Alternatives to standard acute in-patient care in England: differences in content of care and staff-patient contact.
BACKGROUND
Differences in the content of care provided by acute in-patient mental health wards and residential crisis services such as crisis houses have not been researched.


OBJECTIVE
To compare planned and actual care provided at alternative and standard acute wards and to investigate the relationship between care received and patient satisfaction.


METHODS
Perspectives of stakeholders, including local service managers, clinicians and commissioners, were obtained from 23 qualitative interviews. Quantitative investigation of the care provided at four alternative and four standard services was undertaken using three instruments developed for this study. The relationship of care received to patient satisfaction was explored.


RESULTS
No significant difference was found in intensity of staff-patient contact between alternative and standard services. Alternative services provided more psychological and less physical and pharmacological care than standard wards. Care provision may be more collaborative and informal in alternative services. All measured types of care were positively associated with patient satisfaction. Measured differences in the care provided did not explain the greater acceptability of community alternatives.


CONCLUSIONS
Similarities in care may be more marked than differences at alternative and standard services. Staff-patient contact is an important determinant of patient satisfaction, so increasing it should be a priority for all acute in-patient services.
Lloyd-Evans
B
B
Department of Mental Health Sciences, Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UK. b.lloyd-evans@ucl.ac.uk.
Johnson
S
S
Morant
N
N
Gilburt
H
H
Osborn
D P J
DP
Jagielska
D
D
Skinner
R
R
Leese
M
M
Shepherd
G
G
Slade
M
M
D000208:Acute Disease; D016000:Cluster Analysis; D003155:Community Mental Health Centers; D004739:England; D006760:Hospitalization / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric; D006801:Humans; D001523:Mental Disorders / Q000534:rehabilitation / Q000628:therapy*; D008962:Models, Theoretical; D005791:Patient Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012044:Regression Analysis; D013997:Time Factors