Continuity of care in psychiatric post‐ward outpatient services – conceptions of patients and personnel concerning factors contributing to the continuity of care

Abstract

A structural change of the psychiatric services was started in Finland in the 1980s. Its primary objective was to shift the main emphasis from hospital to outpatient services. Hence, the number of psychiatric beds has declined to a third of the maximum rate, inpatient periods have shortened and the number of outpatient appointments has increased significantly. International research shows that when the emphasis of psychiatric services shifts to outpatient services and hospitalization becomes short-term, diverse individual alternatives are needed to support patients' coping. Several Finnish psychiatric hospitals initiated in the 1990s outpatient services provided at inpatient wards, which means, that after the period of hospitalization, further care is provided to the patient at the same ward where s/he was hospitalized. The purpose of this study was to describe and analyse the conceptions of patients, ward personnel, outpatient services personnel and administrative personnel in psychiatric units concerning the factors improving the continuity of care. A phenomenographic approach was used and the objective was to find the different empirical variations of the conceptions, through which people experience, comprehend and become conscious of the phenomena in the surrounding world. The data were gathered by interviewing post-ward outpatients (n=5), personnel at psychiatric wards and in outpatient services (n=18) and administrative personnel in psychiatric units (n=5). As a result of the analysis seven categories of the factors improving the continuity of care were formed: (1) adherence to a good cooperative relationship; (2) adherence to the care environment; (3) flexibility in tailoring care; (4) active maintenance of contacts in care; (5) constant possibility to contact the ward; (6) up-to-date patient data; and (7) active cooperation between outpatient services and other collaborators.

Encounters in a locked psychiatric ward environment

“…1997). On the other hand, fellow patients can, as in our study, be supportive and understanding (Lindström 1995, Wood & Pistrang 2004) and the relationship may remain important, even after discharge (Hautala‐Jylha et al . 2005).…”

Zoning: focused support: a trust wide implementation project

“…However, recent SWLStG national patient survey (Care Quality Commission 2008) indicates that service users are happier with the treatment they are receiving. An appreciated relationship is considered to be a positive way to promote care commitment (Hautala-Jylha et al 2005); these findings would therefore suggest that continuity of care has improved.…”

”You Never Know What Happens Next” – Young Adult Service Users’ Experience with Mental Health Care and Treatment through One Year

“…Many studies demonstrate that continuity of care is premised on a good and stable relationship between patient and provider, and that a good patient-provider relation is vital for the mental health service users to feel they are being helped [10111213141819]. Two of three studies of patients’ experience of continuity referred to the importance of the therapeutic relationship [19].…”

“…In a systematic appraisal of the literature, supplemented by interviews with patients and families, Joyce et al [9] found that continuity of care has been defined in terms of service delivery, accessibility, relationship base and individualized care. In Parker et al’s [10] review of continuity of care-studies based on users’ experiences, they identify the following factors: users’ relationships with the providers, understanding of their condition and treatment, coordination of care, what happened to them during transition, their personal agency, and their existence as a “whole person.” Many studies show the importance of a good cooperative relationship between user and their provider [11121314]. …”