A multidisciplinary job retention vocational rehabilitation programme for patients with chronic rheumatic diseases: patients' and occupational physicians' satisfaction
Author: De Buck P D M, Breedvald J, van der Giesen F J and Vliet Vlieland T P M
Journal: Annals of the Rheumatic Diseases, 2004
Volume/pages: Vol 63, pp562-568
About the study
This Dutch study explored patients and health professionals' satisfaction with a vocational rehabilitation programme provided by a multidisciplinary team. The programme was aimed at patients who had a chronic rheumatic disease with arthritis in one or more joints or reactive arthritis, who had experienced challenges in maintaining their jobs. The team included a rheumatologist, a social worker, a physiotherapist, an occupational therapist and a psychologist.
Patients were asked to complete a single questionnaire, and 59 of 65 returned it (91%). Patients rated highly the interpersonal approach and the professional knowledge of the team, and 98% said they would recommend the programme. There was some dissatisfaction with the length of time they had to wait for their final report.
Key Messages for practiceA multidisciplinary approach to vocational rehabilitation can work well for highly motivated patients.
Stress in carers of individuals with dementia and Community Mental Health Teams: an uncontrolled evaluation study
Author: Hoskins S, Coleman M and McNeely D
Journal: Journal of Advanced Nursing, 2005
Volume/pages: Vol 50(3), pp325-333
About the study
This paper reports the findings of a study which explored the effectiveness of a multidisciplinary Community Mental Health Team (CMHT) in reducing stress in carers of older people with dementia. The study took place in a mental health trust in South Wales.
Structured interviews were undertaken using a tool called the Caregiver Strain Index (CSI) with 26 carers at three points in time: at initial assessment, after three months and after six months. There was no control group. Over the six month period there was a significant decrease in levels of reported stress. When this was explored for specific types of intervention, the difference was only significant for respite care (and not for other interventions such as home help or day care) "“ although no service was received in isolation.
Key Messages for practiceCarers whose relatives received services from a multidisciplinary team experienced reduced levels of stress over a six month period However, it is difficult to draw conclusions about the effect of a model of integrated care from an uncontrolled study: we cannot know whether the impact was related to the mixed nature of the team.
The feasibility and acceptability of a specialist health and social care team for the promotion of health and independence in 'at risk' older adults
Authors: Drennan V, Iliffe S, Haworth D, Tai S, Lenihan P and Deave T
Journal: Health and Social Care in the Community, 2005
Volume/pages: Vol 13(2), pp136-144
About the study
This London-based study describes the impact of a specialist health and social care team for promoting the health of older people perceived by their GPs as being 'at risk'. The team aimed to reduce isolation among older people, improve utilisation of mainstream services, and promote self help to improve quality of life. They proactively contacted 'at risk' people aged over 75 and offered them a joint health and social care assessment, followed by information giving, support, and short-term case management activities where needed.
Semi-structured interviews were undertaken with 13 older people, 6 GPs, 9 managers and all 6 team members. Senior managers and GPs were enthusiastic about joint working but had some concerns about maintaining confidentiality; reconciliation of different professional and organisational cultures was problematic. 13% of those offered the service declined it, and 71% of those assessed had no unmet need. Older people were very positive about the service, particularly where they had been helped to access other services: GPs felt that referrals to them by the team were appropriate and may have helped to prevent future crises.
Key Messages for practiceA joint health and social assessment was demonstrated to be both feasible and acceptable Enthusiasm is not enough: effective approaches to managing collaborative working between different professional groups must be considered and adopted.
Authors: Kodner D and Kyriacou C
Journal: International Journal of Integrated Care, 2000
Volume/pages: Vol 1, pp1-19
About the study
The paper reviews and compares two models of "œfully integrated" care targeted at frail older people in the US: the social health maintenance organisation (Social HMO) and the program of all-inclusive care for the elderly (PACE). Both models have existed for 20 years and are funded through Medicare. PACE provides integrated care through interdisciplinary teams based in adult day health centres. The Social HMO combines health and social care under a single care-managed delivery system in 4 US states, and depends upon less formal multidisciplinary communication and collaboration between health and social care providers.
The authors present a summary of the findings from multiple evaluations of the two models. The Social HMO: While true integration at the clinical level was not achieved, service users experienced good continuity of care. The model actually saw an increase in hospital and nursing home admissions. There were no overall cost savings. 80-95% of service users were satisfied with the programme regarding access and convenience, quality and competence of care, finances and benefits, interpersonal relations, and general satisfaction. PACE: This was an effective model of integration, with pooling of funds allowing for service flexibility. Hospital and nursing home admissions and lengths of stay were reduced, and overall costs were lower than standard services. Participants reported after 6 months a higher quality of life, better health, and greater confidence.
Key Messages for practiceDifferences in the way evaluations are reported can make it difficult to compare the effectiveness of different models of integration The development of fully integrated models of care is a feasible and effective way of improving the delivery of care and its outcomes for service users with complex conditions.
Author: Milette L, Hebert R and Veil A
Journal: Canadian Family Physician, 2005
Volume/pages: Vol 51, pp1104-1105
About the study
This is a Canadian study exploring the impact of Integrated Service Delivery (ISD) Networks from the perspective of family doctors. ISD Networks are networks of organisations aiming to ensure continuity for, and improve effectiveness of services to, a specific population, such as older people. The networks require family doctors to work closely with social workers and nurses in case management roles. The study used a self-completion questionnaire to examine doctors' perspectives before and 6 months after networks were established.
Both the before and after questionnaires were completed by 104 of a possible 267 family doctors across three Canadian municipalities. Before networks were established, 85.7% of doctors indicated that they would be interested in using case managers. After 6 months the results showed that there had been some problems; namely that doctors frequently forgot to use the case managers (69.1%), they were in the habit of using social workers instead (63.6%) and many did not know how to contact the case managers (59.4%).
Key Messages for practiceIt is important to ensure that staff are provided with the information they need to participate effectively in a model for integrated care such as an ISD network To help maintain enthusiasm, staff must be reminded of the advantages to themselves and their patients of taking part in such a network.
Levels of integration and specialisation within professional community teams for people with dementia
Author: Abendstern M, Reilly S, Hughes J, Venables D and Challis D Journal: International Journal of Geriatric Psychiatry, 2006 Volume/pages: Vol 21, pp77-85
Author: Wiglesworth A, Mosqueda L, Burnight K, Younglove T and Jeske D Journal: The Gerontologist, 2006 Volume/pages: Vol 46(2), pp277-283
For the sake of their health: older service users' requirements for social care to facilitate access to social networks following hospital discharge
Author: Mcleod E, Bywaters P, Tanner D, Hirsch M Journal: British Journal of Social Work, 2008 Volume/pages: Vol 38, pp73-90
Author: Clarkson P, Venables D, Hughes J, Burns A and Challis D Journal: Psychological Medicine, 2006 Volume/pages: Vol 36, pp1011-1021
A System of Integrated Care for Older Persons With Disabilities in Canada: Results from a Randomized Controlled Trial
Author: Beland F, Bergman H, Lebel P, Clarfield A M, Tousignant, Contandriopoulos A and Dallaire L Journal: Journal of Gerontology, 2006 Volume/pages: Vol 61A(4), pp367-373
The Effect of a Disease Management Intervention on Quality and Outcomes of Dementia Care: A randomized controlled trial
Author: Vickrey B G, Mittman B S, Connor K I, Pearson M L, Della Penna R D, Ganiats T G, De Monte Jr R W, Chodosh J, Cui X, Vassar S, Duan N and Lee M Journal: Annals of Internal Medicine, 2006 Volume/pages: Vol 145(10), pp713-726
Author: Loader B D, Hardey M, Keeble L Journal: International Journal of Social Welfare, 2008 Volume/pages: Vol 17, pp46-53
Efficacy of a geriatrics team intervention for residents in dementia-specific assisted living facilities: effect on unanticipated transition
Author: Bellantonia S, Kenny A M, Fortinsky R H, Kleppinger A, Robison J, Gruman C, Kulldorff M, Trella P M Journal: Journal of the American Geriatric Society (JAGS), 2008 Volume/pages: Vol 56, pp523-528
Buying Time I: a prospective, controlled trial of a joint health/social care residential rehabilitation unit for older people on discharge from hospital
Author: Trappes-Lomax T, Ellis A, Fox M, Taylor R, Power M, Stead J and Bainbridge I Journal: Health and Social Care in the Community, 2006 Volume/pages: Vol 14(1), pp49-62
Buying Time II: an economic evaluation of a joint NHS/Social Services residential unit for older people on discharge from hospital
Author: Ellis A, Trappes-Lomax T, Fox M, Taylor R, Power M, Stead J and Bainbridge I Journal: Health and Social Care in the Community, 2006 Volume/pages: Vol 14(2), pp95-106
Author: Counsell S R, Callahan C M, Clark D O, Tu W, Buttar A B, Stump T E, Ricketts G D Journal: JAMA, 2007 Volume/pages: Vol 298(22), pp2623-2633
Developing the NICE/SCIE guidelines for dementia care: the challenges of enhancing the evidence base for social and health care
Author: Gould N, Kendall T Journal: British Journal of Social Work, 2007 Volume/pages: Vol 37, pp475-490
Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon Memory Service Model
Author: Banerjee S, Willis R, Matthews D, Contell F, Chan J, Murray J Journal: International Journal of Geriatric Psychiatry, 2007 Volume/pages: Vol 22, pp782-788
An evaluation of a specialist multiagency home support service for older people with dementia using qualitative methods
Author: Rothera I, Jones R, Harwood R, Avery A J, Fisher K, James V, Shaw I, Waite J Journal: International Journal of Geriatric Psychiatry, 2008 Volume/pages: Vol 23, pp65-72
Author: The Audit Commission Journal: , 2002 Volume/pages: Available from the Audit Commission