Mental Health Sciences Unit, University College London, London, UK.
BMC Health Serv Res. 2012 Jun 8;12:145. doi: 10.1186/1472-6963-12-145.
Despite the importance of continuity of care [COC] in contemporary mental health service provision, COC lacks a clearly agreed definition. Furthermore, whilst there is broad agreement that definitions should include service users' experiences, little is known about this. This paper aims to explore a new construct of service user-defined COC and its relationship to a range of health and social outcomes.
In a cross sectional study design, 167 people who experience psychosis participated in structured interviews, including a service user-generated COC measure (CONTINU-UM) and health and social assessments. Constructs underlying CONTINU-UM were explored using factor analysis in order to understand service user-defined COC. The relationships between the total/factor CONTINU-UM scores and the health and social measures were then explored through linear regression and an examination of quartile results in order to assess whether service user-defined COC is related to outcome.
Service user-defined COC is underpinned by three sub-constructs: preconditions, staff-related continuity and care contacts, although internal consistency of some sub-scales was low. High COC as assessed via CONTINU-UM, including preconditions and staff-related COC, was related to having needs met and better therapeutic alliances. Preconditions for COC were additionally related to symptoms and quality of life. COC was unrelated to empowerment and care contacts unrelated to outcomes. Service users who had experienced a hospital admission experienced higher levels of COC. A minority of service users with the poorest continuity of care also had high BPRS scores and poor quality of life.
Service-user defined continuity of care is a measurable construct underpinned by three sub-constructs (preconditions, staff-related and care contacts). COC and its sub-constructs demonstrate a range of relationships with health and social measures. Clinicians have an important role to play in supporting service users to navigate the complexities of the mental health system. Having experienced a hospital admission does not necessarily disrupt the flow of care. Further research is needed to test whether increasing service user-defined COC can improve clinical outcomes. Using CONTINU-UM will allow researchers to assess service users' experiences of COC based on the elements that are important from their perspective.
尽管连续性护理（COC）在当代精神卫生服务提供中非常重要，但 COC 缺乏明确的定义。此外，尽管人们普遍认为定义应包括服务使用者的体验，但对此知之甚少。本文旨在探讨一种新的服务使用者定义的 COC 结构及其与一系列健康和社会结果的关系。
在一项横断面研究设计中，167 名经历过精神病的人参加了结构访谈，包括服务使用者生成的 COC 测量（CONTINU-UM）和健康和社会评估。使用因子分析来探索 CONTINU-UM 背后的结构，以了解服务使用者定义的 COC。然后通过线性回归和四分位数结果的检验，探讨总/因子 CONTINU-UM 评分与健康和社会测量之间的关系，以评估服务使用者定义的 COC 是否与结果相关。
服务使用者定义的 COC 由三个子结构支撑：前提条件、与工作人员相关的连续性和护理接触，尽管一些子量表的内部一致性较低。通过 CONTINU-UM 评估的高 COC，包括前提条件和与工作人员相关的 COC，与需求的满足和更好的治疗联盟有关。COC 的前提条件与症状和生活质量有关。COC 与赋权无关，护理接触与结果无关。经历过住院治疗的服务使用者经历了更高水平的 COC。少数经历过最糟糕连续性护理的服务使用者也有较高的 BPRS 评分和较差的生活质量。
服务使用者定义的连续性护理是一种可衡量的结构，由三个子结构（前提条件、与工作人员相关的和护理接触）支撑。COC 及其子结构与健康和社会测量结果之间存在一系列关系。临床医生在支持服务使用者应对精神卫生系统的复杂性方面发挥着重要作用。经历过住院治疗并不一定会中断护理流程。需要进一步研究以测试增加服务使用者定义的 COC 是否可以改善临床结果。使用 CONTINU-UM 将使研究人员能够根据服务使用者从自身角度认为重要的元素来评估他们对 COC 的体验。
