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Simulating a Community Mental Health Service During the COVID-19 Pandemic: Effects of Clinician-Clinician Encounters, Clinician-Patient-Family Encounters, Symptom-Triggered Protective Behaviour, and Household Clustering.
Cardinal, Rudolf N; Meiser-Stedman, Caroline E; Christmas, David M; Price, Annabel C; Denman, Chess; Underwood, Benjamin R; Chen, Shanquan; Banerjee, Soumya; White, Simon R; Su, Li; Ford, Tamsin J; Chamberlain, Samuel R; Walsh, Catherine M.
  • Cardinal RN; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, United Kingdom.
  • Meiser-Stedman CE; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
  • Christmas DM; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, United Kingdom.
  • Price AC; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, United Kingdom.
  • Denman C; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, United Kingdom.
  • Underwood BR; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, United Kingdom.
  • Chen S; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, United Kingdom.
  • Banerjee S; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
  • White SR; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
  • Su L; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
  • Ford TJ; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
  • Chamberlain SR; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, United Kingdom.
  • Walsh CM; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
Front Psychiatry ; 12: 620842, 2021.
Article in English | MEDLINE | ID: covidwho-1133985
Preprint
This scientific journal article is probably based on a previously available preprint. It has been identified through a machine matching algorithm, human confirmation is still pending.
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ABSTRACT

Objectives:

Face-to-face healthcare, including psychiatric provision, must continue despite reduced interpersonal contact during the COVID-19 (SARS-CoV-2 coronavirus) pandemic. Community-based services might use domiciliary visits, consultations in healthcare settings, or remote consultations. Services might also alter direct contact between clinicians. We examined the effects of appointment types and clinician-clinician encounters upon infection rates.

Design:

Computer simulation.

Methods:

We modelled a COVID-19-like disease in a hypothetical community healthcare team, their patients, and patients' household contacts (family). In one condition, clinicians met patients and briefly met family (e.g., home visit or collateral history). In another, patients attended alone (e.g., clinic visit), segregated from each other. In another, face-to-face contact was eliminated (e.g., videoconferencing). We also varied clinician-clinician contact; baseline and ongoing "external" infection rates; whether overt symptoms reduced transmission risk behaviourally (e.g., via personal protective equipment, PPE); and household clustering.

Results:

Service organisation had minimal effects on whole-population infection under our assumptions but materially affected clinician infection. Appointment type and inter-clinician contact had greater effects at low external infection rates and without a behavioural symptom response. Clustering magnified the effect of appointment type. We discuss infection control and other factors affecting appointment choice and team organisation.

Conclusions:

Distancing between clinicians can have significant effects on team infection. Loss of clinicians to infection likely has an adverse impact on care, not modelled here. Appointments must account for clinical necessity as well as infection control. Interventions to reduce transmission risk can synergize, arguing for maximal distancing and behavioural measures (e.g., PPE) consistent with safe care.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Prognostic study Language: English Journal: Front Psychiatry Year: 2021 Document Type: Article Affiliation country: Fpsyt.2021.620842

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Prognostic study Language: English Journal: Front Psychiatry Year: 2021 Document Type: Article Affiliation country: Fpsyt.2021.620842