Department of Psychiatry, University of Cambridge, Cambridge, UK.
J Eval Clin Pract. 2013 Apr;19(2):298-303. doi: 10.1111/j.1365-2753.2012.01822.x. Epub 2012 Feb 23.
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.
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.
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.
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.
鉴于即将实施的心理健康“按疗效付费”（PbR），越来越多的国民保健制度（NHS）信托基金正在重组其面向工作年龄成年人的社区服务，以创建护理途径。然而，心理健康护理途径模式的研究基础有限。我们的 NHS 基金会信托基金是英国最早引入社区精神病学护理途径的信托基金之一。我们进行了一项定性研究，以评估该模式在实践中的效果，包括其对患者护理质量、心理健康专业人员和初级保健的影响。
我们采访了医生、多学科工作人员和信托基金管理人员（共 19 人）。记录的访谈转录本被编码，并使用扎根理论方法进行主题分析。
总体而言，尽管存在一些初期问题，但在途径中工作通常被视为积极的变化。它导致提供更集中的干预措施，并要求从业人员遵守明确的护理标准。它更具成本效益，并允许进行积极的病例管理和明确的临床领导。它以康复为重点，鼓励社会包容。对于不同团队来说，任意的时间框架、严格的标准和阈值可能会产生问题。改善沟通、灵活和以患者为中心的方法、工作人员监督以及增加对初级保健的支持，被认为是该模式高效运作的核心要素。
引入护理途径是实现心理健康“按疗效付费”有效实施的重要步骤。我们的研究将为未来的护理途径研究提供信息，促进组织学习，并有助于提高服务的有效性。
