Functional Model : Mind the Gap - Prize Presentation


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Dr Ankush Singhal

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Functional Model : Mind the Gap - Prize Presentation

  1. 1. Functional model: Mind the Gap<br />Dr AnkushSinghal<br />MBBS, MD (AIIMS), MRCPsych<br />ST6 (General adult psychiatry)<br />BIPA Annual Conference 2010 <br />
  2. 2.
  3. 3. My Contribution<br />Conceived the idea and led the study.<br />Literature review, the protocol and ethics approval. <br />Collected the data. <br />Co-ordinated.<br />Merged the data & analysed it.<br />Prepared the manuscript and sent for publication. <br />Revisions as first & corresponding author.<br />Presented in RCPsych AGM, Liverpool and in my Trust. <br />
  4. 4. Background<br />NWW: enabling consultant psychiatrists, among others, to deliver effective and person-centred care.<br />Acute care pathway – CRHT + In-patient.<br />Functional model.<br />Acute in-patient psychiatry – a subspecialty?<br />Mind the gap<br />Community consultant<br />In-patient <br />consultant<br />Service user<br />
  5. 5. Aim<br />To investigate <br />health professionals’, service users’ and carers’ <br />opinions <br />about the provision of separate consultants for <br />in-patient settings and the community<br />
  6. 6. Design<br />Multicentre study : North Hertfordshire; the south lakes region of Cumbria; and Winchester. <br />Tool<br /> semi-structured semi-qualitativequestionnaire <br /> (paper and online version)<br />An information leaflet (without introducing any bias).<br />
  7. 7. Data Collection<br />Personally, by post and online.<br />Through CMHTs, out-patient clinics, mental health wards and other places (e.g. the local centre of MIND).<br />Admitted patients were not invited.<br />Reminder - after a month.<br />
  8. 8. Analysis<br />Quantitative data – descriptive statistics. <br />Qualitative data – framework analysis.<br />Carers: too few to be included in the analysis.<br />
  9. 9. Results<br />
  10. 10. Quantitative: Service providers<br />170/330 responded - response rate about 50%.<br />56 participants left after introductory questions.<br />72% participants having > 6 years experience in mental health. <br />
  11. 11.
  12. 12. Distribution of Respondents<br />
  13. 13. Results:contd...<br />
  14. 14. Satisfaction of service providers<br />
  15. 15. Quantitative: Service users<br />20/43 respondents had a history of admission.<br />Duration of contact with mental health: 2-10 years.<br />Awareness: 16/43 (36%) aware<br />
  16. 16. Satisfaction of service users<br />
  17. 17.
  18. 18. Qualitative results<br />Need of functional model: <br />Unaware; divided opinions.<br />to save money and/or time <br />to reduce workload on consultants<br />to improve patient care.<br />Service need, no clinical need.<br />Long-term future:<br />driven by financial issues, so will stay (2/3)<br />would be reversed (1/3)<br />
  19. 19. Qualitative results<br />Advantages <br />1/3 : no advantages of this change<br />Disadvantages<br />In-patient psychiatry – NOT a separate sub-specialty.<br />Skills <br />Training<br />
  20. 20. STRESS, SKILLS & TRAINING<br /><ul><li>Less stress, more time.
  21. 21. De-skilling Vs specialisation,
  22. 22. Poor training.</li></ul>Suggestion: Rotation<br />CONTINUITY/COMMUNICATION<br /><ul><li>Both consultants attend CPA
  23. 23. Care-coordinators
  24. 24. Shared electronic records</li></ul>Qualitative data<br />DYNAMICS<br /><ul><li>Disagreements
  25. 25. Responsibility</li></ul>Suggestions:<br /><ul><li>Communication
  26. 26. Shared decisions</li></ul>SU’s SATISFACTION<br /><ul><li>Poor engagement
  27. 27. Repetition
  28. 28. 2nd opinion</li></ul>Suggestion: Involve SU <br />& C in service designing.<br />Functional Model: <br />Mind the Gap<br />PATIENT CARE<br /><ul><li>Easily available consultant.
  29. 29. Time/cost efficient.
  30. 30. ↓ trust.
  31. 31. Problems with discharge.</li></ul>Suggestion: Communication<br />
  32. 32. In their own words...<br />Assessment tools & referral notes - not a substitute for first hand knowledge of a patient and their circumstances.<br />......... a GP.<br />Smooth running of wards.<br />Likely to improve in-patient and community care individually but discontinuity will offset advantage.<br />.......... Mental health professionals.<br />The old system was on paper and we were seeing a different consultant every 3 months anyway.<br />.......... A service user<br />
  33. 33. Discussion<br />Awareness.<br />Driving force for NWW.<br />It would continue despite a high level of dissatisfaction.<br />The most consistent view - continuity of care, the therapeutic alliance, the doctor-patient relationship and trust<br />Ensuring continuity of care was already a challenge<br />
  34. 34. Evidence base<br />Pioneering work at Guy’s hospital.<br />East Suffolk (pilot in 2005).<br />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. <br />Malik et al (2008) : the implications on training.<br />
  35. 35. Strengths<br />Explorative study<br />Multicentre <br />Both service providers (primary and secondary care, medical and non-medical) as well as service users included<br />Highly relevant and Topical.<br />Solution focussed.<br />
  36. 36. Limitations<br />Sample size and response rate.<br />Response bias.<br />Many participants did not experience this model.<br />Admitted service users were not included.<br />
  37. 37. Future directions<br />To study that ‘actual’ long term impact of functional model on these issues.<br />Thanks<br />