Welcome to the Oxford Psychology Podcast series, brought you today by diammonium,
an advanced training psychiatry or the Oxford Dictionary I'm speaking to,
Stephen Purchases a digital student at the University Department of Psychiatry, currently working with the social psychiatry group.
Welcome, Stephen. Thank you. Thanks for your time.
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.
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.
So maybe you could begin by just telling us a little bit about continuity of care.
I think the interesting thing about the continuity of care is it's an intuitive concept.
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.
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.
And that's how we look after the patient and the period of time.
But I think the interesting thing in how academics is as a social construct that's constantly changing has changed over time.
So in the early days, you could just say, what is the relationship between the patient and the physician over time?
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.
So what you're saying is that continuity of care is the relationship built up over time between
the patient and the physician or the nurse or or whatever health care professional that is?
The continuity of care refers to actually having continued one particular professional.
Is that is that what you mean? That's right. And that's one part of it.
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,
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.
So then the integration of care exactly is very similar to this moment in an integrated
care integrated and continuity of care and integrating can work together in that sense.
So we we're looking at continuity of care.
Whether it was potentially stopping that. I mean, surely it's the idea, isn't it,
that a patient gets into that doctor very well and that their care improves because of that relationship and the trust improves?
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,
I guess, because people move through the system at various points in time.
And so this is a challenge as we try and improve services and people move on.
And I think all those impact on whether a person can have continued.
So, for instance, in mental health,
one of the big things that's happened in the last few years is that in patients and outpatient services have split.
So you have a consultant who is purely inpatient and looks after the people in hospital wards.
And then you have a consultant who sits on the community, looks after and the patient.
And I guess the idea for the patient is split between these two sides.
And the important thing for people who are invested in a patient's continuity of
care is that that seems like an integrated process and that doesn't always happen.
OK, so so actually, when we're trying to get the ward working really well by giving specialised and patient
consultants and getting the community working well by getting a specialist community consultant,
what you've actually done is disrupt continuity of care. And what do you what are your concerns about that?
I mean, why is that a problem? I mean, maybe it's not the ideal, but what's your particular problem with that?
Well, I think I think the most valuable contribution to this is actually coming from
interviews with patients and also the qualitative aspects of what we've asked patients.
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.
And a lot of patients are quite kickout lives.
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.
I can understand, you know, not only the symptomology, but things that impact on their quality of life and their function.
And talks about getting to know the patient's story,
getting to know the narrative and the nature of their condition rather than just necessarily the symptoms you're seeing in front of you.
Exactly. And that sounds quite unscientific. But in actual fact, you know, psychiatry is a very profession, is a very personal profession.
And so this sort of story, the nature of this person's illness, isn't just a tick box.
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.
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,
but not a lot of study on whether continuity of care actually improves outcomes and ways we can measure that.
And that's the topic of my thesis.
OK, and well,
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.
I guess the biggest thing I've found out so far is that there's no continuity in continuity of care that.
Right. So what I'm trying to do is take some measures that other people have used and
apply them and see whether they have any association with well-known outcomes.
So it's a very basic level. I'm taking a broad brush stroke and just seeing what's out there.
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,
whether somebody else has defined it in another way and actually trying to get a coherent
answer from the literature about how it impacts the outcomes have been quite difficult.
Exactly right. I mean, despite that, maybe that difference or perhaps that heterogeneity, is there any is there any relation to the two outcomes?
Well, I've recently completed a systematic review and we do seem to be some trends, although it's quite a messy picture.
And we found the trend in reduction of hospitalisation, i.e. having good continuity of care in the community,
prevents patients from being readmitted or at least progress.
The times when they are at fault for the patients are very ill.
And another trend that we found is towards improving a patient's function.
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.
But two very important results, actually. The continuity of care has an association with with reduced admissions and global assessment of functioning.
So in a sense, independence. Exactly. So, I mean, what are you going to do with that result?
And is there any way that we can we can create greater focus on continuity of care?
What I think I think there is a big focus on continuity of care.
If you look at mental health legislation and certainly not policy documents, people talk about a lot, but there's a lot of action.
And I think partly that's because people don't know what to do.
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,
what kind of psychiatrist to just do basic things that can improve the pace of coming care.
OK, maybe there's a tension between the top down political agenda and the day to day clinical practise.
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.
And I think it's far harder to implement that in day to day care.
You know, I I guess the mental health services have a lot of.
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.
Yeah, Stephen, it's been really interesting speaking to you today.
Thank you for your time. Thank you for inviting me. And thank you for tuning into the Oxford Psychology Podcast series.
I hope you listen to some more. Thank you. Goodbye.