1 00:00:00,210 --> 00:00:03,810 Welcome to the Oxford Psychology Podcast series, brought you today by diammonium, 2 00:00:03,810 --> 00:00:08,400 an advanced training psychiatry or the Oxford Dictionary I'm speaking to, 3 00:00:08,400 --> 00:00:15,210 Stephen Purchases a digital student at the University Department of Psychiatry, currently working with the social psychiatry group. 4 00:00:15,210 --> 00:00:18,420 Welcome, Stephen. Thank you. Thanks for your time. 5 00:00:18,420 --> 00:00:27,450 I'm very interested to hear about your your work because you work in the social psychiatry group and you focus on continuity of care. 6 00:00:27,450 --> 00:00:36,420 That's right. It's continuity of care is a quite an interesting topic at the moment because, well, mental health services are changing so much. 7 00:00:36,420 --> 00:00:41,310 So maybe you could begin by just telling us a little bit about continuity of care. 8 00:00:41,310 --> 00:00:45,790 I think the interesting thing about the continuity of care is it's an intuitive concept. 9 00:00:45,790 --> 00:00:53,520 So you ask a clinician about it and you ask people when they turn, you ask a patient and they all seem to go, oh, I know what that is. 10 00:00:53,520 --> 00:01:00,010 You know, it's you know, how things are coherent that they feel to me, the patient says, and you know the clinicians as well. 11 00:01:00,010 --> 00:01:04,290 And that's how we look after the patient and the period of time. 12 00:01:04,290 --> 00:01:11,790 But I think the interesting thing in how academics is as a social construct that's constantly changing has changed over time. 13 00:01:11,790 --> 00:01:20,640 So in the early days, you could just say, what is the relationship between the patient and the physician over time? 14 00:01:20,640 --> 00:01:31,080 But because not only mental health services, but health care in general is has become so specialised, it's no longer such a simple relationship. 15 00:01:31,080 --> 00:01:38,730 So what you're saying is that continuity of care is the relationship built up over time between 16 00:01:38,730 --> 00:01:44,920 the patient and the physician or the nurse or or whatever health care professional that is? 17 00:01:44,920 --> 00:01:50,250 The continuity of care refers to actually having continued one particular professional. 18 00:01:50,250 --> 00:01:53,910 Is that is that what you mean? That's right. And that's one part of it. 19 00:01:53,910 --> 00:02:04,890 And I think now with modern day health care, that that expands to not only just the sort of longitudinal aspect, i.e. over time, 20 00:02:04,890 --> 00:02:14,430 but also how the different services that provide for a person's care interact with each other to make this experience coherent for the patient. 21 00:02:14,430 --> 00:02:18,720 So then the integration of care exactly is very similar to this moment in an integrated 22 00:02:18,720 --> 00:02:25,290 care integrated and continuity of care and integrating can work together in that sense. 23 00:02:25,290 --> 00:02:28,650 So we we're looking at continuity of care. 24 00:02:28,650 --> 00:02:33,570 Whether it was potentially stopping that. I mean, surely it's the idea, isn't it, 25 00:02:33,570 --> 00:02:40,230 that a patient gets into that doctor very well and that their care improves because of that relationship and the trust improves? 26 00:02:40,230 --> 00:02:52,890 Why hasn't everyone got good continuity of care? And I guess is this because this is a political one, but I'll try to stay out of the downsides, 27 00:02:52,890 --> 00:02:57,690 I guess, because people move through the system at various points in time. 28 00:02:57,690 --> 00:03:06,570 And so this is a challenge as we try and improve services and people move on. 29 00:03:06,570 --> 00:03:11,220 And I think all those impact on whether a person can have continued. 30 00:03:11,220 --> 00:03:13,290 So, for instance, in mental health, 31 00:03:13,290 --> 00:03:20,490 one of the big things that's happened in the last few years is that in patients and outpatient services have split. 32 00:03:20,490 --> 00:03:27,750 So you have a consultant who is purely inpatient and looks after the people in hospital wards. 33 00:03:27,750 --> 00:03:33,750 And then you have a consultant who sits on the community, looks after and the patient. 34 00:03:33,750 --> 00:03:37,400 And I guess the idea for the patient is split between these two sides. 35 00:03:37,400 --> 00:03:42,930 And the important thing for people who are invested in a patient's continuity of 36 00:03:42,930 --> 00:03:48,960 care is that that seems like an integrated process and that doesn't always happen. 37 00:03:48,960 --> 00:03:57,810 OK, so so actually, when we're trying to get the ward working really well by giving specialised and patient 38 00:03:57,810 --> 00:04:02,040 consultants and getting the community working well by getting a specialist community consultant, 39 00:04:02,040 --> 00:04:08,050 what you've actually done is disrupt continuity of care. And what do you what are your concerns about that? 40 00:04:08,050 --> 00:04:14,850 I mean, why is that a problem? I mean, maybe it's not the ideal, but what's your particular problem with that? 41 00:04:14,850 --> 00:04:19,350 Well, I think I think the most valuable contribution to this is actually coming from 42 00:04:19,350 --> 00:04:24,090 interviews with patients and also the qualitative aspects of what we've asked patients. 43 00:04:24,090 --> 00:04:36,120 And so the qualitative yeah, OK. And what they say a lot is that it's this idea of having to retell the story consistently to to new people. 44 00:04:36,120 --> 00:04:41,460 And a lot of patients are quite kickout lives. 45 00:04:41,460 --> 00:04:51,300 And this is an added stressor to them. And they feel like to a certain extent, no one really knows that story or follows them. 46 00:04:51,300 --> 00:05:00,110 I can understand, you know, not only the symptomology, but things that impact on their quality of life and their function. 47 00:05:00,110 --> 00:05:04,250 And talks about getting to know the patient's story, 48 00:05:04,250 --> 00:05:11,540 getting to know the narrative and the nature of their condition rather than just necessarily the symptoms you're seeing in front of you. 49 00:05:11,540 --> 00:05:20,270 Exactly. And that sounds quite unscientific. But in actual fact, you know, psychiatry is a very profession, is a very personal profession. 50 00:05:20,270 --> 00:05:29,780 And so this sort of story, the nature of this person's illness, isn't just a tick box. 51 00:05:29,780 --> 00:05:36,860 Let's move on to your work now. In your defo, you're looking specifically into continuity of care and how this relates to outcomes. 52 00:05:36,860 --> 00:05:48,260 Tell us a bit about that. So I guess there's been a lot of theoretical work on defining continuity of care and how it's changed, 53 00:05:48,260 --> 00:05:55,910 but not a lot of study on whether continuity of care actually improves outcomes and ways we can measure that. 54 00:05:55,910 --> 00:06:01,850 And that's the topic of my thesis. 55 00:06:01,850 --> 00:06:04,040 OK, and well, 56 00:06:04,040 --> 00:06:12,680 have you where you got to with with finding out about maybe what continuity care actually is and and how it actually relates to outcomes. 57 00:06:12,680 --> 00:06:18,940 I guess the biggest thing I've found out so far is that there's no continuity in continuity of care that. 58 00:06:18,940 --> 00:06:26,510 Right. So what I'm trying to do is take some measures that other people have used and 59 00:06:26,510 --> 00:06:32,960 apply them and see whether they have any association with well-known outcomes. 60 00:06:32,960 --> 00:06:39,470 So it's a very basic level. I'm taking a broad brush stroke and just seeing what's out there. 61 00:06:39,470 --> 00:06:49,280 So in a sense, when in the different studies are looking into continuity of care, one one study might look at continuity of care in one way, 62 00:06:49,280 --> 00:06:53,600 whether somebody else has defined it in another way and actually trying to get a coherent 63 00:06:53,600 --> 00:06:58,370 answer from the literature about how it impacts the outcomes have been quite difficult. 64 00:06:58,370 --> 00:07:10,430 Exactly right. I mean, despite that, maybe that difference or perhaps that heterogeneity, is there any is there any relation to the two outcomes? 65 00:07:10,430 --> 00:07:17,090 Well, I've recently completed a systematic review and we do seem to be some trends, although it's quite a messy picture. 66 00:07:17,090 --> 00:07:26,420 And we found the trend in reduction of hospitalisation, i.e. having good continuity of care in the community, 67 00:07:26,420 --> 00:07:31,250 prevents patients from being readmitted or at least progress. 68 00:07:31,250 --> 00:07:35,250 The times when they are at fault for the patients are very ill. 69 00:07:35,250 --> 00:07:41,240 And another trend that we found is towards improving a patient's function. 70 00:07:41,240 --> 00:07:54,680 And I guess what I mean by functioning is the ability to do any tasks and look after themselves and I guess involve themselves in community life. 71 00:07:54,680 --> 00:08:04,820 But two very important results, actually. The continuity of care has an association with with reduced admissions and global assessment of functioning. 72 00:08:04,820 --> 00:08:13,340 So in a sense, independence. Exactly. So, I mean, what are you going to do with that result? 73 00:08:13,340 --> 00:08:19,580 And is there any way that we can we can create greater focus on continuity of care? 74 00:08:19,580 --> 00:08:22,940 What I think I think there is a big focus on continuity of care. 75 00:08:22,940 --> 00:08:31,790 If you look at mental health legislation and certainly not policy documents, people talk about a lot, but there's a lot of action. 76 00:08:31,790 --> 00:08:35,630 And I think partly that's because people don't know what to do. 77 00:08:35,630 --> 00:08:47,210 And in my research, I think the overarching theme is to try and figure out ways that we found service overall as to what we can coordinate to do, 78 00:08:47,210 --> 00:08:53,490 what kind of psychiatrist to just do basic things that can improve the pace of coming care. 79 00:08:53,490 --> 00:09:03,980 OK, maybe there's a tension between the top down political agenda and the day to day clinical practise. 80 00:09:03,980 --> 00:09:13,520 It would. Would you agree with that? Yeah, I think so. And I think, you know, it makes sense in policy to say continuity of care is important. 81 00:09:13,520 --> 00:09:19,280 And I think it's far harder to implement that in day to day care. 82 00:09:19,280 --> 00:09:27,020 You know, I I guess the mental health services have a lot of. 83 00:09:27,020 --> 00:09:36,990 Other important things that they may need to achieve with anyone patient and and a lot of what's the right word, competing based on their time. 84 00:09:36,990 --> 00:09:40,340 Yeah, Stephen, it's been really interesting speaking to you today. 85 00:09:40,340 --> 00:09:45,950 Thank you for your time. Thank you for inviting me. And thank you for tuning into the Oxford Psychology Podcast series. 86 00:09:45,950 --> 00:09:48,800 I hope you listen to some more. Thank you. Goodbye.