Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness

Patients with a serious mental illness requiring admission were randomised to home care or standard hospital care. Over the initial 18 months, 60 patients entered each group and were studied for a mean of 10 months. Home care reduced hospital use by 80%, with patients being admitted for a mean of 14 days, compared with 72 days for the standard group, but this bed-saving made no difference in direct treatment costs. Home care offers individualised treatment, and many patients require continuing support with the emphasis on areas such as finances and housing.

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Continuity of care in serious mental illness

Psychiatric Bulletin ◽

10.1192/pb.17.3.140 ◽

1993 ◽

Vol 17 (3) ◽

pp. 140-141 ◽

Cited By ~ 3

Author(s):

Joy Abbati ◽

Greg Oles

Keyword(s):

Mental Illness ◽

Psychosocial Factors ◽

Continuity Of Care ◽

Serious Mental Illness ◽

Extended Period ◽

Professional Involvement ◽

Long Period ◽

The Past ◽

Potential Problems ◽

The Individual

It has been claimed (Abbati et al, 1987) that patients benefit from continuity of professional involvement sustained over a long period. Schizophrenia sufferers in particular find it harder than non-sufferers to articulate their difficulties and concerns, and may adjust poorly to change, only building up trust in professionals over an extended period. In their turn, professionals need time to get to know such individuals and to recognise ‘early signs’ (Birchwood et al, 1989) of possible relapse. Management of potential decompensation involves a knowledge of how the individual has responded to changes in medication in the past and what psychosocial factors may be relevant. Working with such patients refines the clinician's skills in interacting with them, obtaining their compliance with a particular regime, and pre-empting potential problems. Without this background of knowledge and experience, the management of sufferers may be crude with adverse results for the patient.

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Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results.

Psychiatric Rehabilitation Journal ◽

10.2975/32.1.2008.9.22 ◽

2008 ◽

Vol 32 (1) ◽

pp. 9-22 ◽

Cited By ~ 64

Author(s):

Carla A. Green ◽

Michael R. Polen ◽

Shannon L. Janoff ◽

David K. Castleton ◽

Jennifer P. Wisdom ◽

...

Keyword(s):

Mental Illness ◽

Continuity Of Care ◽

Serious Mental Illness ◽

Relational Continuity ◽

Study Results ◽

Patient Relationships

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Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice.

10.21203/rs.2.21849/v3 ◽

2020 ◽

Author(s):

Kirsti Marieke Jakobs ◽

Anne Posthuma ◽

Wim JC de Grauw ◽

Bianca WM Schalk ◽

Reinier P Akkermans ◽

...

Keyword(s):

Diabetes Mellitus ◽

Mental Illness ◽

Cardiovascular Risk ◽

Family Practice ◽

Serious Mental Illness ◽

Mental Healthcare ◽

Screening Rate ◽

Risk Screening ◽

Family Practices ◽

Patients With Diabetes

Abstract Background: Patients with serious mental illness (SMI) and patients on antipsychotics (AP) have an elevated risk for cardiovascular diseases. In the Netherlands, the mental healthcare for these patients is increasingly taken care of by family practitioners (FP) as a result of a shift from secondary to primary care. Therefore, it is essential to increase our knowledge regarding the characteristics of this patient group and the (somatic) care provided by their FPs. The aim was to examine the rate of cardiovascular risk screening in patients with SMI or the use of AP in family practice.Methods: We performed a retrospective cohort study of 151.238 patients listed in 24 family practices in the Netherlands.From electronic medical records we extracted data concerning diagnoses, measurement values of CVR factors, medication and frequency of visits over a 2 year period. Primary outcome was the rate of patients who were screened for CVR factors. We compared three groups: patients with SMI/AP without diabetes or CVD (SMI/AP-only), patients with SMI/AP and diabetes mellitus (SMI/AP+DM), patients with SMI/AP and a history of cardiovascular disease (SMI/AP+CVD). We explored factors associated with adequate screening using multilevel logistic regression.Results: We identified 1705 patients with SMI/AP, 834 with a SMI diagnosis, 1150 using AP. The screening rate for CVR in the SMI/AP-only group (n=1383) was adequate in 8.5%. Screening was higher in the SMI/AP-+DM (n=206, 68.4% adequate, OR 24.6 (95%CI, 17.3-35.1) and SMI/AP+CVD (n=116, 26.7% adequate, OR 4.2 (95%CI, 2.7-6.6). A high frequency of visits, age, the use of AP and a diagnosis of COPD were associated with a higher screening rate. In addition we also examined differences between patients with SMI and patients using AP without SMI.Conclusion: CVR screening in patients with SMI/AP is performed poorly in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as comorbidity. The finding of a large group of AP users without a SMI diagnosis may indicate that FPs often prescribe AP off-label, lack information about the diagnosis, or use the wrong code.

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Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice

BMC Family Practice ◽

10.1186/s12875-020-01225-7 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Kirsti M. Jakobs ◽

Anne Posthuma ◽

Wim J. C. de Grauw ◽

Bianca W. M. Schalk ◽

Reinier P. Akkermans ◽

...

Keyword(s):

Mental Illness ◽

Cardiovascular Risk ◽

Family Practice ◽

Serious Mental Illness ◽

Risk Screening

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Cardiovascular risk screening of patients with serious mental illness or using antipsychotics in family practice.

10.21203/rs.2.21849/v1 ◽

2020 ◽

Author(s):

Kirsti Marieke Jakobs ◽

Anne Posthuma ◽

Wim JC de Grauw ◽

Bianca WM Schalk ◽

Reinier P Akkermans ◽

...

Keyword(s):

Diabetes Mellitus ◽

Mental Illness ◽

Cardiovascular Risk ◽

The Netherlands ◽

Family Practice ◽

Serious Mental Illness ◽

Mental Healthcare ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Family Practices

Abstract Background Patients with a serious mental illness (SMI) and those using antipsychotics (AP) have an elevated risk for cardiovascular disease (CVD). In the Netherlands, the mental healthcare for these patients is increasingly provided by family practitioners (FPs), following a shift from secondary to primary care. It is therefore essential to better understand the characteristics of this patient group and the (somatic) care provided by their FPs. The aim of this study was to examine the rate of cardiovascular risk (CVR) screening in patients with SMI or those using APs in family practice. Methods We performed a retrospective cohort study of 151,238 patients registered with 24 family practices in the Netherlands. From electronic medical records, we extracted data concerning diagnoses, the measurement of CVR factors, medication, and the frequency of visits over a two-year year period. The primary outcome was the proportion of patients who were screened for CVR factors. We compared three groups: patients with SMI or using AP without diabetes or CVD (SMI/AP only), patients with SMI or using AP and diabetes mellitus (SMI/AP+DM), and patients with SMI or using AP and a history of CVD (SMI/AP+CVD). We explored the factors associated with adequate screening using a multilevel logistic regression. Results We identified 1705 patients with SMI or using AP, 834 of whom had a SMI diagnosis and 1150 of whom used AP. CVR was adequately screened in 8.5% of the SMI/AP-only group (117 of 1383 patients). Screening was much more commonly performed in the SMI/AP+DM (n=206, 68.4% adequate) and SMI/AP+CVD (n=116, 26.7% adequate) groups. (ORs for moderate and adequate screening 21.8 (95%CI, 15.4-30.8) and 4.3 (95%CI, 2.8-6.6) respectively). A high frequency of FP visits, age, the use of AP, and a diagnosis of chronic obstructive pulmonary disease were associated with a higher screening rate. In addition, we examined the differences between patients with SMI and patients using AP in the absence of a SMI. ConclusionsCVR screening in patients with SMI or using AP is often inadequate or lacking in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as a comorbidity.

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Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice.

10.21203/rs.2.21849/v2 ◽

2020 ◽

Author(s):

Kirsti Marieke Jakobs ◽

Anne Posthuma ◽

Wim JC de Grauw ◽

Bianca WM Schalk ◽

Reinier P Akkermans ◽

...

Keyword(s):

Diabetes Mellitus ◽

Mental Illness ◽

Cardiovascular Risk ◽

Family Practice ◽

Serious Mental Illness ◽

Mental Healthcare ◽

Screening Rate ◽

Risk Screening ◽

Family Practices ◽

Patients With Diabetes

Abstract Background Patients with serious mental illness (SMI) and patients on antipsychotics (AP) have an elevated risk for cardiovascular diseases. In the Netherlands, the mental healthcare for these patients is increasingly taken care of by family practitioners (FP) as a result of a shift from secondary to primary care. Therefore, it is essential to increase our knowledge regarding the characteristics of this patient group and the (somatic) care provided by their FPs. The aim was to examine the rate of cardiovascular risk screening in patients with SMI or the use of AP in family practice.Methods We performed a retrospective cohort study of 151.238 patients listed in 24 family practices in the Netherlands.From electronic medical records we extracted data concerning diagnoses, measurement values of CVR factors, medication and frequency of visits over a 2 year period. Primary outcome was the rate of patients who were screened for CVR factors. We compared three groups: patients with SMI/AP without diabetes or CVD (SMI/AP-only), patients with SMI/AP and diabetes mellitus (SMI/AP+DM), patients with SMI/AP and a history of cardiovascular disease (SMI/AP+CVD). We explored factors associated with adequate screening using multilevel logistic regression.Results We identified 1705 patients with SMI/AP, 834 with a SMI diagnosis, 1150 using AP. The screening rate for CVR in the SMI/AP-only group (n=1383) was adequate in 8.5%. Screening was higher in the SMI/AP-+DM (n=206, 68.4% adequate, OR 24.6 (95%CI, 17.3-35.1) and SMI/AP+CVD (n=116, 26.7% adequate, OR 4.2 (95%CI, 2.7-6.6). A high frequency of visits, age, the use of AP and a diagnosis of COPD were associated with a higher screening rate. In addition we also examined differences between patients with SMI and patients using AP without SMI.Conclusion CVR screening in patients with SMI/AP is performed poorly in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as comorbidity. The finding of a large group of AP users without a SMI diagnosis may indicate that FPs often prescribe AP off-label, lack information about the diagnosis, or use the wrong code.

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