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The role of boundary spanners in delivering collaborative care: a process evaluation

机译:边界扳手在提供合作医疗中的作用:过程评估

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Background On average, people with schizophrenia and psychosis die 13–30 years sooner than the general population (World Psychiatry 10 (1):52–77, 2011). Mental and physical health care is often provided by different organisations, different practitioners and in different settings which makes collaborative care difficult. Research is needed to understand and map the impact of new collaborative ways of working at the primary/secondary care interface (PloS One 7 (5); e36468). The evaluation presented in this paper was designed to explore the potential of a Community and Physical Health Co-ordinator role (CPHC) (CPHCs were previously Care Co-ordinators within the Community Mental Health Team, Community in the title CPHC refers to Community Mental Health) and Multi-Disciplinary Team (MDT) meetings across primary and community care, with the aim of improving collaboration of mental and physical health care for service users with Severe Mental Illness (SMI). Methods Data collection took place across five general practices (GPs) and a Community Mental Health Team (CMHT) in the Northwest of England, as part of a process evaluation. Semi-structured interviews were conducted with a purposive sample of GP staff ( n = 18) and CMHT staff ( n =4), a focus group with CMHT staff ( n =8) and a survey completed by 13 CMHT staff, alongside cardiovascular risk data and MDT actions. Framework analysis was used to manage and interpret data. Results The results from the evaluation demonstrate that a CPHC role and MDT meetings are effective mechanisms for improving the collaboration and co-ordination of physical health care for SMI service users. The findings highlight the importance of embedding and supporting the CPHC role, with an emphasis on protected time and continuing professional roles and integrating multiple perspectives through MDT meetings. Considering the importance of physical health care for SMI service users and the complex environment, these are important findings for practitioners, researchers and policy makers in the field of primary care and?mental health. Conclusion There is an increasing focus on integration and collaborative working to ensure the delivery of quality care across the whole patient pathway, with a growing need for professionals to work together across service and professional boundaries. The introduction of a two pronged approach to collaboration has shown some important improvements in the management of physical health care for service users with SMI.
机译:背景知识平均而言,精神分裂症和精神病患者的死亡时间比一般人群早13–30年(World Psychiatry 10(1):52–77,2011)。心理和身体保健通常由不同的组织,不同的从业人员和在不同的环境中提供,这给协作医疗带来了困难。需要进行研究以了解和绘制在初级/二级护理界面上新的协作工作方式的影响(PloS One 7(5); e36468)。本文中提出的评估旨在探索社区和身体健康协调员角色(CPHC)的潜力(CPHC以前是社区心理健康团队中的护理协调员,社区的标题为CPHC指的是社区心理健康)和跨初级和社区护理的多学科团队(MDT)会议,目的是为患有严重精神疾病(SMI)的服务使用者改善精神和身体保健的协作。方法作为过程评估的一部分,在英格兰西北部的五个常规诊所(GP)和一个社区精神卫生小组(CMHT)进行了数据收集。采用GP员工(n = 18)和CMHT员工(n = 4)的目的性样本,CMHT员工(n = 8)的焦点小组进行了半结构式访谈,并由13名CMHT员工完成了一项调查,并进行了心血管风险调查数据和MDT操作。框架分析用于管理和解释数据。结果评估结果表明,CPHC角色和MDT会议是改善SMI服务用户身体保健的协作和协调的有效机制。调查结果强调了嵌入和支持CPHC角色的重要性,并强调了保护时间和继续担任专业角色,并通过MDT会议整合了多种观点。考虑到身体保健对SMI服务使用者和复杂环境的重要性,对于初级保健和心理健康领域的从业者,研究人员和决策者来说,这些都是重要的发现。结论越来越重视集成和协作工作,以确保在整个患者途径中提供优质的护理,并且越来越需要专业人员跨服务和跨专业领域进行合作。引入两管齐下的协作方法已显示出在SMI服务用户的身体保健管理方面的一些重要改进。

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