Specialised teams or personal continuity across inpatient and outpatient mental healthcare? Study protocol for a natural experiment

Abstract

IntroductionMental healthcare organisation can either pursue specialisation, that is, distinct clinicians and teams for inpatient and outpatient care or personal continuity of care, that is, the same primary clinician for a patient across the two settings. Little systematic research has compared these approaches. Existing studies subject have serious methodological shortcomings. Yet, costly reorganisations of services have been carried out in different European countries, inconsistently aiming to achieve specialisation or personal continuity of care. More reliable evidence is required on whether specialisation or continuity of care is more effective and cost-effective, and whether this varies for different patient groups and contexts.Design and methodsIn a natural experiment, we aim to recruit at least 6000 patients consecutively admitted to inpatient psychiatric care in Belgium, Germany, Italy, Poland, and the UK. In each country, care approaches supporting specialisation and personal continuity coexist. Patients will be followed up at 1 year to compare outcomes, costs and experiences. Inclusion criteria are: 18 years of age or older; clinical diagnosis of psychosis, affective disorder or anxiety/somatisation disorder; sufficient command of the language of the host country; absence of cognitive deterioration and/or organic brain disorders; and capacity to provide informed consent.Ethics and disseminationEthical approval was obtained in all countries: (1) England: NRES Committee North East—Newcastle & North Tyneside (ref: 14/NE/1017); (2) Belgium: Comité d'Ethique hospitalo-facultaire des Cliniques St-Luc; (3) Germany: Ethical Board, Technische Universität Dresden; (4) Italy: Comitati Etici per la sperimentazione clinica (CESC) delle provincie di Verona, Rovigo, Vicenza, Treviso, Padova; (5) Poland: Komisja Bioetyczna przy Instytucie Psychiatrii i Neurologii w Warszawie. We will disseminate the findings through scientific publications and a study-specific website. At the end of the study, we will develop recommendations for policy decision-making, and organise national and international workshops with stakeholders.Trial registration numberISRCTN registry: ISRCTN40256812.

Mental health care for adult refugees in high-income countries

“…Yet, the fragmentation of health and social care services is a commonly reported concern in highincome countries (Giacco et al 2015). Different strategies have been suggested to improve the coordination, usually following one of two models.…”

Correspondence

“…Two potential models of care have been proposed: a continuity model of care, in which the same consultant is responsible for both inpatient and outpatient management; and a split model of care, in which two consultants are involved, one responsible for inpatient and the other for outpatient care. There are several examples internationally of health services moving from a continuity model of care to a split model of care, and vice versa (Giacco et al 2015). There does not appear to be strong evidence that either model result in better outcomes for patients, however, and there is currently a large international multi-centre study underway to investigate this issue (Giacco et al 2015).…”

“…There are several examples internationally of health services moving from a continuity model of care to a split model of care, and vice versa (Giacco et al 2015). There does not appear to be strong evidence that either model result in better outcomes for patients, however, and there is currently a large international multi-centre study underway to investigate this issue (Giacco et al 2015). In the context of limited and inconclusive evidence, how can mental health service planners make decisions in relation to consultant models of care?…”

“…It is worth reflecting on the reported benefits of each model of care outlined in the literature, as summarised by Giacco et al (2015). Proposed advantages of the split model of care include quick clinical decision making; positive risk management; specialisation of interventions; enhancement of clinical leadership; and development of specialised expertise.…”

Bridging the gap between research and clinical practice - a new initiative

“…One example of this is the Comparing Policy Framework, Structure, Effectiveness and Cost-effectiveness of Functional and Integrated Systems of Mental Health Care (COFI) project aimed at comparing functional and integrated systems of mental health care in 14 different hospitals in six countries. 8 The study involved interviewing every new inpatient within 48 hours of admission -without the RAs' input the Trust would simply not have had the capability to take on this project.…”