Author: Fritzner MontalmantPublisher:
ISBN:
Category : Mental illness
Languages : en
Pages : 0
Book Description
Background: Mental illness is the most common cause of major disability in community settings worldwide. Patients with serious mental illness (SMI) are often unable to communicate their wishes during acute illness. However, evidence supports improved outcomes in patients with Psychiatric Advance Directive (PAD) on file prior to entering and acute phase indicating that primary care providers are very instrumental to patients' response prior to acute illness. This forms the basis for this evdience-based system-change project intended to facilitate providers' interest in discussing PAD and ultimately obtaining advance instruction (AI) and/or health care power of attorney (HCPA) from patients when these patients are most capacitated. Design: A combination of the Advancing Research and Clinical Practice through Close Collaboration (ARCC) EBP model. Orem's Self-care Deficit theory, and Kotter's Leading Change model form the framework for this project. Participants engaged in Advance Directive activities guided by a toolkit developed by Bazelon Center for Mental Health Law, and adopted by the National Mental Health Consumer's Self Help Clearinghouse. Method: Utlizing the Bazelon toolkit, three consenting primary care providrs were guided in EBP methods to engage patients in PAD discussions and answer patients' questions. Pre-implementation, 150 charts were randomly selected fro review of providers' documentation of PAD behavior/activities in the 6-week before intervention. Post-intervention, 150 charts were also randomly selected for review and comparison. The PI was available in person, by phone and text to support, guide, and encourage patients throughout the period but was not present at patient-provider visits. Outcomes: The findings show a positive change in providers' pre intervention of PAD discussion from 21% compared to post intervention rate of 51% over he 6-week period. Descriptive analysis of retroactive charts review of data from 150 randomly selected medical records of patients seen at the clinic during the period indicates an 85% increase in rates of provider who discussed PAD with patients during their scheduled visits over a 6-week of intervention period. Conclusion: These findings are consisent with several research studies, which suggest that when providers offer opportunities for PAD completion to patients with SMI, they are more likely to receive better health care and recover faster from acute conditions. It is recommended that primary care providers routinely offer Advance Directive discussions to their patients to facilitate and improve outcomes.