Developing an Integrated Model of Care for Veterans with Alcohol Problems

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Abstract

Introduction:

Veterans often do not present with alcohol problems in isolation, they may have a wide range of social, physical, and psychological needs. The aim of this study was to facilitate the development of a co-designed integrated model of care for veterans with alcohol problems.

Methods:

Following the development model by the Agency for Clinical Innovation, a planning symposium was held in North East of England to engage health and social care planners, public health leads, clinical commissioning groups and providers. Service users were empowered in discussions to provide insights and look for solutions (N = 43).

Results:

Using diagramming techniques, three examples of health and social care provision were created demonstrating the current commissioning landscape, one veteran’s experience of accessing services and a proposal for a new integrated model of care for veterans with alcohol problems.

Discussion:

By engaging stakeholders and service users, the model proposed a potential solution to reducing the number of veterans ‘falling through the gaps’ or disengaging from services. The collaborative approach highlighted the difficulties in navigating the current complex health and social care systems. The co-designed hub and spoke model aims to enable alcohol misuse services to adapt and evolve so that they better fit the needs of veterans.

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Most cited references 35

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The hub-and-spoke organization design: an avenue for serving patients well

James Elrod, John Fortenberry (2017)

Background The healthcare industry is characterized by intensive, never-ending change occurring on a multitude of fronts. Success in such tumultuous environments requires healthcare providers to be proficient in myriad areas, including the manner in which they organize and deliver services. Less efficient designs drain precious resources and hamper efforts to deliver the best care possible to patients, making it imperative that optimal pathways are identified and pursued. One particular avenue that offers great potential for serving patients efficiently and effectively is known as the hub-and-spoke organization design. Discussion The hub-and-spoke organization design is a model which arranges service delivery assets into a network consisting of an anchor establishment (hub) which offers a full array of services, complemented by secondary establishments (spokes) which offer more limited service arrays, routing patients needing more intensive services to the hub for treatment. Hub-and-spoke networks afford many benefits for healthcare providers, but in order to capitalize fully, proper assembly is required. To advance awareness, knowledge, and use of the hub-and-spoke organization design, this article profiles Willis-Knighton Health System’s service delivery network which has utilized the model for over three decades. Among other things, the hub-and-spoke organization design is defined, benefits are stipulated, and applications are discussed, permitting healthcare providers essential insights for the establishment and operation of these networks. Conclusions The change-rich nature of the healthcare industry places a premium on incorporating advancements that permit health and medical providers to operate as optimally as possible. The hub-and-spoke organization design represents an option that, when deployed correctly, can greatly assist healthcare establishments in their quests to serve patients well.

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Peer support among adults with serious mental illness: a report from the field.

Michael Rowe, Larry Davidson, Pat D Sells … (2006)

Peer support is based on the belief that people who have faced, endured, and overcome adversity can offer useful support, encouragement, hope, and perhaps mentorship to others facing similar situations. While this belief is well accepted for many conditions, such as addiction, trauma, or cancer, stigma and stereotypes about mental illness have impeded attempts on the part of people in recovery to offer such supports within the mental health system. Beginning in the early 1990s with programs that deployed people with mental illness to provide conventional services such as case management, opportunities for the provision and receipt of peer support within the mental health system have proliferated rapidly across the country as part of the emerging recovery movement. This article defines peer support as a form of mental health care and reviews data from 4 randomized controlled trials, which demonstrated few differences between the outcomes of conventional care when provided by peers versus non-peers. We then consider what, if any, unique contributions can be made by virtue of a person's history of serious mental illness and recovery and review beginning efforts to identify and evaluate these potential valued-added components of care. We conclude by suggesting that peer support is still early in its development as a form of mental health service provision and encourage further exploration and evaluation of this promising, if yet unproven, practice.

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What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study.

Matthew Hotopf, Lisa Hull, Norman Jones … (2010)

Concerns have been raised about the psychological effect of continued combat exposure and of repeated deployments. We examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009, the effect of multiple deployments, and time since return from deployment. We reassessed the prevalence of probable mental disorders in participants of our previous study (2003-05). We also studied two new randomly chosen samples: those with recent deployment to Afghanistan, and those who had joined the UK armed forces since April, 2003, to ensure that the final sample continued to be representative of the UK armed forces. Between November, 2007, and September, 2009, participants completed a questionnaire about their deployment experiences and health outcomes. 9990 (56%) participants completed the study questionnaire (8278 regulars, 1712 reservists). The prevalence of probable post-traumatic stress disorder was 4.0% (95% CI 3.5-4.5; n=376), 19.7% (18.7-20.6; n=1908) for symptoms of common mental disorders, and 13.0% (12.2-13.8; n=1323) for alcohol misuse. Deployment to Iraq or Afghanistan was significantly associated with alcohol misuse for regulars (odds ratio 1.22, 95% CI 1.02-1.46) and with probable post-traumatic stress disorder for reservists (2.83, 1.23-6.51). Regular personnel in combat roles were more likely than were those in support roles to report probable post-traumatic stress disorder (1.87, 1.26-2.78). There was no association with number of deployments for any outcome. There was some evidence for a small increase in the reporting of probable post-traumatic stress disorder with time since return from deployment in regulars (1.13, 1.03-1.24). Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of probable post-traumatic stress disorder was low. These findings show the importance of continued health surveillance of UK military personnel. UK Ministry of Defence. Copyright 2010 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Alison K. Osborne:

ORCID: https://orcid.org/0000-0003-2203-7106

Journal

Journal ID (nlm-ta): Int J Integr Care

Journal ID (iso-abbrev): Int J Integr Care

Journal ID (issn): 1568-4156

Title: International Journal of Integrated Care

Publisher: Ubiquity Press

ISSN (Electronic): 1568-4156

Publication date (Electronic, pub): 18 February 2022

Publication date Collection: Jan-Mar 2022

Volume: 22

Issue: 1

Electronic Location Identifier: 15

Affiliations

[1 ]Northumbria University, UK

Author notes

CORRESPONDING AUTHOR: Alison K. Osborne Northumbria University, UK alison.osborne2@ 123456northumbria.ac.uk

Author information

Alison K. Osborne https://orcid.org/0000-0003-2203-7106

Gill McGill https://orcid.org/0000-0003-0559-1666

Peta Jane Greaves https://orcid.org/0000-0002-3209-9960

Matthew D. Kiernan https://orcid.org/0000-0002-8360-1965

Article

DOI: 10.5334/ijic.5500

PMC ID: 8855732

SO-VID: 6cdf4dfb-4692-4a8f-85f0-b62209c51c24

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.

Developing an Integrated Model of Care for Veterans with Alcohol Problems

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Abstract

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Methods:

Results:

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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 35

The hub-and-spoke organization design: an avenue for serving patients well

Peer support among adults with serious mental illness: a report from the field.

What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study.

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