Improving mental health service users’ with medical co-morbidity transition between tertiary medical hospital and primary care services: a qualitative study

Abstract

BackgroundMental health service users have high rates of medical co-morbidity but frequently experience problems accessing and transitioning between tertiary medical and primary care services. The aim of this study was to identify ways to improve service users’ with medical co-morbidity care and experience during their transition between tertiary medical hospitals and primary care services.MethodExperience-based co-design (EBCD) qualitative study incorporating a focus group discussion. The study took place in a large tertiary medical service, incorporating three medical hospitals, and primary care services, in Melbourne, Australia. A purposive sample of service users and their caregivers and tertiary medical and primary care clinicians participated in the focus group discussion, in August 2014. A semi-structured interview guide was used to inform data collection. A thematic analysis of the data was undertaken.ResultsThirteen participants took part in the focus group interview, comprising 5 service users, 2 caregivers and 6 clinicians. Five themes were abstracted from the data, illustrating participants’ perspectives about factors that facilitated (clinicians’ expertise, engagement and accessibility enhancing transition) and presented as barriers (improving access pathways; enhancing communication and continuity of care; improving clinicians’ attitudes; and increasing caregiver participation) to service users’ progress through tertiary medical and primary care services. A sixth theme, enhancing service users’ transition, incorporated three strategies to enhance their transition through tertiary medical and primary care services.ConclusionEBCD is a useful approach to collaboratively develop strategies to improve service users’ with medical co-morbidity and their caregivers’ transition between tertiary medical and primary care services. A whole-of-service approach, incorporating policy development and implementation, change of practice philosophy, professional development education and support for clinicians, and acceptance of the need for caregiver participation, is required to improve service users’ transition.

Examining health disparities and characteristics in general practice utilization: based on outpatient data from 2014 - 2018 in Shanghai

“…However, because the referral system is not strict under the loosely regulated insurance system, more patients are inclined to initially visit higher-level hospitals. Community health care institutions are usually defined as playing a main role in disease prevention and control [32,33]. Much work still needs to be done regarding the improvement of the medical functionality of community health care centres and the prevention and treatment of endemic diseases, which represents a gap between China and high-income countries [34,35].…”

Psychological resilience in people experiencing schizophrenia and suicidal thoughts and behaviours

“…Nurturing psychological resilience in people experiencing mental health problems is an important therapeutic and public health goal (APA). It can be argued that such ventures will be successful only if an understanding of what resilience means and an understanding of factors which can promote psychological resilience in the face of negative internal stressors (e.g., hearing internal denigrating voices) and external stressors (e.g., being made redundant) is shared between mental health professionals and those with experience of severe mental health problems (Chisholm, Hart, Mann, & Peters, 2014;Cranwell, Polacsek, & McCann, 2016;Ditton-Phare et al, 2015;Peters et al, 2009). This necessitates the use of qualitative methodologies to understanding personal experiences of resilience to negative stressors in those with severe mental health problems.…”

Using experience‐based co‐design for the development of physical activity provision in rehabilitation and recovery mental health care

“…In utilizing EBCD for developing one specific aspect of a service, it is likely that reduced nonparticipant observation may be required than that of a project striving for overall service improvement. This downscaling or removal of observation was shown in an Australian study looking at one aspect of mental health care (Cranwell et al., ), thus strengthening the case for such adaptation.…”

“…The application of EBCD in a mental health setting is relatively new. To the authors’ knowledge, five previous research studies with published literature have been carried out in mental health services to date, as shown in Table (Cooper, Gillmore, & Hogg, ; Cranwell, Polacsek, & Mccann, ; Larkin, Boden, & Newton, ; Palmer et al., ; Springham & Robert, ). In addition, other research has carried out methods of coproduction in mental health services but did not specifically adopt EBCD (Gillard et al., ).…”