The post COVID-19 healthcare landscape and the use of long-acting injectable antipsychotics for individuals with schizophrenia and bipolar I disorder: the importance of an integrated collaborative-care approach

Background Long-acting injectable antipsychotics (LAIs) are an essential maintenance treatment option for individuals with schizophrenia or bipolar I disorder (BP-I). This report summarizes a roundtable discussion on the impact of COVID-19 on the mental healthcare landscape and use of LAIs for individuals with schizophrenia or BP-I. Methods Ten experts and stakeholders from diverse fields of healthcare participated in a roundtable discussion on the impact of the COVID-19 pandemic, treatment challenges, and gaps in healthcare for individuals with schizophrenia or BP-I, informed by a literature search. Results Individuals with schizophrenia or BP-I are at increased risk of COVID-19 infection and increased risk of mortality after COVID-19 diagnosis. LAI prescriptions decreased early on in the pandemic, driven by a decrease in face-to-face consultations. Mental healthcare services are adapting with increased use of telehealth and home-based treatment. Clinical workflows to provide consistent, in-person LAI services include screening for COVID-19 exposure and infection, minimizing contact, and ensuring mask-wearing by individuals and staff. The importance of continued in-person visits for LAIs needs to be discussed so that staff can share that information with patients, their caregivers, and families. A fully integrated, collaborative-care model is the most important aspect of care for individuals with schizophrenia or BP-I during and after the COVID-19 pandemic. Conclusions The COVID-19 pandemic has highlighted the importance of a fully integrated collaborative-care model to ensure regular, routine healthcare contact and access to prescribed treatments and services for individuals with schizophrenia and BP-I.

Building Sustainable Practice Transformation Through Payment Reform Initiatives

PURPOSE: Novel value-based payment approaches provide an opportunity to deploy and sustain health care delivery interventions, such as treatment planning documentation. However, limited data are available on implementation costs. METHODS: We described key factors affecting the cost of implementing care improvements under value-based payments, using treatment planning and Medicare's Oncology Care Model as examples. We estimated expected costs of implementing treatment plans for years 1 and 2-6 under (1) different staffing models, (2) use of technology, and (3) differences in the patients engaged. We compared costs to the payment amounts under the Oncology Care Model. RESULTS: Team-based models where staffing is aligned with skills needed for key tasks (eg, a combination of lay navigator, nurse, and physician) are more financially feasible when compared with using physicians or nurses alone. When existing staff are at or near capacity, hiring new staff focused on practice transformation activities allows adequate time for new initiatives without negative impacts on existing services. Investments in information technology can enhance staff productivity, but initial costs may be high. Interventions may not be financially feasible if implemented for a small patient volume or only for patients insured by a particular payer. Finally, costs may be higher for disadvantaged populations, and equity in care delivery may require higher payments from payers. CONCLUSION: Estimating the cost of implementing an intervention in different types of practice settings with various types of patients is essential to ensure that a value-based payment system will adequately support desired improvements in quality of care for all patients.

Continuing health education for qualification of professional practice in Psychosocial Care Centers

ABSTRACT Objective: to describe and analyze a strategy of continuing health education to manage the quality of professionals’ work in Psychosocial Care Centers. Method: this is a research-intervention carried out in Psychosocial Care Centers in the state of Goiás, Brazil, with the participation of 58 professionals. Data were collected in 2016 through seminars and workshops. Thematic content analysis was carried out. Results: professionals associated the Singular Therapeutic Project to the record of performed procedures and described the need to develop skills for correct completion and interpretation of procedures, use of a record software and computerization of processes. The qualification strategy used was considered to be effective in making improvements to the work carried out feasible. Final Considerations: the study presents a qualification strategy for community mental health service teams to guide the care model for territorial care centered on users.

Perbandingan Model Asuhan Keperawatan Profesional Tim dengan Primary Nursing dalam Peningkatan Kualitas Asuhan Keperawatan di Rumah Sakit Kota Medan

The development of science and technology that continues to progress, especially in the health sector requires changes in terms of service so that in providing more professional services in hospitals, nursing care must be of high quality. Nursing Law Number 38 of 2014 Article 3B states that nursing arrangements aim to improve the quality of nursing services, therefore the provision of quality nursing services is important in today's health services. The model of professional nursing care is divided into several models, namely primary, team and case nursing. Based on the results of a survey of research journals, the researchers concluded that there was no research that compared the professional nursing care team model with primary nursing in improving the quality of nursing care. The purpose of this study was to identify the use of the professional nursing care team model with the primary nursing model in improving the quality of nursing care. This type of research is a quantitative research type with a comparative design. The population in this study were all patients at the Inpatient Hospital where the study was conducted. The sampling technique used was purposive sampling technique. Data collection on the quality of nursing care used a quality scale patient assessment instrument – the acute care version (PAQS-ACV). This instrument was developed to assess the quality of nursing care. Data analysis in this study used an independent t-test. normality test using the Kolmorogov-Smirnov test with a significance value (p > 0.05). The results showed that there was a significant difference between the quality of nursing care in the team group and the quality of nursing care in the primary nursing group where the value of sig (2-tailed) was 0.008 where > 0.05, the results also showed that based on the results of the frequency distribution test the quality of nursing care was using the team model and the primary nursing model has a high majority value of nursing care quality, but there is a difference in the average value (mean) where the quality of nursing care in the nursing care model group in the team method group is 144.86 and the quality of nursing care in the primary nursing model group is 155.83. These results indicate that the quality of nursing care with the primary nursing model has a higher quality of care value than the group nursing care model with the team method. Based on the results of this study, it is recommended that hospitals can apply a professional nursing practice model, especially the primary nursing model to further improve the quality of nursing care provided.

Relationship between care model and disease activity states and health-related quality of life in systemic lupus erythematosus patients

Objective To assess whether the care model (comprehensive vs regular) has any impact on the clinical outcomes of systemic lupus erythematosus patients. Methods Between August 2019 and January 2020, we evaluated SLE patients being cared for at two Peruvian hospitals to define the impact of care model on disease activity state and health-related quality of life (HRQoL). Disease activity was ascertained with the SLEDAI-2K and the Physician Global Assessment (PGA) which allows to define Lupus Low Disease Activity State (LLDAS) and Remission. HRQoL was measured with the LupusQoL. The association between care model and disease activity (Remission and LLDAS) state was examined using a binary logistic regression model. The association with HRQoL was examined with a linear regression model. All multivariable analyses were adjusted for possible confounders. Results 266 SLE patients were included, 227 from the comprehensive care model and 39 from the regular care model. The regular care model was associated with a lower probability of achieving remission (OR 0.381; CI: 95% 0.163–0.887) and LLDAS (OR 0.363; CI: 95% 0.157–0.835). Regular care was associated with a better HRQoL in two domains (pain and emotional health). We found no association between the care model and the other HRQoL domains. Conclusion A comprehensive care model was associated with the probability of achieving remission and LLDAS but had no apparent impact on the patients’ HRQoL.

Family care model development in treating schizophrenia patients that have self-deficit nursing based system

The purpose of this study is to develop a family care model in treating schizophrenia patients who experience self-deficit based on the nursing system during the COVID-19 pandemic. Explanatory research design with cross-sectional approach. The population in this study were all families of schizophrenic patients in two mental health institutions in Bangkalan, Indonesia with a total sample of 72 families. The research instrument used was a re-control checklist sheet and a questionnaire about family factors and conditioning factors, nursing system, and self-deficit observations. Data analysis was performed using SEM (Structural Equation Modeling) using PLS (partial least square) software. Family factors affect Nursing System with a value (T-statistic 2.079), the conditioning factor affects Nursing System with a value (T-statistic 24,827), and Nursing System affects the Self Deficit with a value (T-statistic 4,104). Family factors and Conditioning factors make a major contribution in influencing the nursing system so that the nursing system has a significant impact on the self-care process in schizophrenic patients who experience self-deficit.

Mutual trust is a prerequisite for nurses’ sense of safety and work satisfaction – Mobile Integrated Care Model: A qualitative interview study

An increasing number of older persons have complex health care needs. This, along with the organizational principle of remaining at home, emphasizes the need to develop collaborations among organizations caring for older persons. A health care model developed in Sweden, the Mobile Integrated Care Model aims to promote work in teams across organizations. The aim of the study was to describe nurses’ experiences in working and providing health care in the Mobile Integrated Care Model in the home with home health care physicians. Semi-structured interviews were conducted with 18 nurses and analyzed through qualitative content analysis. The method was compliant with the COREQ checklist. A mutually trusting collaboration with physicians, which formed person-centered care, created work satisfaction for the nurses. Working within the Mobile Integrated Care Model was negatively impacted by being employed by different organizations, lack of time to provide health care, and physicians’ person-centered work abilities.

Evaluation of a Non-Face-to-Face Multidisciplinary Health Care Model in a Population with Rheumatoid Arthritis Vulnerable to COVID-19 in a Health Emergency Situation

This study evaluated a non-face-to-face-multidisciplinary consultation model in a population with rheumatoid arthritis (RA) during the COVID-19 pandemic. This is an analytical observational study of a prospective cohort with simple random sampling. RA patients were followed for 12 weeks (Jul–Oct 2020). Two groups were included: patients in telemedicine care (TM), and patients in the usual face-to-face care (UC). Patients could voluntarily change the care model (transition model (TR)). Activity of disease, quality of life, disability, therapeutic adherence, and self-care ability were analyzed. Bivariate analysis was performed. A qualitative descriptive exploratory study was conducted. At the beginning, 218 adults were included: (109/TM-109/UC). The groups didn’t differ in general characteristics. At the end of the study, there were no differences in TM: (n = 71). A significant (p < 0.05) decrease in adherence, and increase in self-care ability were found in UC (n = 18) and TR (n = 129). Seven patients developed COVID-19. Four categories emerged from the experience of the subjects in the qualitative assessment (factors present in communication, information and communication technologies management, family support and interaction, and adherence to treatment). The telemedicine model keeps RA patients stable without major differences compared to the usual care or mixed model.