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The effect of integrated care on self-management and emergency department attendance

  • Nikki Scheiner (a1), Sarah Cohen (a1), Ruth Davis (a2), Tim Gale (a3) (a4) and Amanda Agyare (a1)...
Abstract
Aims and method

The Frequent Attenders Programme is a joint initiative between Hertfordshire Rapid Assessment, Interface and Discharge service and the Emergency Department of the West Hertfordshire NHS Trust, which aims to divert frequent attenders from the emergency department by addressing their unmet needs. This paper describes the range of interventions put in place from the time that the service was set up in 2014 until the introduction of the new national Commissioning for Quality and Innovation 2017–2019, which tasked National Health Service trusts to improve services for people with mental health needs who present to Accident and Emergency. The terms emergency department and Accident and Emergency are used interchangeably, reflecting the practice in policy documents. A subsequent article will report on the impact of the Commissioning for Quality and Innovation in Hertfordshire.

Results

Analysis of the interventions indicated a highly significant (P < 0.0001) mean reduction in attendances. Lower gains were made in patients whose primary presentations were alcohol-related. A failure to effect change in two patients led to a significant revision of their respective care plans, resulting in a subsequent reduction in their attendances.

Clinical implications

An integrated approach to patients with complex presentations was associated with high levels of both patient and referrer satisfaction. It is hypothesised that dismantling the barriers between physical and mental health may lead to similar successes in frequent attenders in other in-patient and community medical and psychiatric services.

Declaration of interest

None.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Dr Nikki Scheiner (nikki.scheiner@nhs.net)
References
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1Baker, C. Accident and Emergency Statistics: Demand, Performance and Pressure. Briefing Paper 6964. House of Commons, 2017 (Researchbriefings.files.parliament.uk/documents/SN06964/SN06964.pdf).
2Chesney, E, Goodwin, G, Fazel, S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry 2014; 13: 153–60.
3Bentham, M. Revealed: ‘Repeat offender’ patients visit London A&E departments 200 times a year. London Evening Standard, 23 February 2015 (https://www.standard.co.uk/news/health/revealed-repeat-offender-patients-visit-london-ae-departments-200-times-a-year-10064811.html).
4Fletcher, D. Overview of Frequent Callers of London Ambulance Services. London Ambulance Service NHS Trust, 2016 (http://www.londonsenate.nhs.uk/wp-content/uploads/2017/01/FC-Overview-.pdf).
5Murray, R, Jabbal, J, Thompson, J, Baird, B, Maguire, D. Quarterly Monitoring Report of the King's Fund, 23 June 2017. The King's Fund, 2017 (http://qmr.kingsfund.org.uk/2017/23).
6Bolton, J. ‘We've got another one for you’. Liaison psychiatry's experience of stigma towards patients with mental illness and mental health professional. Psychiatrist 2012; 36: 450–54.
7Hilton, C. Evolving a Model for Integrating Physical Health, Mental Health and Social Care to Include Closer Collaboration with Primary Care. NHS England, 2016 (https://www.kingsfund.org.uk/sites/files/kf/media/Christopher%20Hilton.pdf).
8Baker, M, Stallard, J, Gibson, S. A pilot project targeting frequent attenders at the emergency department with medically unexplained symptoms. Emerg Med J 2013; 30(10): 866.
9Bermingham, S, Cohen, A, Hague, J, Parsonage, M. The cost of somatization among the working-age population in England for the year 2008-2009. Ment Health Fam Med 2010; 7(2): 7184.
10Radio 4, Today Programme interview, 9 January 2014. Marszal A. ed. Patients who vist A&E four times a week adding to NHS burden. Telegraph, 2014 (https://www.telegraph.co.uk/news/nhs/10555831/Patients-who-visit-AandE-four-times-a-week-adding-to-NHS-burden.html).
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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The effect of integrated care on self-management and emergency department attendance

  • Nikki Scheiner (a1), Sarah Cohen (a1), Ruth Davis (a2), Tim Gale (a3) (a4) and Amanda Agyare (a1)...
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