topical.Solution focussed.
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LimitationsSample size and response rate.
Response bias.
Many participants did not experience this model.
Admitted service users were not included.
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Future directionsTo study that ‘actual’ long term impact of
functional model on these issues.
Thanks