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Biomedical subjects

M Fiander

Publications and source records attributed to M Fiander.

10 recordsLinked to original sources
PubMed2003

Does extra staff change clinical practice? A prospective study of the impact of extra resources in mental health teams.

OBJECTIVE: To compare patterns of clinical activity amongst existing staff in two inner-city community mental health teams before and after their enhancement with extra resources using a new activity schedule containing 11 comprehensive and mutually exclusive practice categories. METHOD: Patterns of clinical activity amongst existing members of two inner-London community mental health teams were compared before and after the addition of extra resources. RESULTS: The amount of time spent in face-to-face contact with patients and carers showed no meaningful change following team enhancement. Patterns of clinical activity amongst team members remained relatively static. CONCLUSION: Adding resources to community mental teams without considering how to target the time released amongst existing staff may reduce their capacity to work more innovatively.

Adolescent↗
PubMed2001

Factors that influence the cost of caring for patients with severe psychotic illness: report from the UK 700 trial.

BACKGROUND: Many factors influence the type and quantity of services received by patients and, thus, the total cost of care. Knowledge of these factors can aid budgetary and service-planning decisions. AIMS: To investigate factors that influence the cost of caring for patients with severe psychotic illness. METHOD: Univariate and multivariate analyses were used to examine associations between baseline characteristics and subsequent 2-year total direct costs in 667 patients from the UK 700 case management trial. RESULTS: Significantly more money was spent on younger patients, those with longer duration of illness, those who had spent less time living independently and those who had spent longer in hospital for psychiatric reasons. CONCLUSIONS: Total costs of caring for patients with severe psychotic illness appear to be influenced to a large extent by age, duration of illness and past levels of dependence on statutory services. The strength of these relationships is greater than the impact of illness severity.

Adolescent↗
PubMed2000

Effects of case-load size on the process of care of patients with severe psychotic illness. Report from the UK700 trial.

BACKGROUND: Studies of intensive case management (ICM) for patients with psychotic illnesses have produced conflicting results in terms of outcome. Negative results have sometimes been attributed to a failure to deliver differing patterns of care. AIMS: To test whether the actual care delivered in a randomised clinical trial of ICM v. standard case management (the UK700 trial) differed significantly. METHOD: Data on 545 patients' care were collected over 2 years. All patient contacts and all other patient-centred interventions (e.g. telephone calls, carer contacts) of over 15 minutes were prospectively recorded. Rates and distributions of these interventions were compared. RESULTS: Contact frequency was more than doubled in the ICM group. There were proportionately more failed contacts and carer contacts but there was no difference in the average length of individual contacts or the proportion of contacts in the patients' homes. CONCLUSIONS: The failure to demonstrate outcome differences in the UK700 study is not due to a failure to vary the treatment process. UK standard care contains many of the characteristics of assertive outreach services and differences in outcome may require that greater attention be paid to delivering evidence-based interventions.

Activities of Daily Living↗
PubMed2000

A Delphi approach to describing service models of community mental health practice.

OBJECTIVE: The activities of mental health practitioners are poorly understood and described because of a lack of generally accepted and understandable categories. Greater precision is needed for accountability, planning, and evaluation. The objective of this study was to identify a valid and reliable set of categories to describe the clinical work practices of intensive case managers in the United Kingdom. METHODS: Eight intensive case managers participated in a Delphi process to produce a set of categories that described their clinical work practices. They each completed three questionnaires and participated in a final group discussion. RESULTS: The initial open questionnaire generated 38 potential categories after exact duplicates were removed. In round 2, the intensive case managers each rated the 38 categories from 1 to 5 (essential to unimportant). A high degree of consensus on the relative importance of the 38 suggested practice categories was rapidly achieved. In round 3, they re-rated the categories in the light of group medians and their own round 2 ratings. In a structured face-to-face discussion group, the intensive case managers then reduced the 38 potential categories to ten comprehensive and mutually exclusive categories that were judged to adequately and accurately reflect work practices. They were housing, finance, daily living skills, criminal justice system, occupation and leisure, engagement, physical health, caregivers and significant others, specific mental health intervention or assessment, and medication. CONCLUSIONS: Delphi methods were effective and relatively straightforward in producing an agreed-on set of categories with which to record clinical activity and inform care planning.

Case Management↗
PubMed2000

A delphi approach to characterising "relapse" as used in UK clinical practice.

BACKGROUND: 'Relapse' is a common outcome indicator in intervention studies in schizophrenia. In community studies it is frequently equated with hospitalisation and in psychopharmacological studies with predetermined symptom scores. Its clinical meaning, however, remains undefined. METHOD: Consensus on the defining features of 'relapse' in schizophrenia used by academic and clinical schizophrenia experts in the UK, was investigated using a four stage Delphi process. A two panel, four stage, Delphi based methodology was used to investigate the implicit meanings of 'relapse' in clinical practice. A multidisciplinary panel of twelve members each listed anonymously ten indicators of relapse. A second panel, of ten experienced psychiatrists, rated the 188 submitted indicators from essential-unimportant (1-5). This panel completed a one day workshop during the remaining Delphi rounds ending with a structured discussion of the results. RESULTS: Very strong consensus was achieved on the relative importance of potential relapse indicators. There was complete agreement about some aspects of a definition of relapse (such as recurrence of positive symptoms) and a number of the complex issues underlying the concept were clearly articulated. CONCLUSIONS: This four stage Delphi process achieved consensus on core features of relapse. The elucidation of the "softer" features at the threshold between normal fluctuations in functioning and the start of relapse require continuing investigations.

Delphi Technique↗
PubMed1998

Essential components of schizophrenia care: a Delphi approach.

Other than medication and access to in-patient care, there is little published consensus on the essential components of schizophrenia care. This paper reports a Delphi approach to the identification of these components. This approach identifies and measures the degree of consensus, using a structured iterative series of questionnaires by a group of experienced UK and Irish psychiatrists (n = 15) on the essential components. Pharmacotherapy, in-patient care and community mental health team (CMHT) staffing were explicitly excluded from the study. In total, 106 components were identified and their importance was rated twice. There was consensus on 92% of the components and strong consensus on 64%. The Delphi results were refined by the participants to produce 10 essential components of care.

Delphi Technique↗
PubMedDate not supplied

Missed 'psychiatric' cases? The effectiveness of a Court Diversion Scheme.

Court Diversion Schemes have been evaluated in terms of clinical outcome or case disposal in studies focusing on individuals who are referred to the scheme. Little is known about the 'psychiatric caseness' of court defendants not referred. The present study was undertaken with the aims of identifying levels of 'missed caseness' in an 'in-custody' population at a busy London Magistrates court and to consider how such populations might be more effectively screened. A random sample of individuals in custody was selected and semi-structured interviews conducted (n = 100). Very high levels of alcohol abuse, illicit drug misuse and histories of deliberate self-harm were found. Such individuals were very unlikely to be referred to the duty psychiatrist scheme. These findings highlight the difficulties in screening for alcohol abuse, illicit drug misuse and histories of deliberate self-harm in an in-custody court population. The context in which screening takes place is discussed. Realistic and inexpensive improvements are suggested for identifying those at greatest risk.

Adolescent↗