Functional Model : Mind the Gap - Prize Presentation

Functional model: Mind the Gap
Dr AnkushSinghal
MBBS, MD (AIIMS), MRCPsych
ST6 (General adult psychiatry)
BIPA Annual Conference 2010

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.

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

Aim
To investigate
health professionals’, service users’ and carers’
opinions
about the provision of separate consultants for
in-patient settings and the community

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).

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.

Analysis
Quantitative data – descriptive statistics.
Qualitative data – framework analysis.
Carers: too few to be included in the analysis.

Results

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.

Distribution of Respondents

Results:contd...

Satisfaction of service providers

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

Satisfaction of service users

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)

Qualitative results
Advantages
1/3 : no advantages of this change
Disadvantages
In-patient psychiatry – NOT a separate sub-specialty.
Skills
Training

STRESS, SKILLS & TRAINING
Less stress, more time.
De-skilling Vs specialisation,
Poor training.
Suggestion: Rotation
CONTINUITY/COMMUNICATION
Both consultants attend CPA
Care-coordinators
Shared electronic records
Qualitative data
DYNAMICS
Disagreements
Responsibility
Suggestions:
Communication
Shared decisions
SU’s SATISFACTION
Poor engagement
Repetition
2nd opinion
Suggestion: Involve SU
& C in service designing.
Functional Model:
Mind the Gap
PATIENT CARE
Easily available consultant.
Time/cost efficient.
↓ trust.
Problems with discharge.
Suggestion: Communication

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

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

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.

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.

Limitations
Sample size and response rate.
Response bias.
Many participants did not experience this model.
Admitted service users were not included.

Future directions
To study that ‘actual’ long term impact of functional model on these issues.
Thanks

Functional Model : Mind the Gap - Prize Presentation

by JP Rajendran on Aug 28, 2010

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