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      Loss of relational continuity of care in schizophrenia: associations with patient satisfaction and quality of care

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          Abstract

          Background

          Users of mental health service are concerned about changes in clinicians providing their care, but little is known about their impact.

          Aims

          To examine associations between changes in staff, and patient satisfaction and quality of care.

          Method

          A national cross-sectional survey of 3379 people aged 18 or over treated in secondary care for schizophrenia or schizoaffective disorder.

          Results

          Nearly 41.9% reported at least one change in their key worker during the previous 12 months and 10.5% reported multiple changes. Those reporting multiple changes were less satisfied with their treatment and less likely to report having a care plan, knowing how to obtain help when in a crisis or to have had recommended physical health assessments.

          Conclusions

          Frequent changes in staff providing care for people with psychosis are associated with poorer quality of care. Greater efforts need to be made to protect relational continuity of care for such patients.

          Declaration of interest

          M.J.C. was co-chair of the expert advisory group on the NICE quality standard on Service User Experience in Adult Mental Health. S.J.C. has previously been a member of the Health and Social Care Board Northern Ireland Formulary Committee. D.S. received a speaker’s fee from Janssen Cilag in 2011. He is a topic expert on NICE guideline for psychosis and schizophrenia in children and young people and a board member of National Collaborating Centre for Mental Health.

          Copyright and usage

          © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

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          Most cited references11

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          Physical health disparities and mental illness: the scandal of premature mortality.

          A 20-year mortality gap for men, and 15 years for women, is still experienced by people with mental illness in high-income countries. The combination of lifestyle risk factors, higher rates of unnatural deaths and poorer physical healthcare contribute to this scandal of premature mortality that contravenes international conventions for the 'right to health.'
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            Achieving Continuity of Care: Facilitators and Barriers in Community Mental Health Teams

            Background The integration of mental health and social services for people diagnosed with severe mental illness (SMI) has been a key aspect of attempts to reform mental health services in the UK and aims to minimise user and carer distress and confusion arising from service discontinuities. Community mental health teams (CMHTs) are a key component of UK policy for integrated service delivery, but implementing this policy has raised considerable organisational challenges. The aim of this study was to identify and explore facilitators and barriers perceived to influence continuity of care by health and social care professionals working in and closely associated with CMHTs. Methods This study employed a survey design utilising in-depth, semi-structured interviews with a proportionate, random sample of 113 health and social care professionals and representatives of voluntary organisations. Participants worked in two NHS Mental Health Trusts in greater London within eight adult CMHTs and their associated acute in-patient wards, six local general practices, and two voluntary organisations. Results Team leadership, decision making, and experiences of teamwork support were facilitators for cross boundary and team continuity; face-to-face communication between teams, managers, general practitioners, and the voluntary sector were facilitators for information continuity. Relational, personal, and longitudinal continuity were facilitated in some local areas by workforce stability. Barriers for cross boundary and team continuity were specific leadership styles and models of decision making, blurred professional role boundaries, generic working, and lack of training for role development. Barriers for relational, personal, and longitudinal continuity were created by inadequate staffing levels, high caseloads, and administrative duties that could limit time spent with users. Incompatibility of information technology systems hindered information continuity. Flexible continuity was challenged by the increasingly complex needs of service users. Conclusions Substantive challenges exist in harnessing the benefits of integrated CMHT working to deliver continuity of care. Team support should be prioritised in terms of IT provision linked to a review of current models of administrative support. Investment in education and training for role development, leadership, workforce retention, and skills to meet service users' complex needs are recommended.
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              Providing continuity of care for people with severe mental illness- a narrative review.

              Service users and providers have stated that delivering continuity of care to people with severe mental illness should be a service priority. We reviewed literature on continuity of care for people with severe mental illness (SMI) in order to identify factors that promote and impede this process. A systematic search of electronic databases, sources of grey literature and contact with experts in the field. Two reviewers independently rated all papers for possible inclusion. Data extracted from papers formed the basis of a narrative review. We identified 435 papers on continuity of care, of which 60 addressed the study aims. Most did not define continuity of care. Available evidence suggests that assertive community treatment, case management, community mental health teams and crisis intervention reduce the likelihood of patients dropping out of contact with services. Evidence on which to base services that enhance continuity of care for people with SMI is limited because previous research has often failed to define continuity of care or consider the patient's perspective.
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                Author and article information

                Journal
                BJPsych Open
                BJPsych Open
                bjporcpsych
                bjporcpsych
                BJPsych Open
                The Royal College of Psychiatrists
                2056-4724
                6 October 2016
                September 2016
                : 2
                : 5
                : 318-322
                Affiliations
                [1] Rahil Sanatinia MD, Centre for Mental Health, Imperial College London, London, UK
                [2] Violet Cowan, BSc, Centre for Mental Health, Imperial College London, London, UK
                [3] Kirsten Barnicot, PhD, Centre for Mental Health, Imperial College London, London, UK
                [4] Krysia Zalewska, BSc, College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
                [5] David Shiers, MBChB MRCGP, College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
                [6] Stephen J. Cooper, MD, College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK;
                [7] Mike J. Crawford, MD, College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
                Author notes
                Correspondence: Mike J. Crawford, College Centre for Quality Improvement, Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, UK. Email: m.crawford@ 123456imperial.ac.uk
                Article
                bjporcpsych003186
                10.1192/bjpo.bp.116.003186
                5052512
                a75f9524-c3bb-4b90-8ccd-2ff30d4ef877
                © 2016 The Royal College of Psychiatrists

                This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 3 May 2016
                : 30 June 2016
                : 8 September 2016
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