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A comparison of early psychosis treatment services using consensus and evidence-based performance measures: moving towards setting standards.

https://arctichealth.org/en/permalink/ahliterature147647
Source
Early Interv Psychiatry. 2009 Nov;3(4):274-81
Publication Type
Article
Date
Nov-2009
Author
Donald Addington
Ross Norman
Carol E Adair
Rahul Manchanda
Emily McKenzie
Beth Mitchell
Cathy Pryce
Author Affiliation
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. addingto@ucalgary.ca
Source
Early Interv Psychiatry. 2009 Nov;3(4):274-81
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Adult
Canada
Early Medical Intervention - standards
Feasibility Studies
Female
Humans
Male
Mental Health Services - statistics & numerical data
Outcome Assessment (Health Care) - standards - statistics & numerical data
Outcome and Process Assessment (Health Care) - methods - statistics & numerical data
Psychotic Disorders - therapy
Abstract
This study used data from two Canadian early psychosis programs to assess the feasibility of using common performance measures and to assess the extent to which each program meets suggested standards for early intervention.
Data were extracted from administrative databases and supplemented by health records for 332 individuals admitted to two services in order to calculate values for 19 performance indicators for January 2000 to January 2004. Inter-rater reliability was established for data abstraction.
The two samples had similar demographic and clinical profiles. There were no statistically significant differences in 1-, 2- and 3-year admission rates (year 1: 27% vs. 30%, P=0.625; year 2: 31% vs. 38%, P=0.248; year 3: 35% vs. 42%, P=0.260), duration of untreated psychosis (DUP) (24 vs. 28 weeks; P=0.844) and positive symptom remission at 1 year (72% vs. 78%; P=0.285). There were statistically significant differences between the two services in mean wait time (18 vs. 13 days; P=0.045), proportion of patients on second-generation anti-psychotics at 1 year (75% vs. 89%; P=0.002), and proportion of patients adherent to antipsychotic medication for a minimum of 12 months (76% vs. 83%; P=0.007).
The data provides useful information on the feasibility of implementing key performance measures across early psychosis programs to assess the extent to which they are meeting standards for such services.
PubMed ID
22642730 View in PubMed
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Distinctive trajectory groups of mental health functioning among assertive community treatment clients: an application of growth mixture modelling analysis.

https://arctichealth.org/en/permalink/ahliterature105711
Source
Can J Psychiatry. 2013 Dec;58(12):670-8
Publication Type
Article
Date
Dec-2013
Author
Piotr Wilk
Evelyn Vingilis
Joan E H Bishop
Wenqing He
John Braun
Cheryl Forchuk
Jane Seeley
Beth Mitchell
Author Affiliation
Assistant Professor, Departments of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario; Scientist, Children's Health Research Institute, London, Ontario.
Source
Can J Psychiatry. 2013 Dec;58(12):670-8
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Adult
Bipolar Disorder - therapy
Community Mental Health Services - methods
Disease Progression
Female
Humans
Longitudinal Studies
Male
Middle Aged
Models, Statistical
Ontario
Prospective Studies
Psychotic Disorders - therapy
Schizophrenia - therapy
Treatment Outcome
Abstract
Assertive community treatment (ACT) studies that have used conventional, statistical growth modelling methods have not examined different trajectories of outcomes or covariates that could influence different trajectories, even though heterogeneity in outcomes has been established in other research on severe mental illness. The purpose of our study was to examine the general trend in mental health functioning of ACT clients over a 2-year follow-up time period, to discover groups of ACT clients with distinctive longitudinal trajectories of mental health functioning, and to examine if some of the key sociodemographic and illness-related factors influence group membership.
A 2-year, prospective, within-subjects study of 216 ACT clients within southern Ontario, collected functional outcome data at baseline and 12 and 24 months using the Colorado Client Assessment Record. Baseline covariates included sex, primary diagnosis, number of comorbidities, hospitalization history, and duration of illness. Growth mixture modelling (GMM) was used to examine trajectories.
Clinical staff assessments of ACT clients showed a statistically significant improvement in functioning and 84% achieved successful community tenure. GMM analysis identified 2 classes of ACT clients: class 1 (79.63% of clients) experienced lower and stable overall functioning, and class 2 (20.37%) showed a better baseline functioning score and improvement in the overall functioning over time. Class membership was predicted by the number of comorbidities and diagnosis.
Our study suggests general stability in overall functioning for the sampled ACT clients over 2 years, but significant heterogeneity in trajectories of functioning.
PubMed ID
24331286 View in PubMed
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Integrating knowledge generation with knowledge diffusion and utilization: a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health.

https://arctichealth.org/en/permalink/ahliterature182200
Source
Can J Public Health. 2003 Nov-Dec;94(6):468-71
Publication Type
Article
Author
Evelyn Vingilis
Kathleen Hartford
Ted Schrecker
Beth Mitchell
Barbara Lent
Joan Bishop
Author Affiliation
Population & Community Health Unit, Family Medicine, The University of Western Ontario, 100 Collip Circle, Suite 245, London, ON. evingili@uwo.ca
Source
Can J Public Health. 2003 Nov-Dec;94(6):468-71
Language
English
Publication Type
Article
Keywords
Humans
Mental Health Services - utilization
Ontario
Research Design
Abstract
Knowledge diffusion and utilization (KDU) have become a key focus in the health research community because of the limited success to date of research findings to inform health policies, programs and services. Yet, evidence indicates that successful KDU is often predicated on the early involvement of potential knowledge users in the conceptualization and conduct of the research and on the development of a "partnership culture". This study describes the integration of KDU theory with practice via a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health (CAREMH).
This qualitative study, using a single-case design, included a number of data sources: proposals, meeting minutes, presentations, publications, reports and curricula vitae of CAREMH members.
CAREMH has adopted the following operational strategies to increase KDU capacity: 1) viewing research as a means and not as an end; 2) bringing the university and researcher to the community; 3) using participatory research methods; 4) embracing transdisciplinary research and interactions; and 5) using connectors. Examples of the iterative process between researchers and potential knowledge users in their contribution to knowledge generation, diffusion and utilization are provided.
This case study supports the importance of early and ongoing involvement of relevant potential knowledge users in research to enhance its utilization potential. It also highlights the need for re-thinking research funding approaches.
PubMed ID
14700249 View in PubMed
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Process and outcome evaluation of an emergency department intervention for persons with mental health concerns using a population health approach.

https://arctichealth.org/en/permalink/ahliterature167158
Source
Adm Policy Ment Health. 2007 Mar;34(2):160-71
Publication Type
Article
Date
Mar-2007
Author
Evelyn Vingilis
Kathleen Hartford
Kristine Diaz
Beth Mitchell
Raj Velamoor
Marnie Wedlake
Dawn White
Author Affiliation
Department of Family Medicine, The University of Western Ontario, London, ON, Canada N6A 5C1. evingili@uwo.ca
Source
Adm Policy Ment Health. 2007 Mar;34(2):160-71
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Counseling
Data Collection
Emergency Services, Psychiatric
Female
Focus Groups
Humans
Male
Mental disorders
Middle Aged
Ontario
Triage
Abstract
To evaluate an emergency department's use of a mental health triage and mental health crisis counsellor for persons presenting with mental health concerns.
Mixed method (qualitative and quantitative), multiple measures.
Significant pre- and post-intervention reductions for wait time, security incidents and hospital admissions were found. Follow ups with a community agency, medications and a psychiatrist increased post-intervention, while follow ups with detox decreased post-intervention.
The qualitative and quantitative findings are congruent with other studies supporting the use of properly implemented mental health triage and crisis counsellors to improve the care of persons with mental health concerns.
PubMed ID
17024576 View in PubMed
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