Decentralized outpatient teams in community-based psychiatric care

Valdés-Stauber, Juan; Putzhammer, Albert; Kilian, Reinhold

doi:10.1007/s00115-013-3836-2

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…The authors conclude that the number of persons admitted has slightly increased, as did the number of admissions. Despite that, the number of admissions per person admitted to the hospital did not suffer any alterations [53].…”

Section: Plos Onementioning

confidence: 94%

“…Positive results were also observed in the dimension of decentralization of services, increasing the efficiency of the health system. In addition to increasing the proportion of the population served, actions related to the decentralization dimension can reduce inequality in health spending [17,19,26,49,53]. The literature also indicates that the decentralization of resources in the context of regionalization increases public participation in decision-making, as it brings local resource planning closer to the needs of the population [73].…”

Section: Plos Onementioning

confidence: 99%

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Regionalization for health improvement: A systematic review

et al. 2020

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Regionalization is the integrated organization of a healthcare system, wherein regional structures are responsible for providing and administrating health services in a specific region. This method was adopted by several countries to improve the quality of provided care and to properly utilize available resources. Thus, a systematic review was conducted to verify effective interventions to improve health and management indicators within the health services regionalization. The protocol was registered in PROSPERO (CRD42016042314). We performed a systematic search in databases during February and March 2017 which was updated in October 2020. There was no language or date restriction. We included experimental and observational studies with interventions focused on regionalization-related actions, measures or policies aimed at decentralizing and organizing health offerings, rationalizing scarce capital and human resources, coordinating health services. A methodological assessment of the studies was performed using instruments from the Joanna Briggs Institute and GRADE was also used to assess outcomes. Thirty-nine articles fulfilled the eligibility criteria and sixteen interventions were identified that indicated different degrees of recommendations for improving the management of health system regionalization. The results showed that regionalization was effective under administrative decentralization and for rationalization of resources. The most investigated intervention was the strategy of concentrating procedures in high-volume hospitals, which showed positive outcomes, especially with the reduction of hospitalization days and in-hospital mortality rates. When implementing regionalization, it must be noted that it involves changes in current standards of health practice and in the distribution of health resources, especially for specialized services.

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Section: Plos Onementioning

confidence: 94%

Section: Plos Onementioning

confidence: 99%

Regionalization for health improvement: A systematic review

et al. 2020

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“…Another strength is that this real-world study involved patients and healthcare professionals from a non-academic setting, which is representative for many European services. Additionally, multidisciplinary outpatient teams like the FACT-teams in the Netherlands are comparable to services in other European countries (Rosenheck et al 2016;Valdes-Stauber et al 2014). However, some limitations need to be addressed.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Delegating Clozapine Monitoring to Advanced Nurse Practitioners: An Exploratory, Randomized Study to Assess the Effect on Prescription and Its Safety

Zalm

Schulte

Bogers

et al. 2020

Adm Policy Ment Health

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To test whether: (1) psychiatrists will prescribe clozapine more often if they can delegate the monitoring tasks to an advanced nurse practitioner (ANP), (2) clozapine monitoring by an ANP is at least as safe as monitoring by a psychiatrist. Patients from 23 Dutch outpatient teams were assessed for an indication for clozapine. ANPs affiliated to these teams were randomized to Condition A: clozapine monitoring by an ANP, or Condition B: monitoring by the psychiatrist. The safety of monitoring was evaluated by determining whether the weekly neutrophil measurements were performed. Staff and patients were blinded regarding the first hypothesis. Of the 173 patients with an indication for clozapine at baseline, only seven in Condition A and four in Condition B were prescribed clozapine (Odds Ratio = 2.24, 95% CI 0.61-8.21; p = 0.225). These low figures affected the power of this study. When we considered all patients who started with clozapine over the 15-month period (N = 49), the Odds Ratio was 1.90 (95% CI 0.93-3.87; p = 0.078). With regard to the safety of the monitoring of the latter group of patients, 71.2% of the required neutrophil measurements were performed in condition A and 67.3% in condition B (OR = 0.98; CI = 0.16-3.04; p = 0.98). Identifying patients with an indication for clozapine does not automatically lead to improved prescription rates, even when an ANP is available for the monitoring. Clozapine-monitoring performed by an ANP seemed as safe as that by a psychiatrist.

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Section: Plos Onementioning

confidence: 94%

Section: Plos Onementioning

confidence: 99%

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View full text Add to dashboard Cite

Decentralized outpatient teams in community-based psychiatric care

Cited by 5 publications

References 13 publications

Regionalization for health improvement: A systematic review

Regionalization for health improvement: A systematic review

Delegating Clozapine Monitoring to Advanced Nurse Practitioners: An Exploratory, Randomized Study to Assess the Effect on Prescription and Its Safety

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