Pathway for inpatients with depressive episode in Flemish psychiatric hospitals: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Within the context of a biopsychosocial model of the treatment of depressive episodes, a multidisciplinary approach is needed. Clinical pathways have been developed and implemented in hospitals to support multidisciplinary teamwork. The aim of this study is to explore current practice for the treatment of depressive episodes in Flemish psychiatric hospitals. Current practice in different hospitals is studied to get an idea of the similarities (outlined as a pathway) and the differences in the treatment of depressive episodes.</p> <p>Methods</p> <p>A convenience sample of 11 Flemish psychiatric hospitals participated in this qualitative study. Semi-structured interviews were conducted with different types of health care professionals (n = 43). The websites of the hospitals were searched for information on their approach to treating depressive episodes.</p> <p>Results</p> <p>A flow chart was made including the identified stages of the pathway: pre-admission, admission (observation and treatment), discharge and follow-up care. The characteristics of each stage are described. Although the stages are identified in all hospitals, differences between hospitals on various levels of the pathway exist. Hospitals emphasized the individual approach of each patient. The results point to a biopsychosocial approach to treating depressive episodes.</p> <p>Conclusion</p> <p>This study outlined current practice as a pathway for Flemish inpatients with depressive episodes. Within the context of surveillance of quality and quantity of care, this study may encourage hospitals to consider developing clinical pathways.</p

Following up patients with depression after hospital discharge: a mixed methods approach

<p>Abstract</p> <p>Background</p> <p>A medication information intervention was delivered to patients with a major depressive episode prior to psychiatric hospital discharge.</p> <p>Methods</p> <p>The objective of this study was to explore how patients evolved after hospital discharge and to identify factors influencing this evolution. Using a quasi-experimental longitudinal design, the quantitative analysis measured clinical (using the Hospital Anxiety and Depression Scale, the somatic dimension of the Symptom Checklist 90 and recording the number of readmissions) and humanistic (using the Quality of Life Enjoyment and Satisfaction Questionnaire) outcomes of patients via telephone contacts up to one year following discharge. The qualitative analysis was based on the researcher diary, consisting of reports on the telephone outcome assessment of patients with major depression (n = 99). All reports were analyzed using the thematic framework approach.</p> <p>Results</p> <p>The change in the participants' health status was as diverse as it was at hospital discharge. Participants reported on remissions; changes in mood; relapses; and re-admissions (one third of patients). Quantitative data on group level showed low anxiety, depression and somatic scores over time. Three groups of contributing factors were identified: process, individual and environmental factors. Process factors included self caring process, medical care after discharge, resumption of work and managing daily life. Individual factors were symptom control, medication and personality. Environmental factors were material and social environment. Each of them could ameliorate, deteriorate or be neutral to the patient's health state. A mix of factors was observed in individual patients.</p> <p>Conclusions</p> <p>After hospital discharge, participants with a major depressive episode evolved in many different ways. Process, individual and environmental factors may influence the participant's health status following hospital discharge. Each of the factors could be positive, neutral or negative for the patient.</p

Barriers to medication counselling for people with mental health disorders : A six country study

Provision of medication information may improve adherence and prevent medication related problems. People with mental health disorders commonly receive less medication counselling from pharmacists than people with other common long term and persistent disorders. Objective: The objective of this study was to compare and contrast barriers pharmacy students perceive toward providing medication counselling for people with mental health disorders in Australia, Belgium, Estonia, Finland, India and Latvia. Methods: Barriers identified by third-year pharmacy students as part of the International Pharmacy Students' Health Survey were content analysed using a directed approach. Students' responses were categorised as pharmacist related, patient related, health-system related, or social or cultural related. Quantitative data were analysed using SPSS version 14.0. Results: Survey instruments were returned by 649 students. Of the respondents, 480 identified one or more barriers to medication counselling for people with mental health disorders. Patient related factors accounted for between 25.3% and 36.2% of barriers identified by the pharmacy students. Pharmacist related factors accounted for between 17.6% and 45.1% of the barriers identified by the pharmacy students. Students in India were more likely to attribute barriers to pharmacist and social and cultural related factors, and less likely to healthsystem related factors, than students studying in other countries. Conclusion: The nature of barriers identified by pharmacy students differed according to the country in which they studied. Undergraduate and postgraduate pharmacy education programs may need to be amended to address common misconceptions among pharmacy students.publishersversionPeer reviewe

Information on antidepressants for psychiatric inpatients: the divide between patient needs and professional practice

Background: Medicine information is an integral part of patient care and a patient right. In particular, patients with a mental health diagnosis have a need for information on medicines. Objective: This study aims to describe the current practice on information provision on antidepressants to inpatients in psychiatric hospitals. Methods: A qualitative study was conducted consisting of semi-structured interviews with health care professionals (n=46) and patients (n=17) in 11 Flemish psychiatric hospitals. Two topic guides were designed for conducting the interviews with these respective stakeholders. The issues addressed in the topic guides related to: organization of information provision in the hospital, information on demand of the patient, information provision by health care professionals, information for relatives, evaluation of provided information, interdisciplinary contacts on information provision and satisfaction on current practice of information provision. The interviews were analysed according to the five stages of the framework analysis. Results: Psychiatrists and nurses are the key players to provide information on antidepressants. Their approach depends on patient characteristics and mental state. Information is provided mainly orally. Health care professionals consider non-verbal cues of patients to verify if information has been understood. Health care professionals reported lack of time and lack of interdisciplinary contacts as negative aspects. Patients indicated that health care professionals take too little initiative to provide medicine information. Conclusions: Patients are informed about their antidepressants through various pathways. Although the awareness is present of the importance of the individual approach and efforts are done to tailor information to the individual patient, improvement is still possible. Tailoring communication; assessing patient needs and preferences; matching of health care professional style and patient needs; and achieving concordance, is a complex and challenging task for health care professionals in mental health care.Antecedentes: La información sobre medicamentos es parte integral de la atención al paciente y un derecho del paciente. En particular, los pacientes con diagnóstico de enfermedad mental necesitan información sobre los medicamentos. Objetivo: Este estudio intenta describir la práctica actual de provisión de información sobre antidepresivos a pacientes psiquiátricos hospitalizados. Métodos: Se realizó un estudio cualitativo consistente en entrevistas semi-estructuradas con profesionales de la salud (n=46) y pacientes (n=17) en 11 hospitales psiquiátricos flamencos. Se diseñaron dos guías de asuntos para realizar las entrevistas con los respectivos decisores. Los asuntos tratados en las guías estaban relacionados con: la organización de la provisión de información en el hospital, información a demanda del paciente, provisión de información por los profesionales de la salud, información para familiares, evaluación de la información proporcionada, contactos interdisciplinarios en la provisión de información, y satisfacción con la práctica actual de provisión de información. Las entrevistas se analizaron de acuerdo a los cinco etapas del análisis contextual. Resultados: Los psiquiatras y enfermeras son los actores principales en la provisión de información sobre antidepresivos. Su abordaje depende de las características del paciente y de su estado mental. La información se proporciona fundamentalmente oral. Los profesionales de la salud tienen en cuenta señales no verbales para verificar si la información fue entendida. Los profesionales reportaron falta de tiempo y falta de contactos interdisciplinarios como aspectos negativos. Los pacientes indicaron que los profesionales de la salud tienen demasiado poca iniciativa en proporcionar información sobre medicamentos. Conclusiones: Los pacientes están informados sobre sus antidepresivos por varios caminos. Aunque existe una conciencia de la importancia del abordaje individual y se realizan esfuerzos para adaptar la información a cada paciente, es posible mejorar. Adaptar la comunicación; evaluar las necesidades y las preferencias del paciente; alcanzar la concordancia son tareas complejas y desafiantes para los profesionales de la salud en cuidados de salud mental

Hoe kan de continuïteit van de medica-menteuze behandeling tussen zieken-huis en thuis geoptimaliseerd worden?

The continuity of pharmacotherapy is of vital importance when patients move from one health care setting to another. Unfortunately, this continuity is not always guaranteed. The aim of this study is to propose solutions to enhance the continuity of pharmacotherapy at hospital admission and discharge. The study consists of a systematic review of the international literature and an analysis of seamless care initiatives in seven selected countries; a summary of Belgian data on problems as well as solutions with regard to continuity of care; a quantification of the extent of medication changes as a result of a hospital stay in Belgium; and a qualitative analysis of the perception of Belgian health care professionals (HCPs) on approaches to improve seamless care. The literature review yielded 15 papers of sufficient quality. However, this review did not generate definitive conclusions on the clinical impact and the cost-effectiveness of interventions aiming to enhance the continuity of pharmacotherapy. The most important initiatives that have been put in practice in foreign countries include the development and implementation of guidelines for HCPs; national information campaigns; education of HCPs; and the development of information technologies as to share patient and prescription data between settings of care. For Belgium, 66 seamless care initiatives were identified. The high number and variety of projects show the interest for this topic as well as the involvement of various HCPs from diverse settings in the development of solutions. Based on this research, and the solutions discussed in the focus groups, the following elements are proposed to enhance the continuity of pharmacotherapy: a national guideline governing the continuity of pharmacotherapy; a national campaign to sensitize HCPs and patients in this area; the availability of a comprehensive and up to date medication list for each patient; and electronic healthcare infrastructure that facilitates sharing of information.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Comment optimiser la continuité du traitement médicamenteux entre l'hôpital et le domicile

The continuity of pharmacotherapy is of vital importance when patients move from one health care setting to another. Unfortunately, this continuity is not always guaranteed. The aim of this study is to propose solutions to enhance the continuity of pharmacotherapy at hospital admission and discharge. The study consists of a systematic review of the international literature and an analysis of seamless care initiatives in seven selected countries; a summary of Belgian data on problems as well as solutions with regard to continuity of care; a quantification of the extent of medication changes as a result of a hospital stay in Belgium; and a qualitative analysis of the perception of Belgian health care professionals (HCPs) on approaches to improve seamless care. The literature review yielded 15 papers of sufficient quality. However, this review did not generate definitive conclusions on the clinical impact and the cost-effectiveness of interventions aiming to enhance the continuity of pharmacotherapy. The most important initiatives that have been put in practice in foreign countries include the development and implementation of guidelines for HCPs; national information campaigns; education of HCPs; and the development of information technologies as to share patient and prescription data between settings of care. For Belgium, 66 seamless care initiatives were identified. The high number and variety of projects show the interest for this topic as well as the involvement of various HCPs from diverse settings in the development of solutions. Based on this research, and the solutions discussed in the focus groups, the following elements are proposed to enhance the continuity of pharmacotherapy: a national guideline governing the continuity of pharmacotherapy; a national campaign to sensitize HCPs and patients in this area; the availability of a comprehensive and up to date medication list for each patient; and electronic healthcare infrastructure that facilitates sharing of information.SCOPUS: ar.jinfo:eu-repo/semantics/publishe