The OPTIMA Core Programme: early audit findings on the effectiveness of an inner-city specialist service for frequently admitted patients with bipolar disorder
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1
South London and Maudsley NHS Foundation Trust, OPTIMA Mood Disorders Service, United Kingdom
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2
Hospital Clinic of Barcelona, Psychiatry, Spain
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3
Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Centre for Affective Disorders, United Kingdom
Background:
The period following a hospital admission for bipolar disorder brings a high risk for episode recurrence, re-admission and suicide (1). People recovering from bipolar episodes often face further medical, financial, housing and safeguarding problems (2). This important period brings a valuable opportunity to establish mood stability, promote recovery and to develop preventative strategies. A Danish specialist clinic demonstrated the effectiveness of this approach in a group of patients with bipolar disorder recently discharged from hospital, using British Association of Psychopharmacology Guidelines and psycho-education. The number of episode recurrences and re-admissions was significantly reduced in comparison to those receiving ‘treatment as usual’ (3).
The South London and Maudsley NHS Foundation Trust OPTIMA Mood Disorders Service (OPTIMA) is a specialist programme for people with bipolar disorder recently discharged from periods of care in hospital and/or with our home treatment teams (4). Approximately 1400 patients with bipolar disorder are registered with the Trust: some 150 are admitted more than once a year. Established in April 2015, the OPTIMA Core Programme aims to prevent recurrence and re-admission in patients at highest risk of recurrence in the Trust, using a combination of frequent psychiatric review, psycho-education and the promotion of self-management and functional recovery.
The OPTIMA Core Programme commences with a screening appointment for psychiatric and ‘key-worker’ assessments. The programme offers expert pharmacotherapy and related medical treatments, specialist nursing, occupational therapy and elements of psycho-education. It was originally anticipated that the core programme would span 12 weeks, but a more flexible approach was adopted to allow for longer periods of engagement and treatment.
Aim: This audit examined the demographic characteristics of the patients treated at OPTIMA´s core programme to date, and compared data on hospital admissions and home treatment contacts before and after the programme.
Methods:
This early audit included all the patients who were admitted to OPTIMA between April 2015 and March 2017, but it focused on those admitted to the core programme. Data on demographic factors, the number of hospital admissions and home treatment team (HTT) episodes in the three year period before OPTIMA admission and in the period following completion of the programme were extracted from electronic health records. The monthly rates of admission and HTT contacts in the 36 months before OPTIMA were calculated. For the period after the OPTIMA Core Programme, the aforementioned rates were calculated by dividing the number of admissions and HTT contacts by the ‘months since discharge’ from the programme. Descriptive statistical analyses were used to characterize the sample. A Wilcoxon signed-rank test (Shapiro-Wilk, p=0.001) was used to conduct comparisons of pre- and post- OPTIMA hospital admission rates and HTT spells (non-parametric data).
Results:
Fifty-two patients were found eligible for the specialist core programme in OPTIMA because they had been admitted frequently in the previous three years and had been recently discharged from hospital. A further fifty-eight patients were referred for other treatments available in OPTIMA, such as group psycho-education, couple therapy and specialist psychiatric opinions.
The thirty patients who had been seen in the core programme and have been discharged were included in the following analyses. Of this sample, 20 were female and 10 were male and their mean age was 43 years (SD=14). Only 17% of service users were actively working at the time of admission to OPTIMA; 44% were unemployed, 26% were on permanent sick leave and 9% were on temporary sick leave. For these 30 patients, the mean number of months since discharge from Optima was 9.4 (SD=4.6). Eighteen patients did not complete the whole programme and were discharged earlier for the following reasons: relapse or recurrence (N=4), personal issues (N=6) and lack of engagement (N=8).
Considering the 30 patients initially admitted to the core programme and now discharged, the mean monthly rate of admissions before OPTIMA was 0.05 (SD=0.05) and the rate after discharge from the programme was 0.01 (SD=0.03). There was a statistical difference between these rates of hospitalisations before and after OPTIMA (Z=-3.1, p=0.002).
The mean monthly rate of HTT contacts prior to OPTIMA was 0.04 (SD=0.05) while the mean monthly rate after OPTIMA was 0.02 (SD=0.05). There were no statistical differences regarding these rates when compared using a Wilcoxon signed ranks test (Z=-1.5, p=0.136).
Conclusion:
These very early audit results support the effectiveness of referral to the OPTIMA core programme in reducing hospital re-admissions in our frequently admitted patients from an inner-city catchment area. There was no statistical difference regarding the HTT contacts before and after the programme. This may reflect the still limited sample size or the short follow-up period of this audit. It is possible that when OPTIMA ‘graduates’ do suffer recurrence, they are better able to use home treatment team services, and avoid the need for admission to hospital.
Our initial findings emphasise the importance of frequent specialist post-episode psychiatric care and maintenance phase interventions to stabilise bipolar disorder in this group of most frequently admitted patients. Future work will include the expansion of this model of care in a in the provision of an OPTIMA Ward Liaison Service, to improve continuity of care and recruitment to the programme.
References
1. Strakowski SM, Keck PE, McElroy SL, West SA, Sax KW, Hawkins JM, et al. Twelve-month outcome after a first hospitalization for affective psychosis. Arch Gen Psychiatry. 1998 Jan;55(1):49–55.
2. Gerson LD, Rose LE. Needs of Persons With Serious Mental Illness Following Discharge From Inpatient Treatment: Patient and Family Views. Arch Psychiatr Nurs. 2012;26(4):261–71.
3. Kessing LV, Hansen HV, Hvenegaard A, Christensen EM, Dam H, Gluud C, et al. Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial. Br J Psychiatry. 2013 Mar 1;202(3):212–9.
4. Macritchie K, Dewing B, Mantingh T, Young AH. The OPTIMA Mood Disorders Programme: Optimising Treatment for People with Bipolar Disorder in South London. In: International society of Affective Disorders. 2016.
Keywords:
Specialist service development,
audit,
Bipolar Disorder,
functional recovery,
Recurrence prevention
Conference:
ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future, London, United Kingdom, 6 Jul - 7 Jul, 2017.
Presentation Type:
Poster
Topic:
Service management / Integration of treatments
Citation:
Macritchie
K,
Borthwick
E,
Bourne
S,
Hidalgo-Mazzei
D,
Mantingh
T and
Young
AH
(2019). The OPTIMA Core Programme: early audit findings on the effectiveness of an inner-city specialist service for frequently admitted patients with bipolar disorder.
Front. Psychiatry.
Conference Abstract:
ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future.
doi: 10.3389/conf.fpsyt.2017.48.00024
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Received:
01 Jun 2017;
Published Online:
25 Jan 2019.
*
Correspondence:
MD. Karine Macritchie, South London and Maudsley NHS Foundation Trust, OPTIMA Mood Disorders Service, London, United Kingdom, Karine.Macritchie@slam.nhs.uk
MD, PhD. Diego Hidalgo-Mazzei, Hospital Clinic of Barcelona, Psychiatry, Barcelona, Spain, diego.hidalgo_mazzei@kcl.ac.uk
Mr. Tim Mantingh, South London and Maudsley NHS Foundation Trust, OPTIMA Mood Disorders Service, London, United Kingdom, tim.mantingh@kcl.ac.uk