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Poster Abstracts

Testing person-centered care in acute psychosis settings

Authors:

Katarina Allerby ,

Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden Department of Psychotic Disorders, Sahlgrenska University Hospital, SE
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Anneli Goulding,

Department of Psychotic Disorders, Sahlgrenska University Hospital, SE
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Lilas Ali,

Department of Psychotic Disorders, Sahlgrenska University Hospital Department of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, SE
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Margda Waern

Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden Department of Psychotic Disorders, Sahlgrenska University Hospital, SE
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Abstract

Introduction: Inpatient care is frequently used to assist recovery from the most acute phase of psychotic disorder. It is however depicted by patients as patriarchal, depersonalizing and chaotic. Staff, being a major gatekeeper to patients’ perceptions of care, describe a struggle to deliver good care in a stressful and traditional setting. Person-centered care may alleviate these shortcomings as it acknowledge and involve the person in individualized care. As PCC has been found to improve patient outcomes, reduce care consumption and improve staff work experience in other settings, this study tests whether increasing person-centeredness could achieve changes in acute psychoses settings¹.

Methods: An educational intervention for staff was created based on participatory principles to engage participants in enhancing their person-centered approach and creating sustainable ward-relevant changes at all four wards in Gothenburg’s psychosis clinic. Patients were involved in the edcational days. In a quasi-experimental design, patients’ empowerment and satisfaction ratings (n=100), staff workload ratings (n=965) and registry data on length of hospital stay and rapid re-hospitalization (n=751) were compared before and after the intervention. Staff experiences were studied in six focus groups interviews (n=23).

Results: Interview data suggests that staff both understand and practice the principles of person-centered care following the intervention, although obstacles were identified and uneven delivery of PCC was suggested. Overall positive changes for both patients and staff were reported in terms of improved care environment and evolving roles. In line with our hypothesis, patients’ satisfaction with care was higher post-intervention; 4.5 vs 11.71 (the UKU ConSat scale ranging from -34-34) in analysis controlled for overall health, F=4.17, p=.44, while empowerment was not². Staff workload decreased as hypothesized, from 5.5 to 4.5 (VAS-scale 1-10), t=7.5 (968); p <.0005. Contrary to our hypothesis, care consumption as measured in hospital days was greater after the intervention, Md=25.2 vs Md=34.2, U=81409.5, z=3.7, p<.0005, r=.13, while rapid re-admission rates did not differ.

Conclusions: PCC has potential to improve psychosis inpatient care. Staff are open to the concept and willing to work for change, but need continued support. Benefits are indicated for both patients and staff. Cost-effectiveness needs to be addressed as initial care consumption might increase.

Implications: This study suggests that interventions targeting staff attitudes and procedures can improve inpatient care of persons with psychotic illness, during episodes with seriously affected cognitive abilities. A major limitation of this study is the before/after design, and the intervention needs to be tested in cluster-randomized trial. 

¹Goulding, A., Allerby, K., Ali, L., Gremyr, A., & Waern, M. (2018). Study protocol design and evaluation of a hospital-based multi-professional educational intervention: Person-Centred Psychosis Care (PCPC). BMC Psychiatry, 18(1), 269. doi:10.1186/s12888-018-1852-2

²Allerby, K., Goulding, A., Ali, L., & Waern, M. (2020). Striving for a more person-centered psychosis care: results of a hospital-based multi-professional educational intervention. BMC Psychiatry, 20(1), 1-10.

How to Cite: Allerby K, Goulding A, Ali L, Waern M. Testing person-centered care in acute psychosis settings. International Journal of Integrated Care. 2022;22(S3):73. DOI: http://doi.org/10.5334/ijic.ICIC22290
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Published on 04 Nov 2022.

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