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Rolf Wynn - One of the best experts on this subject based on the ideXlab platform.
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Inpatients´ utilization of GP and psychiatric outpatient care. A comparison of a Central-Institution versus a local-Institution based system of psychiatry. A case-register study
International Journal of Integrated Care, 2016Co-Authors: Lars Henrik Myklebust, Rolf WynnAbstract:Introduction: The deInstitutionalization of psychiatry has in its essence been a downsizing of Central psychiatric Institutions in favor of outpatient- and community-based services. ‘Continuity of care’ has been a key concept from the onset in these ever more complex systems, both used as a measure of outcome and processes as well as a strategic priority (1). Recent research advocates systems that facilitate continuous clinical relationships between patients and clinicians rather than collaboration between specialized teams, but findings are limited (2-4). At the same time, the international literature has seen an increasing interest of the General Practitioners` (GP) role in the care of mental health patients, and underlines the need for integration of primary care and psychiatric services (5, 6). Recent studies suggest that for patients with severe conditions, cross boundary continuity are poor, and many are not seen in specialized care (7, 8). Purpose and methods: We review and discuss findings from studies on continuity of care in North Norway, focusing on the collaboration in the total of mental health services. We now want to focus on the continuity of care for individual patients with severe conditions between primary care and specialized mental health services: 1. Municipality (GPs), 2. Community mental health centers (CMHC), and 3. Central Mental hospitals (CMH). The two neighboring CMHCs of Vesteralen and of Lofoten, County of Nordland, North-Norway represent an interesting opportunity for mental health services research, because they are organized quite differently in spite of almost identical catchment-area characteristics. The one may be termed a Central Institution based model, the other a local Institution based model. Both operate in concert with the county’s` CMH. These two models compared, particularly whether if local psychiatric beds rather than at a Central hospital affects the utilization of GPs and municipality care. It is a retrospective cohort study of the total psychiatric care for all patients in two areas in North Norway, based on a prevalence sample from the routine case-registries of general practice and specialist services over the five years 2008-2012. Results and discussion: The most interesting result is that model of services exert at profound effect on the collaborative care between primary and specialist care. From a total of 971 inpatients included in the study, a majority in the local Institution based model also utilized GPs- as well as specialist outpatient consultations. This was not the case in the Centralized model, where a substantial proportion of inpatients did not receive specialist outpatient care at all. Further, those patients did neither use GP-care to the same extent as those who utilized both in- and outpatient services. Condition (diagnosis) and length of inpatient stay modified these findings, but system model still exerted an independent and profound effect on whether patients received collaborative care or not. Demographic and clinical variables like gender, age, or diagnosis did not alter these effects. The distinction between ‘continuity systems’ and ‘specialization systems’ described in recent literature may at least partly explain this (2). It may be that our two models facilitate continuous clinical contact between a therapist and patient to a different degree, and that this exerts an effect at both the primary and specialist level of services. In our local Institution based system, one therapist may keep continuous contact with the patients over the transition from inpatient to outpatient care, whereas the Central Institution based model is more specialized and that patients may establish new relationships depending on in need of inpatient or outpatient services. Conclusion: The results suggests that smaller local inpatient units rather than Central mental Institutions might represent one way of achieving better continuity of care between primary and specialist services for patients with severe conditions. Further, utilization of both in-and outpatient services predicts also more use of general practitioners care. This relationship should be examined further in future research involving the North Norwegian psychiatric health services. References: 1- Myklebust LH, Olstad R, Bjorbekkmo S, Eisemann M, Wynn R, Sorgaard K. Impact on continuity of care of deCentralized versus partly Centralized mental health care in Northern Norway. International journal of integrated care. 2011;11:e142. 2- Omer S, Priebe S, Giacco D. Continuity across inpatient and outpatient mental health care or specialisation of teams? A systematic review. European psychiatry : the journal of the Association of European Psychiatrists. 2015;30:258-270. 3- Myklebust LH, Sorgaard K, Rotvold K, Wynn R. Factors of importance to involuntary admission. Nordic journal of psychiatry. 2012;66:178-182. 4- Myklebust LH, Sorgaard K, Wynn R. Local psychiatric beds appear to decrease the use of involuntary admission: a case-registry study. BMC health services research. 2014;14:64. 5- Fleury MJ IA, Aube D, Farand L, Lambert Y General practitioners`management of mental disorders: A rewarding practice with considerable obstacles. BMC Family Practice. 2012;13. 6- Mykletun A KA, Tangen T, Overland S. General practitioners`opinions on how to improve treatment of mental disoders in primary helath care. Interviews with one hunders Norwegian general practitioners. BMC Health Service Research. 2010;10. 7- Reilly S PC, Hann M, Reeves D, Nazareth I, Lester H. The Role of Primary Care in Service Provision for People with Severe Mental Illness in the United Kingdom. PLoS ONE. 2012;7. 8- Myklebust LH SK, Wynn R. Local inpatient units may increase patients’ utilization of outpatient services. A case-register study. Submitted.
Wiebke Kirleis - One of the best experts on this subject based on the ideXlab platform.
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Governing Tripolye: Integrative architecture in Tripolye settlements.
PLOS ONE, 2019Co-Authors: Robert Hofmann, Johannes Müller, Liudmyla Shatilo, Mykhailo Videiko, René Ohlrau, Vitalii Rud, Nataliia Burdo, Marta Dal Corso, Stefan Dreibrodt, Wiebke KirleisAbstract:Recently, high-resolution magnetometry surveys have led to the discovery of a special category of buildings–so-called ‘mega-structures’–situated in highly visible positions in the public space of Tripolye giant-settlements of the late 5th and first half of the 4th millennium BCE. In this paper we explore what these buildings actually are and how they can contribute to the understanding of the development of social space in Tripolye giant-settlements. For this investigation, we linked newly obtained excavation data from the giant-settlement Maidanetske, Ukraine, with a much larger sample of such buildings from magnetic plans obtained in the region between the Carpathian foothills and the Dnieper River. Accordingly, Tripolye mega-structures represent a particular kind of integrative building documented in many non-ranked ethnographic contexts. Based on our results we are interpreting that these buildings were used for various ritual and non-ritual activities, joint decision-making, and the storage and consumption of surplus. In Tripolye giant-settlements at least three different categories of mega-structures could be identified which most likely represent different levels of socio-political integration and decision-making. The emergence of this hierarchical system of high-level integrative buildings for the whole community and different low-level integrative architectures for certain segments of local communities was related to the rise of Tripolye mega-sites. The presence of different integrative levels most likely reflects the fusion of different previously independent communities in the giant-settlements. Later in the mega-site development, we observe how low-level integrative buildings increasingly lose their importance indicated by shrinking size and, finally, their disappearance. This observation might indicate that the power which was previously distributed across the community was transferred to a Central Institution. It is argued that the non-acceptance of this concentration of power and the decline of lower decision-making levels might be a crucial factor for the disintegration of Tripolye giant-settlements around 3600 BCE.
Lars Henrik Myklebust - One of the best experts on this subject based on the ideXlab platform.
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Inpatients´ utilization of GP and psychiatric outpatient care. A comparison of a Central-Institution versus a local-Institution based system of psychiatry. A case-register study
International Journal of Integrated Care, 2016Co-Authors: Lars Henrik Myklebust, Rolf WynnAbstract:Introduction: The deInstitutionalization of psychiatry has in its essence been a downsizing of Central psychiatric Institutions in favor of outpatient- and community-based services. ‘Continuity of care’ has been a key concept from the onset in these ever more complex systems, both used as a measure of outcome and processes as well as a strategic priority (1). Recent research advocates systems that facilitate continuous clinical relationships between patients and clinicians rather than collaboration between specialized teams, but findings are limited (2-4). At the same time, the international literature has seen an increasing interest of the General Practitioners` (GP) role in the care of mental health patients, and underlines the need for integration of primary care and psychiatric services (5, 6). Recent studies suggest that for patients with severe conditions, cross boundary continuity are poor, and many are not seen in specialized care (7, 8). Purpose and methods: We review and discuss findings from studies on continuity of care in North Norway, focusing on the collaboration in the total of mental health services. We now want to focus on the continuity of care for individual patients with severe conditions between primary care and specialized mental health services: 1. Municipality (GPs), 2. Community mental health centers (CMHC), and 3. Central Mental hospitals (CMH). The two neighboring CMHCs of Vesteralen and of Lofoten, County of Nordland, North-Norway represent an interesting opportunity for mental health services research, because they are organized quite differently in spite of almost identical catchment-area characteristics. The one may be termed a Central Institution based model, the other a local Institution based model. Both operate in concert with the county’s` CMH. These two models compared, particularly whether if local psychiatric beds rather than at a Central hospital affects the utilization of GPs and municipality care. It is a retrospective cohort study of the total psychiatric care for all patients in two areas in North Norway, based on a prevalence sample from the routine case-registries of general practice and specialist services over the five years 2008-2012. Results and discussion: The most interesting result is that model of services exert at profound effect on the collaborative care between primary and specialist care. From a total of 971 inpatients included in the study, a majority in the local Institution based model also utilized GPs- as well as specialist outpatient consultations. This was not the case in the Centralized model, where a substantial proportion of inpatients did not receive specialist outpatient care at all. Further, those patients did neither use GP-care to the same extent as those who utilized both in- and outpatient services. Condition (diagnosis) and length of inpatient stay modified these findings, but system model still exerted an independent and profound effect on whether patients received collaborative care or not. Demographic and clinical variables like gender, age, or diagnosis did not alter these effects. The distinction between ‘continuity systems’ and ‘specialization systems’ described in recent literature may at least partly explain this (2). It may be that our two models facilitate continuous clinical contact between a therapist and patient to a different degree, and that this exerts an effect at both the primary and specialist level of services. In our local Institution based system, one therapist may keep continuous contact with the patients over the transition from inpatient to outpatient care, whereas the Central Institution based model is more specialized and that patients may establish new relationships depending on in need of inpatient or outpatient services. Conclusion: The results suggests that smaller local inpatient units rather than Central mental Institutions might represent one way of achieving better continuity of care between primary and specialist services for patients with severe conditions. Further, utilization of both in-and outpatient services predicts also more use of general practitioners care. This relationship should be examined further in future research involving the North Norwegian psychiatric health services. References: 1- Myklebust LH, Olstad R, Bjorbekkmo S, Eisemann M, Wynn R, Sorgaard K. Impact on continuity of care of deCentralized versus partly Centralized mental health care in Northern Norway. International journal of integrated care. 2011;11:e142. 2- Omer S, Priebe S, Giacco D. Continuity across inpatient and outpatient mental health care or specialisation of teams? A systematic review. European psychiatry : the journal of the Association of European Psychiatrists. 2015;30:258-270. 3- Myklebust LH, Sorgaard K, Rotvold K, Wynn R. Factors of importance to involuntary admission. Nordic journal of psychiatry. 2012;66:178-182. 4- Myklebust LH, Sorgaard K, Wynn R. Local psychiatric beds appear to decrease the use of involuntary admission: a case-registry study. BMC health services research. 2014;14:64. 5- Fleury MJ IA, Aube D, Farand L, Lambert Y General practitioners`management of mental disorders: A rewarding practice with considerable obstacles. BMC Family Practice. 2012;13. 6- Mykletun A KA, Tangen T, Overland S. General practitioners`opinions on how to improve treatment of mental disoders in primary helath care. Interviews with one hunders Norwegian general practitioners. BMC Health Service Research. 2010;10. 7- Reilly S PC, Hann M, Reeves D, Nazareth I, Lester H. The Role of Primary Care in Service Provision for People with Severe Mental Illness in the United Kingdom. PLoS ONE. 2012;7. 8- Myklebust LH SK, Wynn R. Local inpatient units may increase patients’ utilization of outpatient services. A case-register study. Submitted.
Robert Hofmann - One of the best experts on this subject based on the ideXlab platform.
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Governing Tripolye: Integrative architecture in Tripolye settlements.
PLOS ONE, 2019Co-Authors: Robert Hofmann, Johannes Müller, Liudmyla Shatilo, Mykhailo Videiko, René Ohlrau, Vitalii Rud, Nataliia Burdo, Marta Dal Corso, Stefan Dreibrodt, Wiebke KirleisAbstract:Recently, high-resolution magnetometry surveys have led to the discovery of a special category of buildings–so-called ‘mega-structures’–situated in highly visible positions in the public space of Tripolye giant-settlements of the late 5th and first half of the 4th millennium BCE. In this paper we explore what these buildings actually are and how they can contribute to the understanding of the development of social space in Tripolye giant-settlements. For this investigation, we linked newly obtained excavation data from the giant-settlement Maidanetske, Ukraine, with a much larger sample of such buildings from magnetic plans obtained in the region between the Carpathian foothills and the Dnieper River. Accordingly, Tripolye mega-structures represent a particular kind of integrative building documented in many non-ranked ethnographic contexts. Based on our results we are interpreting that these buildings were used for various ritual and non-ritual activities, joint decision-making, and the storage and consumption of surplus. In Tripolye giant-settlements at least three different categories of mega-structures could be identified which most likely represent different levels of socio-political integration and decision-making. The emergence of this hierarchical system of high-level integrative buildings for the whole community and different low-level integrative architectures for certain segments of local communities was related to the rise of Tripolye mega-sites. The presence of different integrative levels most likely reflects the fusion of different previously independent communities in the giant-settlements. Later in the mega-site development, we observe how low-level integrative buildings increasingly lose their importance indicated by shrinking size and, finally, their disappearance. This observation might indicate that the power which was previously distributed across the community was transferred to a Central Institution. It is argued that the non-acceptance of this concentration of power and the decline of lower decision-making levels might be a crucial factor for the disintegration of Tripolye giant-settlements around 3600 BCE.
Johannes Müller - One of the best experts on this subject based on the ideXlab platform.
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Governing Tripolye: Integrative architecture in Tripolye settlements.
PLOS ONE, 2019Co-Authors: Robert Hofmann, Johannes Müller, Liudmyla Shatilo, Mykhailo Videiko, René Ohlrau, Vitalii Rud, Nataliia Burdo, Marta Dal Corso, Stefan Dreibrodt, Wiebke KirleisAbstract:Recently, high-resolution magnetometry surveys have led to the discovery of a special category of buildings–so-called ‘mega-structures’–situated in highly visible positions in the public space of Tripolye giant-settlements of the late 5th and first half of the 4th millennium BCE. In this paper we explore what these buildings actually are and how they can contribute to the understanding of the development of social space in Tripolye giant-settlements. For this investigation, we linked newly obtained excavation data from the giant-settlement Maidanetske, Ukraine, with a much larger sample of such buildings from magnetic plans obtained in the region between the Carpathian foothills and the Dnieper River. Accordingly, Tripolye mega-structures represent a particular kind of integrative building documented in many non-ranked ethnographic contexts. Based on our results we are interpreting that these buildings were used for various ritual and non-ritual activities, joint decision-making, and the storage and consumption of surplus. In Tripolye giant-settlements at least three different categories of mega-structures could be identified which most likely represent different levels of socio-political integration and decision-making. The emergence of this hierarchical system of high-level integrative buildings for the whole community and different low-level integrative architectures for certain segments of local communities was related to the rise of Tripolye mega-sites. The presence of different integrative levels most likely reflects the fusion of different previously independent communities in the giant-settlements. Later in the mega-site development, we observe how low-level integrative buildings increasingly lose their importance indicated by shrinking size and, finally, their disappearance. This observation might indicate that the power which was previously distributed across the community was transferred to a Central Institution. It is argued that the non-acceptance of this concentration of power and the decline of lower decision-making levels might be a crucial factor for the disintegration of Tripolye giant-settlements around 3600 BCE.