Heli Hätönen

Patient complaints in Finland 2000–2004: a retrospective register study

Today, monitoring of patient complaints in healthcare services is being used as a tool for quality assurance systems and in the future development of services. This nationwide register study describes the number of all complaints processed, number of complaints between different state provinces, healthcare services and healthcare professionals, and outcomes of complaints in Finland during the period 2000–2004. All complaints processed at the State Provincial Offices and the National Authority for Medicolegal Affairs were analysed by statistical methods. Complaints about mental healthcare were explored in greater detail. The analysis showed that the number of patient complaints increased considerably during the study period. There were changes in the number of complaints between study years in different provinces. Out of different healthcare services, an especially marked increase was seen in private healthcare. Nearly all complaints were lodged against physicians, and over half of the complaints were made because of medical error. In mental health care, patients more often complained about unsatisfactory certificates and statements and the use of compulsory hospital care. An analysis of the outcomes revealed that in mental health care complaints more seldom led to consequences. The results need to be utilised when planning interventions for advanced supervision, prevention of adverse events and patient safety in healthcare, and especially in mental health care. From the patients’ perspective, it is important to create a culture where most problem situations are handled where the treatment was provided, thus avoiding a complex complaints process.

The effectiveness of technology-based patient education on self-reported deprivation of liberty among people with severe mental illness: A randomized controlled trial

Deprivation of liberty (DL) in psychiatric inpatient care is common worldwide. As liberty is a central element of patients’ rights, there is a need to develop most effective methods supporting patients’ personal liberty. The article presents initial results from a study to determine the effectiveness of an information technology (IT)-based patient education programme on patients’ experiences of being deprived of their liberty during their in-hospital stay. An overall sample of 311 patients with schizophrenia spectrum psychosis was randomized into three groups: an intervention group with needs-based computerized patient education, a patient education group with conventional education and a control group with standard care. Data on the general experience of DL were collected at baseline and during the patient discharge process. In general, all patients experienced less DL at the time of their discharge. The change in patients’ experiences of their DL did not differ statistically between the three groups. Male patients in the standard care group were significantly more likely to drop out of the study than female patients. Although technology-based patient education was not found to be superior to other approaches, we did not find any reason to inhibit its utilization in patient care among persons with severe mental health problems. From the healthcare organizations’ perspective, a cost-effectiveness analysis is needed, as the IT education was slightly more time-consuming.

Assessing quality of life in patients with schizophrenia in an acute psychiatric setting: Reliability, validity and feasibility of the EQ-5D and the Q-LES-Q

Background: Quality of life (QoL) is considered an important outcome of treatment in psychiatry. Two QoL instruments, the EuroQoL-5D (EQ-5D) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), have been increasingly used among patients with schizophrenia. Aims: The aim of this study was to investigate the reliability, validity and feasibility of the EQ-5D and the Q-LES-Q among patients with schizophrenia and related disorders (n = 311) in the most acute stage of their illness. Methods: The study was carried out in nine acute psychiatric wards of two psychiatric hospitals in Finland. The instruments’ internal consistency, construct validity and missing values were evaluated. Results: Our findings show high internal consistency for the Q-LES-Q (Cronbachs alpha 0,89). For the EQ-5D, the Cronbachs alpha value was minimally acceptable (0.63) taking in to consideration the low number of items. Lower overall functioning indicated poorer QoL measured by the EQ-5D (U = 3098, P < 0.001) or the Q-LES-Q (U = 3357, P < 0.001). Missing values in the EQ-5D ranged from 6% to 7% and in the Q-LES-Q from 6% to 31%. Conclusion: Our results suggest that both QoL scales are reasonably reliable, valid and feasible in this patient group. The decision regarding which instrument to use would depend on clinical or research questions. When more detailed information for patients’ satisfaction with QoL is needed then the Q-LES-Q would be a better choice, whereas if the primary interest is to briefly assess patients’ QoL problems related to health status the EQ-5D would be a better choice.

Patient education practices in psychiatric hospital wards: A national survey in Finland

Background: Despite the fact that patients’ receiving of information is one of the fundamental rights of patients, there is still limited information available on how patient education is carried out in psychiatric healthcare organizations. Aims: The aim of this study was to describe patient education practices in adult acute psychiatric hospitals. Methods: A descriptive questionnaire survey was administered in all adult acute psychiatric wards in Finland. Data was analysed using descriptive statistics and qualitative content analysis. Results: A total of 55 head nurses participated in the study (response rate 60%). The content of patient education covered almost all investigated informational areas and patient education was mostly carried out orally and with leaflets. However, patients’ individual needs for certain communication methods were not met. Moreover, staff rarely received adequate on-the-job training. In the study wards, there were only few systematic procedures and instructions regarding patient education. Problems relating to the delivery of patient education were described in four themes: patients’ poor condition, lack of staff resources, discrepancies in procedures and poor operational conditions. Conclusion: Patient education in psychiatric hospitals covers the informational areas investigated. However, there are numerous quality gaps in the realization of patient education in psychiatric hospitals. The results of this study suggest that to ensure patients’ right to receive information, specific guidelines and instructions are needed for psychiatric patients. These guidelines and instructions should thoroughly consider different domains of patient education including content, communication methods, definition of patients individual needs and delivery personnel.

Mobile.net: Mobile Telephone Text Messages to Encourage Adherence to Medication and to Follow up With People With Psychosis: Methods and Protocol for a Multicenter Randomized Controlled Two-Armed Trial

Background Schizophrenia is a high-cost, chronic, serious mental illness. There is a clear need to improve treatments and expand access to care for persons with schizophrenia, but simple, tailored interventions are missing. Objective To evaluate the impact of tailored mobile telephone text messages to encourage adherence to medication and to follow up with people with psychosis at 12 months. Methods Mobile.Net is a pragmatic randomized trial with inpatient psychiatric wards allocated to two parallel arms. The trial will include 24 sites and 45 psychiatric hospital wards providing inpatient care in Finland. The participants will be adult patients aged 18–65 years, of either sex, with antipsychotic medication (Anatomical Therapeutic Chemical classification 2011) on discharge from a psychiatric hospital, who have a mobile phone, are able to use the Finnish language, and are able to give written informed consent to participate in the study. The intervention group will receive semiautomatic system (short message service [SMS]) messages after they have been discharged from the psychiatric hospital. Patients will choose the form, content, timing, and frequency of the SMS messages related to their medication, keeping appointments, and other daily care. SMS messages will continue to the end of the study period (12 months) or until participants no longer want to receive the messages. Patients will be encouraged to contact researchers if they feel that they need to adjust the message in any way. At all times, both groups will receive usual care at the discretion of their team (psychiatry and nursing). The primary outcomes are service use and healthy days by 12 months based on routine data (admission to a psychiatric hospital, time to next hospitalization, time in hospital during this year, and healthy days). The secondary outcomes are service use, coercive measures, medication, adverse events, satisfaction with care, the intervention, and the trial, social functioning, and economic factors. Data will be collected 12 months after baseline. The outcomes are based on the national health registers and patients’ subjective evaluations. The primary analysis will be by intention-to-treat. Trial Registration International Standard Randomised Controlled Trial Number (ISRCTN): 27704027; http://www.controlled-trials.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/69FkM4vcq)

Attitudes towards schizophrenia on YouTube: A content analysis of Finnish and Greek videos

Objective: To investigate attitudes towards schizophrenia and people with schizophrenia presented in YouTube videos. Methods: We searched YouTube using the search terms “schizophrenia” and “psychosis” in Finnish and Greek language on April 3rd, 2013. The first 20 videos from each search (N = 80) were retrieved. Deductive content analysis was first applied for coding and data interpretation and it was followed by descriptive statistical analysis. Results: A total of 52 videos were analyzed (65%). The majority of the videos were in the “Music” category (50%, n = 26). Most of the videos (83%, n = 43) tended to present schizophrenia in a negative way, while less than a fifth (17%, n = 9) presented schizophrenia in a positive or neutral way. Specifically, the most common negative attitude towards schizophrenia was dangerousness (29%, n = 15), while the most often identified positive attitude was objective, medically appropriate beliefs (21%, n = 11). All attitudes identified were similarly present in the Finnish and Greek videos, without any statistically significant difference. Conclusions: Negative presentations of schizophrenia are most likely to be accessed when searching YouTube for schizophrenia in Finnish and Greek language. More research is needed to investigate to what extent, if any, YouTube viewers’ attitudes are affected by the videos they watch.

Developing an Internet-Based Support System for Adolescents with Depression

Background Depression is the most common mental health problem among adolescents. Despite policy guidance and governmental support to develop usable mental health services, there is still a lack of easily accessible and modern interventions available for adolescents in Finland’s majority official language. Objective Our objective was to develop a user-friendly and feasible Internet-based support system for adolescents with depression. Methods The Internet-based support system for adolescents with depression was developed. To create this new intervention, some examples of existing interventions were studied, the theoretical basis for the intervention was described, and the health needs of adolescents identified. As an outcome of the process, the results were combined and the content and delivery of a new intervention will be described here. Results Six individual weekly Internet-based support sessions were delivered by a tutor over a 6-week period of time and developed to form an intervention called Depis.Net. This was an Internet-based support system for adolescents with depression tailored to improve self-management skills and increase awareness of their own well-being and mental health. The intervention was accessible via an electronic platform, which was secured and password protected for users. The intervention on the Depis.Net website consisted of elements identifying adolescents’ needs, and offering self-monitoring, access to health information and self-reflective written exercises. An educated nurse tutor gave written feedback to each adolescent via the electronic platform. Conclusions An Internet-based support system for adolescents with depression was developed using a systematic approach with four steps. This was done to ensure that the intervention had a sound theoretical background and at the same time caters flexibly for the problems that adolescents commonly face in their daily lives. Its potential for adolescents visiting outpatient clinics will be evaluated in the next phase by means of a randomized controlled trial.

An analysis of online health information on schizophrenia or related conditions: a cross-sectional survey

BackgroundAround 20% of those who seek health information online, search specifically for mental health. However, little is known about the nature of the online health information offered by two European countries, Finland and Greece, which are characterized by markedly differing levels of Internet access and online health information seeking. This study aims to assess, describe and compare websites, written in two European, non-English languages (Finnish and Greek) that appear first after performing an online search concerning schizophrenia or related conditions.MethodsThe first 20 results from four search terms (searched in Finnish and Greek) in the Web search engine ‘Google’ were screened. A total of 160 websites were retrieved (80 Finnish, 80 Greek) and evaluated using a preformulated coding system which consisted of websites’ indicators, such as: types, characteristics, accountability, interactivity, aesthetics and content. Differences between websites were evaluated with Chi-Square or Fisher’s Exact tests for categorical data and independent t-tests for parametric data.ResultsTwenty-four Finnish and thirty-four Greek websites (36% in total) were included. Almost two-thirds (62%, n=36) were owned by an organization, compared to 17% (n=10) by an individual. In both countries, aesthetics had the highest score (possible range 0–4, mean = 2.6, SD = .62), while interactivity the lowest (range 0–5, mean = 1.79, SD = .87). There were no statistically significant differences among the accountability, interactivity and aesthetics scores of the Finnish and Greek websites.ConclusionsAll assessed indicators suggest there is a need to improve Finnish and Greek online information about schizophrenia or related conditions. The poor website interactivity is of particular concern given the challenges faced by the target group. The findings can be used to guide the development and dissemination of online mental health information aimed at Finnish and Greek online health-seekers.

Connectivity to computers and the Internet among patients with schizophrenia spectrum disorders: a cross-sectional study

Purpose Information and communication technologies have been developed for a variety of health care applications and user groups in the field of health care. This study examined the connectivity to computers and the Internet among patients with schizophrenia spectrum disorders (SSDs). Patients and methods A cross-sectional survey design was used to study 311 adults with SSDs from the inpatient units of two psychiatric hospitals in Finland. The data collection lasted for 20 months and was done through patients’ medical records and a self-reported, structured questionnaire. Data analysis included descriptive statistics. Results In total, 297 patients were included in this study (response rate =96%). More than half of them (n=156; 55%) had a computer and less than half of them (n=127; 44%) had the Internet at home. Of those who generally had access to computers and the Internet, more than one-fourth (n=85; 29%) used computers daily, and >30% (n=96; 33%) never accessed the Internet. In total, approximately one-fourth of them (n=134; 25%) learned to use computers, and less than one-third of them (n=143; 31%) were known to use the Internet by themselves. Older people (aged 45–65 years) and those with less years of education (primary school) tended not to use the computers and the Internet at all (P<0.001), and younger people and those with higher education were associated with more active use. Conclusion Patients had quite good access to use computers and the Internet, and they mainly used the Internet to seek information. Social, occupational, and psychological functioning (which were evaluated with Global Assessment of Functioning) were not associated with access to and frequency of computer and the Internet use. The results support the use of computers and the Internet as part of clinical work in mental health care.

Short Text Messages to Encourage Adherence to Medication and Follow-up for People With Psychosis (Mobile.Net): Randomized Controlled Trial in Finland

Background A text messaging service (short message service [SMS]) has the potential to target large groups of people with long-term illnesses such as serious mental disorders, who may have difficulty with treatment adherence. Robust research on the impact of mobile technology interventions for these patients remains scarce. Objective The main objective of our study was to investigate the impact of individually tailored short text messages on the rate of psychiatric hospital readmissions, health care service use, and clinical outcomes. In addition, we analyzed treatment costs. Methods Between September 2011 and November 2012, we randomly assigned 1139 people to a tailored text message intervention (n=569) or usual care (n=570). Participants received semiautomated text messages for up to 12 months or usual care. The primary outcome, based on routinely collected health register data, was patient readmission into a psychiatric hospital during a 12-month follow-up period. Secondary outcomes were related to other service use, coercion, medication, adverse events, satisfaction, social functioning, quality of life, and economic factors (cost analysis). Results There was 98.24% (1119/1139) follow-up at 12 months. Tailored mobile telephone text messages did not reduce the rate of hospital admissions (242/563, 43.0% of the SMS group vs 216/556, 38.8% of the control group; relative risk 1.11; 95% CI 0.92-1.33; P=.28), time between hospitalizations (mean difference 7.0 days 95% CI –8.0 to 24.0; P=.37), time spent in a psychiatric hospital during the year (mean difference 2.0 days 95% CI –2.0 to 7.0; P=.35), or other service outcomes. People who received text messages were less disabled, based on Global Assessment Scale scores at the time of their readmission, than those who did not receive text messages (odds ratio 0.68; 95% CI 0.47-0.97; P=.04). The costs of treatment were higher for people in the SMS group than in the control group (mean €10,103 vs €9210, respectively, P<.001). Conclusions High-grade routinely collected data can provide clear outcomes for pragmatic randomized trials. SMS messaging tailored with the input of each individual patient did not decrease the rate of psychiatric hospital visits after the 12 months of follow-up. Although there may have been other, more subtle effects, the results of these were not evident in outcomes of agreed importance to clinicians, policymakers, and patients and their families. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 27704027; http://www.isrctn.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/6rVzZrbuz).