I find your model very interesting, and would be glad to hear more about your experiences. We are piloting similar concept in the Helsinki university hospital. Some of our wards provide intensive telemedicine care to schizophrenia patients in nursing homes around our district. We see many advantages in the fact that patients stay physically at their nursing home while getting intensive and specialized psychiatric treatment.
We think that chronic schizophrenia patients in nursing homes, forensic patients in prisons and mentally retarded patients with psychiatric symptoms are especially suited for this model. We select patients with milder symptoms, and those for whom moving from their nursing home might be harmful.
Patient experiences are good for the first patients, and no safety issues in these patients yet. As this is still a pilot we dont have a billing system. I believe this is a very important way of taking the most out of specialized inpatient units – and one major step towards our future mental health system.
Tough issue. If there are some low hanging fruit, you should use and emphasize them. For example tele-medicine makes the life of psychiatrists much easier, and they will adopt it. Digital solutions that engage patient more in his treatment can make the appointments easier for the doctors. When a new system is built, in optimal case you should be able to take something away. Doctors will adopt it if the total count of clicks goes down. Of cource most of the steps “in the way to digital era” dont have these elements…
Good topic. I am not very deep in this issue but I know that my organisation, a university hospital, is building and coordinating a network of palliative teams in the region (1,6 milj people). We are also building “end of life-web page” with therapeutic elements as well as advice in practical things that a dying person may find useful. There are surprisingly many aspects in a good end of life.
Important topic. What kind of patient population you have in PCMH? That defines what kind of integration would be optimal. While you can train staff to give non-specific psychosocial support, which in many case would be enough it is important to identify disorders that can be treated e.g by specific brief psychotherapies. Scalable specific web-based psychiatric treatments, or group therapies work if you have the right patient population. Large use of web-based solutions is good for many topics as Amanda points out.
We made and are still making a large structural change in our psychiatric services. We closed a couple of psychiatric hospitals and have opened or are opening psychiatric wards in each of our somatic hospitals – so in every emergency unit there are psychiatric nurses and psychiatrist on call as well as some acute psychiatric beds for acute situations; the heavier stuff is treated in our specialized central psychiatric hospital. The resources came from closing psychiatric beds. Our ER and psychiatric services are in the same organisation. I guess it would not be easy in a fragmented system.