CZ11 NF-CZ11-PDP Supported by grant from Norway

Transcription

1 CZ11 NF-CZ11-PDP Supported by grant from Norway Project S.U.P.R.: The creation of the comprehensive rehabilitation system for the mentally ill and its implementation in the Inpatient Facilities Číslo projektu: NF-CZ11-PDP Programme Operators Meeting Marek Páv Psychiatric Hospital Bohnice, Prague

2 Czech systém of Psychiatric care Large hospitals Community care is limited Psychiatric care reform strategy 2013 Structural similarity to other countries HDP per capita in USD

3 Participating institutions Recruitment of all major psychiatric hospitals from Czech republic- major providers of rehabilitation care 8 000beds Cooperation with Norwegian partner- DPS Nydalen (Oslo university hospital) Czech National institute of menthal Health and Psychiatric clinic 1st. MF Charles university

4 Project overview Analyze current situation in participating hospitals in the field of psychiatric rehab. Suggest improvements in rehabilitation field, develop a working methodology Implement the changes, train the people Support implementation (literature, bilateral visits) Measure outcomes, correct working methodology Develop a final methodology, establish a standard of rehabilitation care

5 Project harmonogram Preparatory phase Implementation phase Final phase Contracting X X x Analysis x x x x Analysis in particular fields X X X Choice of evaluation tools, therapeutic procedures X X X X translations X X X X X X X X X X X Adaptation X X X X X X X X X X X X X X X X X X X Pilot study X X X X X X X X X X X X Implementation X X X X X X X X X X X X X X X X X X Training in rehabilitation x x x x x x x x x x Publication outputs x x x x x x x x x x Conferences x x x x x Working visits X X X Preventive activities x x x x x x x x x x

6 Analysis Relatively rich therapeutic regimes across hospitals Lack of therapeutic planning No individual Rehabilitation planning No crisis plan Lack of cognitive training and diagnostics Lack of personnel trained in psychiatric Rehabilitation No supervision Weak connection with care outside the hospital

7 Initial analysis Built environment 70 Recovery oriented practice Therapeutic environment Human rights Treatment and interventions Social inclusion Self management and authonomy 13 departments N=462 patients (age20-50, průměr 35) QuIRc (Quality Indicator for Rehabilitative Care) ( Killaspy et al, PLoS One, 2012)

8 Selected priorities Support individual Rehabilitation planning by modifying hospital information system (all but one hospitals use the same NIS) Rehabilitation training- CARe (Comprehensive Approach to Rehabilitation) 32 trainers (at least 2 from each hospital) Cognitive training (computer kiosks and cognitive training), MATRICS testing Support supervision on participating departments Translations: Preventive activities: workshops, information materials

9 Pilot study Treatment procedure according to the working methodology (SUPR short methodic) Instruments: SUPR sociodemographic characteristic SKPS (CSRI CZ In) economy and service use EQ-5D QALY (self-report) GAF overall functioning CAN analysis on needs BPRS - psychopathology CAT satisfaction with treatment (self-report) MANSA quality of life(self-report) SSMIS self stigmatization (self-report) Recruitment of 150 patients, length of treatment 90 days

10 Role of project partner Veronica Vaage-Kowalzik MD, Chief psychiatrist of Inpatient Unit-main partner Grete Larsen MD MHA, Psychiatrist Head of the psychosis outpatient unit Nydalen DPS Wenche Andreassen, Head of Ward Treatment Section Jeanette Engeset, Head of Unit Nydalen DPS Visits 11/2013 Bohnice, Psychiatric clinic CUNI, 11/2014 in Bohnice, Dobřany, Horní Beřkovice, 11/2015 Jihlava, Havlíčkův Brod familiarity with our system of care study materials Comment information system changes 2 visits to Oslo (11 czech experts)

11 Working visist to Oslo

12 Specific solution

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17 Working visist to Oslo

18 Lessons learned from Cooperation Funding is crucial, much more personnel in Norway Structure of teams, cooperation, horizontal not vertical Information transfer Individualized approach to each patient Not preparing patients in the hospital, training in situ Regional responsibility for each patient In many aspects psychiatry is the same Both sides would welcome more predictability in project terms Sometimes different approach to formalization

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