Multidisciplinary Outreach Teams Research Articles

Hepatitis B virus (HBV) screening, linkage and retention-in-care in inclusion health populations: Evaluation of an outreach screening programme in London

We evaluated a hepatitis B virus (HBV) screening programme, delivered by a specialist pan-London multidisciplinary outreach team, to understand population characteristics and care cascade among people who experience extreme social exclusion (Inclusion Health (IH) groups). Point-of-care HBV screening was performed in temporary accommodation for people experiencing homelessness (PEH) and people seeking asylum (initial accommodation centres, IACs) via a mobile unit staffed by peers with lived experience, nurses, and doctors. We analysed demographics and HBV characteristics of adults screened between May 2020 and January 2022. We ascertained linkage-to-care (LTC), retention-in-care (RIC) and loss-to-follow-up (LTFU). People LTFU were contacted by peers to re-engage in care. 2473 people were screened: 809 in IACs, 1664 in other temporary accommodation. Overall hepatitis B surface antigen (HBsAg) prevalence was 1.7% (43/2473), highest in IACs (3.5%, 28/809). LTC within 3 months was 56% (24/43) and RIC, 87% (26/30). LTC was higher when referred to a local IH-specialist hepatitis service, compared to other services (77%, 17/22 vs 33%, 7/21; p=0.006). LTFU was 30% (13/43), reduced to 21% (9/43) after intervention by peers. Our findings support outreach screening among IH populations and peer-supported linkage to IH-specialist hepatitis services. We recommend increased HBV testing and HBV-specific IH specialist services.

P208: The activities of Initial- phase Intensive Support Team for Dementia (IPIST) in Japan

Objective:The Intensive Initial Support Team for Dementia (IPIST) is a multidisciplinary outreach team that provides intensive initial assessment and support for dementia in Japan, introduced based on the Memory Service in the UK. All municipalities are required to establish at least one team, which consists of at least one physician and two professional staffs such as public health nurses and care workers. IPIST usually complete the work within approximately six months, including consultation with medical specialists and introduction of public supports. IPIST sometimes faces “complex case” that is difficult to manage. Because complex cases often have psychiatric problems, accessibility to psychiatric resources is important for IPIST. This study investigated the percentage of psychiatric professionals among IPIST members and the characteristics of complex cases they face.Methods:Through all 1741 municipalities in Japan, a questionnaire was distributed to each IPIST regarding the complex cases they experienced during April-September 2020. The questionnaire asked for the characteristics of each IPIST (e.g., specialty of the team physician, availability of staff with psychiatric expertise, etc.) and which of the 12 categories each complex case fit into, allowing multiple choice.Results:We could collect responses from 1291 IPISTs. 43.3% of IPISTs had a psychiatrist, 43.1% had an internal medicine physician, 13.4% had a neurologist, and 17.0% had some other physician as their team physician. In addition, 59.4% of the teams had medical staff members with psychiatric experience, including psychiatrists. A total of 7340 cases were reported as complex cases. While the most common category for difficulties in case management was “refusal of services” (19.5%), factors requiring psychiatric intervention such as “behavioral and psychological symptoms of dementia” (16.0%), “co-occurring mental illness” (7.3%), “complaints from neighbors” (7.1%), and “trash-house” (4.3%) were also frequently observed.Conclusion:The survey revealed that many IPISTs already had psychiatrists and other professionals with clinical psychiatric experience, and that they managed a lot of complex cases with issues that would be the target of psychiatric intervention. We believe early psychiatric engagement is important in many complex cases in outreach support for community residents with suspected dementia.

Cardiovascular disease screening in homeless individuals-a feasibility study

Abstract Background The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals, yet population-level CVD screening largely excludes homeless individuals. Purpose (i)To investigate feasibility of dedicated mobile CVD screening for homeless individuals; and (ii)To estimate prevalence of risk factors and burden of CVD Methods With patients, health professionals and researchers, we co-developed and implemented a 15-minute CVD assessment for homeless individuals as an add-on service to the Find&Treat service (a peer-led, multi-disciplinary outreach team across London) during scheduled, routine visits to homeless hostels. We included a questionnaire (demographic, past medical history and symptom data) as well as clinical assessment (blood pressure, ABPI, cholesterol, HDL, HDL ratio, glucose, HbA1c and mobile ECG to detect atrial fibrillation, AF). Results Among 656 individuals screened in 75 routine visits between May 2019 and January 2023, we recruited 524 (79.9%) individuals. Mean age was 47 (SD 13.1) years (range 18-87). Male gender (79%) and white ethnicity (55%) were more common. Current or previous smoking (79%), previous CVD (stroke, myocardial infarction, or peripheral arterial disease) (15%) and family history of heart attack in a 1st degree relative<60 years (27%) were common. Although only 2% reported previously diagnosed hypercholesterolaemia, 24% of screened individuals had total cholesterol>5.0 mmol/L. Prevalence of AF was high, particularly among those aged 18-30 (7/57, 12.3%). Asian and British Asian individuals had highest prevalence of raised HbA1C levels (>6%) (8/33, 24.2%), compared to black and black British (22/120, 18.3%) and white (15/283, 5.3%) individuals. Among individuals aged 25 – 84 with no previous CVD, one third had a 10-year QRISK score of ≥10% (120/362, 33.1%), consistent across different ethnic groups: white (75/233, 32.2%), black (24/77, 31.2%) and Asian (6/17, 35.3%). Conclusions A simple, pragmatic CVD assessment for homeless individuals was feasible and acceptable, and identified gaps in diagnosis and prevention. There is a high burden of CVD risk factors and CVD amongst homeless individuals, which could be addressed by integration of CVD screening into existing inclusion health outreach frameworks.

Factors Influencing Subjective QOL Among Community-Dwelling People with SMI Receiving Home-Visit Occupational Therapy

IntroductionImproving the subjective quality of life (QOL) of people with severemental illness (SMI) is the main objective of psychiatric occupational therapy (OT). For people with SMI to perform desired daily activities, a newly designed home-visit OT has been implemented in Japan. This study aimed to investigate the predictors of subjective QOL in people with SMI receiving home-visit OT.MethodTwenty-five people with SMI (average age: 46.7 years) were recruited from 20 multidisciplinary outreach teams in Japan. They were diagnosed with either F2 (i.e., schizophrenia, schizotypal and delusional disorders) or F3 (i.e., mood [affective] disorders) using ICD-10. To create a predictive model of subjective QOL, we performed a stepwise multiple regression analysis using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) total score as a response variable. The following independent variables were analyzed: demographic and clinical data, subjective evaluation of the scores of performance of and satisfaction with daily activity rated on a 10-point Likert scale, the Social Functioning Scale (SFS) total and subscale scores, and the Global Assessment of Functioning (GAF) Scale score.ResultsPredictors of subjective QOL were satisfaction in daily activity (adjusted β = 0.584) and social engagement of the SFS subscale (adjusted β = 0.405). The contribution rate of the model was 53.4%.ConclusionSatisfaction in daily activity and social engagement may contribute to individuals’ subjective QOL. To improve the subjective QOL of people with SMI, their satisfaction with daily activity and social participation should be promoted through meaningful daily activities.

A scoping review of community-based post-opioid overdose intervention programs: implications of program structure and outcomes

BackgroundAn emergent intervention to address the opioid epidemic is the use of multidisciplinary outreach teams which connect an individual in the community to healthcare resources after the experience of an opioid overdose. While these interventions are receiving federal funding, less is known empirically to inform future interventions. Understanding the process and outcomes of these interventions is advisable due to the novel partnerships of public health and law enforcement agencies who sometimes hold divergent goals. The objective of the present review was to describe program structure and evaluated outcomes of community-based post-overdose interventions.ResultsA search of PubMed, PsycInfo, and Web of Science yielded 5 peer-reviewed articles that detail the implementation and outcomes of interventions delivered in the United States published from 2001 to July 2021. Most interventions used a multidisciplinary outreach team and referenced first responder data to contact individuals who recently experienced an overdose at their residence. Services offered often included referral to substance use treatment, recovery coaches, and social services. Method of outreach, evaluation measures, and outcomes varied. From the available literature, facilitators of program engagement included communication, information sharing, and leadership buy-in among multidisciplinary partners.ConclusionsFuture studies could benefit from exploration of service provision in rural areas, for family affected by overdose, and for minoritized populations. Community-based post-overdose interventions utilizing a law enforcement partnership are emergent with promising yet limited examples in empirical literature.

77 EXPERIENCES OF OLDER PEOPLE AND CARERS REFERRED TO AMBULATORY OUTREACH TEAM WITHIN INTEGRATED CARE PROGRAMME FOR OLDER PERSONS (ICPOP) SERVICE

Abstract Background Ambulatory outreach services are part of new pathways to reduce reliance on secondary care as outlined in the Integrated Care Programme for Older Persons. Multidisciplinary outreach teams provide urgent medical and rehabilitation services in the person’s home to stabilise a health crisis. Methods The study aimed to explore the experiences of older people accessing a ambulatory outreach service and identify development opportunities. Interpretive description, an inductive analytic approach, was used to seek an understanding of clinical phenomena that illuminate their characteristics, patterns and structure. Data collection used qualitative telephone interviews. A purposeful sample of older people and carers were recruited following discharge from the outreach service over a three-month period. Results Sixteen participants (patients n=9 and carers n=7) were interviewed, 77% were female with a mean age of 83 years. Three major themes and seven sub-themes were identified: Theme 1: Gratitude for specialised care: a) Moment of crisis “It was absolutely brilliant”; b) Care in my home: physical and psychological benefits Theme 2: Living with and managing complexity: c) Resilience and resignation: living in the moment “Well she’s doing good at the moment, God forbids if there is more injuries”, d) Work of patients: maintain motivation & control; task and service boundaries e) Work of Families “We’re doing it so far”. Theme 3:Scope for pro-active planning & Integration: f) What happens next? an unpredictable future; h) Integration with GP & community, g) Unspoken plan- sub-conscious advanced care planning “Nobody makes the decision on their own they call someone else” Conclusion The Outreach Team was highly valued by participants and was seen as vital in regaining functional capability and confidence to cope. Future developments need to examine task and service boundaries that undermine resilience, post outreach follow-up, integration with primary care, and opportunities for advanced care conversations.

Routine critical care step-down programmes: Systematic review and meta-analysis.

Patients discharged from critical care to general hospital wards are vulnerable to clinical deterioration, critical care readmission, and death. In response, routine critical care stepdown programmes (CCSDPs) have been widely developed, which involve the review of all patients on general wards following discharge from critical care by multidisciplinary Outreach teams with critical care skills. This review aims to answer the question: do routine CCSDPs reduce readmission and/or mortality among patients discharged from critical care? Systematic review of quantitative studies and meta-analysis. Six databases were comprehensively searched from inception (CENTRAL, Cochrane Reviews, MEDLINE, Embase, CINAHL and web of Science), alongside grey literature and trial registers. Studies investigating the effect of routine CCSDPs delivered by Outreach nurses on readmission and/or mortality following discharge from adult critical care to general hospital wards were included. Study quality was assessed using the Cochrane ROBINS-I tool. Eight studies met the inclusion criteria, with data from 6 studies pooled in 3 meta-analyses. Among patients exposed to routine CCSDPs, pooled data estimated a statistically nonsignificant reduction in the risk of readmission to critical care (risk ratio [RR] 0.85; 95% confidence interval [CI] 0.66-1.09; P = .19), a statistically significant increase in the risk of readmission to critical care within 72 hours (RR 1.49; 95% CI 1.05-2.12; P = .03), a statistically non-significant reduction in risk of mortality following critical care discharge (RR 0.90; 95% CI 0.75-1.07; P = .22), and no association with mortality within 14 days of discharge. This review is unable to definitively conclude whether routine CCSDPs reduce critical care readmission or mortality following critical care discharge. While the synthesized evidence does not suggest a change in policy and practice are warranted, neither does it support routine CCSDPs in the absence of high-quality evidence.

Comparison of hospital admission rates for psychiatric patients cared for by multidisciplinary outreach teams with and without peer specialist: a retrospective cohort study of Japanese Outreach Model Project 2011–2014

ObjectiveThis study examined whether having peer specialists (PS) in psychiatric multidisciplinary outreach teams was associated with a lower risk of hospitalisation, improved social functioning and decreased problem behaviours.Design and settingThis...

Huntington's Disease Outpatient Clinic forFunctional Diagnosis and Treatment: Coming to Consensus: How Long Term Care Facility Procedures Complement Specialist Diagnosis and Treatment.

Huntington’s disease (HD) patients and families deserve expert treatment and care throughout their lives, but uniformity in functional diagnosis and treatment was lacking. In the aim of reaching this uniformity on day-to-day treatment and care offered by multidisciplinary outreach teams from Dutch long term care facilities for ambulatory HD patients, a consensus trajectory was started to harmonise our care programme with international standards and within the country. The consensus statements, given as supplementary material, should lead to expert treatment and care for HD families throughout the Netherlands and this manuscript should contribute and revitalise a global discussion on standards of treatment and care.

Consumer providers' experiences of recovery and concerns as members of a psychiatric multidisciplinary outreach team: A qualitative descriptive study from the Japan Outreach Model Project 2011-2014.

ObjectiveThe objective of this study was to clarify consumer providers (CPs) subjective experiences as members of a psychiatric multidisciplinary outreach team that provided services to individuals with a mental illness living in the community.MethodsA qualitative descriptive study was conducted through semi-structured interviews. Participants were clients hired as CPs in the Japanese Outreach Model Project from September 2011 until March 2014. Of the seventeen CPs, nine participated in this study. We looked at the CPs' subjective experiences of fulfillment and difficulty.ResultsIn the process of providing services, CPs experienced both achievements and concerns. They had a sense of achievement by caring for their clients and they experienced that they themselves were recovering. They were also concerned about having inadequate knowledge and skills to provide psychiatric services to their clients. Further, there were concerns about their dual role on the multidisciplinary team and being support staff while they were still using mental health services themselves.ConclusionThe results show that the activities of CPs included fulfillment, recovery, and dilemmas. Clarifications will likely contribute to an increase in understanding and cooperation between CPs and other professionals with whom they work. Further studies are needed to investigate policies related to mental health consumers who are also providers of mental health services.

Housing outcomes and predictors of success: the role of hospitalization in street outreach.

What is known on the subject? Outreach services are often successful in engaging and housing street homeless individuals. People experiencing homelessness have greatly increased rates of mental illness and substance abuse. What this paper adds to existing knowledge? Given the relative lack of research involving street homeless individuals, this retrospective chart review examined factors associated with successful housing by a multidisciplinary street outreach team, including the use of hospitalization as an intervention within a housing first framework. The majority of clients were successfully housed by the end of outreach team involvement. An admission to hospital was strongly associated with successful housing for those with a psychotic disorder. What are the implications for practice? Multidisciplinary outreach teams, specifically those with psychiatric and nursing support, successfully work with and house people experiencing street homelessness and psychosis. Mental health nurses embedded in the community are an essential link between inpatient and outpatient care for highly vulnerable street homeless individuals. Introduction Housing-first strategies have helped establish housing as a human right. However, endemic homelessness persists. Multidisciplinary outreach teams that include nursing, social and psychiatric services allow for integrative strategies to engage and support clients on their housing trajectory. The following retrospective review focused on the identification of demographic, clinical, and service characteristics that predicted the obtainment of housing, and explored the role of psychiatric hospitalization as an intervention, not an outcome measure, in contrast to previous studies. These have rarely focused on street homelessness. A retrospective chart review of 85 homeless, primarily rough-sleeping, clients was conducted to determine housing outcomes and the factors associated with obtaining housing through care provided by a psychiatric street outreach team in Toronto, Canada. Demographics, homelessness duration, diagnosis, hospitalization and housing status were tracked during team involvement. Overall, 46% (36/79) were housed during the study term. Securing housing at the end of treatment/data collection was significantly enhanced by hospitalization (OR = 9.04, 95% CI [2.43, 33.59]). It was significantly diminished by psychosis (OR = 0.22, 95% CI [0.05, 0.95]) and prior homelessness >36 months (OR = 0.10, 95% CI [0.02, 0.50]). Twenty-three of 31 (74%) hospitalized clients with psychosis were subsequently housed, compared to 4 of 30 (13%) not hospitalized (Fisher's exact, P < .001). Multidisciplinary street outreach teams successfully house long-standing homeless clients (>12 months without a permanent address) with serious mental illness and/or substance abuse. Hospitalization can be utilized as a complimentary intervention, particularly for those with psychosis, in the continuum of housing first initiatives, and can contribute to securing housing for those with persistent psychotic disorders. Implications for nursing practice Community mental health nurses are uniquely positioned to translate care between hospital and community settings, ensuring timely assessment, intervention and treatment of clients who are historically difficult to engage.

Validation of the French translation of the Glasgow Outcome Scale–Extended, Pediatric version (GOS-E Peds): Clinical utility in assessing outcome in children and adolescents following acquired brain injury (ABI)

The GOS-E Pediatric version allows measuring overall outcome in children and adolescents following ABI. Scores range from 1: upper good recovery, to 7: vegetative state. To validate the French translation of the GOS-E Peds in children with (ABI) of various severity and stages post-injury. The GOS-E Peds was used in a PMR department devoted to children with ABI, in three groups of patients: (1) patients shortly hospitalised post-ABI: GOS-E Peds was rated upon admission, at 3 and 6 months post-injury; (2) patients several years post-injury, requiring services of a multi-disciplinary outreach team; (3) patients followed-up on simple medical clinics. The type and severity of ABI were collected. 398 patients were included [2/3 boys; mean age at injury 6 years (SD = 4)]. In group 1 ( n = 124), mean (SD) GOS-E Peds scores were 5.9(.77) upon admission, 5.12(1.2) at 3 months ( n = 99) and 4.88(1.45) at 6 months ( n = 83); scores were significantly worse in case of hemiplegia (66%). GOS-E Peds improved over time (0–3 months P < 0.0001; 3–6 months, P = 0.001). Although age at injury was not correlated with initial rating of GOS-E Peds ( r = –.18), younger age at injury was correlated to worse GOS-E Peds scores at 3 and 6 months ( r = –.3 and–.44; P < 0.001). In group 2, 101 patients were cross-sectionally assessed by the outreach team in April 2014 [mean age 14.8 (SD = 4) years]. Mean GOS-E Peds was 3.95 (SD = 1.4). Factors influencing GOS-E Peds were presence of cerebellar signs, younger age at injury ( r = –.29; P = 0.003) and lower intellectual ability ( r = –.27; P = 0.008). In group 3, 173 patients consecutively seen in clinics were assessed [mean age 10.4 years (SD = 4.5)]. Mean GOS-E Peds score was 3.3 (SD = 1.5). Presence of hemiplegia and cerebellar signs were significantly related to GOS-E Peds scores. Duration of coma, presence of diffuse brain injury and epilepsy negatively influenced GOS-E Peds scores in the three groups. The GOS-E Peds has good sensitivity to change, and higher levels when children need a multi-disciplinary outreach team in the long-term, than when they require simple clinic follow-up. Young age at injury, diffuse brain injury, epilepsy, motor impairments, and intellectual ability all significantly influence overall outcome.

Does deinstitutionalisation work? Relationships between psychiatric outpatient and inpatient care provision in a rural German catchment area

Objective: We intended to find out whether an intensification of outpatient care could have an influence on hospitalisations, readmissions, length of stay, coercive measures and involuntary admissions. Method: We investigated the development of some care variables within a district psychiatric hospital responsible for a rural catchment area of 320,000 inhabitants. Associations between inpatient care variables and outpatient activity were assessed by means of multivariate Prais-Winsten regression models for time series. Results: There was a dramatic reduction of mean LOS figures, associated with the activity level of the outpatient clinic. After the conclusion of the deinstitutionalisation process, total number of admissions, cumulative LOS, quotas of involuntary admissions and number of coercive measures did not increase when the number of beds and mean length of stay decreased. Readmissions decreased significantly when outpatient activity increased. Conclusions: Community-oriented ambulatory care on the basis of multi-disciplinary outreach teams seems to be able to reduce high-frequent readmissions and control mean LOS while at the same time a number of coercive measures keep the number of admissions stable. Economic and clinical effects on real inpatient care, however, cannot be definitively evaluated as long as bed provision does not decrease proportionally with the increase of ambulatory activity.