Issue
Journal of Evaluation in Clinical Practice
Volume 19, Issue 2, pages 298–303, April 2013
Additional Information(Show All)
Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/onlineopen#OnlineOpen_Terms
Evaluating care pathways for community psychiatry in England: a qualitative study
Article first published online: 23 FEB 2012
DOI: 10.1111/j.1365-2753.2012.01822.x
© 2012 Blackwell Publishing Ltd
Abstract
Objectives
In view of forthcoming ‘payment by results’ (PbR) for mental health,
increasing number of National Health Service (NHS) Trusts are
reorganizing their community services for working age adults to create
care pathways. However, research base for the care pathways model in
mental health is limited. Our NHS Foundation Trust was one of the first
to introduce care pathways for community psychiatry in the UK. We have
carried out a qualitative study to evaluate how this model works out in
practice, including its impact on quality of patient care, mental health
professionals and primary care.
Methods
We interviewed doctors, multidisciplinary staff and Trusts managers (19
in total). Transcripts of recorded interviews were coded and analysed
thematically using a grounded theory approach.
Results
Overall, despite teething problems, working in pathways was generally
seen as a positive change. It led to more focused interventions being
offered, and practitioners being held to account over clear standards of
care. It is more cost-effective and allows for active case management
and clear clinical leadership. It is recovery focused and encourages
social inclusion. The arbitrary time frame, strict criteria and
thresholds for different teams can create issues. Improved
communication, flexible and patient-centred approach, staff supervision,
and increasing support to primary care were felt to be central to this
model working efficiently and effectively.
Conclusions
Introduction of care pathways is an important step towards effective
implementation of PbR for mental health. Our study would inform future
research into care pathways, facilitate organizational learning and help
to improve effectiveness of services.
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