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Measurement-based care (MBC) in mental health improves patient outcomes and is a component of many national guidelines for mental healthcare delivery. Nevertheless, MBC is not routinely integrated into clinical practice. Several known reasons for the lack of integration exist but one lesser explored variable is the subjective perspectives of providers and patients about MBC. Such perspectives are critical to understand facilitators and barriers to improve the integration of MBC into routine clinical practice.
Aims
This study aimed to uncover the perspectives of various stakeholders towards MBC within a single treatment centre.
Method
Researchers conducted qualitative semi-structured interviews with patients (n = 15), family members (n = 7), case managers (n = 8) and psychiatrists (n = 6) engaged in an early-psychosis intervention programme. Data were analysed using thematic analysis, informed by critical realist theory.
Results
Analysis converged on several themes. These include (a) implicit negative assumptions; (b) relevance and utility to practice; (c) equity versus flexibility; and (d) shared decision-making. Providers assumed patients’ perspectives of MBC were negative. Patients’ perspectives of MBC were actually favourable, particularly if MBC was used as an instrument to engage patients in shared decision-making and communication rather than as a dogmatic and rigid clinical decision tool.
Conclusions
This qualitative study presents the views of various stakeholders towards MBC, providing an in-depth examination of the barriers and facilitators to MBC through qualitative investigation. The findings from this study should be used to address the challenges organisations have experienced in implementing MBC.
Given a lattice L and a convex sublattice K of L, it is well-known that the map Con L → Con K from the congruence lattice of L to that of K determined by restriction is a lattice homomorphism preserving 0 and 1. It is a classical result (first discovered by R. P. Dilworth, unpublished, then by G. Grätzer and E. T. Schmidt [2], see also [1], Theorem II.3.17, p. 81) that any finite distributive lattice is isomorphic to the congruence lattice of some finite lattice. Although it has been conjectured that any algebraic distributive lattice is the congruence lattice of some lattice, this has not yet been proved in its full generality. The best result is in [4]. The conjecture is true for ideal lattices of lattices with 0; see also [3].
Let be an infinite regular cardinal. A poset L is called an -lattice if and only if for all XL satisfying 0 < |X| < m, ∧ X and ∨ X exist.
This paper is a part of a sequence of papers, [5], [6], [7], [8], developing the theory of -lattices. For a survey of some of these results, see [9].
The -lattice is described in [6]; γ denotes the zero and γ′ the unit of . In particular, formulas for -joins and meets are given. (We repeat the essentials of this description in Section 4.)
In [6] we proved the theorem stated below. Our proof was based on characterization of (the free -lattice on P) due to [1]; as a result, our proof was very computational.
It is well known that given the polynomial algebra (for definitions, see §2), an algebra of type τ, and a sequence a of elements of , one can define a congruence relation θa of such that the factor algebra is isomorphic to the subalgebra of generated by a, and the isomorphism is given in a very simple way.