Effectiveness of treatment for 6813 patients with mental health conditions in Cambridgeshire: a cross-sectional study

Dean, Nathan; Arnaoutoglou, Nikitas A.; Underwood, Benjamin R.

doi:10.1192/bjo.2020.14

Cited by 4 publications

(6 citation statements)

References 17 publications

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“…18 HoNOS scores can be a significant resource to gain insights into mental illness and treatment effectiveness. 19 These findings are consistent with reports of pandemic-related worsening of behavioural and psychological symptoms in people with dementia, 20 and can have implications for patients, carers and mental health services at different levels. While the remote attendance rates of patient with dementia were high, the effectiveness and usefulness of these consultations have not been established.…”

Section: Discussionsupporting

confidence: 88%

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts

Hong

Sheriff

Smith

et al. 2021

Evid Based Mental Health

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BackgroundThe effects of COVID-19 on the shift to remote consultations remain to be properly investigated.ObjectiveTo quantify the extent, nature and clinical impact of the use of telepsychiatry during the COVID-19 pandemic and compare it with the data in the same period of the 2 years before the outbreak.MethodsWe used deidentified electronic health records routinely collected from two UK mental health Foundation Trusts (Oxford Health (OHFT) and Southern Health (SHFT)) between January and September in 2018, 2019 and 2020. We considered three outcomes: (1) service activity, (2) in-person versus remote modalities of consultation and (3) clinical outcomes using Health of the Nation Outcome Scales (HoNOS) data. HoNOS data were collected from two cohorts of patients (cohort 1: patients with ≥1 HoNOS assessment each year in 2018, 2019 and 2020; cohort 2: patients with ≥1 HoNOS assessment each year in 2019 and 2020), and analysed in clusters using superclasses (namely, psychotic, non-psychotic and organic), which are used to assess overall healthcare complexity in the National Health Service. All statistical analyses were done in Python.FindingsMental health service activity in 2020 increased in all scheduled community appointments (by 15.4% and 5.6% in OHFT and SHFT, respectively). Remote consultations registered a 3.5-fold to 6-fold increase from February to June 2020 (from 4685 to a peak of 26 245 appointments in OHFT and from 7117 to 24 987 appointments in SHFT), with post-lockdown monthly averages of 23 030 and 22 977 remote appointments/month in OHFT and SHFT, respectively. Video consultations comprised up to one-third of total telepsychiatric services per month from April to September 2020. For patients with dementia, non-attendance rates at in-person appointments were higher than remote appointments (17.2% vs 3.9%). The overall HoNOS cluster value increased only in the organic superclass (clusters 18–21, n=174; p<0.001) from 2019 to 2020, suggesting a specific impact of the COVID-19 pandemic on this population of patients.Conclusions and clinical implicationsThe rapid shift to remote service delivery has not reached some groups of patients who may require more tailored management with telepsychiatry.

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Section: Discussionsupporting

confidence: 88%

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts

Hong

Sheriff

Smith

et al. 2021

Evid Based Mental Health

View full text Add to dashboard Cite

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“…Although some of these changes did not reach statistical significance in the YoD group, this is likely to reflect the lower numbers in that group. 8 In order to conduct a more comprehensive investigation into the differences between our YoD and LoD patients, we undertook a detailed case-note review of 30 cases from each group. The demographic details are given in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…We re-analysed a large data set of HoNOS scores which we had previously reported, in order to investigate differences in presentation and outcomes between YoD and LoD. This comprised data for 173 patients with YoD and 3553 patients with LoD, 8 representing the subset of total referrals that had a HoNOS score on admission and discharge. Using this methodology, we found significant differences in HoNOS scores on entry to the services (data not previously presented), with higher scores on the behaviour ( P = 0.01), cognition ( P < 0.001), hallucinations ( P = 0.01) and living conditions ( P = 0.04) domains in the LoD group; and higher scores for depression ( P < 0.001), occupation ( P = 0.01) and ‘other’ ( P < 0.001) in the YoD group ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Although some of these changes did not reach statistical significance in the YoD group, this is likely to reflect the lower numbers in that group. 8

Fig. 1 Bar chart showing mean scores across HoNOS scales for late- and young-onset dementia on presentation.…”

Section: Resultsmentioning

confidence: 99%

“…Health of the Nation Outcome Scales (HoNOS) data were collected as previously described. 8 We manually reviewed a sample of 90 electronic patient records. This was divided into data for 30 consecutive patients with an established diagnosis of YoD, 30 consecutive patients with a diagnosis of LoD, and 30 consecutive patients under the age of 65 who had been referred to the memory clinic for diagnostic assessment.…”

Section: Methodsmentioning

confidence: 99%

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Patients with young-onset dementia in an older people's mental health service

et al. 2020

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Aims and method Currently, no separate service exists for patients with young-onset dementia in Cambridgeshire. These patients are managed together with late-onset dementia patients within old age psychiatry services. To inform service design, we sought to characterise young-onset dementia patients in our population. We first analysed service-level data and supplemented this with a detailed case review of 90 patients. Results Young-onset dementia remains a relatively rare condition. Only a small proportion of those referred for assessment receive a diagnosis of dementia. Data collected on presenting complaints, comorbidities, medication and Health of the Nation Outcome Scales scores associated young-onset dementia with a greater incidence of depression than late-onset dementia. Outcomes in the two groups did not appear to differ. Clinical implications The data presented here do not suggest a need to create a separate service. Practitioners should be aware of the increased incidence of depression observed in this group.

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Inpatient Treatment of People With Schizophrenia: Quantifying Clinical Change Using the Health of the Nation Outcome Scales

Lay

Roser

Kawohl

2021

Schizophrenia Bulletin Open

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Schizophrenia can require hospital inpatient care in crisis periods or times of severe symptoms, although the length of hospital stays has been considerably reduced in the last few decades. Evidence on individual outcomes under routine psychiatric practice conditions is sparse. This study aims to evaluate the outcomes of inpatient treatment in patients with schizophrenia using the reliable and clinically significant change approach. We used routinely collected Health of the Nation Outcome Scales (HoNOS) data to assess the extent to which and the areas where symptomatic and functional improvement was achieved. Data from 1783 schizophrenia patients admitted to a large psychiatric centre in Switzerland were examined. Mean HoNOS total score dropped from 17.9 to 11.7 (effect size 0.8) during treatment; the greatest improvements were achieved regarding symptomatic problems and aggressive, agitated behaviour. According to the reliable change index formula, 24.5% of patients were to be considered improved, 73.3% unchanged and 2.2% deteriorated. In total, 56.6% were discharged from the hospital in a subclinical or mild functional state. The degree of individual improvement and time to achieve maximum symptom reduction varied considerably, depending on the patients' functional state at admission, as did the length of hospital stay (median 28 days). Rates of readmission within 28 days (17.8%) were significantly lower in patients with clinically significant improvement, discharged in better clinical condition. These findings support reconsidering (length of) inpatient treatment within the overall framework of meaningful clinical change and subsequent treatment needs in patients with schizophrenia.

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Effectiveness of treatment for 6813 patients with mental health conditions in Cambridgeshire: a cross-sectional study

Cited by 4 publications

References 17 publications

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts

Patients with young-onset dementia in an older people's mental health service

Inpatient Treatment of People With Schizophrenia: Quantifying Clinical Change Using the Health of the Nation Outcome Scales

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