Project S.U.P.R.: The creation of the comprehensive rehabilitation … · 2016-06-08 · Project...
Transcript of Project S.U.P.R.: The creation of the comprehensive rehabilitation … · 2016-06-08 · Project...
Marek Páv
Psychiatric Hospital Bohnice, Prague
CZ11 NF-CZ11-PDP-1-002-2014
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-1-002-2014
Programme Operators Meeting 3. 12. 2015
Czech systém of Psychiatric care
Structural similarity to other countries
• Large hospitals
• Community care is limited
• Psychiatric care reform strategy 2013
HDP per capita in USD
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
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
Project harmonogram
2014 2015
2016
9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11
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
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
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Therapeutic environment
Treatment and interventions
Self management and authonomy Social inclusion
Human rights
Recovery oriented practice
13 departments N=462 patients (age20-50, průměr 35)
QuIRc (Quality Indicator for Rehabilitative Care) (www.quirc.eu, Killaspy et al, PLoS One, 2012)
Built environment
Initial analysis
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)
http://thecareeurope.com/ 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
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
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)
Working visist to Oslo
Specific solution
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Working visist to Oslo
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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