Continuity of care in psychiatric post-ward outpatient services--conceptions of patients and personnel concerning factors contributing to the continuity of care.

A structural change of the psychiatric services was started in Finland in the 1980s. Its primary objective was to shift the main emphasis from hospital to outpatient services. Hence, the number of psychiatric beds has declined to a third of the maximum rate, inpatient periods have shortened and the number of outpatient appointments has increased significantly. International research shows that when the emphasis of psychiatric services shifts to outpatient services and hospitalization becomes short-term, diverse individual alternatives are needed to support patients' coping. Several Finnish psychiatric hospitals initiated in the 1990s outpatient services provided at inpatient wards, which means, that after the period of hospitalization, further care is provided to the patient at the same ward where s/he was hospitalized. The purpose of this study was to describe and analyse the conceptions of patients, ward personnel, outpatient services personnel and administrative personnel in psychiatric units concerning the factors improving the continuity of care. A phenomenographic approach was used and the objective was to find the different empirical variations of the conceptions, through which people experience, comprehend and become conscious of the phenomena in the surrounding world. The data were gathered by interviewing post-ward outpatients (n=5), personnel at psychiatric wards and in outpatient services (n=18) and administrative personnel in psychiatric units (n=5). As a result of the analysis seven categories of the factors improving the continuity of care were formed: (1) adherence to a good cooperative relationship; (2) adherence to the care environment; (3) flexibility in tailoring care; (4) active maintenance of contacts in care; (5) constant possibility to contact the ward; (6) up-to-date patient data; and (7) active cooperation between outpatient services and other collaborators.