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      Patients' experiences of the caring encounter with the psychiatric emergency response team in the emergency medical service—A qualitative interview study

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          Abstract

          Background

          Mental illnesses are increasing in the population; consequently, the number of psychiatric emergencies handled by the emergency medical services (EMS) has also increased. Alternative response systems have been developed and evaluated, but there is still a lack of knowledge concerning the patients' experiences of being cared for in the EMS by a psychiatric emergency response unit (In Swedish: Psykiatrisk Akut Mobilitet [PAM]).

          Objective

          The aim of this study was to explore patients' experiences of the caring encounter with the PAM team.

          Design

          A qualitative study design with 14 patients' interviews and content analysis was used.

          Results

          The patients expressed that the PAM team created a safe environment and actively involved the patient in their care by creating an open and safe place for dialogue. In this safe environment, the patients described how they participated in the decision making and received care without fear of being dismissed, ignored or judged.

          Discussion and Conclusion

          The patients' experiences of being cared for by the PAM team show that person‐centred care was achieved by involving the patients in their own care. This participation was possible because mutual trust and confidence existed, and the patients acknowledged the specialist response unit to be a valuable part of the EMS. However, further studies are needed to explore whether the PAM as a response unit in the EMS decreases the risk of suicide and to examine different health economic aspects of using PAM in the EMS.

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          Most cited references36

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          The qualitative content analysis process.

          This paper is a description of inductive and deductive content analysis. Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method. When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge. Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.
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            Person-centered care--ready for prime time.

            Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness. Copyright © 2011 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.
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              Social disparities in the prevalence of multimorbidity – A register-based population study

              Background Prevalences of multimorbidity vary between European studies and several methods and definitions are used. In this study we examine the prevalence of multimorbidity in relation to age, gender and educational attainment and the association between physical and mental health conditions and educational attainment in a Danish population. Methods A cross-sectional design was used to study the prevalence of multimorbidity, defined as two or more chronic conditions, and of comorbid physical and mental health conditions across age groups and educational attainment levels among 1,397,173 individuals aged 16 years and older who lived in the Capital Region of Denmark on January 1st, 2012. After calculating prevalence, odds ratios for multimorbidity and mental health conditions were derived from logistic regression on gender, age, age squared, education and number of physical conditions (only for odds ratios for mental health conditions). Odds ratios for having multimorbidity and mental health conditions for each variable were adjusted for all other variables. Results Multimorbidity prevalence was 21.6%. Half of the population aged 65 and above had multimorbidity, and prevalence was inversely related to educational attainment: 26.9% (95% CI, 26.8–26.9) among those with lower secondary education versus 13.5% (95% CI, 13.5–13.6) among people with postgraduate education. Adjusted odds ratios for multimorbidity were 0.50 (95% CI, 0.49–0.51) for people with postgraduate education, compared to people with lower secondary education. Among all population members, 4.9% (95% CI, 4.9–4.9) had both a physical and a mental health condition, a proportion that increased to 22.6% of people with multimorbidity. Physical and mental health comorbidity was more prevalent in women (6.33%; 95% CI, 6.3–6.4) than men (3.34%; 95% CI, 3.3–3.4) and approximately 50 times more prevalent among older persons than younger ones. Physical and mental health comorbidity was also twice as prevalent among people with lower secondary education than among those with postgraduate education. The presence of a mental health condition was strongly associated with the number of physical conditions; those with five or more physical conditions had an adjusted odds ratio for a mental health condition of 3.93 (95% CI, 3.8–4.1), compared to those with no physical conditions. Conclusion Multimorbidity prevalence and patterns in the Danish population are comparable to those of other European populations. The high prevalence of mental and physical health conditions highlights the need to ensure that healthcare systems deliver care that takes physical and mental comorbidity into account. Further, the higher prevalence of multimorbidity among persons with low educational attainment emphasizes the importance of having a health care system providing care that is beneficial to all regardless of socioeconomic status.
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                Author and article information

                Contributors
                Role: Assoc. profveronica.lindstrom@ki.se
                Journal
                Health Expect
                Health Expect
                10.1111/(ISSN)1369-7625
                HEX
                Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
                John Wiley and Sons Inc. (Hoboken )
                1369-6513
                1369-7625
                22 January 2020
                April 2020
                : 23
                : 2 ( doiID: 10.1111/hex.v23.2 )
                : 442-449
                Affiliations
                [ 1 ] Academic EMS Stockholm Sweden
                [ 2 ] Department of Neurobiology Karolinska Institutet Care Sciences, and Society Division of Nursing Stockholm Stockholm Sweden
                [ 3 ] Department of Clinical Neuroscience Centre for psychiatric research Karolinska Institutet Stockholm Sweden
                Author notes
                [*] [* ] Correspondence

                Veronica Lindström, Department of Neurobiology, Karolinska Institutet, Care Sciences, and Society Division of Nursing Alfred Nobels alle 23 C4/VL, 141 83 Huddinge, Sweden.

                Email: veronica.lindstrom@ 123456ki.se

                Author information
                https://orcid.org/0000-0003-2222-872X
                Article
                HEX13024
                10.1111/hex.13024
                7104631
                31967699
                d06e52bc-7720-46dd-9703-c6f75d782c1d
                © 2020 The Authors Health Expectations published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 02 October 2019
                : 22 November 2019
                : 17 December 2019
                Page count
                Figures: 1, Tables: 2, Pages: 8, Words: 6425
                Funding
                Funded by: Stockholm County Council , open-funder-registry 10.13039/501100004348;
                Categories
                Original Research Paper
                Original Research Papers
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.8 mode:remove_FC converted:30.03.2020

                Health & Social care
                ambulance,emergency medical service,mental illness,patient experience,psychiatric emergency response team,suicide prevention

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