Exploring Continuity of Care in Patients with Alcohol Use Disorders Using Time-Variant Measures

Background/Aims: We used time-variant measures of continuity of care to study fluctuations in long-term treatment use by patients with alcohol-related disorders. Methods: Data on service use were extracted from the Psychiatric Case Register for the Rotterdam Region, The Netherlands. Continuity measures were calculated for each day over a 2-year observation period. Repeated measures analysis was used to identify factors that influence continuity of care over time. Results: Continuity of care was higher for patients with more severe disorders. Though quantity of care was high for patients with long problem history during the first year of treatment, it decreased strongly in the second year. The intervals between treatment contacts were shorter for women, especially young ones, than for men. Conclusion: Time-variant measures showed differences in continuity of care that would not have been revealed if more aggregated measures of service use had been used. Copyright (C) 2008 S. Karger AG, Base

Does mental health service integration affect compulsory admissions?

Background: Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. <br><br> Methods: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991–1993 and 2001–2003. We included patients aged 18–60, who had a first emergency compulsory admission (n=830). Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up. <br><br> Results: Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district. <br><br> Conclusions: Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions

Does mental health service integration affect compulsory admissions?

Abstract. BACKGROUND: Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. METHODS: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991-1993 and 2001-2003. We included patients aged 18-60, who had a first emergency compulsory admission (n=830). Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up. RESULTS: Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district. CONCLUSIONS: Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions

Exploring Continuity of Care in Patients with Alcohol Use Disorders Using Time-Variant Measures

Background/Aims: We used time-variant measures of continuity of care to study fluctuations in long-term treatment use by patients with alcohol-related disorders. Methods: Data on service use were extracted from the Psychiatric Case Register for the Rotterdam Region, The Netherlands. Continuity measures were calculated for each day over a 2-year observation period. Repeated measures analysis was used to identify factors that influence continuity of care over time. Results: Continuity of care was higher for patients with more severe disorders. Though quantity of care was high for patients with long problem history during the first year of treatment, it decreased strongly in the second year. The intervals between treatment contacts were shorter for women, especially young ones, than for men. Conclusion: Timevariant measures showed differences in continuity of care that would not have been revealed if more aggregated measures of service use had been used

Follow-up after Involuntary Mental Healthcare: Who Cares? Emergency Compulsory Admission and Continuity of Care in Rotterdam, the Netherlands

In 2000 Dutch television broadcasted a documentary, filmed by Hans Polak, about people who neglect themselves and their social environment. The film shows public mental health workers visiting people who fall outside of the regular healthcare system. These people live on the frayed fringes of society, such as a man from a wealthy family who lives in a faeces-stained apartment, an old organ-grinder sharing living and working space with a heroin prostitute, a mentally disordered woman who keeps hundreds of mice as pets, an old and lonely opera singer who rarely leaves home, and an addicted couple who have lost parental rights. This opening chapter follows up on the case of the (formerly) addicted couple – names have been omitted to ensure privacy; the couple has given written permission to publish their story. Our study showed that in the period 2000 – 2006 no fewer than 81 social workers or nurses, spread over about 25 health and social services, have been involved in the case

Breakdown of continuity in public mental healthcare in the Netherlands: a longitudinal case study

<strong>Introduction:</strong> Continuity of care for long-term service-dependent patients in the public mental health system requires intensive collaboration between all agencies involved. Understanding the ways in which various aspects of continuity of care interact may reveal help to find out more about how care de­livered over time improves outcomes. <strong>C</strong><strong>ase study:</strong> Based on medical records, an addicted couple was monitored for number and type of contacts with health and social services. Over the years, 81 social workers or nurses, spread over 25 health and social services, have been involved in the rehabilitation process. Breakdown of continuity of care is linked to lack of information, missing procedures and guidelines, fragile relationships with the patient, and a reluctant public health approach. <strong>Conclu</strong><strong>sion: </strong>Prominent among relevant factors is the absence of protocols governing the transfer of patients between the various links in the continuum of mental healthcare services. High-quality follow-up after admission is partly a matter of professional principle in ensuring that problems in the chain of services are discussed. Case presen­tation in psychiatric journals should give syste­matic at­ten­tion to sources of error in continuity of mental health­care