Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-14T06:59:09.885Z Has data issue: false hasContentIssue false
  • English
  • Français

Continuity of care in mental health: understanding and measuring a complex phenomenon

Published online by Cambridge University Press:  23 June 2008

T. Burns ,
J. Catty ,
S. White ,
S. Clement ,
G. Ellis ,
I. R. Jones ,
P. Lissouba ,
S. McLaren ,
D. Rose  and
T. Wykes
T. Burns*
Affiliation:
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
J. Catty
Affiliation:
St George's, University of London, London, UK
S. White
Affiliation:
St George's, University of London, London, UK
S. Clement
Affiliation:
London South Bank University, London, UK
G. Ellis
Affiliation:
St George's, University of London, London, UK
I. R. Jones
Affiliation:
University of Wales, Bangor, Wales, UK
P. Lissouba
Affiliation:
St George's, University of London, London, UK
S. McLaren
Affiliation:
London South Bank University, London, UK
D. Rose
Affiliation:
Institute of Psychiatry, London, UK
T. Wykes
Affiliation:
Institute of Psychiatry, London, UK
*
*Address for correspondence: Professor T. Burns, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. (Email: tom.burns@psych.ox.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Continuity of care is considered by patients and clinicians an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasize it and encourage systems to promote it. Despite this, there is no accepted definition or measure against which to test policies or interventions designed to improve continuity. We aimed to operationalize a multi-axial model of continuity of care and to use factor analysis to determine its validity for severe mental illness.

Method

A multi-axial model of continuity of care comprising eight facets was operationalized for quantitative data collection from mental health service users using 32 variables. Of these variables, 22 were subsequently entered into a factor analysis as independent components, using data from a clinical population considered to require long-term consistent care.

Results

Factor analysis produced seven independent continuity factors accounting for 62.5% of the total variance. These factors, Experience and Relationship, Regularity, Meeting Needs, Consolidation, Managed Transitions, Care Coordination and Supported Living, were close but not identical to the original theoretical model.

Conclusions

We confirmed that continuity of care is multi-factorial. Our seven factors are intuitively meaningful and appear to work in mental health. These factors should be used as a starting-point in research into the determinants and outcomes of continuity of care in long-term disorders.

Keywords

Continuity of carequality of lifesevere mental illness
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 2 , February 2009 , pp. 313 - 323
Copyright
Copyright © 2008 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adair, CE, McDougall, GM, Beckie, A, Joyce, A, Mitton, C, Wild, CT, Gordon, A, Costigan, N (2003). History and measurement of continuity of care in mental health services and evidence of its role in outcomes. Psychiatric Services 54, 1351–1356.CrossRefGoogle ScholarPubMed
Adair, CE, McDougall, GM, Mitton, CR, Joyce, AS, Wild, TC, Gordon, A, Costigan, N, Kowalsky, L, Pasmeny, G, Beckie, A (2005). Continuity of care and health outcomes among persons with severe mental illness. Psychiatric Services 56, 1061–1069.CrossRefGoogle ScholarPubMed
Bachrach, L (1981). Continuity of care for chronic mental users: a conceptual analysis. American Journal of Psychiatry 138, 1449–1455.Google Scholar
Bindman, J, Johnson, S, Wright, S, Szmukler, G, Bebbington, P, Kuipers, E, Thornicroft, G (1997). Integration between primary and secondary services in the care of the severely mentally ill: patients' and general practitioners' views. British Journal of Psychiatry 171, 169–174.CrossRefGoogle ScholarPubMed
Cook, RI, Render, M, Woods, DD (2000). Gaps in the continuity of care and progress on patient safety. British Medical Journal 320, 791–794.CrossRefGoogle ScholarPubMed
Crawford, M, Jonge, E, Freeman, G, Weaver, T (2004). Providing continuity of care for people with severe mental illness. Social Psychiatry and Psychiatric Epidemiology 39, 265–272.CrossRefGoogle ScholarPubMed
DoH (1995). Building Bridges: A Guide to Arrangements for Inter-agency Working for the Care and Protection of Severely Mentally Ill People. Department of Health: London.Google Scholar
DoH (1990). The Care Programme Approach for People with a Mental Illness Referred to the Special Psychiatric Services. Joint Health/Social Services Circular HC (90) 23/LASS (90) 11. Department of Health: London.Google Scholar
DoH (2001). Mental Health Policy Implementation Guide. Department of Health: London.Google Scholar
Freeman, G, Shepperd, S, Robinson, I, Ehrich, K, Richards, S (2000). Continuity of Care: Report of a Scoping Exercise for the SDO Programme of NHS R&D. National Co-ordinating Centre for Service Delivery and Organisation: London.Google Scholar
Freeman, G, Weaver, T, Low, J, de Jonge, E, Crawford, M (2002). Promoting Continuity of Care for People with Severe Mental Illness whose Needs Span Primary, Secondary and Social Care. National Co-ordinating Centre for Service Delivery and Organisation: London.Google Scholar
Haggerty, JL, Reid, RJ, Freeman, GK, Starfield, BH, Adair, CE, McKendry, R (2003). Continuity of care: a multidisciplinary review. British Medical Journal 327, 1219–1221.CrossRefGoogle ScholarPubMed
Heslop, L, Elsom, S, Parker, N (2000). Improving continuity of care across psychiatric and emergency services: combining patient data within a participatory action research framework. Journal of Advanced Nursing 31, 135–143.CrossRefGoogle ScholarPubMed
Johnson, S, Prosser, D, Bindman, J, Szmukler, G (1997). Continuity of care for the severely mentally ill: concepts and measures. Social Psychiatry and Psychiatric Epidemiology 32, 137–142.CrossRefGoogle ScholarPubMed
Joyce, A, Wild, T, Adair, C, McDougall, G, Gordon, A, Costigan, N, Beckie, A, Kowalsky, L, Pasmeny, G, Barnes, F (2004). Continuity of care in mental health services: toward clarifying the construct. Canadian Journal of Psychiatry 49, 539–550.CrossRefGoogle ScholarPubMed
Kaiser, HF (1974). Index of factorial simplicity. Psychometrika 39, 31–36.CrossRefGoogle Scholar
Kopelowicz, A, Wallace, C, Zarate, R (1998). Teaching psychiatric inpatients to re-enter the community: a brief method of improving the continuity of care. Psychiatric Services 49, 1313–1316.CrossRefGoogle ScholarPubMed
McGuffin, P, Farmer, A, Harvey, I (1991). A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Archives of General Psychiatry 48, 764–770.CrossRefGoogle ScholarPubMed
McGuire-Snieckus, R, McCabe, R, Catty, J, Priebe, S (2006). A new scale to assess the therapeutic relationship in community mental health care: STAR. Psychological Medicine 37, 85–95.CrossRefGoogle ScholarPubMed
Mitton, CR, Adair, CE, McDougall, GM, Marcouz, G (2005). Continuity of care and health care costs among persons with severe mental illness. Psychiatric Services 56, 1070–1076.CrossRefGoogle ScholarPubMed
Mueser, KT, Bond, GR, Drake, RE, Resnick, SG (1998). Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin 24, 37–74.CrossRefGoogle ScholarPubMed
Nutting, PA, Goodwin, MA, Flocke, SA, Zyzanski, SJ, Stange, KC (2003). Continuity of primary care: to whom does it matter and when? Annals of Family Medicine 1, 149–155.CrossRefGoogle ScholarPubMed
Phelan, M, Slade, M, Thornicroft, G, Dunn, G, Holloway, F, Wykes, T, Strathdee, G, Loftus, L, McCrone, P, Hayward, P (1995). The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. British Journal of Psychiatry 167, 589–595.CrossRefGoogle ScholarPubMed
Reid, R, Haggerty, J, McKendry, R (2002). Defusing the Confusion: Concepts and Measures of Continuity of Healthcare. Final Report. Canadian Health Services Research Foundation (CHSRF): Ottawa, Canada.Google Scholar
Sytema, S, Burgess, P (1999). Continuity of care and readmission in two service systems: a comparative Victorian and Groningen case-register study. Acta Psychiatrica Scandinavica 100, 212–219.CrossRefGoogle ScholarPubMed
Sytema, S, Micciolo, R, Tansella, M (1997). Continuity of care for patients with schizophrenia and related disorders: a comparative South-Verona and Groningen case-register study. Psychological Medicine 27, 1355–1362.CrossRefGoogle ScholarPubMed
Tessler, RC (1987). Continuity of care and client outcome. Psychosocial Rehabilitation Journal 11, 39–53.CrossRefGoogle Scholar
Ware, NC, Dickey, B, Tugenberg, T, McHorney, CA (2003). CONNECT: a measure of continuity of care in mental health services. Mental Health Services Research 5, 209–221.CrossRefGoogle ScholarPubMed