Functional Model : Mind the Gap - Prize Presentation
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Functional Model : Mind the Gap - Prize Presentation

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Dr Ankush Singhal

Dr Ankush Singhal

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Functional Model : Mind the Gap - Prize Presentation Presentation Transcript

  • 1. Functional model: Mind the Gap
    Dr AnkushSinghal
    MBBS, MD (AIIMS), MRCPsych
    ST6 (General adult psychiatry)
    BIPA Annual Conference 2010
  • 2.
  • 3. My Contribution
    Conceived 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.
  • 4. Background
    NWW: 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?
    Mind the gap
    Community consultant
    In-patient
    consultant
    Service user
  • 5. Aim
    To investigate
    health professionals’, service users’ and carers’
    opinions
    about the provision of separate consultants for
    in-patient settings and the community
  • 6. Design
    Multicentre study : North Hertfordshire; the south lakes region of Cumbria; and Winchester.
    Tool
    semi-structured semi-qualitativequestionnaire
    (paper and online version)
    An information leaflet (without introducing any bias).
  • 7. Data Collection
    Personally, 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.
  • 8. Analysis
    Quantitative data – descriptive statistics.
    Qualitative data – framework analysis.
    Carers: too few to be included in the analysis.
  • 9. Results
  • 10. Quantitative: Service providers
    170/330 responded - response rate about 50%.
    56 participants left after introductory questions.
    72% participants having > 6 years experience in mental health.
  • 11.
  • 12. Distribution of Respondents
  • 13. Results:contd...
  • 14. Satisfaction of service providers
  • 15. 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
  • 16. Satisfaction of service users
  • 17.
  • 18. Qualitative results
    Need of functional model:
    Unaware; divided opinions.
    to save money and/or time
    to reduce workload on consultants
    to 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)
  • 19. Qualitative results
    Advantages
    1/3 : no advantages of this change
    Disadvantages
    In-patient psychiatry – NOT a separate sub-specialty.
    Skills
    Training
  • 20. STRESS, SKILLS & TRAINING
    • Less stress, more time.
    • 21. De-skilling Vs specialisation,
    • 22. Poor training.
    Suggestion: Rotation
    CONTINUITY/COMMUNICATION
    • Both consultants attend CPA
    • 23. Care-coordinators
    • 24. Shared electronic records
    Qualitative data
    DYNAMICS
    • Disagreements
    • 25. Responsibility
    Suggestions:
    • Communication
    • 26. Shared decisions
    SU’s SATISFACTION
    • Poor engagement
    • 27. Repetition
    • 28. 2nd opinion
    Suggestion: Involve SU
    & C in service designing.
    Functional Model:
    Mind the Gap
    PATIENT CARE
    • Easily available consultant.
    • 29. Time/cost efficient.
    • 30. ↓ trust.
    • 31. Problems with discharge.
    Suggestion: Communication
  • 32. 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
  • 33. Discussion
    Awareness.
    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
  • 34. Evidence base
    Pioneering 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.
  • 35. Strengths
    Explorative study
    Multicentre
    Both service providers (primary and secondary care, medical and non-medical) as well as service users included
    Highly relevant and Topical.
    Solution focussed.
  • 36. Limitations
    Sample size and response rate.
    Response bias.
    Many participants did not experience this model.
    Admitted service users were not included.
  • 37. Future directions
    To study that ‘actual’ long term impact of functional model on these issues.
    Thanks