scholarly journals Association between a national primary care pay-for-performance scheme and suicide rates in England: spatial cohort study

2018 ◽  
Vol 213 (4) ◽  
pp. 600-608
Author(s):  
Christos Grigoroglou ◽  
Luke Munford ◽  
Roger T. Webb ◽  
Nav Kapur ◽  
Tim Doran ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Quality Of Care ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Pay For Performance ◽  
Social Fragmentation ◽  
Practice Performance ◽  
The Relationship

BackgroundPay-for-performance policies aim to improve population health by incentivising improvements in quality of care.AimsTo assess the relationship between general practice performance on severe mental illness (SMI) and depression indicators under a national incentivisation scheme and suicide risk in England for the period 2006–2014.MethodLongitudinal spatial analysis for 32 844 small-area geographical units (lower super output areas, LSOAs), using population-structure adjusted numbers of suicide as the outcome variable. Negative binomial models were fitted to investigate the relationship between spatially estimated recorded quality of care and suicide risk at the LSOA level. Incidence rate ratios (IRRs) were adjusted for deprivation, social fragmentation, prevalence of depression and SMI as well as other 2011 Census variables.ResultsNo association was found between practice performance on the mental health indicators and suicide incidence in practice localities (IRR=1.000, 95% CI 0.998–1.002). IRRs indicated elevated suicide risks linked with area-level social fragmentation (1.030; 95% CI 1.027–1.034), deprivation (1.013, 95% CI 1.012–1.014) and rurality (1.059, 95% CI 1.027–1.092).ConclusionsPrimary care has an important role to play in suicide prevention, but we did not observe a link between practices' higher reported quality of care on incentivised mental health activities and lower suicide rates in the local population. It is likely that effective suicide prevention needs a more concerted, multiagency approach. Better training in suicide prevention for general practitioners is also essential. These findings pertain to the UK but have relevance to other countries considering similar programmes.Declaration of interestNone.

scholarly journals Creating a ‘reverse’ integrated primary and mental healthcare clinic for those with serious mental illness

2015 ◽  
Vol 17 (05) ◽  
pp. 421-427 ◽  
Author(s):  
Alexandros Maragakis ◽  
Ragavan Siddharthan ◽  
Jill RachBeisel ◽  
Cassandra Snipes
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Quality Of Care ◽  
Serious Mental Illness ◽  
Mental Healthcare ◽  
Policy Reforms ◽  
Mental Health Settings ◽  
Primary Care Practitioners

Individuals with serious mental illness (SMI) are more likely to experience preventable medical health issues, such as diabetes, hyperlipidemia, obesity, and cardiovascular disease, than the general population. To further compound this issue, these individuals are less likely to seek preventative medical care. These factors result in higher usage of expensive emergency care, lower quality of care, and lower life expectancy. This manuscript presents literature that examines the health disparities this population experiences, and barriers to accessing primary care. Through the identification of these barriers, we recommend that the field of family medicine work in collaboration with the field of mental health to implement ‘reverse’ integrated care (RIC) systems, and provide primary care services in the mental health settings. By embedding primary care practitioners in mental health settings, where individuals with SMI are more likely to present for treatment, this population may receive treatment for somatic care by experts. This not only would improve the quality of care received by patients, but would also remove the burden of managing complex somatic care from providers trained in mental health. The rationale for this RIC system, as well as training and policy reforms, are discussed.

scholarly journals The relationship between deinstitutionalization and quality of care in longer-term psychiatric and social care facilities in Europe: A cross-sectional study

2017 ◽  
Vol 42 ◽  
pp. 95-102 ◽  
Author(s):  
T. Taylor Salisbury ◽  
H. Killaspy ◽  
M. King
Keyword(s):  
Mental Health ◽  
Quality Of Care ◽  
Service User ◽  
Multilevel Models ◽  
Mental Health Problems ◽  
Cross Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
The Relationship

AbstractBackgroundThe process of deinstitutionalization (community-based care) has been shown to be associated with better quality of life for those with longer-term mental health problems compared to long stay hospitals. This project aimed to investigate the relationship between national progress towards deinstitutionalization and (1) quality of longer-term mental health care (2) service users’ ratings of that care in nine European countries.MethodsQuality of care was assessed in 193 longer-term hospital- and community-based facilities in Bulgaria, Germany, Greece, Italy, the Netherlands, Poland, Portugal, Spain and the UK. Data on users’ ratings of care were collected from 1579 users of these services. Country level variables were compiled from publicly available data. Multilevel models were fit to assess associations with quality of care and service user experiences of care.ResultsSignificant positive associations were found between deinstitutionalization and (1) five of seven quality of care domains; and (2) service user autonomy. A 10% increase in expenditure was associated with projected clinically important improvements in quality of care.ConclusionsGreater deinstitutionalization of mental health mental health services is associated with higher quality of care and better service user autonomy.

The role of health services and systems

2019 ◽  
pp. 95-105
Author(s):  
Navneet Kapur ◽  
Robert Goldney
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Services ◽  
Suicide Prevention ◽  
Inpatient Care ◽  
Systems Of Care ◽  
General Hospitals ◽  
Societal Problems

This chapter discusses health services and systems of care and suicide prevention. Although suicide and suicidal behaviour are sometimes seen as societal problems, health services have a key role to play. The majority of those who die by suicide have a psychiatric disorder at the time of death. Many individuals have been in contact with health services prior to suicide. Primary care, general hospitals, and specialist mental health services are all important. Service-wide changes such as crisis provision, dual-diagnosis services, and serious incident reviews can contribute to suicide prevention. Focusing on safety in particular settings (e.g. inpatient care) can also be highly effective. Clinical guidelines can improve the quality of care and outcomes for patients, but implementation is key. Safer systems of care, with a number of interventions introduced simultaneously, may help to reduce suicide.

A Theory of the Art of Nursing Discovered in Rogers’ Science of Unitary Human Beings

2002 ◽  
Vol 6 (2) ◽  
pp. 55-60 ◽  
Author(s):  
Martha Raile Alligood,
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Nursing Practice ◽  
Research Approach ◽  
Individual Rights ◽  
Human Beings ◽  
Delivery Of Care ◽  
Human Caring ◽  
The Relationship

More nurses today than ever before are delivering primary care. As they address the contemporary challenges in the delivery of care, the relationship between the manner of nursing and the quality of care is recognized. The purpose of this project was to formalize a theory of the art of nursing from the writings of Martha Rogers, who recognized the vital nature of interpersonal human caring. Using a qualitative hermeneutic research approach, the author discovered a theory of the art of nursing that specified relationships among respect, responsibility, and empathy. The theory proposes that the art of nursing is the ability to balance responsibility for the welfare of others with respect for their human freedom and individual rights through empathic, knowing participation in the moral action we call nursing practice.

Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample

Crisis ◽  
2016 ◽  
Vol 37 (3) ◽  
pp. 241-246 ◽  
Author(s):  
Tamar Kodish ◽  
Joanna Herres ◽  
Annie Shearer ◽  
Tita Atte ◽  
Joel Fein ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Suicide Attempt ◽  
Suicide Risk ◽  
Mental Health Problems ◽  
Health Concern ◽  
Cross Sectional ◽  
Youth Research ◽  
Verbal Bullying ◽  
The Relationship

Abstract. Background: Suicide is a serious public health concern for US youth. Research has established an association between bullying and suicide risk. However, several questions remain regarding this relationship. Aims: The present study examined (a) whether experiences of verbal, physical, and cyber bullying were uniquely associated with general suicide risk; (b) whether each specific form of bullying was related to suicide attempt; and (c) whether depression moderated the relationship between each type of bullying and suicide risk. Method: The sample included medical records of 5,429 youth screened in primary care when providers had mental health concerns. Patients were screened using the Behavioral Health Screen (BHS), which assessed a range of mental health problems and behaviors, including bullying, depression, and suicide. Results: All types of bullying were associated with suicide risk, but verbal bullying was uniquely associated with suicide attempt. Depression significantly moderated the relationship between each type of bullying and suicide risk. Conclusion: The study’s limitations include the use of cross-sectional and self-data reports. When medical providers evaluate suicide risk, bullying should be considered as a possible precipitant, especially if the patient is depressed. Verbal bullying may be particularly important in understanding severity of suicide risk.

Examining the relationship between pain interference, pain intensity, and mental health symptoms among veterans receiving long-term opioid therapy for chronic noncancer pain in primary care

2021 ◽  
Vol 17 (4) ◽  
pp. 289-299
Author(s):  
Amanda Kutz, PhD ◽  
Amber Martinson, PhD ◽  
Katherine Stratton, PsyD ◽  
Clayton Hamilton, PharmD ◽  
Julie Carney, RN ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Pain Intensity ◽  
Monitoring Program ◽  
Opioid Therapy ◽  
Pain Interference ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain ◽  
The Relationship

Objective: As part of the evaluation of the Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP), we examined the relationship between pain intensity, pain interference, and mental health symptoms among PC-POP enrollees.Design/methods: Retrospective cohort study examining self-reported symptoms of pain intensity, pain interference, anxiety, depression, substance use, and quality of life. Data were retrieved through a combination of chart review and data extracted from the VA Informatics and Computing Infrastructure. Setting: Veterans Health Administration Health Care System Primary Care service.Subjects: Adult veterans with chronic noncancer pain receiving opioid therapy 3 months being managed in primary care and enrolled in PC-POP between August 1, 2018 and April 1, 2019.Results: A total of 439 participants were included in the final analysis. Results showed that anxiety has a unique relationship to pain intensity and that depression and quality of life have unique relationships to pain interference when relevant covariates, eg, gender, age, pain diagnosis, and predictors are examined among this unique sample of veterans enrolled in a pain and opioid education and monitoring program.Conclusions: Given that primary care is the dominant healthcare setting in which opioids are prescribed for chronic noncancer pain, further research is needed to examine factors that influence pain management in this setting. This study examined the role mental health factors have on pain intensity and pain interference among patients enrolled in an opioid monitoring program and found that anxiety and depression appear to uniquely predict how intensely and impactful these veterans experience their pain. This study extends the literature by examining such factors among a unique population that has yet to be studied and offers some recommendations for monitoring and practice.

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