Frequency and predictors of adverse events

1998 ◽  
Vol 173 (5) ◽  
pp. 376-384 ◽  
Author(s):  
Sonia Johnson ◽  
Morven Leese ◽  
Liz Brooks ◽  
Paul Clarkson ◽  
Hilary Guite ◽  
...  
Keyword(s):  
Mental Health ◽  
Adverse Events ◽  
Research Evidence ◽  
Community Based ◽  
Public Records ◽  
Care Services ◽  
Primary Care Services ◽  
Community Based Services ◽  
Major Adverse Events

BackgroundCommunity care has been criticised as a hazardous policy associated with high rates of adverse events. There is little research evidence as to the truth of this claim.MethodBest available evidence from public records, interviews, case notes, key workers and general practitioners was assembled to establish: (a) which of the 514 subjects initially identified as having psychotic illnesses had died during an average follow-up of 4.9 years; (b) care currently received by all 286 subjects originally selected for interview; and (c) rates of major adverse events and of admission for these 286 individuals.ResultsTwenty-eight natural and 11 unnatural deaths had occurred. Among subjects still living at the end of the follow-up, 84% were in contact with specialist mental health services and 11% only with primary care services. Rates of serious violence, imprisonment and homelessness were relatively low. Forty-one per cent had been admitted at least once during a mean follow-up of 3.2 years and 20% at least once under the Mental Health Act. After adjustment, there were no significant differences between standard and intensive care sectors.ConclusionsRates of adverse events and slipping through the net’ are relatively low among individuals receiving community-based services, whether intensive or standard care.

Getting a foot in the door: can expanding the role of podiatry assistant improve access to public podiatry services?

2009 ◽  
Vol 15 (1) ◽  
pp. 45 ◽  
Author(s):  
Shan Bergin
Keyword(s):  
Adverse Events ◽  
Waiting Times ◽  
Significant Proportion ◽  
Practical Training ◽  
Community Based ◽  
The Impact ◽  
Community Based Services ◽  
Improve Access

The aim of this pilot was to evaluate the impact delegation of identified tasks to a qualified podiatry assistant (PA) had on accessibility to footcare services for targeted client groups. The role of PA was defined for the purposes of the pilot. The PA underwent theoretical and practical training and the role was implemented within a community based podiatry unit. Outcome measures included: total number of clients seen, change in available (qualified) podiatry hours through delegation of tasks to the assistant, changes to waiting times for initial and follow-up appointments, adverse events and patient satisfaction. The PA provided footcare to 41 clients during the evaluation period (December 2005 to January 2006 inclusive). Available (qualified) podiatry hours increased by 10 h per week for the same period and waiting times for an initial appointment were reduced from 12 to 2 weeks for the target group and from an ‘indefinite’ waiting period to 12 weeks for follow-up appointments. No adverse events were reported during the pilot. The findings of this pilot have implications for improving affordability and accessibility of footcare services to a significant proportion of the community and reducing the burden on current community based services.

scholarly journals MyCare study: protocol for a controlled trial evaluating the effect of a community-based intervention on psychosocial, clinical outcomes and hospital admission rates for adults with severe mental illness

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040610
Author(s):  
Renée O'Donnell ◽  
Melissa Savaglio ◽  
Debra Fast ◽  
Ash Vincent ◽  
Dave Vicary ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Controlled Trial ◽  
Community Based ◽  
Admission Rates ◽  
Mental Health Support ◽  
Health Support

IntroductionPeople with serious mental illness (SMI) often fail to receive adequate treatment. To provide a higher level of support, mental health systems have been reformed substantially to integrate mental healthcare into the community. MyCare is one such community-based mental health model of care. This paper describes the study protocol of a controlled trial examining the effect of MyCare on psychosocial and clinical outcomes and hospital admission and duration rates for adults with SMI.Methods and analysisThis is a multisite non-randomised controlled trial with a 3, 6 and 12-month follow-up period. The study participants will be adults (18–64 years of age) with SMI recruited from Hobart, Launceston and the North-West of Tasmania. The treatment group will include adults who receive both the MyCare intervention and standard mental health support; the control group will include adults who receive only standard mental health support. The primary outcome includes psychosocial and clinical functioning and the secondary outcome will examine hospital admission rates and duration of stay. Mixed-effects models will be used to examine outcome improvements between intake and follow-up. This trial will generate the evidence needed to evaluate the effect of a community mental health support programme delivered in Tasmania, Australia. If MyCare results in sustained positive outcomes for adults with SMI, it could potentially be scaled up more broadly across Australia, addressing the inequity and lack of comprehensive treatment that many individuals with SMI experience.Ethics and disseminationThis study has been approved by the Tasmanian Health and Medical Human Research Ethics Committee. The findings will be disseminated to participants and staff who delivered the intervention, submitted for publication in a peer-reviewed journal and shared at academic conferences.Trial registration numberACTRN12620000673943.

scholarly journals Screening Neurocognitive Disorders in Primary Care Services: The Quick Mild Cognitive Impairment Approach

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 158-158
Author(s):  
Constanca Paul ◽  
Susana Sousa ◽  
Pedro Santos ◽  
Rónán O’Caoimh ◽  
William Molloy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Cognitive Impairment ◽  
Community Sample ◽  
Neurocognitive Disorders ◽  
Cognitive Status ◽  
Health Concerns ◽  
Care Services ◽  
Primary Care Services ◽  
Mental Health Concerns

Abstract Neurocognitive Disorders (NCD) is an increasingly common condition in the community. The General Practitioner (GP) in Primary Care Services (PCS), have a crucial role in early detection of NCD and is usually the first professional to detect the signs of MCI. The objective of this study was to test the feasibility and utility of the cognitive screening instrument QMCI in Primary Care. A community sample of 436 people 65+ living in the community was randomly selected from a larger group of old people with mental health concerns (N=2734), referred by their GPs. The mean age of the sample was 75.2 years (sd 7.2), with 41.3% men and 58.7% women; 60.4% married followed by 28.7% widows. The education level was low with 21% illiterate and 69,8% people with 4 years education. The QMCI mean was 37.1/100 (sd 16.2). The amount of people screening positive for cognitive impairment QMCI (<62/100) was 94.2%. In the distribution of people with cognitive impairment by Global Deterioration Scale (GDS) three recoded categories, of the 286 people 76,1% where classified as having very mild or mild impairment, 19,4% moderate or moderately serious and 4,5% severe or very severe impairment. These results confirm the perception of GPs about their clients having mental health concerns and the ability of QMCI accurately discriminate MCI. The QMCI is very brief (3-5mins) fitting the short time of GPs to assess cognitive status and timely refer clients to nonpharmacological interventions that could postpone NCD symptoms.

scholarly journals Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045356
Author(s):  
Nick A Francis ◽  
Beth Stuart ◽  
Matthew Knight ◽  
Rama Vancheeswaran ◽  
Charles Oliver ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Hospital Setting ◽  
Health Problems ◽  
Clinical Deterioration ◽  
Care Services ◽  
Increased Risk ◽  
Remote Assessment ◽  
History Of

ObjectiveIdentify predictors of clinical deterioration in a virtual hospital (VH) setting for COVID-19.DesignReal-world prospective observational study.SettingVH remote assessment service in West Hertfordshire NHS Trust, UK.ParticipantsPatients with suspected COVID-19 illness enrolled directly from the community (postaccident and emergency (A&E) or medical intake assessment) or postinpatient admission.Main outcome measureDeath or (re-)admission to inpatient hospital care during VH follow-up and for 2 weeks post-VH discharge.Results900 patients with a clinical diagnosis of COVID-19 (455 referred from A&E or medical intake and 445 postinpatient) were included in the analysis. 76 (8.4%) of these experienced clinical deterioration (15 deaths in admitted patients, 3 deaths in patients not admitted and 58 additional inpatient admissions). Predictors of clinical deterioration were increase in age (OR 1.04 (95% CI 1.02 to 1.06) per year of age), history of cancer (OR 2.87 (95% CI 1.41 to 5.82)), history of mental health problems (OR 1.76 (95% CI 1.02 to 3.04)), severely impaired renal function (OR for eGFR <30=9.09 (95% CI 2.01 to 41.09)) and having a positive SARS-CoV-2 PCR result (OR 2.0 (95% CI 1.11 to 3.60)).ConclusionsThese predictors may help direct intensity of monitoring for patients with suspected or confirmed COVID-19 who are being remotely monitored by primary or secondary care services. Further research is needed to confirm our findings and identify the reasons for increased risk of clinical deterioration associated with cancer and mental health problems.

scholarly journals Utilization of a Cardiometabolic Health Nurse – a Novel Strategy to Manage Comorbid Physical and Mental Illness

2014 ◽  
Vol 4 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Brenda Happell ◽  
Robert Stanton ◽  
David Scott
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Physical Health ◽  
Allied Health ◽  
Cardiometabolic Health ◽  
Community Based ◽  
Mental Health Consumers ◽  
Health Nurse ◽  
Health Consumers ◽  
Community Based Services

Background Comorbid chronic illnesses, such as cardiovascular disease, respiratory conditions, and type 2 diabetes are common among people with serious mental illness. Management of comorbid illness in the mental health setting is sometimes ad hoc and poorly delivered. Use of a cardiometabolic health nurse (CHN) is proposed as one strategy to improve the delivery of physical health care to this vulnerable population. Objective To report the CHN's utilization of primary care and allied health referrals from a trial carried out in a regional community mental health service. Design Feasibility study. Mental health consumers were referred by their case manager or mental health nurse to the CHN. The CHN coordinated the physical health care of community-based mental health consumers by identifying the need for, and providing referrals to, additional services, including primary care, allied health, and community-based services. Results Sixty-two percent of participants referred to the CHN received referrals for primary care, allied health, and community-based services. Almost all referrals received follow-up by the CHN. Referrals were most commonly directed to a general practitioner and for nurse-delivered services. Conclusion The CHN role shows promise in coordinating the physical health of community-based mental health consumers. More studies on role integration and development of specific outcome measurement tools are needed.

scholarly journals Mental health reforms in the Czech Republic

2018 ◽  
Vol 16 (1) ◽  
pp. 4-6 ◽  
Author(s):  
Ondrej Pec
Keyword(s):  
Mental Health ◽  
Czech Republic ◽  
Health Reform ◽  
Mental Healthcare ◽  
Rehabilitation Services ◽  
Community Based ◽  
The Czech Republic ◽  
Mental Health Reform ◽  
Mental Health Reforms ◽  
Community Based Services

This paper describes the history and current provision of mental healthcare in the Czech Republic. After the political changes in 1989, there was an expansion of out-patient care and several non-governmental organisations began to provide social rehabilitation services, but the main focus of care still rested on mental hospitals. In recent years, mental health reform has been in progress, which has involved expanding community-based services and psychiatric wards of general hospitals, simultaneously with educational and destigmatisation programmes.

scholarly journals Business as Un-usual: Access to mental health and primary care services for people with severe mental illness during the COVID-19 restrictions

2021 ◽  
Author(s):  
Elizabeth Newbronner ◽  
Panagiotis Spanakis ◽  
Ruth Wadman ◽  
Suzanne Crosland ◽  
Paul Heron ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Severe Mental Illness ◽  
Care Services ◽  
Primary Care Services ◽  
Mental Health Support ◽  
Health Support

Aims: To explore: how satisfied people with severe mental illness (SMI) are with the support received during the pandemic; understand any difficulties encountered when accessing both mental health and primary care services; consider ways to mitigate these difficulties; and assess the perceived need for future support from mental health services. Materials and Methods: A representative sample was drawn from a large transdiagnostic clinical cohort of people with SMI, which was recruited between April 2016 and March 2020. The sample was re-surveyed a few months after the beginning of the restrictions. Descriptive frequency statistics were used to analyse the quantitative data. The free text responses were analysed thematically. Results: 367 participants responded to the survey. Two thirds were receiving support from mental health services with the rest supported in primary care or self-managing. A quarter thought they would need more mental health support in the coming year. Half had needed to used community mental health services during the pandemic and the majority had been able to get support. A minority reported that their mental health had deteriorated but they had either not got the supported they wanted or had not sought help. The biggest service change was the reduction in face-to-face appointments and increasing use of phone and video call support. Nearly half of those using mental health services found this change acceptable or even preferred it; acceptability was influenced by several factors. Participants were more likely to be satisfied with support received when seen in person. Discussion: Although most participants were satisfied with the mental health support they had received, a minority were not. This, couple with findings on future need for mental health support has implications for post pandemic demand on services. Remote care has brought benefits but also risks that it could increase inequalities in access to services.

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