Demographic and practice characteristics of psychiatrists who primarily treat patients with substance use disorders.
(65/814)
This study examined the sociodemographic and practice characteristics of psychiatrists whose caseloads consist primarily of patients with Substance Use Disorders (SUD). A survey instrument was completed by a random sample of 865 psychiatrists. Study groups were defined as high-SUD providers if psychiatrists reported having 51% or more patients with SUD (n=92) and non-SUD providers as those who reported not having any patients with SUD (n=128). High-SUD providers tended to be younger, more likely to graduate from international medical schools, have larger caseloads, work more hours per week, and have a higher proportion of inpatients and publicly funded patients than non-SUD providers. Results suggest that psychiatrists who primarily treat patients with SUD are in their early careers and treat patients with more clinical, psychosocial, and economic disadvantages. The implications of these findings for psychiatry training programs and policy makers will be discussed. (+info)
Is the quality of care in general medical practice improving? Results of a longitudinal observational study.
(66/814)
BACKGROUND: The demand for increased accountability within health care has led to a myriad of government initiatives in the United Kingdom, with the aim of improving care, setting minimum standards, and addressing poor performance. AIM: To assess the quality of care in English general practice in the year 2001 compared with 1998, in terms of access, interpersonal care, and clinical care (chronic disease management, elderly care, and mental health care). DESIGN OF STUDY: Observational study in a purposive sample of general practices in England. SETTING: Twenty-three general practices in England--eight in North Thames, seven in the North West, and eight in the South West. RESULTS: Outcome measures were: quality of chronic disease management (angina, adult asthma and type 2 diabetes from practice questionnaires and medical record review), elderly care and mental health care (from practice questionnaires), access to care, continuity of care and interpersonal care (from practice and patient questionnaires) and costs (mean change in practice budget between 1998 and 2001). There were significant improvements in quality of care in terms of organisational access to services (P = 0.016), practice organisation of chronic disease management (P = 0.039), and the quality of angina care (P = 0.003). There were no significant changes in quality scores for mental health care, elderly care, access and interpersonal care. The mean practice budget rose by 3.4% between 1998 and 2001 (adjusted for inflation). CONCLUSION: These findings provide evidence of improvements in some aspects of the quality of care, achieved at modest cost. This was achieved during a time when the National Health Service was undergoing a series of reforms. However, primary care in England is characterised by variation in care, with significant improvements still possible. (+info)
Assertive outreach teams in London: models of operation. Pan-London Assertive Outreach Study, part 1.
(67/814)
BACKGROUND: Assertive outreach teams have been introduced in the UK, based on the assertive community treatment (ACT) model. It is unclear how models of community care translate from one culture to another or the degree of adaptation that may result. AIMS: To characterise London assertive outreach teams and determine whether there are distinct groups within them. METHOD: Semi-structured interviews with team managers plus one month's prospective process of care data collection were used to test for 'model fidelity' to ACT and, by cluster analysis, to identify groupings. RESULTS: Fidelity varied widely, with four teams (out of 24 studied) rated 'high fidelity' and three teams rated 'low fidelity' by US standards and 17 rated 'ACT-like'. Three clusters were identified, with voluntary sector teams being the most distinct group. CONCLUSIONS: There is wide variation in the practice of assertive outreach in London. The role of the voluntary sector requires increased attention. Heterogeneity in practice is a clinical challenge but a research opportunity in distinguishing effective from redundant components of the approach. (+info)
Assertive outreach teams in London: staff experiences and perceptions. Pan-London Assertive Outreach Study, part 2.
(68/814)
BACKGROUND: The job satisfaction, burn-out and work experiences of assertive outreach team staff are likely to be important to the model's sustainability. AIMS: To describe self-reported views and work experiences of staff in London's 24 assertive outreach teams and to compare these with staff in community mental health teams (CMHTs) and between different types of assertive outreach team. METHOD: Confidential staff questionnaires in London's assertive outreach teams (n=187, response rate=89%) and nine randomly selected CMHTs (n=114, response rate=75%). RESULTS: Staff in assertive outreach teams and CMHTs were moderately satisfied with their jobs, with similar sources of satisfaction and stress. Mean scores were low or average for all sub-scales of the Maslach Burnout Inventory for the assertive outreach team and the CMHT staff, with some differences suggesting less burn-out in the assertive outreach teams. Nine of the 24 assertive outreach teams had team means in the high range for emotional exhaustion and there were significant differences between types of assertive outreach team in some components of burn-out and satisfaction. CONCLUSIONS: These findings are encouraging, but repeated investigation is needed when assertive outreach teams have been established for longer. (+info)
Assertive outreach teams in London: patient characteristics and outcomes. Pan-London Assertive Outreach Study, part 3.
(69/814)
BACKGROUND: Although the model of assertive outreach has been widely adopted, it is unclear who receives assertive outreach in practice and what outcomes can be expected under routine conditions. AIMS: To assess patient characteristics and outcome in routine assertive outreach services in the UK. METHOD: Patients (n=580) were sampled from 24 assertive outreach teams in London. Outcomes--days spent in hospital and compulsory hospitalisation--were assessed over a 9-month follow-up. RESULTS: The 6-month prevalence rate of substance misuse was 29%, and 35% of patients had been physically violent in the past 2 years. During follow-up, 39% were hospitalised and 25% compulsorily admitted. Outcome varied significantly between team types. These differences did not hold true when baseline differences in patient characteristics were controlled for. CONCLUSIONS: Routine assertive outreach serves a wide range of patients with significant rates of substance misuse and violent behaviour. Over a 9-month period an average of 25% of assertive outreach patients can be expected to be hospitalised compulsorily. Differences in outcome between team types can be explained by differences in patient characteristics. (+info)
Clinical interventions for treatment non-adherence in psychosis: meta-analysis.
(70/814)
BACKGROUND: Studies investigating the efficacy of clinical interventions for reducing treatment non-adherence have generated contrasting findings, and treatment non-adherence remains common in clinical practice. AIMS: To systematically review whether there are effective clinical interventions that community psychiatric services can implement to reduce non-adherence. METHOD: Systematic review and meta-regression analysis of randomised controlled trials (RCTs) and controlled clinical trials (CCTs) were used to assess the efficacy of interventions to enhance adherence. RESULTS: We reviewed 24 studies, more than half of which were RCTs. In 14 studies the experimental intervention was an educational programme. Five studies evaluated pre-discharge educational sessions, three studies explored the benefit of psychotherapeutic interventions and two studies looked at the effect of telephone prompts. The overall estimate of the efficacy of these interventions produced an odds ratio of 2.59 (95% CI 2.21-3.03) for dichotomous outcomes, and a standardised mean difference of 0.36 (95% CI 0.06-0.66) for continuous outcomes. CONCLUSIONS: Community psychiatric services can potentially use effective clinical interventions, backed by scientific evidence, for reducing patient non-adherence. (+info)
Psychiatric deinstitutionalization and its cultural insensitivity: consequences and recommendations for the future.
(71/814)
Despite the plethora of models and strategies for addressing issues that surround the chronically mentally ill, there remains a paucity of literature that addresses the specific implications of deinstitutionalization on racial minorities. Racial minorities comprise a significant number of the homeless, jailed, and geriatric mentally ill. History and current reality suggest the reasons why some chronically mentally ill blacks and their families have feared the impact of deinstitutionalization. This article examines the Ohio State Department of Mental Health's response to these issues as a possible prototype for statewide coordination for deinstitutionalization. (+info)
Mandated treatment in the community for people with mental disorders.
(72/814)
Commitment to community-based mental health treatment bears limited resemblance to commitment to treatment in a closed institution. It can be better understood in the context of a broad movement to apply leverage to induce treatment engagement, a movement that includes use of the social welfare and justice systems and psychiatric advance directives. Understanding "mandated community treatment" in all of its forms can be advanced by viewing it within the framework of health care quality as recently outlined by the Institute of Medicine, particularly along the dimension of patient-centeredness. (+info)