Care system conditions facilitating or hindering personal continuity of care for SMI patients: A comparison of five European systems

Nicaise, Pablo;et.al.
(2015) 11th International Conference of the European Network for Mental Health Service Evaluation (ENMESH) — Location: Malaga (1.October.2015)

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Background/Objectives: In European mental health care systems, there is a debate to decide how to address continuity of care for SMI patients, in particular regarding the transition between in- and outpatient care. COFI is a large European research project aiming to address the effects of integrated personal care continuity, i.e. patients being followed up by one same clinician during and after a hospital stay, against functional continuity, i.e. different clinicians providing care after hospital discharge. Integrated and functional continuity coexist in five systems: Belgium, Germany, Italy, Poland, and England. The aim of this part of the study is to describe how personal continuity is organised in these five systems and analyse the effects of health care systems on care continuity interventions. Methods: The analysis study was based on two data sources: literature and scientific reports on the organisation of the five care systems, and clinical vignettes describing scenarios of how transitional care is organised in practice. The key organisational elements emerging from a content analysis of the data were validated by local experts of the care systems. Finally, a qualitative comparative matrix was produced. Results: The five care systems are very different in terms of financing and insurance coverage arrangements, care provision, and governance mechanisms. Whilst some systems are based on a public sector care provision, others are regulated markets. This engenders a diversity of situations leading to the provision of integrated personal continuity of care. One key element is whether integrated personal continuity of care is determined by the patient/clinician’s choice or by organisational mechanisms. Differences in organisational features could affect outcomes of integrated and functional care continuity, either at the level of patients or at the level of services. Discussion/Conclusion: On the one hand, these results are preparatory to the analysis of data on patients and services involved in functional or integrated care continuity provision in the five systems. In particular, they suggest that integrated and functional care continuity might result in different outcomes according to care system characteristics. On the other hand, they inform system managers and policy-makers about features that might facilitate the delivery of effective personal continuity of care.
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Nicaise, P., & et al. (2015). Care system conditions facilitating or hindering personal continuity of care for SMI patients: A comparison of five European systems. 11th International Conference of the European Network for Mental Health Service Evaluation (ENMESH), Malaga. https://hdl.handle.net/2078.5/189549