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Engagement-focused care during transitions from inpatient and emergency psychiatric facilities

Authors Velligan DI, Fredrick M, Sierra C, Hillner K, Kliewer J, Roberts DL, Mintz J

Received 13 January 2017

Accepted for publication 7 March 2017

Published 12 May 2017 Volume 2017:11 Pages 919—928


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Dawn I Velligan, Megan M Fredrick, Cynthia Sierra, Kiley Hillner, John Kliewer, David L Roberts, Jim Mintz

Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
Dr John Kliewer passed away on April 5, 2017

Objectives: As many as 40% of those with serious mental illness (SMI) do not attend any outpatient visits in the 30 days following discharge. We examined engagement-focused care (EFC) versus treatment as usual in a university-based transitional care clinic (TCC) with a 90-day program serving individuals with SMI discharged from hospitals and emergency rooms. EFC included a unique group intake process (access group) designed to get individuals into care rapidly and a shared decision-making coach.
Methods: Assessments of quality of life, symptomatology, and shared decision-making preferences were conducted at baseline, at 3 months corresponding to the end of TCC treatment and 6 months after TCC discharge. Communication among the patients and providers was assessed at each visit as was service utilization during and after TCC.
Results: Subjective quality of life improved in EFC. Prescribers and patients saw communication more similarly as time went on. Ninety-one percent of patients wanted at least some say in decisions about their treatment.
Conclusions: SDM coaching and improved access improve quality of life. Most people want a say in treatment decisions.

Keywords: shared decision making, mental illness, community mental health, patient education

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