Functional Model : Mind the Gap - Prize Presentation

  • 1,409 views
Uploaded on

Dr Ankush Singhal

Dr Ankush Singhal

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
1,409
On Slideshare
0
From Embeds
0
Number of Embeds
1

Actions

Shares
Downloads
5
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

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
    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