IntroductionQuality assurance (QA) interventions are part of the core competencies that psychiatric trainees need to acquire prior to graduation of residency. The process of developing, implementing and monitoring standards of care for patients on antipsychotic medications is a practical illustration of the teaching of QA methods to psychiatric residents.ObjectiveWe will describe the process used by the residents and faculty of the Outpatient Psychiatry Department of Temple University School of Medicine to create and introduce metabolic follow up protocols for patients on antipsychotic medication.AimsWe will present the challenges encountered in this process.MethodsWe will describe the process used to create a monitoring protocol that satisfies expert practice guidelines. In addition, we will examine the social, economic and organizational variables that are a part of our urban outpatient training clinic. We will present the trends of the monthly QA reviews (July 2010 to February 2011). We will introduce the process of identifying and solving obstacles. Finally, we will describe the feedback loops that inform clinicians and faculty about the effectiveness of the QA protocols.ResultsSome of the challenges met include: expert disagreement on the exact particulars of follow-up frequency, patient noncompliance, disparities in health literacy, trainees’ learning curve, changes in medication, and coordination of care among providers.ConclusionTeaching QA is a difficult experiential process that articulates many of the skills acquired by residents in their training, from evidence-based medicine to delivery of care and program evaluation.
IntroductionHealth literacy (HL) measures the ability of an individual to use health-related information in order to make appropriate health-related decisions and to navigate the healthcare system. It influences a variety of behaviors such as breastfeeding, medication adherence, or the use of screening tests. Research has shown that it is related to the treatment outcome of conditions such as HIV and diabetes.ObjectiveIt is the assumption of this study that health literacy also plays a role in psychiatric patients’ adherence to treatment; in particular, to outpatient psychiatric appointments.AimsWe hypothesized that patients with different health literacy levels would have different adherence rates to outpatient psychiatric appointments.MethodsThe study was conducted in 2006 in the Outpatient Psychiatry Department (OPD) of Temple University School of Medicine in Philadelphia, Pennsylvania. All English and Spanish-speaking patients of the OPD (potential N = 150) were invited to complete the short version of the Test of Functional Health Literacy in Adults (sTOFHLA), yielding three HL groups: adequate, marginal and inadequate. We explored the demographic and clinical correlates of HL and compared the three literacy groups with respect to their adherence to appointments during a 12-month period.ResultsOur study showed that, for our patient population, HL was not significantly related to any of the demographic and clinical variables included in our analysis except appointment adherence.ConclusionPatients with lower HL had lower adherence to appointments. These findings invite further research to explore the significance of HL.
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