7 research outputs found
Multidisciplinary team meetings in community mental health care: a mixed-methods investigation of their functions and organisation
Background Community mental health teams are a central means of delivering specialist mental health care in England. Weekly multidisciplinary team (MDT) meetings are assumed to improve the quality of care by incorporating diverse professional perspectives into care planning. However, these meetings are resource-intensive and there has been little investigation of their operational procedures or their impact. Aim The aim of this PhD is to examine the functions and organisation of MDT meetings in community mental health care, and to identify current challenges to effectiveness and opportunities for improvement. Method A mixed-methods investigation was conducted to examine current practice and stakeholder views in six community-based mental health teams: three general community mental health teams, two memory clinics and one early intervention psychosis service. This involved non-participant observation of 109 MDT meetings; quantitative data on 3,213 MDT case discussions from 181 MDT meetings; and semi-structured interviews with 35 practitioners and patients. Results MDT meetings were perceived to serve a wide variety of functions, ranging from care planning to peer support. However, many practitioners believed that their meetings were poorly managed and lacked clarity of purpose. Teams varied in terms of which patients were discussed, the time dedicated to each discussion, multidisciplinary representation, and operational procedures. Several challenges made it difficult for teams to capitalise on their multidisciplinary diversity, including conflicting models of care, ambiguous leadership, and a struggle to balance profession-specific and generic keyworker roles. Practitioners’ ability to implement agreed MDT care plans was limited by a lack of patient involvement, inadequate resources, administrative requirements, and organisational instability. Conclusions A wide range of factors mediate the potential for MDT meetings to benefit patients. The findings highlight the importance of critical reflection on the purpose and organisation of MDT meetings to ensure that they are a valuable use of practitioner time
Multidisciplinary team meetings in community mental health: a systematic review of their functions
Purpose – Previous research has identified a need for greater clarity regarding the functions of multidisciplinary team (MDT) meetings in UK community mental health services. The purpose of this paper is to identify the functions of these meetings by systematically reviewing both primary research and academic discussion papers. Design/methodology/approach – Papers relating to adult community mental health teams (CMHTs) in the UK and published between September 1999 and February 2014 were reviewed and appraised using NICE quality checklists. The search was broad in scope to include both general CMHTs and specialist CMHTs such as early intervention psychosis services and forensic mental health teams. A thematic synthesis of the findings was performed to develop an overarching thematic framework of the reported functions of MDT meetings. Findings – None of the 4,046 studies identified directly investigated the functions of MDT meetings. However, 49 mentioned functions in passing. These functions were categorised into four thematic domains: discussing the care of individual patients, teamwork, team management and learning and development. Several papers reported a lack of clarity about the purpose of MDT meetings and the roles of different team members which hindered effective collaboration. Practical implications – Without clearly agreed objectives for MDT meetings, monitoring their effectiveness is problematic. Unwarranted variation in their functioning may undermine the quality of care. Originality/value – This is the first systematic review to investigate the functions of CMHT MDT meetings in the UK. The findings highlight a need for empirical research to establish how MDT meetings are being used so that their effectiveness can be understood, monitored and evaluated
Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study.
This is the final version of the article. Available from the publisher via the DOI in this record.OBJECTIVE: Multidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision making which has taken account of clinical and non-clinical information. Additionally, this measure can be compared across MDTs for different conditions. METHODS: We undertook a prospective mixed-methods study of 12 MDTs in London and North Thames. Data were collected by observation of 370 MDT meetings, interviews with 53 MDT members, and from 2654 patient medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation, whether their preferences and other clinical/health behaviours were mentioned) and MDT features (as measured using the 'Team Climate Inventory' and skill mix) on the implementation of MDT treatment plans. RESULTS: The adjusted odds (or likelihood) of implementation was reduced by 25% for each additional professional group represented at the MDT meeting. Implementation was more likely in MDTs with clear goals and processes and a good 'Team Climate' (adjusted OR 1.96; 95% CI 1.15 to 3.31 for a unit increase in Team Climate Inventory (TCI) score). Implementation varied by disease category, with the lowest adjusted odds of implementation in mental health teams. Implementation was also lower for patients living in more deprived areas (adjusted odds of implementation for patients in the most compared with least deprived areas was 0.60, 95% CI 0.39 to 0.91). CONCLUSIONS: Greater multidisciplinarity is not necessarily associated with more effective decision making. Explicit goals and procedures are also crucial. Decision implementation should be routinely monitored to ensure the equitable provision of care.This project was funded by the NIHR Health Services
and Delivery Research programme (project number 09/2001/
04) and will be published in full in the Health Services and
Delivery Research Journal. Further information available at:
(http://www.netscc.ac.uk/hsdr/projdetails.php?ref=09-2001-04).
In accordance with NIHR regulations, the findings reported
here are to be referred to as initial until the NIHR final report
has been published. The sponsors of the study had no role in
study design, data collection, data analysis, data interpretation,
the writing of the report, or the decision to submit the report
for publication
Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study.
Multidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision making which has taken account of clinical and non-clinical information. Additionally, this measure can be compared across MDTs for different conditions
Evaluation of (2S,4S)/(2R,4R) and (2S,4R)/(2R,4S) 6,6-N,N-dimethyl-2-methyl-2-oxo-1,3-dioxa-4-hexadecyl-6,aza-2-phosphacyc looctane bromide as inhibitors for protein kinase C, carnitine octanoyltransferase, and carnitine palmitoyltransferase
(2S,4S)/(2R,4R) and (2S,4R)/(2R,4S) 6,6-N,N-dimethyl-2-methyl-2-oxo-1,3-dioxa-4-hexadecyl-6-aza-2-phosphacyc looctane bromide strongly inhibited protein kinase C and moderately inhibited carnitine octanoyltransferase and carnitine palmitoyltransferase.</p
Evaluation of (2S,4S)/(2R,4R) and (2S,4R)/(2R,4S) 6,6-N,N-dimethyl-2-methyl-2-oxo-1,3-dioxa-4-hexadecyl-6,aza-2-phosphacyc looctane bromide as inhibitors for protein kinase C, carnitine octanoyltransferase, and carnitine palmitoyltransferase
(2S,4S)/(2R,4R) and (2S,4R)/(2R,4S) 6,6-N,N-dimethyl-2-methyl-2-oxo-1,3-dioxa-4-hexadecyl-6-aza-2-phosphacyc looctane bromide strongly inhibited protein kinase C and moderately inhibited carnitine octanoyltransferase and carnitine palmitoyltransferase.</p