Healthcare system performance in continuity of care for patients with severe mental illness: a comparison of five European countries
(2019) 23rd World Congress of Social Psychiatry — Location: Bucharest (25.October.2019)
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- Abstract
- Introduction: Most healthcare systems struggle to provide continuity of care (CoC) for patients with severe mental illness. CoC refers to three dimensions of patients' contacts with the healthcare system within (cross-sectional) and across (longitudinal) care episodes, as well as therapeutic alliance (relational). Objectives: Within the European research "COFI", we reviewed how system features in two national health systems (NHS, England and Veneto, Italy) and two regulated-market systems (RMS, Germany and Belgium) and in one mixed model (Poland), were likely to affect CoC delivery and we empirically assessed system performance. From system features review, we hypothesised that NHS would be more effective than RMS. Methods: 6418 patients recruited from psychiatric hospitals were followed up one year after admission. We collected data on their use of services and contact with professionals and assessed care continuity using indicators on the gap between hospital discharge and outpatient care, access to services, number of contacts with care professionals, satisfaction with care continuity, and helping alliance. Multivariate regressions were used to control for patients' characteristics. Results: Important differences were found between healthcare systems. Globally, NHS countries had more effective longitudinal and cross-sectional CoC than RMS countries, though Germany had similar results to England, and Poland performed poorly despite its mixed model. Relational continuity seemed less affected by organisational mechanisms. Conclusions: This study provides straightforward empirical indicators for assessing healthcare system CoC performance. Despite systems' complexity, findings suggest that stronger regulation of care provision and financing at a local level should be considered for effective care continuity.
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Nicaise, P., & et al. (2019). Healthcare system performance in continuity of care for patients with severe mental illness: a comparison of five European countries. 23rd World Congress of Social Psychiatry, Bucharest. https://hdl.handle.net/2078.5/125508