Continuity of Care and Health Outcomes Among Persons With Severe Mental Illness

Department of psychiatry, University of Calgary, 3330 Hospital Drive, N.W., Calgary, Alberta, Canada T2N 4N1.
Psychiatric Services (Impact Factor: 2.41). 10/2005; 56(9):1061-9. DOI: 10.1176/
Source: PubMed

ABSTRACT Continuity of care is considered to be essential to the effective treatment of persons with severe mental illness, yet evidence to support the association between continuity and outcomes is sparse because of a lack of longitudinal studies and of comprehensive continuity measures. The purpose of this study was to examine the relationship between continuity of care and outcomes.
A new multilevel measure of service continuity, the Alberta Continuity of Services Scale for Mental Health (ACSS-MH), was used in a 17-month follow-up study of 486 adults with severe mental illness in three health regions of Alberta, Canada.
Endpoint information was obtained for 411 participants (85 percent). The mean continuity score reported by patients was 131+/-20 out of a possible 185. The mean continuity score as rated by observers was 39+/-10 out of a possible 59. Higher levels of observer-rated continuity were associated with older age, lower annual household income, a diagnosis of psychotic disorder, and no suicidality or alcohol use. Continuity was also significantly associated with a better quality of life at endpoint (generic and disease specific), better community functioning, lower severity of symptoms, and greater service satisfaction. The associations between continuity and quality of life held after adjustment for empirically identified confounders.
Positive relationships between continuity of care and health outcomes among persons with severe mental illness suggest that efforts at improving continuity in and among mental health services are worthwhile.

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    • "). However, mental health care continuity is crucial, having been linked to patient quality of life indicators such as physical and mental health, symptom severity, and satisfaction with care (Adair et al., 2005). "
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    ABSTRACT: To cite this article: Lara M. Stepleman, Lauren Penwell-Waines & Abbey Valvano (2015) Integrated care psychologists and their role in patient transition from medical to psychiatric specialty care settings: a conceptual model, Health Psychology and Behavioral Medicine: An Open Access Journal, 3:1, 154-168,
    08/2015; 3(1). DOI:10.1080/21642850.2015.1063059
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    • "This suggests that one way to reduce high post-index costs and reduce the risk of readmission is to improve patients’ transition from an inpatient setting to an outpatient setting. It has been reported that better continuity of care among patients with severe mental illness was associated with reduced hospital costs, improved quality of life and functioning, and reduced severity of symptoms [45, 46]. Thus, tailored management and treatment strategies during the first 60 days after hospitalization may be of particular importance. "
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    ABSTRACT: Hospital-discharged patients with schizoaffective disorder have a high risk of re-hospitalization. However, limited data exist evaluating critical post-discharge periods during which the risk of re-hospitalization is significant. Among hospital-discharged patients with schizoaffective disorder, we assessed pharmacotherapy adherence and healthcare utilization and costs during sequential 60-day clinical periods before schizoaffective disorder-related hospitalization and post-hospital discharge. From the MarketScan(®) Medicaid database (2004-2008), we identified patients (≥18 years) with a schizoaffective disorder-related inpatient admission. Study measures including medication adherence and healthcare utilization and costs were assessed during sequential preadmission and post-discharge periods. We conducted univariate and multivariable regression analyses to compare schizoaffective disorder-related and all-cause healthcare utilization and costs (in 2010 US dollars) between each adjacent 60-day post-discharge periods. No adjustment was made for multiplicity. We identified 1,193 hospital-discharged patients with a mean age of 41 years. The mean medication adherence rate was 46 % during the 60-day period prior to index inpatient admission, which improved to 80 % during the 60-day post-discharge period. Following hospital discharge, schizoaffective disorder-related healthcare costs were significantly greater during the initial 60-day period compared with the 61- to 120-day post-discharge period (mean US$2,370 vs US$1,765; p < 0.001), with rehospitalization (36 %) and pharmacy (40 %) accounting for over three-fourths of the initial 60-day period costs. Compared with the initial 60-day post-discharge period, both all-cause and schizoaffective disorder-related costs declined during the 61- to 120-day post-discharge period and remained stable for the remaining post-discharge periods (days 121-365). We observed considerably lower (46 %) adherence during 60 days prior to the inpatient admission; in comparison, adherence for the overall 6-month period was 8 % (54 %) higher. Our study findings suggest that both short-term (e.g., 60 days) and long-term (e.g., 6-12 months) medication adherence likely are important characteristics to examine among patients with schizoaffective disorder and help provide a more holistic view of patients' adherence patterns. Furthermore, we observed a high rate of rehospitalization and greater healthcare costs during the initial 60-day period post-discharge among patients with schizoaffective disorder. Further research is required to better understand and manage transitional care after discharge (e.g., monitor adherence), which may help reduce the likelihood of rehospitalization and the associated downstream costs.
    Applied Health Economics and Health Policy 04/2014; 12(3). DOI:10.1007/s40258-014-0095-8
    • "A basic assumption of the continuum of care is that patients, who passed a period of hospitalization due to severe psychiatric disorders, should be able to move easily between different outpatient settings to prevent relapse and subsequent readmission.[11] However, gaps in continuity of care for patients with severe mental disorders may occur similar to those of other chronic medical conditions.[12] Poor insight, non-adherence to treatment, and weak financial support are additional causes for interruption in continuity of care in patients with mental disorders.[1314151617] "
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    ABSTRACT: Background: Although evidences emphasize on the importance of aftercare programs to achieve continuity of care, different studies have revealed controversial results about the outcome. The objective of this study was to investigate the effect of aftercare program on outcome measures of patients with severe mental disorders. Materials and Methods: Of a total 123 eligible patients with severe mental disorders, 61 patients were randomly assigned to the intervention group and 62 patients to the control group. The interventions included follow-up phone calls, home visits, and psychoeducation for families. Assessments were performed on hospital admission, discharge and the following 3rd, 6th and 12th month. Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), and the World Health Organization Quality of Life Questionnaire (WHO-QOL) were used. Data were analyzed through Chi square, t-test, Mann-Whitney-U, and Repeated Measures Analysis of Co-Variance. Results: Mean of the HDRS scores revealed significant difference between the two groups when HDRS scores on the admission day were controlled (P = 0.028). The level of functioning was significantly different between the two groups based on the sequential assessments of GAF (P = 0.040). One year after the onset of trial, the number of psychiatric readmissions were significantly different between the two groups (P = 0.036). Conclusion: Readmission rates could be reduced by aftercare services, through the first year, after discharge of patients with severe mental disorders. On the other hand, higher levels of functioning would be expected after one year.
    Journal of research in medical sciences 03/2014; 19(3):240-5. · 0.65 Impact Factor
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