Barriers and success factors in clinical pathways: transition process between psychiatric inpatient care and community care

Abstract

Rationale, aims and objectives: This study examines the scope and limitations of clinical pathways to monitor patient-care management of a selected patient group during a specified time period. We aimed to identify (a) the factors that may obstruct the intended clinical care plan as devised by psychiatric hospital centres for implementation by community services and (b) the strategies which support the effective delivery of high quality care. Method: A qualitative design incorporating a descriptive approach was chosen. Seven focus groups with a total of 18 informants were convened. Data were analysed to identify condensed meaningful units, categories (sub-theme) and themes. Results: Three main themes emerged; Coordination, Clinical Care and Ethics. The main barriers were communication errors, lack of adherence to treatment due to disagreement on treatment and lack of competence. The main success factors were adequate direct communication and proper documentation systems between health personnel, patient participation in future plans and working hours of ambulant teams. Conclusions: This study suggests that clinical pathways are useful for securing key objectives at the interface between hospital and community-based psychiatric care. Improved information sharing in/between all care systems is imperative in order to strengthen patients’ participation in decision-making, ownership of the care plan and improve adherence to treatment.