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Continuity of care in mental health: understanding and measuring a complex phenomenon

Published online by Cambridge University Press:  23 June 2008

T. Burns ,
J. Catty ,
S. White ,
S. Clement ,
G. Ellis ,
I. R. Jones ,
P. Lissouba ,
S. McLaren ,
D. Rose  and
T. Wykes
T. Burns*
Affiliation:
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
J. Catty
Affiliation:
St George's, University of London, London, UK
S. White
Affiliation:
St George's, University of London, London, UK
S. Clement
Affiliation:
London South Bank University, London, UK
G. Ellis
Affiliation:
St George's, University of London, London, UK
I. R. Jones
Affiliation:
University of Wales, Bangor, Wales, UK
P. Lissouba
Affiliation:
St George's, University of London, London, UK
S. McLaren
Affiliation:
London South Bank University, London, UK
D. Rose
Affiliation:
Institute of Psychiatry, London, UK
T. Wykes
Affiliation:
Institute of Psychiatry, London, UK
*
*Address for correspondence: Professor T. Burns, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. (Email: tom.burns@psych.ox.ac.uk)
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Abstract

Background

Continuity of care is considered by patients and clinicians an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasize it and encourage systems to promote it. Despite this, there is no accepted definition or measure against which to test policies or interventions designed to improve continuity. We aimed to operationalize a multi-axial model of continuity of care and to use factor analysis to determine its validity for severe mental illness.

Method

A multi-axial model of continuity of care comprising eight facets was operationalized for quantitative data collection from mental health service users using 32 variables. Of these variables, 22 were subsequently entered into a factor analysis as independent components, using data from a clinical population considered to require long-term consistent care.

Results

Factor analysis produced seven independent continuity factors accounting for 62.5% of the total variance. These factors, Experience and Relationship, Regularity, Meeting Needs, Consolidation, Managed Transitions, Care Coordination and Supported Living, were close but not identical to the original theoretical model.

Conclusions

We confirmed that continuity of care is multi-factorial. Our seven factors are intuitively meaningful and appear to work in mental health. These factors should be used as a starting-point in research into the determinants and outcomes of continuity of care in long-term disorders.

Keywords

Continuity of carequality of lifesevere mental illness
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 2 , February 2009 , pp. 313 - 323
Copyright
Copyright © 2008 Cambridge University Press

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