Las demandas educativas de los pueblos indígenas

Research tradition 3: interventions to improve the CPA

Author/s Intervention Outcome

Macpherson et al. (1999)106

Formal clinical goal setting; standard CPA documentation with formalised space to establish any number of treatment goals. Goals set within meeting and agreed with all. Each patient (n_{= 139) offered copies of final} typed CPA documentation

A total of 68% of goals were fully and 11% partially achieved. Goals were no more likely to be achieved in any care setting (i.e. with professional supervision/living independently), or any particular diagnosis

Goals targeting the drug treatment of psychiatric syndromes were most likely to be fully successful (84%), whereas approaches to self-care skills, side effects, physical/medical problems and family relationships were moderately successful. Least successful were the attempts to promote structured day care/activities, and to treat substance abuse, which were fully successful in 39% and 17% of cases, respectively. The study claims that individual care planning can be combined with outcome measurement, to give a meaningful measure of the effectiveness of care Lockwood and

Marshall (1999)107 ‘Needs feedback’ as a technique for

enhancing the CPA. Needs feedback begins with a standardised assessment of patients’ psychiatric and social needs by a nurse specialist. The patient’s CPN is then provided with information from the specialist on: (1) the needs identified; (2) why these needs have been identified; (3) the interventions required to meet the identified needs; and (4) how these interventions may be obtained

Significant improvements were seen in the number of‘unmet’ needs and the level of anxious/ depressive symptoms. Improvements approaching significance were seen for social functioning and negative psychiatric symptoms, but not for positive psychiatric symptoms. This pilot study suggests that needs feedback may improve the quality of nursing assessment and care planning within the CPA

Howells and Thompsell (2002)109

eCPA_{– a computer-based CPA system for} care planning and documentation– using a Microsoft Word template. Completed eCPA care plan is e-mailed to the acute ward, the hospital_{’s emergency clinic and any other} involved agencies. The CPA manager is sent the original signed copy, a copy is filed in the case notes and the GP, the patient and/or his/her carer is given a copy

The system is designed to improve the quality of information in CPA care plans and to enable the rapid and standardised adoption of evidence- based good practice by CMHT staff. The eCPA welcomed by staff: take-up rate of almost 100% Patients also welcomed the legibility and detail of the forms. Care plans are longer and more detailed, no longer constrained by the size of boxes on paper forms. Care plans are adjusted more frequently by CMHT staff, who do not have to completely rewrite the forms by hand; the plans better reflect the current needs of patients. Availability of the form on-screen at team meetings directs discussions onto patients_{’ key} needs, and ensures that the CPA form reflects a multi professional consensus approach

Being able to e-mail the document improved the transfer of information between different agencies. Assists audit as once in electronic format, the information lends itself to statistical analysis and key words can be searched for

Research tradition 3: interventions to improve the CPA

Author/s Intervention Outcome

Blenkiron et al. (2003)99

CUES-U: 17-item service-user outcomes scale in booklet form. Covers the issues of quality of life and satisfaction with mental health services that users rather than professionals have identified as priorities

CUES-U can be an effective and practicable tool within CMHTs, both for increasing users_’ involvement in their care and for service benchmarking. The CUES-U discussion led to a change in clinical care for 49% of respondents. Care co-ordinators rated CUES-U as a good use of their time in 64% of cases. Women and those with a shorter duration of mental disorder were rated as more engaged in the consultation process 84% of service users were satisfied with the level of control and consultation they have; 87% satisfied with relationship with MH workers, high 70% satisfaction for levels of information and advice and access to services. Limitation of high levels of satisfaction was that service users knew their care co-ordinator would see their replies, although many did write negative comments in free-text boxes

Marshall et al. (2004)108

To determine whether feedback from a standardised assessment of need enhances the effectiveness of care planning and whether exposing care co-ordinators to feedback on some patients improves their care of other patients

The only significant effect of the intervention was on patient satisfaction. Patients cluster-randomised to receive feedback were more satisfied than controls, but patients individually randomised to receive feedback were not. Standardised needs assessment did not substantially enhance care planning in this trial. However, giving care co-ordinators some experience of feedback from a standardised assessment of need could improve satisfaction

Killaspy et al. (2012)102

The MHRS: an outcome measure rated collaboratively by staff and service users assessing 10 life domains. The MHRS ratings are agreed through a collaborative discussion between the service user and mental health worker that lasts approximately 1 hour. But its psychometric properties are unknown. Aim is to assess the MHRS_{’s acceptability,} reliability and convergent validity

The MHRS was relatively quick and easy to use and had good test_{–retest reliability, but inter-rater} reliability was inadequate. Collaborative ratings were slightly higher than staff-only ratings. Convergent validity suggests it assesses social function more than recovery. Conclusions: the MHRS cannot be recommended as a routine clinical outcome tool but may facilitate collaborative care planning

APPENDIX 6

NIHR Journals Library www.journalslibrary.nihr.ac.uk

Appendix 7 Key policy documents from England