Integrated Package Of Care Research Articles

Schizophrenia--time to commit to policy change.

Care and outcomes for people with schizophrenia have improved in recent years, but further progress is needed to help more individuals achieve an independent and fulfilled life. This report sets out the current need, informs policy makers and all relevant stakeholders who influence care quality, and supports their commitment to creating a better future. The authors recommend the following policy actions, based on research evidence, stakeholder consultation, and examples of best practice worldwide. (1) Provide an evidence-based, integrated care package for people with schizophrenia that addresses their mental and physical health needs. (2) Provide support for people with schizophrenia to enter and to remain in their community, and develop mechanisms to help guide them through the complex benefit and employment systems. (3) Provide concrete support, information, and educational programs to families and carers on how to enhance care for an individual living with schizophrenia in a manner that entails minimal disruption to their lives. (4) All stakeholders, including organizations that support people living with schizophrenia, should be consulted to regularly revise, update, and improve policy on the management of schizophrenia. (5) Provide support, which is proportionate to the impact of the disease, for research and development of new treatments. (6) Establish adequately funded, ongoing, and regular awareness-raising campaigns that form an integral part of routine plans of action. Implementation of the above recommendations will require engagement by every stakeholder, but with commitment from all, change can be achieved.

EPA-0680 - Towards collaborative intervention that improves the lives of patients with schizophrenia: clinicians as drivers of policy change

An evidence-based, integrated care package that addresses mental and physical health needs would help to transform the lives of people with schizophrenia. It should be underpinned with a co-ordinated approach by healthcare professionals and supported by the national healthcare system and by educational and research facilities. Collaboration between relevant stakeholders at national and local level is required to achieve this. The UK Prescribing Observatory for Mental Health (POMH-UK), based at the Royal College of Psychiatrists within the College Centre for Quality Improvement, illustrates one such collaboration. POMH-UK facilitates national, audit-based, quality improvement programmes (QIPs) that address the use of medicines in psychiatric practice. Since POMH-UK began in 2005, it has initiated QIPs addressing several topics relevant to the treatment of schizophrenia, including the use of high-dose and combined antipsychotics in acute adult inpatient and forensic settings, screening for the metabolic side effects of antipsychotics, the quality of assessment of side effects in patients treated with depot/long-acting injection antipsychotics, and medicines reconciliation at the point of hospital admission. Positive change in prescribing practice in psychiatric services has been achieved for many of these QIPs, although progress is gradual and gains are generally modest. Key elements of the QIPs are feedback of benchmarked performance for local clinical reflection and customised change interventions informed by the national audit findings and parallel qualitative work. The benefits and drawbacks of such an approach will be discussed, in the context of schizophrenia, with a view to evolving a model that other countries might replicate.

Editorial: Dementia and delirium – the need to fix the system

Editorial: Dementia and delirium – the need to fix the system

The cost effectiveness of integrated care for people living with HIV including antiretroviral treatment in a primary health care centre in Bujumbura, Burundi

The incremental cost effectiveness of an integrated care package (i.e., medical care including antiretroviral therapy (ART) and other services such as psychological and social support) for people living with HIV/AIDS was calculated in a not-for-profit primary health care centre in Bujumbura run by Society of Women against AIDS-Burundi (SWAA-Burundi), an African non-governmental organisation (NGO). Results are expressed as cost-effectiveness ratio 2007, constant US$ per disability-adjusted life year (DALY) averted. Unit costs are estimated from the NGO's accounting data and activity reports, healthcare utilisation is estimated from the medical records of a cohort of 149 patients. Effectiveness is modelled on the survival of this cohort, using standard calculation methods. The incremental cost of integrated care for people living with HIV/AIDS in the Bujumbura health centre of SWAA-Burundi is 258 US$ per DALY averted. The package of care provided by SWAA-Burundi is therefore a very cost-effective intervention in comparison with other interventions against HIV/AIDS that include ART. It is however, less cost effective than other types of interventions against HIV/AIDS, such as preventive activities.