Understanding service user-defined continuity of care and its relationship to health and social measures: a cross-sectional study

BMC Health Services Research, Jun 2012

Background Despite the importance of continuity of care [COC] in contemporary mental health service provision, COC lacks a clearly agreed definition. Furthermore, whilst there is broad agreement that definitions should include service users’ experiences, little is known about this. This paper aims to explore a new construct of service user-defined COC and its relationship to a range of health and social outcomes. Methods In a cross sectional study design, 167 people who experience psychosis participated in structured interviews, including a service user-generated COC measure (CONTINU-UM) and health and social assessments. Constructs underlying CONTINU-UM were explored using factor analysis in order to understand service user-defined COC. The relationships between the total/factor CONTINU-UM scores and the health and social measures were then explored through linear regression and an examination of quartile results in order to assess whether service user-defined COC is related to outcome. Results Service user-defined COC is underpinned by three sub-constructs: preconditions, staff-related continuity and care contacts, although internal consistency of some sub-scales was low. High COC as assessed via CONTINU-UM, including preconditions and staff-related COC, was related to having needs met and better therapeutic alliances. Preconditions for COC were additionally related to symptoms and quality of life. COC was unrelated to empowerment and care contacts unrelated to outcomes. Service users who had experienced a hospital admission experienced higher levels of COC. A minority of service users with the poorest continuity of care also had high BPRS scores and poor quality of life. Conclusions Service-user defined continuity of care is a measurable construct underpinned by three sub-constructs (preconditions, staff-related and care contacts). COC and its sub-constructs demonstrate a range of relationships with health and social measures. Clinicians have an important role to play in supporting service users to navigate the complexities of the mental health system. Having experienced a hospital admission does not necessarily disrupt the flow of care. Further research is needed to test whether increasing service user-defined COC can improve clinical outcomes. Using CONTINU-UM will allow researchers to assess service users’ experiences of COC based on the elements that are important from their perspective.

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Understanding service user-defined continuity of care and its relationship to health and social measures: a cross-sectional study

Angela Sweeney 1 Diana Rose 0 Sarah Clement 0 Fatima Jichi Ian Rees Jones Tom Burns Jocelyn Catty Susan Mclaren Til Wykes 0 Department of Health Service and Population Research, Institute of Psychiatry, King's College London , London , UK 1 Mental Health Sciences Unit, University College London , London , UK Background: Despite the importance of continuity of care [COC] in contemporary mental health service provision, COC lacks a clearly agreed definition. Furthermore, whilst there is broad agreement that definitions should include service users' experiences, little is known about this. This paper aims to explore a new construct of service userdefined COC and its relationship to a range of health and social outcomes. Methods: In a cross sectional study design, 167 people who experience psychosis participated in structured interviews, including a service user-generated COC measure (CONTINU-UM) and health and social assessments. Constructs underlying CONTINU-UM were explored using factor analysis in order to understand service user-defined COC. The relationships between the total/factor CONTINU-UM scores and the health and social measures were then explored through linear regression and an examination of quartile results in order to assess whether service userdefined COC is related to outcome. Results: Service user-defined COC is underpinned by three sub-constructs: preconditions, staff-related continuity and care contacts, although internal consistency of some sub-scales was low. High COC as assessed via CONTINU-UM, including preconditions and staff-related COC, was related to having needs met and better therapeutic alliances. Preconditions for COC were additionally related to symptoms and quality of life. COC was unrelated to empowerment and care contacts unrelated to outcomes. Service users who had experienced a hospital admission experienced higher levels of COC. A minority of service users with the poorest continuity of care also had high BPRS scores and poor quality of life. Conclusions: Service-user defined continuity of care is a measurable construct underpinned by three sub-constructs (preconditions, staff-related and care contacts). COC and its sub-constructs demonstrate a range of relationships with health and social measures. Clinicians have an important role to play in supporting service users to navigate the complexities of the mental health system. Having experienced a hospital admission does not necessarily disrupt the flow of care. Further research is needed to test whether increasing service user-defined COC can improve clinical outcomes. Using CONTINU-UM will allow researchers to assess service users' experiences of COC based on the elements that are important from their perspective. - Background Continuity of care [COC] is widely considered to be a central goal of contemporary mental health service provision [1,2]. This centrality is largely due to deinstitutionalization and the advent of community care: services that were formerly provided within one institution - such as shelter, activities and psychiatric treatment have become dispersed amongst a number of agencies. Consequently, the provision of coherent, smooth care has become problematic, and COC has emerged as a central indicator of successful, integrated community services. Furthermore, discontinuities have been linked to adverse outcomes. For example, a number of official inquiries into suicides and homicides by people with psychiatric diagnoses have suggested that a lack of COC may have been a causal factor [3,4]. Whilst there is some evidence that COC positively affects service users outcomes [5-7], such relationships have not been uncovered consistently [8]. Moreover, efforts to research COC and its relationship to outcomes have been hampered by a lack of an agreed definition; COC has been described as a conceptually underdeveloped, vague and over-inclusive construct lacking a solid empirical foundation [9]. Individual research teams have typically defined continuity for their specific research, resulting in sporadic and disconnected measurement. Consequently, there is virtually no consistency in the way that continuity of care has been measured or in the choice of outcome measures [5]. In recent years, there has been a growing consensus that COC is a multi-dimensional construct that should centralise service users experiences [5,10]. However, existing measures tend to assess a single dimension of COC, such as hospital discharge, and either ignore service users definitions [11] or conflate them with those of staff [12,13]. Consequently, little is known about service users views of, priorities for or experiences of COC [14], and, it is not definitively known whether program interventions and administrative policy changes intended to facilitate COC are actually experienced as such by patients [15]. Having the means to measure continuity of care from a service user perspective will enable researchers to establish in the fir (...truncated)


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Angela Sweeney, Diana Rose, Sarah Clement, Fatima Jichi, Ian Jones, Tom Burns, Jocelyn Catty, Susan Mclaren, Til Wykes. Understanding service user-defined continuity of care and its relationship to health and social measures: a cross-sectional study, BMC Health Services Research, 2012, pp. 145, 12, DOI: 10.1186/1472-6963-12-145