Primary Care Mental Health Services in Finland, a hidden Lynchpin of Psychiatric Re-hospitalisation

RESUMO:O reinternamento psiquiátrico é um fenómeno multifacetado, determinado por diversos fatores e frequentemente apontado como um resultado negativo. Investigar os cuidados de saúde ambulatórios, incluindo os Cuidados de Saúde Primários, pode proporcionar mais informações sobre o reinternamento psiquiátrico. O presente estudo retrospectivo incluiu dados do HILMO - Registo dos Cuidados Sociais e de Saúde, assim como do AvoHILMO - Registo dos Cuidados de Saúde Primários a Doentes Ambulatórios. Os dois objetivos principais do estudo abrangeram a pesquisa sobre o reinternamento psiquiátrico no contexto finlandês e a análise do uso dos Cuidados de Saúde Primários utilizando um estudo de coorte. O estudo de coorte 6 (N=16.814 adultos) compreendeu pessoas com experiência em regime de internamento psiquiátrico no ano de 2012. Esperava-se que serviços de Cuidados de Saúde Primários mais variados pudessem ter um impacto mais protetor em casos de reinternamento psiquiátrico. A taxa média de reinternamento foi de 40%, variando entre distritos hospitalares, desde 28% no hospital Kymenlaakso até 54% no hospital Länsi-Pohja. O índice de reinternamento hospitalar esteve correlacionado com o tempo de estadia, parte do estudo de coorte em distritos hospitalares e aspectos de tipo de serviço. As consultas nos Cuidados de Saúde Primários uma semana depois da alta mostraram uma correlação negativa com a densidade populacional, com áreas de menor densidade populacional possuindo um maior nível de consultas nos cuidados primários durante essa semana. As consultas de saúde mental tiveram mais frequentemente lugar em centros de saúde primários, enquanto outras especialidades privilegiaram o cuidado domiciliar como meio de contato. Houve uma forte correlação positiva entre a probabilidade de atendimento em cuidados de saúde primários no prazo de uma semana depois da alta e o número de profissionais de saúde mental incluído na equipe de Cuidados de Saúde Primários. Diferenças na utilização de serviços entre os vários distritos hospitalares foram evidentes. O presente estudo mostra como pessoas com perturbações mentais suficientemente graves para requerer hospitalização, acedem aos cuidados ambulatórios, particularmente aos Cuidados de Saúde Primários. O melhoramento dos Cuidados de Saúde Primários através do aumento da diversidade de profissionais e dos tipos de serviços disponíveis estaria em consonância com as recomendações atuais para cuidados de saúde mental mais holísticos ou centrados na pessoa.ABSTRACT:Psychiatric re-hospitalisation is multifaceted, determined by many factors, and often highlighted as a negative outcome. Investigating outpatient care including primary care can further insights of psychiatric re-hospitalisation. The retrospective register based study included data from the HILMO Care Register for Health Care, and the AvoHILMO Register for Outpatient Visits in Primary Care encompassing two main objectives, investigating psychiatric re-hospitalisation in the Finnish context, and exploring the use of primary care by the study cohort. The study cohort (N= 16 814 adults) comprised of people with experience of psychiatric inpatient care in 2012. More diverse primary care services were expected to have protective impacts on psychiatric re-hospitalisation. The average re-hospitalisation rate was 40%, varying between hospital districts with Kymenlaakso Hospital District at 28% and Länsi-Pohja Hospital District at 54%. Re-hospitalisation rate correlated with length of stay, share of study cohort in hospital district, and aspects of service type. Primary care visits within a week following discharge were seen to correlate negatively with population density, areas with lower population density having a higher level of a primary care visit within a week. Mental health care visits were more likely to take place at the primary care centre, with other specialities having more home based care means of contact. There was a strong positive correlation between likelihood of being seen within a week within primary care, and amount of Mental Health Care Assistants included in the primary care workforce. Differences in service use between the hospital districts was apparent, the current study illuminating how people with mental health disorders severe enough to require hospitalisation access outpatient care, particularly primary care. Further developing primary care by developing the diversity of the workforce and types of services available would be in line with current recommendations for more holistic or person centred mental health care

Life Conditions as Mediators of Welfare State Effect on Mental Wellbeing among Oldest Old in Europe

Background: Mental wellbeing is formed by our daily environments, which are, in turn, influenced by public policies, such as the welfare state. This paper looks at how different aspects of life conditions may mediate the welfare state effect on mental wellbeing in oldest old age. Methods: Data were extracted from Round 6 of the European Social Survey (2012). The dataset comprised of 2058 people aged 80 years and older from 24 countries. Mediation analyses determined possible links between the welfare state, including eleven intervening variables representing life conditions and five mental wellbeing dimensions. Results: Our study confirms that the higher the level of welfare state, the better mental wellbeing, irrespective of dimension. Although several life conditions were found to mediate the welfare state effect on mental wellbeing, subjective general health, coping with income and place in society were the most important intervening variables. Conclusions: All three variables centre around supporting autonomy in the oldest old age. By teasing out how the welfare state influences mental wellbeing in the oldest old, we can better understand the many drivers of wellbeing and enable evidence informed age-friendly policy making.Peer reviewe

Life Conditions as Mediators of Welfare State Effect on Mental Wellbeing among Oldest Old in Europe

Background: Mental wellbeing is formed by our daily environments, which are, in turn, influenced by public policies, such as the welfare state. This paper looks at how different aspects of life conditions may mediate the welfare state effect on mental wellbeing in oldest old age. Methods: Data were extracted from Round 6 of the European Social Survey (2012). The dataset comprised of 2058 people aged 80 years and older from 24 countries. Mediation analyses determined possible links between the welfare state, including eleven intervening variables representing life conditions and five mental wellbeing dimensions. Results: Our study confirms that the higher the level of welfare state, the better mental wellbeing, irrespective of dimension. Although several life conditions were found to mediate the welfare state effect on mental wellbeing, subjective general health, coping with income and place in society were the most important intervening variables. Conclusions: All three variables centre around supporting autonomy in the oldest old age. By teasing out how the welfare state influences mental wellbeing in the oldest old, we can better understand the many drivers of wellbeing and enable evidence informed age-friendly policy making.Peer reviewe

Exploring the Association between Welfare State and Mental Wellbeing in Europe: Does Age Matter?

Previous research reports show mixed results regarding the age gradient in population mental wellbeing, which may be linked to the role that welfare states play. In this study, we investigate whether an age gradient exists in relation to the association between welfare state and mental wellbeing within the adult population in Europe. We combine individual level data from Round 6 of the European Social Survey and country level data on welfare state and use multilevel regression analyses to explore population mental wellbeing. Subjective and psychological wellbeing dimensions were analyzed, and different approaches to measuring welfare state were explored, including a regime typology and composite welfare state measures constructed on the basis of a set of eight individual indicators. We found the age gradient for mental wellbeing to differ between welfare states, with the positive impact of the welfare state increasing with age. A universal and generous welfare state seems to be particularly important for older adults, who are also more likely to be in higher need of transfers and services provided by the welfare state.publishedVersio

Comprehending socio-relational factors of mental wellbeing in the oldest old within Nordic and Mediterranean countries

Socio-relational aspects are essential for mental wellbeing (MWB), especially in the oldest old age. Our study aims to explore the socio-relational aspects related to MWB in accord ance with the experiences of the oldest old of four European countries; and to examine how these differ between Mediterranean and Nordic people. A total of 117 participants aged 80+ years old were recruited, and 23 focus groups were performed. Qualitative con tent analysis identified five main themes. Family seemed to be the most important driver of the MWB of the oldest old, followed by relationships with close friends. Participants felt better when they had a sense of being needed, cared for, and connected. Loneliness and isolation negatively affected MWB, although solitude was appreciated. Differences appeared between Mediterranean and Nordic regions. Initiatives to promote positive interactions with family and friends, as well as social activities within the community, may contribute to strengthening MWB in the oldest ol

Investigating and learning lessons from early experiences of implementing ePrescribing systems into NHS hospitals:a questionnaire study

Background: ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned.Methods: a descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated.Results: we obtained responses from 85 of 108 NHS staff (78.7% response rate). At least 6% (n = 10) of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4) have no plans of implementing, and 34% (n = 55) are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity.Conclusions: whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in relation to implementation strategy, system choice and standards, as well as increased financial resources to fund local activitie

Is Mental Well-Being in the Oldest Old Different from That in Younger Age Groups? Exploring the Mental Well-Being of the Oldest-Old Population in Europe

The oldest-old population is increasing in Europe, and greater focus is placed on promoting mental well-being (MWB) in this population. The European Welfare Models and Mental Wellbeing in Final Years of Life project aims to develop a better understanding of how best to promote positive MWB in the oldest-old population. Using a resources approach, the present study aimed to provide empirical evidence about the structure of MWB in the 80 + year age group and to compare this with the structure of MWB in the old (65-79 years) and adult (18-64 years) population. Twenty-eight items reflecting a focus on positive aspects of MWB were selected from the European Social Survey data (24 countries). After application of an exploratory approach using Exploratory Structural Equation Modelling, five- and six-factor model solutions were found to be statistically appropriate, and the results are consistent with the most widely studied dimensions of MWB. Despite specific differences in the factor models and item loadings, evaluation of formal invariance showed that dimensions built in the same way are comparable across age groups. Although explorative and not conclusive, the results of this study contribute insights into the multidimensional structure of MWB in the oldest-old population and provide a starting point for further research on promoting MWB in the later stages of life