Do integrated mental healthcare organisations facilitate process quality in the treatment of people with schizophrenia and related psychoses?

OBJECTIVE: The objective of this study is to investigate the influence of mergers of ambulatory and mental healthcare organisations on the process quality of care for persons suffering from schizophrenia or related psychoses. THEORY: On the basis of the theory of Donabedian we assume the relationships between three types of quality in healthcare: structure quality, process quality and outcome quality. This study focuses on the influences of structure quality, i.e. years since merger and catchment area size upon process quality. METHODS: Criteria according to Tugwell for evaluating healthcare were used to describe the process quality of schizophrenia care, resulting in a process quality questionnaire with 6 subscales and 21 items. Leading psychiatrists of 31 Dutch mental healthcare organisations, covering 89% of the country, answered the questionnaire. Both programmes and documents from the responding institutions and schizophrenia projects were analysed. Correlations of two determinants, age of the merged organisation and catchment area size, were made with total scale scores and the sub scores of the questionnaire. RESULTS: The response rate was 97% (31/32). Twenty-two organisations (71%) had a score of more than 50% on the used scale, 8 (29%) scored less. Two evidence-based interventions were implemented in more than 50% of the organisations, three in less than 50%. A low degree of implementation occurs in establishing care for people with schizophrenia from ethnic minorities, standardising diagnostic procedures and continuity of care. No significant relationship between the age of the merged organisation (‘age’) and the total process quality of schizophrenia care was found, however, the relationships between age and the subscales availability of interventions and integrated treatment were significant. No association was found between the size of the MHO's catchment area and any of the used subscales. CONCLUSIONS: The age of integration of residential and ambulatory mental health institutions correlates significantly with two subscales of process quality of schizophrenia care, i.e. availability of interventions and treatment. Catchment area size is not significantly associated with process quality or any of the subscales. Despite the mentioned positive effects, the overall picture of schizophrenia care is not very positive. Additional forces other than merely integration of ambulatory and residential services are needed for the further implementation of evidence-based interventions, diagnostic standards and continuity of care. The development of a national ‘schizophrenia standard’ (like in other countries) in relation with implementation plans and strategies to evaluate care on a regional level is recommended as well as further research on patient outcomes in relation to mergers of mental healthcare organisations

Onderzoek naar rijgeschiktheid door de psychiater na rijden onder invloed; beschrijving van 101 overtreders en aanbevelingen voor preventie

Contains fulltext : 77435.pdf (publisher's version ) (Open Access)achtergrond Alcoholgebruik in het verkeer vormt een evident risico voor verkeersongevallen. Er is een dalende trend in het rijden onder invloed, waarschijnlijk ten gevolge van handhaving en voorlichting, behalve wat betreft de ‘zware overtreders’ (alcoholpromillage > 1,3 bij aanhouding). Dergelijke zware overtreders alsmede recidivisten worden verplicht tot een onderzoek door een psychiater. doel Bepalen van kenmerken van deze verplicht onderzochte overtreders, teneinde preventie te kunnen bevorderen.methode Met dossieronderzoek werden van 101 overtreders bepaald: persoonskenmerken, gegevens rondom de overtredingen, alcoholanamnese, uitslagen van laboratoriumonderzoek, lichamelijk en psychiatrisch onderzoek en uitkomst van het onderzoek naar rijgeschiktheid. Middels beschrijvende statistiek werden de kenmerken van de groep geïnventariseerd en waar mogelijk vergeleken met die van de algemene bevolking. resultaten De groep bestond vooral uit mannen van rond de 40 jaar, uit de lagere sociaaleconomische klasse, aangehouden vanwege afwijkend rijgedrag of het veroorzaken van een verkeersongeval. Bij 92% van de gevallen was er alcoholmisbruik of - afhankelijkheid met relatief vaak comorbide psychiatrische problematiek. conclusie Verdergaande preventie is mogelijk door het verhogen van de sociale controle, het sneller opsporen van afwijkend rijgedrag en adequate, tijdige behandeling van de alcoholproblematiek en de daarmee samenhangende comorbiditeit

Neonatal outcome of pregnancies complicated by hypertensive disorders

OBJECTIVE: The objective of the study was to determine the neonatal morbidity in late preterm infants born from mothers with a hypertensive disorder. STUDY DESIGN: Data were obtained from the national Perinatal Registry in The Netherlands on women who delivered between 34(+0) and 36(+6) weeks with gestational hypertension (n = 4316), preeclampsia (n = 1864), and normotensive controls (n = 20,749). RESULTS: Children from mothers with preeclampsia had an increased risk for admission to the neonatal intensive care unit compared with children from normotensive mothers (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.8-2.2). A cesarean delivery and decreasing gestational age were independent risk factors for neonatal respiratory morbidity. Gestational hypertension or preeclampsia reduced the risk of respiratory distress syndrome compared with the control group (OR, 0.81; 95% CI, 0.64-1.0 and OR, 0.69; 95% CI, 0.49-0.96, respectively). CONCLUSION: Neonatal morbidity in the late preterm period is considerable. Hypertensive disorders appear to protect for neonatal respiratory morbidity, but higher rates of cesarean section diminish this protective effect.