'In some ways it all helps but in some ways it doesn't': The complexities of service users' experiences of inpatient mental health care in Australia.

PubMed

Isobel, Sophie

2018-06-13

Recovery-oriented mental health care requires active involvement of service users in the evaluation of care. While experience of care surveys is routinely given out upon discharge, capturing the depth and detail of service users' experiences in such a way to meaningfully improve services may require more in-depth and targeted approaches. This study aimed to gather voluntary and involuntary service users' experiences of care during hospitalization in two acute adult mental health inpatient units, through the collaborative completion of a purpose designed tool. The purpose of the study was to examine broad experiences of care and to identify the utility of proactive approaches to ongoing service evaluation. Overall, 67 participants were interviewed. Findings highlight the complexity of experiences of care including how an admission can seemingly facilitate clinical recovery while not being recovery-oriented. The findings also detail areas for improvement in the way that care is delivered and evaluated. The implications are particularly pertinent for mental health nurses to consider how, within the existing constraints of their roles, they can provide therapeutic care to all service users. © 2018 Australian College of Mental Health Nurses Inc.

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study.

PubMed

Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P; Krettek, Alexandra

2014-01-01

Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

Characteristics of service users and provider organisations associated with experience of out of hours general practitioner care in England: population based cross sectional postal questionnaire survey.

PubMed

Warren, Fiona C; Abel, Gary; Lyratzopoulos, Georgios; Elliott, Marc N; Richards, Suzanne; Barry, Heather E; Roland, Martin; Campbell, John L

2015-04-29

To investigate the experience of users of out of hours general practitioner services in England, UK. Population based cross sectional postal questionnaire survey. General Practice Patient Survey 2012-13. Potential associations between sociodemographic factors (including ethnicity and ability to take time away from work during working hours to attend a healthcare consultation) and provider organisation type (not for profit, NHS, or commercial) and service users' experience of out of hours care (timeliness, confidence and trust in the out of hours clinician, and overall experience of the service), rated on a scale of 0-100. Which sociodemographic/provider characteristics were associated with service users' experience, the extent to which any observed differences could be because of clustering of service users of a particular sociodemographic group within poorer scoring providers, and the extent to which observed differences in experience varied across types of provider. The overall response rate was 35%; 971,232/2,750,000 patients returned surveys. Data from 902,170 individual service users were mapped through their registered practice to one of 86 providers of out of hours GP care with known organisation type. Commercial providers of out of hours GP care were associated with poorer reports of overall experience of care, with a mean difference of -3.13 (95% confidence interval -4.96 to -1.30) compared with not for profit providers. Asian service users reported lower scores for all three experience outcomes than white service users (mean difference for overall experience of care -3.62, -4.36 to -2.89), as did service users who were unable to take time away from work compared with service users who did not work (mean difference for overall experience of care -4.73, -5.29 to -4.17). Commercial providers of out of hours GP care were associated with poorer experience of care. Targeted interventions aimed at improving experience for patients from ethnic minorities and patients who are unable to take time away from work might be warranted. © Warren et al 2015.

Involving older people in intermediate care.

PubMed

Andrews, JoyAnn; Manthorpe, Jill; Watson, Roger

2004-05-01

Intermediate care has become a crucial part of the United Kingdom government's programme for improving services for older people. Older people comprise a substantial part of the user base for these services, and it is increasingly recognized that there is a need for greater user involvement in service development for intermediate care. National initiatives undertaken in intermediate care have sought to widen and deepen the remit of such services, and in this way promote greater independence and improved quality of care for older people. In particular, the government has set out clear plans for reshaping services for older people in the National Health Service Plan and the rationale for greater involvement of older people in service development. This article considers ways in which these national and local objectives may be achieved and considers some of the implications for nursing. This paper aims to explore the concept of intermediate care and to identify trends and existing evidence of user involvement in care. In this way it charts a possible way forward for the development of a more 'user sensitive' approach. The following databases were searched: Medline, Cochrane Library, the Social Science Citation Index and CINAHL. Key words were 'intermediate care', 'older people', 'formal care', 'primary care', 'social services' and 'geriatrics', used in combination. The findings from this study indicate that there is considerable scope for increased user involvement in service development for intermediate care. Such challenges may be more effectively met through greater clarity of the concept of intermediate care, and a bridging of user involvement at the practice and policy levels. Nurses are key providers of intermediate care in the community. The involvement of older people in intermediate care service development must be premised on a shared comprehension of the purpose and function of intermediate care. Nurses must be involved in shifting intermediate care from being service-focused to patient-centred. Effective participation eschews the application of global constructs for older people, while supporting greater participation at all levels and robust implementation processes.

'If they're helping me then how can I be independent?' The perceptions and experience of users of home-care re-ablement services.

PubMed

Wilde, Alison; Glendinning, Caroline

2012-11-01

Home-care re-ablement is a short-term, intensive service that helps people to (re-) establish their capacity and confidence in performing basic personal care and domestic tasks at home, thereby reducing needs for longer term help. Home-care re-ablement is an increasingly common feature of English adult social care services; there are similar service developments in Australia and New Zealand. This paper presents evidence from semi-structured interviews conducted in early 2010 with 34 service users and 10 carers from five established re-ablement services in England. The interviews formed part of a larger, mixed-methods study into the immediate and longer term impacts and cost-effectiveness of home-care re-ablement services. There was clear evidence that interviewees felt that they had benefitted from re-ablement services; most service users and their families valued the intervention. However, the interviews also identified potential barriers to optimal independence for some service users, particularly those with progressive conditions, sensory impairments, specific cultural needs, or who lived alone. The beneficial impacts of re-ablement could also be reduced if users failed to understand the aims of the service, or if the service failed to provide support with activities or outcomes that were particularly important to the service user or carer. Putting the lived experiences of people receiving re-ablement at the centre of analysis, this paper concludes that re-ablement services have the potential for enhanced effectiveness, particularly if there is more understanding of users' own priorities and concepts of independence. © 2012 Blackwell Publishing Ltd.

Service quality and clinical outcomes: an example from mental health rehabilitation services in England.

PubMed

Killaspy, Helen; Marston, Louise; Omar, Rumana Z; Green, Nicholas; Harrison, Isobel; Lean, Melanie; Holloway, Frank; Craig, Tom; Leavey, Gerard; King, Michael

2013-01-01

Current health policy assumes better quality services lead to better outcomes. To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes. Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes. A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life. Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

PubMed Central

Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P.; Krettek, Alexandra

2014-01-01

Background Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. Design We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Results Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Conclusions Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps. PMID:25119066

[Questionnaire survey of the actual working conditions of care-managers].

PubMed

Yagame, Mitsunori; Takasuna, Hiroko; Aoki, Jun'ichi; Abe, Mitsuhiro; Ogiwara, Masumi; Saito, Norimoto; Shiozaki, Yoshihiro; Nagai, Masako; Yamano, Atsushi; Yoshitaki, Ken'ichi; Yonehana, Nao; Tanaka, Chieko; Seto, Tsunehiko; Saito, Manabu; Narukawa, Yoshio

2003-12-01

In order to clarify the present status of care-managers, a questionnaire was sent to 1,714 care-managers working in Kanagawa Prefecture in June 2002. The aspects Investigated included their background, amount of care-management and degree of achievement, conditions of employment, opinion poll and training system. The response rate was 45.6% (782 out of 1,714). Concerning the total number of users in care at present, 37% of care-managers had less than 30 people, 24% from 31 to 50 and, surprisingly, 39% had more than 51 people. However, 42% answered that less than 30 was an appropriate number of users, 52% said 31 to 50 and only 6% answered that more than 51 people was an appropriate number. The conferences of users service representative were held only 8%. Concerning the burden of care-management, 87% of them answered the evaluation of every month and 86% did the conferences of users service representative. The cases requiring much time for the support, had problems not only the users but also in the household, who lacked the understanding and judgment for long-term care insurance. Most care-managers needed information on the available services and newly open care-service institutions. 27% of care-managers satisfied their care-management, 25% dissatisfied and the remainder were neither off nor on. The satisfaction to the care-management correlated well with the intelligibility of the management leader, motivation regarding care-management and the degree of satisfaction with their income. It is concluded that the number of users per care-manager is too large, and that unfortunately it might further increase in the future. The conferences of users service representative were extremely held too low. It is also showed that information of the other service office and informal service with the exception of long-term care insurance are required.

[Questionnaire survey of the actual working conditions of care-managers].

PubMed

Yagame, Mitsunori; Takasuna, Hiroko; Aoki, Jun'ichi; Abe, Mitsuhiro; Ogiwara, Masumi; Saito, Norimoto; Shiozaki, Yoshihiro; Nagai, Masako; Yamano, Atsushi; Yoshitaki, Ken'ichi; Yonehana, Nao; Tanaka, Chieko; Seto, Tsunehiko; Saito, Manabu; Narukawa, Yoshio

2003-12-01

In order to clarify the present status of care-managers, a questionnaire was sent to 1,714 care-managers working in Kanagawa Prefecture in June 2002. The aspects investigated included their background, amount of care-management and degree of achievement, conditions of employment, opinion poll and training system. The response rate was 45.6% (782 out of 1,714). Concerning the total number of users in care at present, 37% of care-managers had less than 30 people, 24% from 31 to 50 and, surprisingly, 39% had more than 51 people. However, 42% answered that less than 30 was an appropriate number of users, 52% said 31 to 50 and only 6% answered that more than 51 people was an appropriate number. The conferences of users service representative were held only 8%. Concerning the burden of care-management, 87% of them answered the evaluation of every month and 86% did the conferences of users service representative. The cases requiring much time for the support, had problems not only the users but also in the household, who lacked the understanding and judgment for long-term care insurance. Most care-managers needed information on the available services and newly open care-service institutions. 27% of care-managers satisfied their care-management, 25% dissatisfied and the remainder were neither off nor on. The satisfaction to the care-management correlated well with the intelligibility of the management leader, motivation regarding care management and the degree of satisfaction with their income. It is concluded that the number of users per care-manager is too large, and that unfortunately it might further increase in the future. The conferences of users service representative were extremely held too low. It is also showed that information of the other service office and informal service with the exception of long-term care insurance are required.

Mental health service users' experiences of mental health care: an integrative literature review.

PubMed

Newman, D; O'Reilly, P; Lee, S H; Kennedy, C

2015-04-01

A number of studies have highlighted issues around the relationship between service users and providers. The recovery model is predominant in mental health as is the recognition of the importance of person-centred practice. The authors completed an in-depth search of the literature to answer the question: What are service users' experiences of the mental health service? Three key themes emerged: acknowledging a mental health problem and seeking help; building relationships through participation in care; and working towards continuity of care. The review adds to the current body of knowledge by providing greater detail into the importance of relationships between service users and providers and how these may impact on the delivery of care in the mental health service. The overarching theme that emerged was the importance of the relationship between the service user and provider as a basis for interaction and support. This review has specific implications for mental health nursing. Despite the recognition made in policy documents for change, issues with stigma, poor attitudes and communication persist. There is a need for a fundamental shift in the provider-service user relationship to facilitate true service-user engagement in their care. The aim of this integrative literature review was to identify mental health service users' experiences of services. The rationale for this review was based on the growing emphasis and requirements for health services to deliver care and support, which recognizes the preferences of individuals. Contemporary models of mental health care strive to promote inclusion and empowerment. This review seeks to add to our current understanding of how service users experience care and support in order to determine to what extent the principles of contemporary models of mental health care are embedded in practice. A robust search of Web of Science, the Cochrane Database, Science Direct, EBSCO host (Academic Search Complete, MEDLINE, CINAHL Plus Full-Text), PsycINFO, PsycARTICLES, Social Sciences Full Text and the United Kingdom and Ireland Reference Centre for data published between 1 January 2008 and 31 December 2012 was completed. The initial search retrieved 272 609 papers. The authors used a staged approach and the application of predetermined inclusion/exclusion criteria, thus the numbers of papers for inclusion were reduced to 34. Data extraction, quality assessment and thematic analysis were completed for the included studies. Satisfaction with the mental health service was moderately good. However, accessing services could be difficult because of a lack of knowledge and the stigma surrounding mental health. Large surveys document moderate satisfaction ratings; however, feelings of fear regarding how services function and the lack of treatment choice remain. The main finding from this review is while people may express satisfaction with mental health services, there are still issues around three main themes: acknowledging a mental health problem and seeking help; building relationship through participation and care; and working towards continuity of care. Elements of the recovery model appear to be lacking in relation to user involvement, empowerment and decision making. There is a need for a fundamental shift in the context of the provider-service user relationship to fully facilitate service users' engagement in their care. © 2015 John Wiley & Sons Ltd.

Setting up recovery clinics and promoting service user involvement.

PubMed

John, Thomas

2017-06-22

Service user involvement in mental health has gained considerable momentum. Evidence from the literature suggests that it remains largely theoretical rather than being put into practice. The current nature of acute inpatient mental health units creates various challenges for nurses to put this concept into practice. Recovery clinics were introduced to bridge this gap and to promote service user involvement practice within the current care delivery model at Kent and Medway NHS and Social Care Partnership Trust. It has shaped new ways of working for nurses with a person-centred approach as its philosophy. Service users and nurses were involved in implementing a needs-led and bottom-up initiative using Kotter's change model. Initial results suggest that it has been successful in meeting its objectives evidenced through increased meaningful interactions and involvement in care by service users and carers. The clinics have gained wide recognition and have highlighted a need for further research into care delivery models to promote service user involvement in these units.

Characteristics and Service Use of Medicare Beneficiaries Using Federally Qualified Health Centers.

PubMed

Chang, Chiang-Hua; Lewis, Valerie A; Meara, Ellen; Lurie, Jon D; Bynum, Julie P W

2016-08-01

Federally Qualified Health Centers (FQHCs) provide primary care for millions of Americans, but little is known about Medicare beneficiaries who use FQHCs. To compare patient characteristics and health care service use among Medicare beneficiaries stratified by FQHC use. Cross-sectional analysis of 2011 Medicare fee-for-service beneficiaries aged 65 years and older. Subjects included beneficiaries with at least 1 evaluation and management (E&M) visit in 2011, categorized as FQHC users (≥1 E&M visit to FQHCs) or nonusers living in the same primary care service areas as FQHC users. Users were subclassified as predominant if the majority of their E&M visits were to FQHCs. Demographic characteristics, physician visits, and inpatient care use. Most FQHC users (56.6%) were predominant users. Predominant and nonpredominant users, compared with nonusers, markedly differed by prevalence of multiple chronic conditions (18.2%, 31.7% vs. 22.7%) and annual mortality (2.8%, 3.8% vs. 4.0%; all P<0.05). In adjusted analyses (reference: nonusers), predominant users had fewer physician visits (RR=0.81; 95% CI, 0.81-0.81) and fewer hospitalizations (RR=0.84; 95% CI, 0.84-0.85), whereas nonpredominant users had higher use of both types of service (RR=1.18, 95% CI, 1.18-1.18; RR=1.09, 95% CI, 1.08-1.10, respectively). Even controlling for primary care delivery markets, nonpredominant FQHC users had a higher burden of chronic illness and service use than predominant FQHC users. It will be important to monitor Medicare beneficiaries using FQHCs to understand whether primary care only payment incentives for FQHCs could induce fragmented care.

From admission to discharge in mental health services: a qualitative analysis of service user involvement.

PubMed

Wright, Nicola; Rowley, Emma; Chopra, Arun; Gregoriou, Kyriakos; Waring, Justin

2016-04-01

User involvement and recovery are now widely used terms within the mental health policy, research and practice discourse. However, there is a question mark about the impact these ideas have in everyday practice. Of interest is the degree of involvement in key transitions of care. In particular, admission to and discharge from acute inpatient mental health wards. To explore the nature of service user involvement in the admission and discharge process into and out of acute inpatient mental health care. A qualitative study using focus groups. One acute, inpatient mental health ward was the focus of the study. Seven uniprofessional focus group interviews were conducted with ward staff, community staff and service users (total number of participants = 52). Conventional, thematic qualitative techniques were used to analyse the data. The data analysed and presented in this article relate to the loss of the service user voice at the key transition points into and out of acute inpatient care. Due to the lack of resources (inpatient beds and community care follow-up), the role service users could play was diminished. In their narratives, clinical staff associated the person with the process and used language which dehumanized the individual. Service users experience numerous care transitions into and out of hospital. As there is the potential for these encounters to have a lasting negative effect, the importance of ensuring service users have a voice in what is happening to them is crucial. © 2015 John Wiley & Sons Ltd.

Ethnic minority inequalities in access to treatments for schizophrenia and schizoaffective disorders: findings from a nationally representative cross-sectional study.

PubMed

Das-Munshi, Jayati; Bhugra, Dinesh; Crawford, Mike J

2018-04-18

Ethnic minority service users with schizophrenia and schizoaffective disorders may experience inequalities in care. There have been no recent studies assessing access to evidence-based treatments for psychosis amongst the main ethnic minority groups in the UK. Data from nationally representative surveys from England and Wales, for 10,512 people with a clinical diagnosis of schizophrenia or schizoaffective disorders, were used for analyses. Multi-level multivariable logistic regression analyses were used to assess ethnic minority inequalities in access to pharmacological treatments, psychological interventions, shared decision making and care planning, taking into account a range of potential confounders. Compared with white service users, black service users were more likely prescribed depot/injectable antipsychotics (odds ratio 1.56 (95% confidence interval 1.33-1.84)). Black service users with treatment resistance were less likely to be prescribed clozapine (odds ratio 0.56 (95% confidence interval 0.39-0.79)). All ethnic minority service users, except those of mixed ethnicity, were less likely to be offered cognitive behavioural therapy, compared to white service users. Black service users were less likely to have been offered family therapy, and Asian service users were less likely to have received copies of care plans (odds ratio 0.50 (95% confidence interval 0.33-0.76)), compared to white service users. There were no clinician-reported differences in shared decision making across each of the ethnic minority groups. Relative to white service users, ethnic minority service users with psychosis were generally less likely to be offered a range of evidence-based treatments for psychosis, which included pharmacological and psychological interventions as well as involvement in care planning.

More than what the eye can see: the emotional journey and experience of powerlessness of integrated care service users and their carers

PubMed Central

Boudioni, Markella; Hallett, Nina; Lora, Cristina; Couchman, Wendy

2015-01-01

Purpose This article presents the emotional journey and experience of powerlessness of integrated care service users and carers. Materials and methods The experiences of seven integrated care service users and carers affected by complex conditions in a London borough were captured as video stories. The integrated care service coordinated a system of health and social care: primary care, community matrons, social workers, and the voluntary sector. The service was designed to respond to identified cases of high-risk individuals with long-term, multiple, and age-related conditions needing preventive interventions. The video stories were analyzed by researchers in collaboration with service users using a visual thematic qualitative approach. This report is part of an independent analysis of the integrated care service evaluation that used the experience-based codesign model. Results The findings are presented in the respective contexts of people with complex conditions and their carers. The overwhelming feelings and emotions of both were loss of control and power throughout their emotional journey, with family carers adopting a protective attitude toward the patients. Their experience of powerlessness was variable throughout their emotional journey. They were affected more strongly when in need of extra help and support and while they were undergoing the process of receiving extra services. When they were receiving help and support outside and within hospitals, some participants were empowered, gaining skills and knowledge by being provided with the mechanisms to cope with their condition at present and in the future. Conclusion Feelings of powerlessness were very common among integrated care service users and their carers. Powerless/empowerment has been poorly investigated to date. Visual methods and collaborative visual analysis with service users have proved to be powerful methods too, but have been rarely reported. PMID:25848232

Reassurance as a key outcome valued by emergency ambulance service users: a qualitative interview study.

PubMed

Togher, Fiona J; O'Cathain, Alicia; Phung, Viet-Hai; Turner, Janette; Siriwardena, Aloysius Niroshan

2015-12-01

There is an increasing need to assess the performance of emergency ambulance services using measures other than the time taken for an ambulance to arrive on scene. In line with government policy, patients and carers can help to shape new measures of ambulance service performance. To investigate the aspects of emergency ambulance service care valued by users. Qualitative interview study. One of 11 ambulance services in England. Twenty-two users and eight of their spouses (n = 30). Users of the emergency ambulance service, experiencing different types of ambulance service response, valued similar aspects of their pre-hospital care. Users were often extremely anxious about their health, and the outcome they valued was reassurance provided by ambulance service staff that they were receiving appropriate advice, treatment and care. This sense of being reassured was enhanced by the professional behaviour of staff, which instilled confidence in their care; communication; a short wait for help; and continuity during transfers. A timely response was valued in terms of allaying anxiety quickly. The ability of the emergency ambulance service to allay the high levels of fear and anxiety felt by users is crucial to the delivery of a high quality service. Measures developed to assess and monitor the performance of emergency ambulance services should include the proportion of users reporting feeling reassured by the response they obtained. © 2014 John Wiley & Sons Ltd.

Perspectives of self-direction: a systematic review of key areas contributing to service users' engagement and choice-making in self-directed disability services and supports.

PubMed

Lakhani, Ali; McDonald, Donna; Zeeman, Heidi

2018-05-01

Self-directed disability support policies aim to encourage greater choice and control for service users in terms of the health and social care they receive. The proliferation of self-directed disability support policies throughout the developed world has resulted in a growing amount of research exploring the outcomes for service users, and their families and carers. Our understanding of the issues faced by people with disabilities, particularly how they make health and social care decisions and the key areas that determine their engagement with service providers within a self-directed environment is limited. A synthesis of research is timely and can provide knowledge for service users and health and social care support providers to ensure their successful participation. A systematic review guided by the PRISMA approach explored (i) the key areas determining service users' engagement with self-directed disability services and supports, and (ii) how service users make informed decisions about providers. In October 2014 and April 2016, three databases - MEDLINE, CINAHL and Web of Science - were searched for research and review articles. Eighteen sources met the search criteria. Findings were mapped into either: key areas determining service user engagement, or service users' informed decision-making. Findings concerning key areas determining engagement fell into three themes - personal responsibility for budgeting, personalised approaches, and a cultural shift in practice and delivery among service providers. Findings about decision-making yielded two themes - supporting informed decision-making and inhibiting informed decision-making. Literature suggests that self-directed models of care may provide service users with increased control over the services that they receive. Increased control for some service users and their families requires independent external decision-making support, particularly around the domains of budgeting, planning and hiring. Future research must continue to investigate the perspectives of service users pertaining to their engagement, as their participation is central to the effectiveness of the approach. © 2016 John Wiley & Sons Ltd.

Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study.

PubMed

Catalao, Raquel; Eshetu, Tigist; Tsigebrhan, Ruth; Medhin, Girmay; Fekadu, Abebaw; Hanlon, Charlotte

2018-05-21

In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such services in LMICs. Our study aimed to explore the perspectives of service users and caregivers on the accessibility, experience and perceived impact of epilepsy treatment received in a task-shared model in a rural district of Ethiopia. A qualitative study was carried out using interviews with purposively sampled service users (n = 13) and caregivers (n = 3) from a community-ascertained cohort of people with epilepsy receiving integrated services in primary care in rural Ethiopia. Interviews followed a topic guide with questions regarding acceptability, satisfaction, barriers to access care, pathways through care and impact of services. Framework analysis was employed to analyse the data. Proximity of the new service in local primary health centers decreased the cost of transportation for the majority of service users thus improving access to services. First-hand experience of services was in some cases associated with a willingness to promote the services and inform others of the existence of effective biomedical treatment for epilepsy. However, most service users and their caregivers continued to seek help from traditional healers alongside biomedical care. Most of the care received was focused on medication provision with limited information provided on how to manage their illness and its effects. Caregivers and service users spoke about the high emotional and financial burden of the disease and lack of ongoing practical and emotional support. The majority of participants reported clinical improvement on medication, which in over half of the participants was associated with ability to return to money generating activities. Task-sharing improved the accessibility of epilepsy care for services users and caregivers and was perceived as having a positive impact on symptoms and productivity. Nonetheless, promotion of self-management, holistic care and family engagement were highlighted as areas requiring further improvement. Future work on implementing chronic care models in LMIC contexts is warranted.

Professional perspectives on service user and carer involvement in mental health care planning: a qualitative study.

PubMed

Bee, Penny; Brooks, Helen; Fraser, Claire; Lovell, Karina

2015-12-01

Involving users/carers in mental health care-planning is central to international policy initiatives yet users frequently report feeling excluded from the care planning process. Rigorous explorations of mental health professionals' experiences of care planning are lacking, limiting our understanding of this important translational gap. To explore professional perceptions of delivering collaborative mental health care-planning and involving service users and carers in their care. Qualitative interviews and focus groups with data combined and subjected to framework analysis. UK secondary care mental health services. 51 multi-disciplinary professionals involved in care planning and recruited via study advertisements. Emergent themes identified care-planning as a meaningful platform for user/carer involvement but revealed philosophical tensions between user involvement and professional accountability. Professionals emphasised their individual, relational skills as a core facilitator of involvement, highlighting some important deficiencies in conventional staff training programmes. Although internationally accepted on philosophical grounds, user-involved care-planning is poorly defined and lacks effective implementation support. Its full realisation demands greater recognition of both the historical and contemporary contexts in which statutory mental healthcare occurs. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

A cluster randomised controlled trial and process evaluation of a training programme for mental health professionals to enhance user involvement in care planning in service users with severe mental health issues (EQUIP): study protocol for a randomised controlled trial.

PubMed

Bower, Peter; Roberts, Chris; O'Leary, Neil; Callaghan, Patrick; Bee, Penny; Fraser, Claire; Gibbons, Chris; Olleveant, Nicola; Rogers, Anne; Davies, Linda; Drake, Richard; Sanders, Caroline; Meade, Oonagh; Grundy, Andrew; Walker, Lauren; Cree, Lindsey; Berzins, Kathryn; Brooks, Helen; Beatty, Susan; Cahoon, Patrick; Rolfe, Anita; Lovell, Karina

2015-08-13

Involving service users in planning their care is at the centre of policy initiatives to improve mental health care quality in England. Whilst users value care planning and want to be more involved in their own care, there is substantial empirical evidence that the majority of users are not fully involved in the care planning process. Our aim is to evaluate the effectiveness and cost-effectiveness of training for mental health professionals in improving user involvement with the care planning processes. This is a cluster randomised controlled trial of community mental health teams in NHS Trusts in England allocated either to a training intervention to improve user and carer involvement in care planning or control (no training and care planning as usual). We will evaluate the effectiveness of the training intervention using a mixed design, including a 'cluster cohort' sample, a 'cluster cross-sectional' sample and process evaluation. Service users will be recruited from the caseloads of care co-ordinators. The primary outcome will be change in self-reported involvement in care planning as measured by the validated Health Care Climate Questionnaire. Secondary outcomes include involvement in care planning, satisfaction with services, medication side-effects, recovery and hope, mental health symptoms, alliance/engagement, well-being and quality of life. Cost- effectiveness will also be measured. A process evaluation informed by implementation theory will be undertaken to assess the extent to which the training was implemented and to gauge sustainability beyond the time-frame of the trial. It is hoped that the trial will generate data to inform mental health care policy and practice on care planning. ISRCTN16488358 (14 May 2014).

Quality of life, autonomy, satisfaction, and costs associated with mental health supported accommodation services in England: a national survey.

PubMed

Killaspy, Helen; Priebe, Stefan; Bremner, Stephen; McCrone, Paul; Dowling, Sarah; Harrison, Isobel; Krotofil, Joanna; McPherson, Peter; Sandhu, Sima; Arbuthnott, Maurice; Curtis, Sarah; Leavey, Gerard; Shepherd, Geoff; Eldridge, Sandra; King, Michael

2016-12-01

Little research has been done into the effectiveness of mental health supported accommodation services. We did a national survey to investigate provision and costs of services and assess service user quality of life and outcomes across England. We randomly sampled three types of services from 14 nationally representative regions-residential care, supported housing, and floating outreach-and recruited up to ten service users per service. Service quality and costs and service users' quality of life, autonomy, and satisfaction with care were assessed in a standardised manner with validated tools and compared by multilevel modelling. 619 service users were recruited from 22 residential care, 35 supported housing, and 30 floating outreach services. Those in residential care and supported housing had more severe mental health problems than those in floating outreach. 348 (57%) were assessed as being at risk of severe self-neglect and 229 (37%) as being vulnerable to exploitation in the previous 2 years. Residential care was most expensive but provided for people with the greatest needs. The mean annual budget was £466 687 for residential care (range £276 000-777 920), compared with £365 452 for supported housing (£174 877-818 000), and £172 114 for floating outreach (£17 126-491 692). Quality of care was best in supported housing. People in supported housing and floating outreach were more socially included but experienced more crime than those in residential care. After adjustment for service quality and service user sociodemographic and clinical factors, quality of life was similar for service users in residential care and supported housing (mean difference -0·138, 95% CI -0·402 to 0·126, p=0·306) and lower for those in floating outreach than in residential care (-0·424, -0·734 to -0·114, p=0·007). However, autonomy was greater for those in supported housing than for those in residential care (0·145, 0·010 to 0·279, p=0.035). Satisfaction with care was similar across services. Supported housing might be cost-effective, but the benefits need to be weighed against the risks associated with increased autonomy. National Institute for Health Research. Copyright © 2016 Elsevier Ltd. All rights reserved.

Shared decision-making for psychiatric medication: A mixed-methods evaluation of a UK training programme for service users and clinicians.

PubMed

Ramon, Shulamit; Morant, Nicola; Stead, Ute; Perry, Ben

2017-12-01

Shared decision making (SDM) is recognised as a promising strategy to enhance good collaboration between clinicians and service users, yet it is not practised regularly in mental health. Develop and evaluate a novel training programme to enhance SDM in psychiatric medication management for service users, psychiatrists and care co-ordinators. The training programme design was informed by existing literature and local stakeholders consultations. Parallel group-based training programmes on SDM process were delivered to community mental health service users and providers. Evaluation consisted of quantitative measures at baseline and 12-month follow-up, post-programme participant feedback and qualitative interviews. Training was provided to 47 service users, 35 care-coordinators and 12 psychiatrists. Participant feedback was generally positive. Statistically significant changes in service users' decisional conflict and perceptions of practitioners' interactional style in promoting SDM occurred at the follow-up. Qualitative data suggested positive impacts on service users' and care co-ordinators confidence to explore medication experience, and group-based training was valued. The programme was generally acceptable to service users and practitioners. This indicates the value of conducting a larger study and exploring application for non-medical decisions.

Interprofessional learning in primary care: an exploration of the service user experience leads to a new model for co-learning.

PubMed

Worswick, Louise; Little, Christine; Ryan, Kath; Carr, Eloise

2015-01-01

Research about service user involvement in research and education focuses on the purpose, the methods, the barriers and the impact of their involvement. Few studies report on the experience of the service users who get involved. This paper reports an exploration of the experience of service users who participated in an interprofessional educational initiative in primary care - the Learning to Improve the Management of Back Pain in the Community (LIMBIC) project. Service users attended workshops with practice teams and assisted them in developing small scale quality improvement projects to improve their provision of care for people with back pain. To explore the experience of service users involved in the LIMBIC project. Using the philosophical and methodological approaches of pragmatism this study analysed data from the wider LIMBIC project and collected primary data through semi structured interviews with service users. Secondary data were reanalysed and integrated with primary data to address the research question. The study was undertaken in the primary health care setting. Patients participated as service users in workshops and quality improvement projects with members from their practice teams. Interviews with service users were transcribed and analysed thematically. Document and thematic analyses of secondary data from the LIMBIC project included focus group transcripts, patient stories, film, emails, meeting notes, a wiki and educational material such as presentations. Themes identified through the analyses illustrated the importance, to the service users, of the sense of community, of clear communication, and of influencing change through involvement. A model for co-learning with service users resulted from the analyses. The experience of service users can be optimised by planning, preparation and support so that their wealth of expertise can be recognised and utilised. A model for co-learning was developed and is presented in this paper. Copyright © 2014 Elsevier Ltd. All rights reserved.

A collaborative exploration of the reasons for lower satisfaction with services among Bangladeshi and Pakistani social care users.

PubMed

Blake, Margaret; Bowes, Alison; Gill, Valdeep; Husain, Fatima; Mir, Ghazala

2017-05-01

This study explored underlying reasons for the expression of dissatisfaction with services among Bangladeshi and Pakistani social care users in England and investigated, using a collaborative approach, how these could be addressed. In-depth interviews were conducted in Birmingham, Leeds and London during 2012-2013 with 63 Bangladeshi, Pakistani and white British service users and 24 social care managers, social workers and care workers. A further 34 cognitive interviews were conducted within the same study. Following data analysis, three collaborative workshops involving service users and providers were held to validate the findings and to draw out policy and practice recommendations. Analysis of the cognitive interviews showed that higher dissatisfaction among Bangladeshi and Pakistani service users reported in social care surveys was not due to questionnaire design. Instead in-depth interviews showed that dissatisfaction across all three groups was expressed along the social care journey, including accessing care, communication with social workers and the nature of care received. While many issues were common to all three groups, cultural differences also emerged as affecting experiences of social care. These included misunderstandings about family roles in care; gender issues, especially relating to women; language and communication barriers, alongside the need for a more nuanced approach to ethnic 'matching'; and continuing limited cultural understanding among care workers. The collaborative workshops identified practical actions that could address some of the issues identified. These covered raising awareness of services within communities; improving support for informal carers; service user input to assessments; consistent and ongoing sharing of information; improving access; and more efforts to diversify and appropriately train the social care workforce. In conclusion, the paper presents the reality of dissatisfaction among these groups and argues for more action involving communities and service providers to address these persistent issues collaboratively. © 2016 John Wiley & Sons Ltd.

[A survey about quality of care and user’s' rights in Chilean psychiatric services].

PubMed

Minoletti, Alberto; Toro, Olga; Alvarado, Rubén; Carniglia, Claudia; Guajardo, Alejandro; Rayo, Ximena

2015-12-01

Quality of care and respect for the rights of users are critical to achieve positive health outcomes and respond appropriately to the expectations of people, particularly if they have mental illnesses. To carry out a baseline diagnosis of quality of care and respect for rights in public outpatient psychiatric services. Quality of care and respect for patients'’ rights was assessed by a mental health professional and a trained psychiatric service user in 15 ambulatory psychiatric services. The WHO QualityRights instrument was used, reviewing documentation and making observations in each facility, as well as interviewing 146 patients, 148 health care workers and 64 relatives of patients. A high level of achievement was accomplished in terms of discrimination-free health care, availability of psychotropic medications, lack of abuse or neglect and use of informed consents. A low level of achievement was found in terms of user support to cope with community living, access to education or work and participation in community activities, respect for user treatment preferences and preventive measures to avoid maltreatment and cruelty. Chile could improve the performance of psychiatry services having laws based on the “Convention of Rights of Persons with Disabilities” and standards of the World Health Organization, having national policies about quality of care and rights of users, reinforcing the community work of mental health care teams, reinforcing and informing users about their rights and promoting research on interventions to improve the respect of their rights.

Service user and care giver involvement in mental health system strengthening in Nepal: a qualitative study on barriers and facilitating factors.

PubMed

Gurung, Dristy; Upadhyaya, Nawaraj; Magar, Jananee; Giri, Nir Prakash; Hanlon, Charlotte; Jordans, Mark J D

2017-01-01

Service user and caregiver involvement has become an increasingly common strategy to enhance mental health outcomes, and has been incorporated in the mental healthpolicies of many developed nations. However, this practice is non-existent or fragmented in low and middle income countries (LMICs). Instances of service user and caregiver involvement have been rising slowly in a few LMICs, but are rarely described in the literature. Very little is known about the context of user and caregiver participation in mental health system strengthening processes in a low-income, disaster- and conflict-affected state such as Nepal. This study explores (a) the extent and experiences of service user and caregiver involvement in policy making, service planning, monitoring, and research in Nepal; (b) perceived barriers to such involvement; and (c) possible strategies to overcome barriers. Key Informant Interviews (n = 24) were conducted with service users and caregivers who were either affiliated to a mental health organization or receiving menta health care integrated within primary care. Purposive sampling was employed. Data collection was carried out in 2014 in Chitwan and Kathmandu districts of Nepal. Data analysis was carried out in NVivo10 using a framework approach. The involvement of service users affiliated to mental health organizations in policy development was reported to be 'tokenistic'. Involvement of caregivers was non-existent. Perceived barriers to greater involvement included lack of awareness, stigma and discrimination, poor economic conditions, the centralized health system, and lack of strong leadership and unity among user organizations. Increased focus on reducing public as well as self-stigma, improved policy frameworks and initiatives, and decentralization of care are some strategies that may facilitate service user and caregiver involvement. The study highlighted need for user and caregiver networks free from competing interests and priorities. Improved policy frameworks and decentralization of care may support meaningful service user and caregiver involvement.

SEQUenCE: a service user-centred quality of care instrument for mental health services.

PubMed

Hester, Lorraine; O'Doherty, Lorna Jane; Schnittger, Rebecca; Skelly, Niamh; O'Donnell, Muireann; Butterly, Lisa; Browne, Robert; Frorath, Charlotte; Morgan, Craig; McLoughlin, Declan M; Fearon, Paul

2015-08-01

To develop a quality of care instrument that is grounded in the service user perspective and validate it in a mental health service. The instrument (SEQUenCE (SErvice user QUality of CarE)) was developed through analysis of focus group data and clinical practice guidelines, and refined through field-testing and psychometric analyses. All participants were attending an independent mental health service in Ireland. Participants had a diagnosis of bipolar affective disorder (BPAD) or a psychotic disorder. Twenty-nine service users participated in six focus group interviews. Seventy-one service users participated in field-testing: 10 judged the face validity of an initial 61-item instrument; 28 completed a revised 52-item instrument from which 12 items were removed following test-retest and convergent validity analyses; 33 completed the resulting 40-item instrument. Test-retest reliability, internal consistency and convergent validity of the instrument. The final instrument showed acceptable test-retest reliability at 5-7 days (r = 0.65; P < 0.001), good convergent validity with the Verona Service Satisfaction Scale (r = 0.84, P < 0.001) and good internal consistency (Cronbach's alpha = 0.87). SEQUenCE is a valid, reliable scale that is grounded in the service user perspective and suitable for routine use. It may serve as a useful tool in individual care planning, service evaluation and research. The instrument was developed and validated with service users with a diagnosis of either BPAD or a psychotic disorder; it does not yet have established external validity for other diagnostic groups. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Characteristics of service users and provider organisations associated with experience of out of hours general practitioner care in England: population based cross sectional postal questionnaire survey

PubMed Central

Abel, Gary; Lyratzopoulos, Georgios; Elliott, Marc N; Richards, Suzanne; Barry, Heather E; Roland, Martin; Campbell, John L

2015-01-01

Objective To investigate the experience of users of out of hours general practitioner services in England, UK. Design Population based cross sectional postal questionnaire survey. Setting General Practice Patient Survey 2012-13. Main outcome measures Potential associations between sociodemographic factors (including ethnicity and ability to take time away from work during working hours to attend a healthcare consultation) and provider organisation type (not for profit, NHS, or commercial) and service users’ experience of out of hours care (timeliness, confidence and trust in the out of hours clinician, and overall experience of the service), rated on a scale of 0-100. Which sociodemographic/provider characteristics were associated with service users’ experience, the extent to which any observed differences could be because of clustering of service users of a particular sociodemographic group within poorer scoring providers, and the extent to which observed differences in experience varied across types of provider. Results The overall response rate was 35%; 971 232/2 750 000 patients returned surveys. Data from 902 170 individual service users were mapped through their registered practice to one of 86 providers of out of hours GP care with known organisation type. Commercial providers of out of hours GP care were associated with poorer reports of overall experience of care, with a mean difference of −3.13 (95% confidence interval −4.96 to −1.30) compared with not for profit providers. Asian service users reported lower scores for all three experience outcomes than white service users (mean difference for overall experience of care −3.62, −4.36 to −2.89), as did service users who were unable to take time away from work compared with service users who did not work (mean difference for overall experience of care −4.73, −5.29 to −4.17). Conclusions Commercial providers of out of hours GP care were associated with poorer experience of care. Targeted interventions aimed at improving experience for patients from ethnic minorities and patients who are unable to take time away from work might be warranted. PMID:25926616

Early experiences with e-health services (1999-2002): promise, reality, and implications.

PubMed

Fung, Vicki; Ortiz, Eduardo; Huang, Jie; Fireman, Bruce; Miller, Robert; Selby, Joseph V; Hsu, John

2006-05-01

E-health services may improve the quality and efficiency of care; however, there is little quantitative data on e-health use. The objective of this study was to examine trends in e-health use and user characteristics. This was a longitudinal study of e-health use (1999-2002) within an integrated delivery system (IDS). We classified 4 e-health services into transactional (drug refills and appointment scheduling) and care-related (medical and medication advice) services. Approximately 3.3 million members of a large, prepaid IDS. Amount and frequency of e-health use over time and characteristics of users. The number of members registered for access to e-health increased from 20,617 (0.7% of all members) in Q1 1999 to 270,987 (8.6%) in Q3 2002. Between Q1 and Q3 2002, 42,845 members (1.3%) used the drug refill service and 55,901 (1.7%) used the appointment scheduling service compared with 10,756 members (0.3%) who used the medical advice service and 3069 (0.1%) who used the medication advice service. Over the same period, transactional service users averaged 3.5 uses/user versus 1.6 uses/user among care-related service users. Members most likely to use e-health services had a high level of clinical need, a regular primary care provider, were 30 to 64 years old, female, white, and lived in a nonlow socioeconomic status neighborhood. These findings were consistent across e-health service types. Although use of all e-health services grew rapidly, use of care-related services lagged significantly behind use of transactional services. Subjects with greater clinical need and better ties to the health system were more likely to use both types of e-health services.

Outsourcing mental health care services? The practice and potential of community-based farms in psychiatric rehabilitation.

PubMed

Iancu, Sorana C; Zweekhorst, Marjolein B M; Veltman, Dick J; van Balkom, Anton J L M; Bunders, Joske F G

2015-02-01

Psychiatric rehabilitation supports individuals with mental disorders to acquire the skills needed for independent lives in communities. This article assesses the potential of outsourcing psychiatric rehabilitation by analysing care farm services in the Netherlands. Service characteristics were analysed across 214 care farms retrieved from a national database. Qualitative insights were provided by five case descriptions, selected from 34 interviews. Institutional care farms were significantly larger and older than private care farms (comprising 88.8% of all care farms). Private, independent care farms provide real-life work conditions to users who are relatively less impaired. Private, contracted care farms tailor the work activities to their capacities and employ professional supervisors. Institutional care farms accommodate for the most vulnerable users. We conclude that collaborations with independent, contracted and institutional care farms would provide mental health care organizations with a diversity in services, enhanced community integration and a better match with users' rehabilitation needs.

"The View from Inside": Understanding Service User Involvement in Health and Social Care Education

ERIC Educational Resources Information Center

Fox, Joanna

2011-01-01

Service users are increasingly involved in health and social care education, whilst the government is committed to increasing access to employment for people with mental health needs. The benefits of involving service users in social work education have been identified, including increasing skills, confidence, and building capacity; yet there is…

Duty of care and autonomy: how support workers managed the tension between protecting service users from risk and promoting their independence in a specialist group home.

PubMed

Hawkins, R; Redley, M; Holland, A J

2011-09-01

In the UK those paid to support adults with intellectual disabilities must manage two potentially conflicting duties that are set out in policy documents as being vital to their role: protecting service users (their duty of care) and recognising service users' autonomy. This study focuses specifically on the support of people with the genetically determined condition, Prader-Willi syndrome (PWS). Due to the behaviours associated with PWS, the support of this group of people vividly illustrates the tension between respect for autonomy and duty of care. This article explores how support workers working in a residential group home managed their competing duties of managing risk and promoting independence in practice. An ethnographic study, comprising of qualitative observations, semi-structured interviews and documentary analysis, was undertaken to investigate the work of support workers in a UK residential group home specialising in the support of adults diagnosed with PWS. The study focused on how support workers attempted to reconcile the tension between protecting service users from the risks associated with the syndrome and acknowledging service users' autonomy by enabling independence. Findings demonstrate that risk was central to the structure of care delivery at the group home and support workers often adhered to standardised risk management procedures. The organisation also required support workers to promote service users' independence and many thought acknowledging service users' autonomy through the promotion of their independence was important. To manage tensions between their differing duties, some support workers deviated from standardised risk management procedures to allow service users a degree of independence. There is a tension between the duty of care and the duty to recognise autonomy at the level of service delivery in residential homes. Support workers attempt to manage this tension; however, further work needs to be done by both residential services and policy makers to facilitate the reconciliation of the duty of care with the duty to recognise service users' autonomy in practice. © 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd.

Differences between patients' and clinicians' research priorities from the Anaesthesia and Peri-operative Care Priority Setting Partnership.

PubMed

Boney, O; Nathanson, M H; Grocott, M P W; Metcalf, L

2017-09-01

The James Lind Alliance Anaesthesia and Peri-operative Care Priority Setting Partnership was a recent collaborative venture bringing approximately 2000 patients, carers and clinicians together to agree priorities for future research into anaesthesia and critical care. This secondary analysis compares the research priorities of 303 service users, 1068 clinicians and 325 clinicians with experience as service users. All three groups prioritised research to improve patient safety. Service users prioritised research about improving patient experience, whereas clinicians prioritised research about clinical effectiveness. Clinicians who had experience as service users consistently prioritised research more like clinicians than like service users. Individual research questions about patient experience were more popular with patients and carers than with clinicians in all but one case. We conclude that patients, carers and clinicians prioritise research questions differently. All groups prioritise research into patient safety, but service users also favour research into patient experience, whereas clinicians favour research into clinical effectiveness. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

A Statewide Profile of Frequent Users of School-Based Health Centers: Implications for Adolescent Health Care.

PubMed

Koenig, Kevin T; Ramos, Mary M; Fowler, Tara T; Oreskovich, Kristin; McGrath, Jane; Fairbrother, Gerry

2016-04-01

The purpose of this study is to describe patterns of care and service use among adolescent school-based health center (SBHC) users in New Mexico and contrast patterns and services between frequent and infrequent users. Medical claims/encounter data were analyzed from 59 SBHCs located in secondary schools in New Mexico during the 2011-2012 school year. We used Pearson's chi-square test to examine the differences between frequent (≥ 4 visits/year) and infrequent users in their patterns of SBHC care, and we conducted logistic regression to examine whether frequent use of the SBHC predicted receipt of behavioral, reproductive, and sexual health; checkup; or acute care services. Most of the 26,379 adolescent SBHC visits in New Mexico were for behavioral health (42.4%) and reproductive and sexual health (22.9%). Frequent users have greater odds of receiving a behavioral, reproductive, and sexual health; and acute care visit than infrequent users (p < .001). American Indians, in particular, have higher odds of receiving behavioral health and checkup visits, compared with other races/ethnicities (p < .001). SBHCs deliver core health care services to adolescents, including behavioral, reproductive, and checkup services, to high need populations. American-Indian youth, more than their peers, use SBHCs for behavioral health and checkups. © 2016, American School Health Association.

Relationship between home care service use and changes in the care needs level of Japanese elderly.

PubMed

Kato, Gohei; Tamiya, Nanako; Kashiwagi, Masayo; Sato, Mikiya; Takahashi, Hideto

2009-12-21

With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels. The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician. In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to sustaining or improving the user's care needs level. There were different home service use in two groups (the sustained/improved group and the deteriorated group). Respite stay in a nursing home service use and more types of service use were related to experiencing a deterioration of care needs level in lower care needs level community-dwelling elderly persons in Japan. Further, medical management by a physician service was related to experiencing a deterioration of care needs level in higher care needs level community-dwelling elderly persons.

The implementation of the Care Programme Approach for service users with a learning disability. Building Bridges to the same Old Horizons?

PubMed

Kelly, M

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: People with mental health problems and learning disabilities often do not receive the care they require. The Care Programme Approach (CPA) is meant to help with this. However, there have been many problems in the past with the introduction of the CPA into mental health services. There is no literature which explores what factors help or hinder the introduction of the CPA for service users with a mental health and learning disability, especially from the perspective of those responsible for overseeing this process. WHAT DOES THIS ARTICLE ADD TO EXISTING KNOWLEDGE?: The implementation of the CPA for this service user group is fragmented, and services are not working together in partnership. The CPA is being effectively implemented for people who are deemed to present with a risk to themselves or others. If a service user does not present with a high risk, they are not provided care through the CPA. Service users were not involved in the development or introduction of the policy in practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Services need to work better at engaging service users when they are developing and introducing new policies. Rather than applying the CPA for all service users, across all services, it should only be considered for those deemed to present with a high risk. It is effectively implemented for these people. For those not deemed to present with a high risk, services should consider using alternative service user led care planning frameworks. Introduction The Care Programme Approach was introduced in England to ensure services met the needs of people with mental health problems and a concurrent learning disability (dual diagnosis). The CPA implementation was patchy and services failed to work in partnership. Aim This study aimed to explore the factors shaping the recent implementation of the CPA for service users with a dual diagnosis. Method A single case study approach was undertaken. Data were collected through interview (n = 26), documentary analysis (n = 64), steering group observation (n = 3) and the Partnership Assessment Tool (n = 26). Data were analysed using the Framework Approach. Results The CPA was only effectively implemented for people who were deemed to present with a high level of risk. Discussion The problems associated with implementation in the 1990s continue more recently for those with a dual diagnosis. The CPA has become more aligned with risk management protocols than supporting individual service user's recovery. Implications for practice Service users should be involved in the implementation of policies which have an impact on their recovery. The CPA should only be applied for those who present with high-risk issues, whilst alternative user-led initiatives should be considered for other service users. © 2017 John Wiley & Sons Ltd.

Identifying profiles of service users in housing services and exploring their quality of life and care needs.

PubMed

Bitter, Neis A; Roeg, Diana P K; van Nieuwenhuizen, Chijs; van Weeghel, Jaap

2016-11-23

Housing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not always match their recovery. In order to improve the quality of care, this study aims to explore whether subgroups of service users exist based on three dimensions of recovery and to examine and compare the quality of life and care needs of the persons in these subgroups. Latent class analysis was performed with data from 263 service users of housing services in the Netherlands. Classes were based on three variables: personal recovery (Mental Health Recovery Measure), social recovery (Social Functioning Scale), and clinical recovery (Brief Symptom Inventory). Subsequently, the quality of life (MANSA) and care needs (CANSAS) of the different classes were analysed by the use of descriptive and inferential statistics. Three classes could be distinguished. Class 1 (45%) comprised of people who score the highest of the three classes in terms of personal and social recovery and who experience the least number of symptoms. People in class 2 (44%) and class 3 (11%) score significantly lower on personal and social recovery, and they experience significantly more symptoms compared to class 1. The distinction between class 2 and 3 can be made on the significantly higher number of symptoms in class 3. All three classes differ significantly on quality of life and unmet needs. The quality of life of service users of housing services needs improvement, as even persons in the best-recovered subgroup have a lower quality of life than the average population. Workers of housing services need to be aware of the recovery of a client and what his or her individual needs and goals are. Furthermore, better care (allocation) concerning mental and physical health and rehabilitation is needed. Care should be provided on all dimensions of recovery at the same time, therefore mental health care organisations should work together and integrate their services. ISRCTN registry ISRCTN77355880 retrospectively registered 05/07/2013.

Shifting Practices Toward Recovery-Oriented Care Through an E-Recovery Portal in Community Mental Health Care: A Mixed-Methods Exploratory Study.

PubMed

Gammon, Deede; Strand, Monica; Eng, Lillian Sofie; Børøsund, Elin; Varsi, Cecilie; Ruland, Cornelia

2017-05-02

Mental health care is shifting from a primary focus on symptom reduction toward personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based portals may facilitate this shift, but little is known about how such tools are used or the role they may play in personal recovery. The aim was to illustrate uses and experiences with the secure e-recovery portal "ReConnect" as an adjunct to ongoing community mental health care and explore its potential role in shifting practices toward recovery. ReConnect was introduced into two Norwegian mental health care communities and used for 6 months. The aim was to support personal recovery and collaboration between service users and health care providers. Among inclusion criteria for participation were long-term care needs and at least one provider willing to interact with service users through ReConnect. The portal was designed to support ongoing collaboration as each service user-provider dyad/team found appropriate and consisted of (1) a toolbox of resources for articulating and working with recovery processes, such as status/goals/activities relative to life domains (eg, employment, social network, health), medications, network map, and exercises (eg, sleep hygiene, mindfulness); (2) messaging with providers who had partial access to toolbox content; and (3) a peer support forum. Quantitative data (ie, system log, questionnaires) were analyzed using descriptive statistics. Qualitative data (eg, focus groups, forum postings) are presented relative to four recovery-oriented practice domains: personally defined recovery, promoting citizenship, working relationships, and organizational commitment. Fifty-six participants (29 service users and 27 providers) made up 29 service user-provider dyads. Service users reported having 11 different mental health diagnoses, with a median 2 (range 1-7) diagnoses each. The 27 providers represented nine different professional backgrounds. The forum was the most frequently used module with 1870 visits and 542 postings. Service users' control over toolbox resources (eg, defining and working toward personal goals), coupled with peer support, activated service users in their personal recovery processes and in community engagement. Some providers (30%, 8/27) did not interact with service users through ReConnect. Dyads that used the portal resources did so in highly diverse ways, and participants reported needing more than 6 months to discover and adapt optimal uses relative to their individual and collaborative needs. Regardless of providers' portal use, service users' control over toolbox resources, coupled with peer support, offered an empowering common frame of reference that represented a shift toward recovery-oriented practices within communities. Although service users' autonomous use of the portal can eventually influence providers in the direction of recovery practices, a fundamental shift is unlikely without broader organizational commitments aligned with recovery principles (eg, quantified goals for service user involvement in care plans). ©Deede Gammon, Monica Strand, Lillian Sofie Eng, Elin Børøsund, Cecilie Varsi, Cornelia Ruland. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.05.2017.

Evaluating service user pedagogy in UK higher education: Validating the Huddersfield Service User Pedagogy Scale.

PubMed

Tobbell, Jane; Boduszek, Daniel; Kola-Palmer, Susanna; Vaughan, Joanne; Hargreaves, Janet

2018-04-01

There is global recognition that the inclusion of service users in the education of health and social care students in higher education can lead to more compassionate professional identities which will enable better decision making. However, to date there is no systematic tool to explore learning and service user involvement in the curriculum. To generate and validate a psychometric instrument which will allow educators to evaluate service user pedagogy. Construction and validation of a new scale. 365 undergraduate students from health and social care departments in two universities. A two correlated factor scale. Factor 1 - perceived presence of service users in the taught curriculum and factor 2 - professionals and service users working together (correlation between factor 1 and factor 2 - r = 0.32). The Huddersfield Service User Pedagogy Scale provides a valid instrument for educators to evaluate student learning. In addition, the tool can contribute to student reflections on their shifting professional identities as they progress through their studies. Copyright © 2018 Elsevier Ltd. All rights reserved.

Predicting use of case management support services for adolescents and adults living in community following brain injury: A longitudinal Canadian database study with implications for life care planning.

PubMed

Baptiste, B; Dawson, D R; Streiner, D

2015-01-01

To determine factors associated with case management (CM) service use in people with traumatic brain injury (TBI), using a published model for service use. A retrospective cohort, with nested case-control design. Correlational and logistic regression analyses of questionnaires from a longitudinal community data base. Questionnaires of 203 users of CM services and 273 non-users, complete for all outcome and predictor variables. Individuals with TBI, 15 years of age and older. Out of a dataset of 1,960 questionnaires, 476 met the inclusion criteria. Eight predictor variables and one outcome variable (use or non-use of the service). Predictor variables considered the framework of the Behaviour Model of Health Service Use (BMHSU); specifically, pre-disposing, need and enabling factor groups as these relate to health service use and access. Analyses revealed significant differences between users and non-users of CM services. In particular, users were significantly younger than non-users as the older the person the less likely to use the service. Also, users had less education and more severe activity limitations and lower community integration. Persons living alone are less likely to use case management. Funding groups also significantly impact users. This study advances an empirical understanding of equity of access to health services usage in the practice of CM for persons living with TBI as a fairly new area of research, and considers direct relevance to Life Care Planning (LCP). Many life care planers are CM and the genesis of LCP is CM. The findings relate to health service use and access, rather than health outcomes. These findings may assist with development of a modified model for prediction of use to advance future cost of care predictions.

Divided care and the Third Way: user involvement in statutory and voluntary sector cancer services.

PubMed

Tritter, J Q; Barley, V; Daykin, N; Evans, Simon; McNeill, Judith; Rimmer, James; Sanidas, M; Turton, Pat

2003-07-01

In health care, as in much of the public sphere, the voluntary sector is playing an increasingly large role in the funding, provision and delivery of services and nowhere is this more apparent than in cancer care. Simultaneously the growth of privatisation, marketisation and consumerism has engendered a rise in the promotion of 'user involvement' in health care. These changes in the organisation and delivery of health care, in part inspired by the 'Third Way' and the promotion of public and citizen participation, are particularly apparent in the British National Health Service. This paper presents initial findings from a three-year study of user involvement in cancer services. Using both case study and survey data, we explore the variation in the definition, aims, usefulness and mechanisms for involving users in the evaluation and development of cancer services across three Health Authorities in South West England. The findings have important implications for understanding shifts in power, autonomy and responsibility between patients, carers, clinicians and health service managers. The absence of any common definition of user involvement or its purpose underlines the limited trust between the different actors in the system and highlights the potentially negative impact of a Third Way health service.

Impact of home and community-based services on hospitalisation and institutionalisation among individuals eligible for long-term care insurance in Japan.

PubMed

Tomita, Naoki; Yoshimura, Kimio; Ikegami, Naoki

2010-12-22

This population-based retrospective cohort study aimed to clarify the impact of home and community-based services on the hospitalisation and institutionalisation of individuals certified as eligible for long-term care insurance (LTCI) benefits. Health insurance data and LTCI data were combined into a database of 1,020 individuals in two farming communities in Hokkaido who were enrolled in Citizen's Health Insurance. They had not received long-term care services prior to April 1, 2000 and were newly certified as eligible for Long-Term Care Insurance benefits between April 1, 2000 and February 29, 2008. The analysis covered 565 subjects who had not been hospitalised or institutionalised at the time of first certification of LTCI benefits. The adjusted hazard ratios (HRs) of hospitalisation or institutionalisation or death after the initial certification were calculated using the Cox proportional hazard model. The predictors were age, sex, eligibility level, area of residence, income, year of initial certification and average monthly outpatient medical expenditures, in addition to average monthly total home and community-based services expenditures (analysis 1), the use or no use of each type of service (analysis 2), and average monthly expenditures for home-visit and day-care types of services, the use or no use of respite care, and the use or no use of rental services for assistive devices (analysis 3). Users of home and community-based services were less likely than non-users to be hospitalised or institutionalised. Among the types of services, users of respite care (HR: 0.71, 95% confidence interval [CI]: 0.55-0.93) and rental services for assistive devices (HR: 0.70, 95% CI: 0.54-0.92) were less likely to be hospitalised or institutionalised than non-users. For those with relatively light needs, users of day care were also less likely to be hospitalised or institutionalized than non-users (HR: 0.77, 95% CI: 0.61-0.98). Respite care, rental services for assistive devices and day care are effective in preventing hospitalisation and institutionalisation. Our results suggest that home and community-based services contribute to the goal of the LTCI system of encouraging individuals certified as needing long-term care to live independently at home for as long as possible.

Impact of home and community-based services on hospitalisation and institutionalisation among individuals eligible for long-term care insurance in Japan

PubMed Central

2010-01-01

Background This population-based retrospective cohort study aimed to clarify the impact of home and community-based services on the hospitalisation and institutionalisation of individuals certified as eligible for long-term care insurance (LTCI) benefits. Methods Health insurance data and LTCI data were combined into a database of 1,020 individuals in two farming communities in Hokkaido who were enrolled in Citizen's Health Insurance. They had not received long-term care services prior to April 1, 2000 and were newly certified as eligible for Long-Term Care Insurance benefits between April 1, 2000 and February 29, 2008. The analysis covered 565 subjects who had not been hospitalised or institutionalised at the time of first certification of LTCI benefits. The adjusted hazard ratios (HRs) of hospitalisation or institutionalisation or death after the initial certification were calculated using the Cox proportional hazard model. The predictors were age, sex, eligibility level, area of residence, income, year of initial certification and average monthly outpatient medical expenditures, in addition to average monthly total home and community-based services expenditures (analysis 1), the use or no use of each type of service (analysis 2), and average monthly expenditures for home-visit and day-care types of services, the use or no use of respite care, and the use or no use of rental services for assistive devices (analysis 3). Results Users of home and community-based services were less likely than non-users to be hospitalised or institutionalised. Among the types of services, users of respite care (HR: 0.71, 95% confidence interval [CI]: 0.55-0.93) and rental services for assistive devices (HR: 0.70, 95% CI: 0.54-0.92) were less likely to be hospitalised or institutionalised than non-users. For those with relatively light needs, users of day care were also less likely to be hospitalised or institutionalized than non-users (HR: 0.77, 95% CI: 0.61-0.98). Conclusions Respite care, rental services for assistive devices and day care are effective in preventing hospitalisation and institutionalisation. Our results suggest that home and community-based services contribute to the goal of the LTCI system of encouraging individuals certified as needing long-term care to live independently at home for as long as possible. PMID:21176165

[Introduction of long-term care insurance: changes in service usage].

PubMed

Matsuda, Tomoyuki; Tamiya, Nanako; Kashiwagi, Masayo; Moriyama, Yoko

2013-09-01

With the aging of the population, Japan's long-term care system has shifted from a welfare-placement system to a social-insurance system, which is a precedent of policies for the elderly. We examined how individuals who used care services before the implementation of long-term care insurance (LTCI) (previous service users) currently use the LTCI services, with a focus on the processes of service use. Panel data were obtained from the Nihon University Japanese Longitudinal Study of Aging database. These data were collected by interviews conducted before (November 1999 and March 2000) and after (November 2001 and December 2001) the establishment of LTCI. Among the 3992 individuals who participated in these interviews, 416 of the previous service users, aged ≥65 years, were sampled. The outcome measures were the processes of using LTCI services (application for LTCI, certification of long-term care need, and contract with LTCI service providers). Logistic regression analysis was performed to identify individual factors associated with the process of application for LTCI. There were 133 LTCI users among the 416 previous service users (32.0%). Of the service processes used, 45.5% of previous service users were applicants, 85.7% of the applicants were certified individuals, and 88.7% of those certified used services with service contracts. The application process was significantly easier for individuals with disease (odds ratio[OR], 8.34 : 95% confidence interval [CI], 1.86-37.46), those dependent for their instrumental activities of daily living (IADL) (OR, 11.21 : 95% CI, 5.22-24.07), those with an equivalent income of <1.25 million yen (OR, 2.72 : 95% CI, 1.30-5.69), and those who had used respite care (OR, 3.29 : 95% CI, 1.16-9.35) previously. In contrast, the application process was significantly difficult for community rehabilitation users (OR, 0.38 : 95% CI, 0.17-0.82). Only half of the previous service users were applicants, and they had severe diseases or were more dependent for their IADL. Our findings suggest that many individuals who were functionally independent were covered under the welfare-placement system. Additionally, low-income individuals did not refrain from applying.

A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems

PubMed Central

Taylor, Tatiana L; Killaspy, Helen; Wright, Christine; Turton, Penny; White, Sarah; Kallert, Thomas W; Schuster, Mirjam; Cervilla, Jorge A; Brangier, Paulette; Raboch, Jiri; Kališová, Lucie; Onchev, Georgi; Dimitrov, Hristo; Mezzina, Roberto; Wolf, Kinou; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitri; Gonidakis, Fragiskos; Caldas-de-Almeida, José; Cardoso, Graça; King, Michael B

2009-01-01

Background A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. Methods We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. Results We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). Conclusion Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening. PMID:19735562

A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems.

PubMed

Taylor, Tatiana L; Killaspy, Helen; Wright, Christine; Turton, Penny; White, Sarah; Kallert, Thomas W; Schuster, Mirjam; Cervilla, Jorge A; Brangier, Paulette; Raboch, Jiri; Kalisová, Lucie; Onchev, Georgi; Dimitrov, Hristo; Mezzina, Roberto; Wolf, Kinou; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitri; Gonidakis, Fragiskos; Caldas-de-Almeida, José; Cardoso, Graça; King, Michael B

2009-09-07

A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.

Health care service utilization and associated factors among heroin users in northern Taiwan.

PubMed

Chen, Yi-Chih; Chen, Chih-Ken; Lin, Shih-Ku; Chiang, Shu-Chuan; Su, Lien-Wen; Wang, Liang-Jen

2013-11-01

Due to the needs of medical care, the probability of using health care service from heroin users is high. This cross-sectional study investigated the frequency and correlates of health service utilization among heroin users. From June to September 2006, 124 heroin users (110 males and 14 females, mean age: 34.2 ± 8.3 years) who entered two psychiatric hospitals (N = 83) and a detention center (N = 41) in northern Taiwan received a face-to-face interview. Therefore, socio-demographic characteristics, patterns of drug use, psychiatric comorbidities, blood-borne infectious diseases and health service utilization were recorded. The behaviors of health service utilization were classified into the frequency of out-patient department visit and hospitalization, as well as the purchase of over-the-counter drugs. During 12 months prior to interview, 79.8% of the participants attended health care service at least once. The rate of having any event in out-patients service visit, hospitalization, and over-the-counter drugs were 66.1%, 29.8% and 25.8% respectively. The frequency of health service utilization was associated with numerous factors. Among these factors, patients who were recruited from hospital and having a mood disorder were conjoint predictors of out-patient department visit, hospitalization and purchase of over-the-counter drugs. According to the results of this study, social education and routine screening for mood disorders can help heroin users to obtain adequate health care service. The findings of this study are useful references for targeting the heroin users for whom a successful intervention represents the greatest cost benefit. © 2013 Elsevier Ltd. All rights reserved.

Co-designing for quality: Creating a user-driven tool to improve quality in youth mental health services.

PubMed

Hackett, Christina L; Mulvale, Gillian; Miatello, Ashleigh

2018-04-29

Although high quality mental health care for children and youth is a goal of many health systems, little is known about the dimensions of quality mental health care from users' perspectives. We engaged young people, caregivers and service providers to share experiences, which shed light on quality dimensions for youth mental health care. Using experience-based co-design, we collected qualitative data from young people aged 16-24 with a mental disorder (n = 19), identified caregivers (n = 12) and service providers (n = 14) about their experiences with respect to youth mental health services. Experience data were collected using multiple approaches including interviews, a suite of online and smartphone applications (n = 22), and a co-design event (n = 16) and analysed to extract touch points. These touch points were used to prioritize and co-design a user-driven prototype of a questionnaire to provide feedback to service providers. Young people, caregiver and service provider reports of service experiences were used to identify aspects of care quality at eight mental health service contact points: Access to mental health care; Transfer to/from hospital; Intake into hospital; Services provided; Assessment and treatment; Treatment environment; and Caregiver involvement in care. In some cases, low quality care was harmful to users and their caregivers. Young people co-designed a prototype of a user-driven feedback questionnaire to improve quality of service experiences that was supported by service providers and caregivers at the co-design event. By using EBCD to capture in-depth data regarding experiences of young people, their caregivers and service providers, study participants have begun to establish a baseline for acceptable quality of mental health care for young people. © 2018 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Development of a mental health smartphone app: perspectives of mental health service users.

PubMed

Goodwin, John; Cummins, John; Behan, Laura; O'Brien, Sinead M

2016-10-01

Current mental health policy emphasises the importance of service user involvement in the delivery of care. Information Technology can have an effect on quality and efficiency of care. The aim of this study is to gain the viewpoint of service users from a local mental health service in developing a mental health app. A qualitative descriptive approach was used. Eight volunteers aged 18-49 years were interviewed with the aid of a semi-structured questionnaire. Interviewees defined a good app by its ease of use. Common themes included availability of contact information, identifying triggers, the ability to rate mood/anxiety levels on a scale, guided relaxation techniques, and the option to personalise the app. The researchers will aim to produce an app that is easily accessible, highly personalisable and will include functions highlighted as important (i.e. contact information, etc.). This research will assist in the development of an easy-to-use app that could increase access to services, and allow service users to take an active role in their care. In previous studies, apps were developed without the involvement of service users. This study recognises the important role of service users in this area.

Alternatives to seclusion and restraint in psychiatry and in long-term care facilities for the elderly: perspectives of service users and family members.

PubMed

Gagnon, Marie-Pierre; Desmartis, Marie; Dipankui, Mylène Tantchou; Gagnon, Johanne; St-Pierre, Michèle

2013-01-01

There is growing interest in involving patients in decisions regarding healthcare technologies. This research project was conducted in collaboration with decision makers and health technology assessment agents in order to involve healthcare service users (and their loved ones) in the assessment of alternatives to seclusion and restraint in short-term psychiatric wards and long-term care facilities for the elderly. This paper explores the viewpoints and suggestions of service users and service users' families about alternatives to restraint and seclusion, as well as conditions under which they could be used among adults in short-term psychiatric care and residents in long-term care facilities. Using a semi-structured guide, we held eight focus groups: five with mental health service users and three with family members of elderly people in long-term care facilities. Focus group discussions were digitally recorded and transcribed verbatim, and we performed content analysis using NVivo 8 software. In both care environments, participants emphasized the importance of communicating with service users, as well as assessing their needs and their particular situation, for reducing the use of restraint and seclusion. A better welcome and accompaniment of people admitted for short-term psychiatric care emerged also as key approaches to reduce the use of restraint and seclusion. Long-term care facilities could also reduce the need for restraint and seclusion by creating a stimulating home environment and individualized occupational therapy programs. Participants in both groups suggested that caregivers other than healthcare staff could be more involved, especially peer-support workers in the case of psychiatric care and volunteers in the case of long-term care facilities. Participants suggested that changes were needed at a broader and more systemic level than simply replacing current measures of restraint and seclusion with alternative techniques. They favored an approach focused more on the person than on the techniques: they suggested that listening to and communicating with the service user could reduce the use of restraint and seclusion in both healthcare environments.

Shifting Practices Toward Recovery-Oriented Care Through an E-Recovery Portal in Community Mental Health Care: A Mixed-Methods Exploratory Study

PubMed Central

Strand, Monica; Eng, Lillian Sofie; Børøsund, Elin; Varsi, Cecilie; Ruland, Cornelia

2017-01-01

Background Mental health care is shifting from a primary focus on symptom reduction toward personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based portals may facilitate this shift, but little is known about how such tools are used or the role they may play in personal recovery. Objective The aim was to illustrate uses and experiences with the secure e-recovery portal “ReConnect” as an adjunct to ongoing community mental health care and explore its potential role in shifting practices toward recovery. Methods ReConnect was introduced into two Norwegian mental health care communities and used for 6 months. The aim was to support personal recovery and collaboration between service users and health care providers. Among inclusion criteria for participation were long-term care needs and at least one provider willing to interact with service users through ReConnect. The portal was designed to support ongoing collaboration as each service user-provider dyad/team found appropriate and consisted of (1) a toolbox of resources for articulating and working with recovery processes, such as status/goals/activities relative to life domains (eg, employment, social network, health), medications, network map, and exercises (eg, sleep hygiene, mindfulness); (2) messaging with providers who had partial access to toolbox content; and (3) a peer support forum. Quantitative data (ie, system log, questionnaires) were analyzed using descriptive statistics. Qualitative data (eg, focus groups, forum postings) are presented relative to four recovery-oriented practice domains: personally defined recovery, promoting citizenship, working relationships, and organizational commitment. Results Fifty-six participants (29 service users and 27 providers) made up 29 service user-provider dyads. Service users reported having 11 different mental health diagnoses, with a median 2 (range 1-7) diagnoses each. The 27 providers represented nine different professional backgrounds. The forum was the most frequently used module with 1870 visits and 542 postings. Service users’ control over toolbox resources (eg, defining and working toward personal goals), coupled with peer support, activated service users in their personal recovery processes and in community engagement. Some providers (30%, 8/27) did not interact with service users through ReConnect. Dyads that used the portal resources did so in highly diverse ways, and participants reported needing more than 6 months to discover and adapt optimal uses relative to their individual and collaborative needs. Conclusions Regardless of providers’ portal use, service users’ control over toolbox resources, coupled with peer support, offered an empowering common frame of reference that represented a shift toward recovery-oriented practices within communities. Although service users’ autonomous use of the portal can eventually influence providers in the direction of recovery practices, a fundamental shift is unlikely without broader organizational commitments aligned with recovery principles (eg, quantified goals for service user involvement in care plans). PMID:28465277

Participation in mental healthcare: a qualitative meta-synthesis.

PubMed

Stomski, Norman J; Morrison, Paul

2017-01-01

Facilitation of service user participation in the co-production of mental healthcare planning and service delivery is an integral component of contemporary mental health policy and clinical guidelines. However, many service users continue to experience exclusion from the planning of their care. This review synthesizes qualitative research about participation in mental healthcare and articulates essential processes that enable service user participation in mental health care. Electronic databases were systematically searched. Studies were included if they were peer reviewed qualitative studies, published between 2000 and 2015, examining participation in mental health care. The Critical Appraisal Skills Program checklist was used to assess the quality of each included study. Constant comparison was used to identify similar constructs across several studies, which were then abstracted into thematic constructs. The synthesis resulted in the identification of six principal themes, which articulate key processes that facilitate service user participation in mental healthcare. These themes included: exercising influence; tokenism; sharing knowledge; lacking capacity; respect; and empathy. This meta-synthesis demonstrates that service user participation in mental healthcare remains a policy aspiration, which generally has not been translated into clinical practice. The continued lack of impact on policy on the delivery of mental healthcare suggests that change may have to be community driven. Systemic service user advocacy groups could contribute critically to promoting authentic service user participation in the co-production of mental health services.

Unique Characteristics of High-Cost Users of Medical Care With Comorbid Mental Illness or Addiction in a Population-Based Cohort.

PubMed

Hensel, Jennifer M; Taylor, Valerie H; Fung, Kinwah; de Oliveira, Claire; Vigod, Simone N

To understand whether high-cost users of medical care with and without comorbid mental illness or addiction differ in terms of their sociodemographic and health characteristics. Unique characteristics would warrant different considerations for interventions and service design aimed at reducing unnecessary health care utilization and associated costs. From the top 10% of Ontarians ranked by total medical care costs during fiscal year 2011/2012 (N = 314,936), prior 2-year mental illness or addiction diagnoses were determined from administrative data. Sociodemographics, medical illness characteristics, medical costs, and utilization were compared between those high-cost users of medical care with and without comorbid mental illness or addiction. Odds of being a frequent user of inpatient (≥3 admissions) and emergency (≥5 visits) services were compared between groups, adjusting for age, sex, socioeconomic status and medical illness characteristics. High-cost users of medical care with comorbid mental illness or addiction were younger, had a lower socioeconomic status, had greater historical medical morbidity, and had higher total medical care costs (mean excess of $2,031/user) than those without. They were more likely to be frequent users of inpatient (12.8% vs 10.2%; adjusted OR, 1.14; 95% CI: 1.12-1.17) and emergency (8.4% vs 4.8%; adjusted OR, 1.55; 95% CI: 1.50-1.59) services. Effect sizes were larger in major mood, psychotic, and substance use disorder subgroups. High-cost medical care users with mental illness or addiction have unique characteristics with respect to sociodemographics and service utilization patterns to consider in interventions and policies for this patient group. Copyright © 2018 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.

Support as a complement, intrusion and right--evidence from ageing and disability support service users in Sweden and Australia.

PubMed

Laragy, Carmel; Fisher, Karen R; Cedersund, Elisabet; Campbell-McLean, Carolyn

2011-12-01

How service users conceptualise their personal support services is under researched, even though this understanding is important for responsive policy development and service implementation. This paper tests the proposition that service users understand formal support in three ways: support is a complement to their other arrangements, an intrusion into their personal life and a right. These three concepts were identified using discourse analysis in a Swedish study of older people wanting in-home support services. To test generalisability of these concepts, they were applied to data from an Australian study of people using disability personal support. The analysis found that the three concepts were core to people's views of their support, although the construction of the concepts differed in the two countries. Service users in Sweden asserted their right to services more forcefully than those in Australia, and they had higher expectations that their support needs would be met. These differences reflect the impact of each country's social policy environment on service users' expectations. The analysis suggests that service users and their families want to control their formal support arrangements to complement their informal care and their life preferences and to minimise the intrusive aspects of formal support. The findings imply that the three concepts have utility for theorising service users' perspectives, informing policy and developing implementation strategies which enhance peoples' quality of life. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

Duty of Care and Autonomy: How Support Workers Managed the Tension between Protecting Service Users from Risk and Promoting Their Independence in a Specialist Group Home

ERIC Educational Resources Information Center

Hawkins, R.; Redley, M.; Holland, A. J.

2011-01-01

Background: In the UK those paid to support adults with intellectual disabilities must manage two potentially conflicting duties that are set out in policy documents as being vital to their role: protecting service users (their duty of care) and recognising service users' autonomy. This study focuses specifically on the support of people with the…

The experiences of detained mental health service users: issues of dignity in care

PubMed Central

2014-01-01

Background When mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular challenges for healthcare professionals. Respecting the dignity of others is a key element of the code of conduct for health professionals. Often from the service user perspective this is ignored. Methods This paper reports on the experiences of 19 adult service users who were, at the time of interview, detained under a Section of the MHA. These service users had experienced coercive interventions and they gave their account of how they considered their dignity to be protected (or not), and their sense of self respected (or not). Results The service users considered their dignity and respect compromised by 1) not being ‘heard’ by staff members, 2) a lack of involvement in decision-making regarding their care, 3) a lack of information about their treatment plans particularly medication, 4) lack of access to more talking therapies and therapeutic engagement, and 5) the physical setting/environment and lack of daily activities to alleviate their boredom. Conclusions Dignity and respect are important values in recovery and practitioners need time to engage with service user narratives and to reflect on the ethics of their practice. PMID:24972627

User fees and maternity services in Ethiopia.

PubMed

Pearson, Luwei; Gandhi, Meena; Admasu, Keseteberhan; Keyes, Emily B

2011-12-01

To examine user fees for maternity services and how they relate to provision, quality, and use of maternity services in Ethiopia. The national assessment of emergency obstetric and newborn care (EmONC) examined user fees for maternity services in 751 health facilities that provided childbirth services in 2008. Overall, only about 6.6% of women gave birth in health facilities. Among facilities that provided delivery care, 68% charged a fee in cash or kind for normal delivery. Health centers should be providing maternity services free of charge (the healthcare financing proclamation), yet 65% still charge for some aspect of care, including drugs and supplies. The average cost for normal and cesarean delivery was US $7.70 and US $51.80, respectively. Nineteen percent of these facilities required payment in advance for treatment of an obstetric emergency. The health facilities that charged user fees had, on average, more delivery beds, deliveries (normal and cesarean), direct obstetric complications treated, and a higher ratio of skilled birth attendants per 1000 deliveries than those that did not charge. The case fatality rate was 3.8% and 7.1% in hospitals that did and did not charge user fees, respectively. Utilization of maternal health services is extremely low in Ethiopia and, although there is a government decree against charging for maternity service, 65% of health centers do charge for some aspects of maternal care. As health facilities are not reimbursed by the government for the costs of maternity services, this loss of revenue may account for the more and better services offered in facilities that continue to charge user fees. User fees are not the only factor that determines utilization in settings where the coverage of maternity services is extremely low. Additional factors include other out-of-pocket payments such as cost of transport and food and lodging for accompanying relatives. It is important to keep quality of care in mind when user fees are under discussion. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Predicting use of case management support services for adolescents and adults living in community following brain injury: A longitudinal Canadian database study with implications for life care planning

PubMed Central

Baptiste, B.; Dawson, D.R.; Streiner, D.

2015-01-01

Abstract OBJECTIVE: To determine factors associated with case management (CM) service use in people with traumatic brain injury (TBI), using a published model for service use. DESIGN: A retrospective cohort, with nested case-control design. Correlational and logistic regression analyses of questionnaires from a longitudinal community data base. STUDY SAMPLE: Questionnaires of 203 users of CM services and 273 non-users, complete for all outcome and predictor variables. Individuals with TBI, 15 years of age and older. Out of a dataset of 1,960 questionnaires, 476 met the inclusion criteria. METHODOLOGY: Eight predictor variables and one outcome variable (use or non-use of the service). Predictor variables considered the framework of the Behaviour Model of Health Service Use (BMHSU); specifically, pre-disposing, need and enabling factor groups as these relate to health service use and access. RESULTS: Analyses revealed significant differences between users and non-users of CM services. In particular, users were significantly younger than non-users as the older the person the less likely to use the service. Also, users had less education and more severe activity limitations and lower community integration. Persons living alone are less likely to use case management. Funding groups also significantly impact users. CONCLUSIONS: This study advances an empirical understanding of equity of access to health services usage in the practice of CM for persons living with TBI as a fairly new area of research, and considers direct relevance to Life Care Planning (LCP). Many life care planers are CM and the genesis of LCP is CM. The findings relate to health service use and access, rather than health outcomes. These findings may assist with development of a modified model for prediction of use to advance future cost of care predictions. PMID:26409333

Stigma, Social Structure, and the Biomedical Framework: Exploring the Stigma Experiences of Inpatient Service Users in Two Belgian Psychiatric Hospitals.

PubMed

Sercu, Charlotte; Bracke, Piet

2017-07-01

The study discusses the stigma experiences of service users in mental health care, within the debate on the role of the biomedical framework for mental health care and power relations in society. Interview data of inpatient users ( n = 42) and care providers ( n = 43) from two Belgian psychiatric hospitals were analyzed using a constructivist grounded theory approach: Findings offer insight into how stigma experiences are affected by social structure. Stigma seemed to be related to the relation between care providers and service users their social position. The concept "mental health literacy" is used to frame this finding. In paying attention to the specific cultural and normative context, which influences the relationship between mental health literacy and stigma, it is further possible to cast some light on the meaning of the biomedical model for the construction and maintenance of power relations in mental health care and broader society.

The relationship between health literacy and quality of life among frequent users of health care services: a cross-sectional study.

PubMed

Couture, Éva Marjorie; Chouinard, Maud-Christine; Fortin, Martin; Hudon, Catherine

2017-07-06

Although health literacy and quality of life are important concepts in health care, the link between them is unclear, especially for a population of frequent users of health care services with chronic diseases. Low health literacy is a common problem that has been linked to several negative health outcomes. Quality of life is an important health outcome in patient-centered care. Frequent users of health care services are a vulnerable population that deserves attention due to high costs and negative outcomes such as lower quality of life and higher mortality. The objective of this study was to examine the relationship between health literacy and the physical and mental components of quality of life among frequent users of health care services with chronic diseases. This study presents the cross-sectional analysis of data collected through the V1SAGES project, a randomized controlled trial on the effectiveness of a case management intervention in primary care in Quebec, Canada. Participants (n = 247) were frequent users of health care services presenting at least one chronic condition. Health literacy was measured by the Newest Vital Sign (NVS), and the physical and mental components of quality of life were evaluated by the Short Form Health Survey Version 2 (SF-12v2). The association between health literacy (independent variable) and the physical and mental components of quality of life was examined using biserial correlation. No association was found between health literacy and quality of life (physical component: r = 0.108, ρ = 0.11; mental component: r = 0.147, ρ = 0.15). This study suggests that there is no relationship between health literacy and the physical and mental components of quality of life among frequent users of health care services. NCT01719991 . Registered October 25, 2012.

Service User- and Carer-Reported Measures of Involvement in Mental Health Care Planning: Methodological Quality and Acceptability to Users

PubMed Central

Gibbons, Chris J.; Bee, Penny E.; Walker, Lauren; Price, Owen; Lovell, Karina

2014-01-01

Background: Increasing service user and carer involvement in mental health care planning is a key healthcare priority but one that is difficult to achieve in practice. To better understand and measure user and carer involvement, it is crucial to have measurement questionnaires that are both psychometrically robust and acceptable to the end user. Methods: We conducted a systematic review using the terms “care plan$,” “mental health,” “user perspective$,” and “user participation” and their linguistic variants as search terms. Databases were searched from inception to November 2012, with an update search at the end of September 2014. We included any articles that described the development, validation or use of a user and/or carer-reported outcome measures of involvement in mental health care planning. We assessed the psychometric quality of each instrument using the “Evaluating the Measurement of Patient-Reported Outcomes” (EMPRO) criteria. Acceptability of each instrument was assessed using novel criteria developed in consultation with a mental health service user and carer consultation group. Results: We identified eleven papers describing the use, development, and/or validation of nine user/carer-reported outcome measures. Psychometric properties were sparsely reported and the questionnaires met few service user/carer-nominated attributes for acceptability. Where reported, basic psychometric statistics were of good quality, indicating that some measures may perform well if subjected to more rigorous psychometric tests. The majority were deemed to be too long for use in practice. Discussion: Multiple instruments are available to measure user/carer involvement in mental health care planning but are either of poor quality or poorly described. Existing measures cannot be considered psychometrically robust by modern standards, and cannot currently be recommended for use. Our review has identified an important knowledge gap, and an urgent need to develop new user and carer measures of care-planning involvement. PMID:25566099

A systematic narrative review of consumer-directed care for older people: implications for model development.

PubMed

Ottmann, Goetz; Allen, Jacqui; Feldman, Peter

2013-11-01

Consumer-directed care is increasingly becoming a mainstream option in community-based aged care. However, a systematic review describing how the current evaluation research translates into practise has not been published to date. This review aimed to systematically establish an evidence base of user preferences for and satisfaction with services associated with consumer-directed care programmes for older people. Twelve databases were searched, including MedLine, BioMed Central, Cinahl, Expanded Academic ASAP, PsychInfo, ProQuest, Age Line, Science Direct, Social Citation Index, Sociological Abstracts, Web of Science and the Cochrane Library. Google Scholar and Google were also searched. Eligible studies were those reporting on choice, user preferences and service satisfaction outcomes regarding a programme or model of home-based care in the United States or United Kingdom. This systematic narrative review retrieved literature published from January 1992 to August 2011. A total of 277 references were identified. Of these 17 met the selection criteria and were reviewed. Findings indicate that older people report varying preferences for consumer-directed care with some demonstrating limited interest. Clients and carers reported good service satisfaction. However, research comparing user preferences across countries or investigating how ecological factors shape user preferences has received limited attention. Policy-makers and practitioners need to carefully consider the diverse contexts, needs and preferences of older adults in adopting consumer-directed care approaches in community aged care. The review calls for the development of consumer-directed care programmes offering a broad range of options that allow for personalisation and greater control over services without necessarily transferring the responsibility for administrative responsibilities to service users. Review findings suggest that consumer-directed care approaches have the potential to empower older people. © 2013 Blackwell Publishing Ltd.

Hidden costs: the direct and indirect impact of user fees on access to malaria treatment and primary care in Mali.

PubMed

Johnson, Ari; Goss, Adeline; Beckerman, Jessica; Castro, Arachu

2012-11-01

About 20 years after initial calls for the introduction of user fees in health systems in sub-Saharan Africa, a growing coalition is advocating for their removal. Several African countries have abolished user fees for health care for some or all of their citizens. However, fee-for-service health care delivery remains a primary health care funding model in many countries in sub-Saharan Africa. Although the impact of user fees on utilization of health services and household finances has been studied extensively, further research is needed to characterize the multi-faceted health and social problems associated with charging user fees. This ethnographic study aims to identify consequences of user fees on gender inequality, food insecurity, and household decision-making for a group of women living in poverty. Ethnographic life history interviews were conducted with 24 women in Yirimadjo, Mali in 2007. Purposive sampling selected participants across a broad socio-economic spectrum. Semi-structured interviews addressed participants' past medical history, socio-economic status, social and family history, and access to health care. Interview transcripts were coded using the guiding analytical framework of structural violence. Interviews revealed that user fees for health care not only decreased utilization of health services, but also resulted in delayed presentation for care, incomplete or inadequate care, compromised food security and household financial security, and reduced agency for women in health care decision making. The effects of user fees were amplified by conditions of poverty, as well as gender and health inequality; user fees in turn reinforced the inequalities created by those very conditions. The qualitative data reveal multi-faceted health and socioeconomic effects of user fees, and illustrate that user fees for health care may impact quality of care, health outcomes, food insecurity, and gender inequality, in addition to impacting health care utilization and household finances. As many countries consider user fee abolition policies, these findings indicate the need to create a broader evaluation framework-one that can measure the health and socioeconomic impacts of user fee polices and of their removal. Copyright © 2012 Elsevier Ltd. All rights reserved.

Same description, different values. How service users and providers define patient and public involvement in health care.

PubMed

Rise, Marit By; Solbjør, Marit; Lara, Mariela C; Westerlund, Heidi; Grimstad, Hilde; Steinsbekk, Aslak

2013-09-01

Patient and public involvement in health care is important, but the existing definitions of the concept do not integrate the stakeholders' own perceptions. To investigate and compare service users' and service providers' own definitions of patient and public involvement and their implications. Qualitative study with mainly individual in-depth semi-structured interviews conducted between June 2007 and June 2009. Data were analysed using a grounded theory approach. A total of 20 patients, 13 public representatives and 44 health service providers/managers in both somatic and mental health care were interviewed. A common definition of patient and public involvement emerged: It is founded on mutual respect, carried out through dialogue aiming at achieving shared decision making. Nevertheless, users and providers assigned different values to the core aspects: Respect was imperative for service users and implied for providers, dialogue was a way to gain respect for service users and to achieve good outcome for providers, and both worried that the other party wanted to make sole decisions. Users and providers need to consider that although they have a common definition of involvement in health care, they assign different values to its aspects. Increasing and improving patient and public involvement therefore requires knowledge on and dialogue between the parties about these differences. © 2011 John Wiley & Sons Ltd.

Models of user involvement in the mental health context: intentions and implementation challenges.

PubMed

Storm, Marianne; Edwards, Adrian

2013-09-01

Patient-centered care, shared decision-making, patient participation and the recovery model are models of care which incorporate user involvement and patients' perspectives on their treatment and care. The aims of this paper are to examine these different care models and their association with user involvement in the mental health context and discuss some of the challenges associated with their implementation. The sources used are health policy documents and published literature and research on patient-centered care, shared decision-making, patient participation and recovery. The policy documents advocate that mental health services should be oriented towards patients' or users' needs, participation and involvement. These policies also emphasize recovery and integration of people with mental disorders in the community. However, these collaborative care models have generally been subject to limited empirical research about effectiveness. There are also challenges to implementation of the models in inpatient care. What evidence there is indicates tensions between patients' and providers' perspectives on treatment and care. There are issues related to risk and the person's capacity for user involvement, and concerns about what role patients themselves wish to play in decision-making. Lack of competence and awareness among providers are further issues. Further work on training, evaluation and implementation is needed to ensure that inpatient mental health services are adapting user oriented care models at all levels of services.

A Statewide Profile of Frequent Users of School-Based Health Centers: Implications for Adolescent Health Care

ERIC Educational Resources Information Center

Koenig, Kevin T.; Ramos, Mary M.; Fowler, Tara T.; Oreskovich, Kristin; McGrath, Jane; Fairbrother, Gerry

2016-01-01

Background: The purpose of this study is to describe patterns of care and service use among adolescent school-based health center (SBHC) users in New Mexico and contrast patterns and services between frequent and infrequent users. Methods: Medical claims/encounter data were analyzed from 59 SBHCs located in secondary schools in New Mexico during…

Users of home-care services in a Nordic welfare state under marketisation: the rich, the poor and the sick.

PubMed

Mathew Puthenparambil, Jiby; Kröger, Teppo; Van Aerschot, Lina

2017-01-01

Stricter access to public services, outsourcing of municipal services and increasing allocation of public funding for the purchase of private services have resulted in a marketisation wave in Finland. In this context of a Nordic welfare state undergoing marketisation, this paper aims to examine the use of Finnish care services among older people and find out who are using these new kinds of private services. How wide is their use and do the users of private care services differ from those who are using public services? How usual is it to mix both public and private care services? The questionnaire survey data set used here was gathered in 2010 among the population aged 75 and over in the cities of Jyväskylä and Tampere (N = 1436). The methods of analysis used include cross-tabulation, chi-square tests and multinomial logistic regression. The findings showed that among those respondents who used care services (n = 681), 50% used only public services, 24% utilised solely private services and the remaining 26% used both kinds of services. Users of solely private services had significantly higher income and education as well as better health than those using public services only. The users of public services had the lowest education and income levels and usually lived in rented housing. The third group, those mixing both public and private services, reported poorer health than others. The results increase concerns about the development towards a two-tier service system, jeopardising universalistic Nordic principles, and also suggest that older people with the highest needs do not receive adequate services without complementing their public provisions with private services. © 2015 John Wiley & Sons Ltd.

Hearing Health Care: perception of the users of a public service.

PubMed

Jardim, Débora Soares; Maciel, Fernanda Jorge; Piastrelli, Marina Teixeira; Lemos, Stela Maris Aguiar

2017-03-30

Evaluate hearing health service under the users' perspective according to the aspects: access, care, communication, and professional competence, and its correlation with clinical, sociodemographic and assistance characteristics. This is an observational analytic cross-sectional study with a probability sample stratified by gender and age. The Hearing Health Care Assessment questionnaire and the Brazilian Economic Classification Criterion questionnaire were used. In total, 214 users were interviewed, which were assisted from May 2009 to May 2013. It was observed that most of the evaluated users are female, elderly, literate, presenting moderate degree of hearing impairment, who had access to transportation out-of-pocket, was submitted to ENT evaluation for diagnosis and sought the service to purchase a hearing aid, besides belonging to class C. Regarding user satisfaction, most were satisfied with access, hearing evaluation, personalized service, benefit for the family, communication and information, and professional competence. In the analysis of correlation between the scores, it was found that when users are satisfied with access, as well as with communication and information, the total score increases with moderate correlation coefficient. The users showed greater satisfaction with the professional competence domain and lower satisfaction with the benefit for the family. In addition, assessment proved that access and communication are considered important quality indicators for the hearing health service according to users.

Understanding patient e-loyalty toward online health care services.

PubMed

Martínez-Caro, Eva; Cegarra-Navarro, Juan Gabriel; Solano-Lorente, Marcelina

2013-01-01

Public health institutions are making a great effort to develop patient-targeted online services in an attempt to enhance their effectiveness and reduce expenses. However, if patients do not use those services regularly, public health institutions will have wasted their limited resources. Hence, patients' electronic loyalty (e-loyalty) is essential for the success of online health care services. In this research, an extended Technology Acceptance Model was developed to test e-loyalty intent toward online health care services offered by public health institutions. Data from a survey of 256 users of online health care services provided by the public sanitary system of a region in Spain were analyzed. The research model was tested by using the structural equation modeling approach. The results obtained suggest that the core constructs of the Technology Acceptance Model (perceived usefulness, ease of use, and attitude) significantly affected users' behavioral intentions (i.e., e-loyalty intent), with perceived usefulness being the most decisive antecedent of affective variables (i.e., attitude and satisfaction). This study also reveals a general support for patient satisfaction as a determinant of e-loyalty intent in online health care services. Policy makers should focus on striving to get the highest positive attitude in users by enhancing easiness of use and, mainly, perceived usefulness. Because through satisfaction of patients, public hospitals will enlarge their patient e-loyalty intent, health care providers must always work at obtaining satisfied users and to encourage them to continue using the online services.

Maintaining quality of health services after abolition of user fees: A Uganda case study

PubMed Central

Nabyonga-Orem, Juliet; Karamagi, Humphrey; Atuyambe, Lynn; Bagenda, Fred; Okuonzi, Sam A; Walker, Oladapo

2008-01-01

Background It has been argued that quality improvements that result from user charges reduce their negative impact on utilization especially of the poor. In Uganda, because there was no concrete evidence for improvements in quality of care following the introduction of user charges, the government abolished user fees in all public health units on 1st March 2001. This gave us the opportunity to prospectively study how different aspects of quality of care change, as a country changes its health financing options from user charges to free services, in a developing country setting. The outcome of the study may then provide insights into policy actions to maintain quality of care following removal of user fees. Methods A population cohort and representative health facilities were studied longitudinally over 3 years after the abolition of user fees. Quantitative and qualitative methods were used to obtain data. Parameters evaluated in relation to quality of care included availability of drugs and supplies and; health worker variables. Results Different quality variables assessed showed that interventions that were put in place were able to maintain, or improve the technical quality of services. There were significant increases in utilization of services, average drug quantities and stock out days improved, and communities reported health workers to be hardworking, good and dedicated to their work to mention but a few. Communities were more appreciative of the services, though expectations were lower. However, health workers felt they were not adequately motivated given the increased workload. Conclusion The levels of technical quality of care attained in a system with user fees can be maintained, or even improved without the fees through adoption of basic, sustainable system modifications that are within the reach of developing countries. However, a trade-off between residual perceptions of reduced service quality, and the welfare gains from removal of user fees should guide such a policy change. PMID:18471297

Library services and user satisfaction in developing countries: a case study.

PubMed

Mairaj, Muhammad Ijaz; Naseer, Mirza Muhammad

2013-12-01

Punjab Institute of Cardiology (PIC) is a recognised teaching hospital for cardiac care in the Punjab province of Pakistan. PIC has established a library to fulfil the research and information needs of health care professionals. This study aims to evaluate the satisfaction of users with the services of PIC library. A purposive sample of 15 health care professionals was selected. A semistructured interview technique based on an interview guide was used for collection of data. The data were qualitatively analysed using a thematic approach. Users of PIC library were satisfied with the library collection, organisation, reference and circulation services, staff attitudes, cooling and heating. They were concerned about library space, hours, furniture and environment, and suggested more availability of electronic library services, newer collections, better Internet access and comfortable furniture. The study proved useful to investigate users' satisfaction with the services of PIC library. It concludes that the PIC library should maintain and strengthen the services with which users are satisfied, and improve those about which they are concerned. The study will be useful to libraries in other developing countries for improvement in their services. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning.

PubMed

Grundy, A C; Walker, L; Meade, O; Fraser, C; Cree, L; Bee, P; Lovell, K; Callaghan, P

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: There is consistent evidence that service users and carers feel marginalized in the process of mental health care planning. Mental health professionals have identified ongoing training needs in relation to involving service users and carers in care planning. There is limited research on the acceptability of training packages for mental health professionals which involve service users and carers as co-facilitators. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A co-produced and co-delivered training package on service user- and carer-involved care planning was acceptable to mental health professionals. Aspects of the training that were particularly valued were the co-production model, small group discussion and the opportunity for reflective practice. The organizational context of care planning may need more consideration in future training models. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses using co-production models of delivering training to other mental health professionals can be confident that such initiatives will be warmly welcomed, acceptable and engaging. On the basis of the results reported here, we encourage mental health nurses to use co-production approaches more often. Further research will show how clinically effective this training is in improving outcomes for service users and carers. Background There is limited evidence for the acceptability of training for mental health professionals on service user- and carer-involved care planning. Aim To investigate the acceptability of a co-delivered, two-day training intervention on service user- and carer-involved care planning. Methods Community mental health professionals were invited to complete the Training Acceptability Rating Scale post-training. Responses to the quantitative items were summarized using descriptive statistics (Miles, ), and qualitative responses were coded using content analysis (Weber, ). Results Of 350 trainees, 310 completed the questionnaire. The trainees rated the training favourably (median overall TARS scores = 56/63; median 'acceptability' score = 34/36; median 'perceived impact' score = 22/27). There were six qualitative themes: the value of the co-production model; time to reflect on practice; delivery preferences; comprehensiveness of content; need to consider organizational context; and emotional response. Discussion The training was found to be acceptable and comprehensive with participants valuing the co-production model. Individual differences were apparent in terms of delivery preferences and emotional reactions. There may be a need to further address the organizational context of care planning in future training. Implications for practice Mental health nurses should use co-production models of continuing professional development training that involve service users and carers as co-facilitators. © 2017 The Authors. Journal of Psychiatric and Mental Health Nursing Published by John Wiley & Sons Ltd.

Legal, social, cultural and political developments in mental health care in the UK: the Liverpool black mental health service users' perspective.

PubMed

Pierre, S A

2002-02-01

Documentary evidence suggests that attitudes among local health and social services professionals towards the concept of user involvement in health and social care remain deeply polarized, a position characterized by commentators simultaneously as praise and damnation. Perhaps user involvement in health and social care will enhance, and it appears to resonate with the logic of, participatory democracy, in localities where the centralization of power has posed questions as to the nature and purpose of local governance in public services provision. The problems experienced by Britain's black and ethnic minorities within the mental health system have been the subject of exhaustive social inquiry. This essay attempts to explore the way in which legal, social, cultural, and political developments interface with mental health care practice in the UK, in order to assist those responsible for mental health services provision to deliver services that are in line with the Government's expectation of a modernized mental health service that is safe, sound, and supportive. An exploration of these developments within the European, national (UK), and local (Liverpool) contexts is undertaken. An appropriate local response to national priorities will ostensibly cut a swathe through the barriers confronted by the ethnic minority mental health service user in the cross-cultural context, an important prerequisite for the implementation of genuine user involvement.

The Effect of Diagnostic Label on Care Staff's Perceptions of Cause of Challenging Behaviour in Individuals with Learning Disabilities

ERIC Educational Resources Information Center

Gifford, Clive; Knott, Fiona

2016-01-01

Background: This study investigated whether care staff's causal attributions and emotional reactions to the challenging behaviour displayed by service users were influenced by the service user's diagnostic label. Materials and Method: One hundred and twenty care staff were randomly allocated to one of three conditions. Participants viewed a video…

Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa.

PubMed

Sokhela, Dudu G; Makhanya, Nonhlanhla J; Sibiya, Nokuthula M; Nokes, Kathleen M

2013-07-05

Comprehensive Primary Health Care (PHC), based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients' experiences led to satisfaction or dissatisfaction with the Fast Queue service. A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources. Effective health communication strategies contribute to positive experiences by health care users and these can be effected by: (1) involvement of health care providers in planning the construction of health facilities to give input about patient flow, infection prevention and control and provision of privacy, (2) effective complaints mechanisms for users to ensure that complaints are followed up and (3)encouraging users to arrive at the facility throughout the day, rather than the present practice where all users arrive at the clinic early in the morning.

EQUIP training the trainers: an evaluation of a training programme for service users and carers involved in training mental health professionals in user-involved care planning.

PubMed

Fraser, C; Grundy, A; Meade, O; Callaghan, P; Lovell, K

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: UK NHS policy highlights the importance of user and carer involvement in health professional training. We know little about service user and carer motivations and experiences of accessing training courses for delivering training to health professionals and how well such courses prepare them for delivering training to healthcare professionals. 'Involvement' in training has often been tokenistic and too narrowly focused on preregistration courses. There is limited data on how best to prepare and support potential service user and carer trainers. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study adds to the international literature by highlighting service user and carer motivations for accessing a training course for delivering training to health professionals. Service users and carers wanted to gain new skills and confidence in presentation/facilitation as well as to make a difference to healthcare practice. We also learned that service users desired different levels of involvement in training facilitation - some wanted to take a more active role than others. A one-size-fits-all approach is not always appropriate. Encountering resistance from staff in training was a previously unidentified challenge to service user and carers' experience of delivering training in practice and is a key challenge for trainers to address in future. Professional training involvement can be enhanced via specialist training such as the EQUIP training the trainers programme evaluated here. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When training service users and carers to deliver training to mental health professionals, it is important that service users are equipped to deal with resistance from staff. It is important that service user and carer roles are negotiated and agreed prior to delivering training to healthcare professionals to accommodate individual preferences and allay anxieties. Training for service users and carers must be offered alongside ongoing support and supervision. Mental health nurses (and other health professionals) will be better able to involve service users and carers in care planning. Service users and carers may feel more involved in care planning in future. Introduction Limited evidence exists on service user and carer perceptions of undertaking a training course for delivering care planning training to qualified mental health professionals. We know little about trainee motivations for engaging with such train the trainers courses, experiences of attending courses and trainees' subsequent experiences of codelivering training to health professionals, hence the current study. Aim To obtain participants' views on the suitability and acceptability of a training programme that aimed to prepare service users and carers to codeliver training to health professionals. Method Semi-structured interviews with nine service users and carers attending the training programme. Transcripts were analysed using inductive thematic analysis. Results Participants' reasons for attending training included skill development and making a difference to mental health practice. Course content was generally rated highly but may benefit from review and/or extension to allow the range of topics and resulting professional training programme to be covered in more depth. Trainees who delivered the care planning training reported a mix of expectations, support experiences, preparedness and personal impacts. Implications for Practice Mental health nurses are increasingly coproducing and delivering training with service users and carers. This study identifies possibilities and pitfalls in this endeavour, highlighting areas where user and carer involvement and support structures might be improved in order to fully realize the potential for involvement in training. © 2017 The Authors. Journal of Psychiatric and Mental Health Nursing Published by John Wiley & Sons Ltd.

Effect of health system reforms in Turkey on user satisfaction

PubMed Central

Stokes, Jonathan; Gurol–Urganci, Ipek; Hone, Thomas; Atun, Rifat

2015-01-01

In 2003, the Turkish government introduced major health system changes, the Health Transformation Programme (HTP), to achieve universal health coverage (UHC). The HTP leveraged changes in all parts of the health system, organization, financing, resource management and service delivery, with a new family medicine model introducing primary care at the heart of the system. This article examines the effect of these health system changes on user satisfaction, a key goal of a responsive health system. Utilizing the results of a nationally representative yearly survey introduced at the baseline of the health system transformation, multivariate logistic regression analysis is used to examine the yearly effect on satisfaction with health services. During the 9–year period analyzed (2004–2012), there was a nearly 20% rise in reported health service use, coinciding with increased access, measured by insurance coverage. Controlling for factors known to contribute to user satisfaction in the literature, there is a significant (P < 0.001) increase in user satisfaction with health services in almost every year (bar 2006) from the baseline measure, with the odds of being satisfied with health services in 2012, 2.56 (95% confidence interval (CI) of 2.01–3.24) times that in 2004, having peaked at 3.58 (95% CI 2.82–4.55) times the baseline odds in 2011. Additionally, those who used public primary care services were slightly, but significantly (P < 0.05) more satisfied than those who used any other services, and increasingly patients are choosing primary care services rather than secondary care services as the provider of first contact. A number of quality indicators can probably help account for the increased satisfaction with public primary care services, and the increase in seeking first–contact with these providers. The implementation of primary care focused UHC as part of the HTP has improved user satisfaction in Turkey. PMID:26528391

Effect of health system reforms in Turkey on user satisfaction.

PubMed

Stokes, Jonathan; Gurol-Urganci, Ipek; Hone, Thomas; Atun, Rifat

2015-12-01

In 2003, the Turkish government introduced major health system changes, the Health Transformation Programme (HTP), to achieve universal health coverage (UHC). The HTP leveraged changes in all parts of the health system, organization, financing, resource management and service delivery, with a new family medicine model introducing primary care at the heart of the system. This article examines the effect of these health system changes on user satisfaction, a key goal of a responsive health system. Utilizing the results of a nationally representative yearly survey introduced at the baseline of the health system transformation, multivariate logistic regression analysis is used to examine the yearly effect on satisfaction with health services. During the 9-year period analyzed (2004-2012), there was a nearly 20% rise in reported health service use, coinciding with increased access, measured by insurance coverage. Controlling for factors known to contribute to user satisfaction in the literature, there is a significant (P < 0.001) increase in user satisfaction with health services in almost every year (bar 2006) from the baseline measure, with the odds of being satisfied with health services in 2012, 2.56 (95% confidence interval (CI) of 2.01-3.24) times that in 2004, having peaked at 3.58 (95% CI 2.82-4.55) times the baseline odds in 2011. Additionally, those who used public primary care services were slightly, but significantly (P < 0.05) more satisfied than those who used any other services, and increasingly patients are choosing primary care services rather than secondary care services as the provider of first contact. A number of quality indicators can probably help account for the increased satisfaction with public primary care services, and the increase in seeking first-contact with these providers. The implementation of primary care focused UHC as part of the HTP has improved user satisfaction in Turkey.

Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach.

PubMed

Lago, Rozilaine Redi; Peter, Elizabeth; Bógus, Cláudia Maria

2017-03-08

People seeking care for substance use (PSCSU) experience deep social and health inequities. Harm reduction can be a moral imperative to approach these persons. The purpose of this study was to explore relationships among users, health care providers, relatives, and society regarding harm reduction in mental health care, using a trust approach rooted in feminist ethics. A qualitative study was conducted in a mental health service for PSCSU, and included fifteen participants who were health care providers, users, and their relatives. Individual in-depth and group interviews, participant observation, and a review of patients' records and service reports were conducted. Three nested levels of (dis)trust were identified: (dis)trust in the treatment, (dis)trust in the user, and self-(dis)trust of the user, revealing the interconnections among different layers of trust. (Dis)trust at each level can amplify or decrease the potential for a positive therapeutic response in users, their relatives' support, and how professionals act and build innovations in care. Distrust was more abundant than trust in participants' reports, revealing the fragility of trust and the focus on abstinence within this setting. The mismatch between wants and needs of users and the expectations and requirements of a society and mental health care system based on a logic of "fixing" has contributed to distrust and stigma. Therefore, we recommend policies that increase the investment in harm reduction education and practice that target service providers, PSCSU, and society to change the context of distrust identified.

How patient participation is constructed in mental health care: a grounded theory study.

PubMed

Jørgensen, Kim; Rendtorff, Jacob Dahl; Holen, Mari

2018-05-06

The aim of the study was to explore how patient participation is constructed in social interaction processes between nurses, other health professionals and service users, and which structures provide a framework for the participation of service users in a psychiatric context? Ten tape-recorded interviews of nurses and observations of interactions between nurses, other health professionals and service users reflected differing constructed views of patient participation. Charmaz's interpretation of the grounded theory method was used, and the data were analysed using constant comparative analysis. The study was designed in accordance with the ethical principles of the Helsinki Declaration (1) and Danish law (2). Each study participant in the two psychiatric departments gave informed consent after verbal and written information. The articulation of patient participation emphasises the challenge between, on the one side, orientations of ethical care, and, on the other, paternalism and biomedicine. The core category was generated from four inter-related categories: (i) taking care of the individual needs; (ii) the service user as expert; and (iii) biomedicine, and (iv) paternalism, and their 13 subcategories. This study illuminates the meaning of patient participation in a psychiatric context based on social interaction between nurses, other health professionals and service users. This can contribute to dealing with the challenges of incorporating patient participation as an ideology in all service users in a psychiatric context and is therefore important knowledge for health professionals. © 2018 Nordic College of Caring Science.

[Multidimensional assessment of public health care services for adolescents in Chile].

PubMed

Williams, Catalina de T; Poblete, Fernando A; Baldrich, Francisca A

2012-09-01

Adolescents are an especially vulnerable age group in terms of behavioral issues and require skilled teams in health centers. To assess the quality of health services provided to teenage users in Primary Health Care. A study of multiple cases was carried out in two family health centers in Puente Alto, Chile. Health services delivered to adolescents were evaluated from the provider's perspective, through qualitative design of focus groups and interviews to the care teams at each centre. For technical quality, comparing electronic records of two tracer conditions (prenatal care and depression) with technical standards established by Delphi methodology and from teenage users perspective, through a survey of service satisfaction. In both centers, providers perceived a lack of training in adolescent care, a deficient preventive approach and a limited access to care. The technical evaluation showed an inappropriate recording of both tracer conditions. The instrument used to assess user satisfaction survey was reliable and showed that the best perceived issue was medical care and treatment, and the least perceived, was the access to the services. Professionals working in these health care facilities, feel unprepared to provide comprehensive approach to adolescents. The surveyed teenagers complained of limited access to care. Therefore this age group continues to be as a non-priority group for health care.

Developing the knowledge base about carers and personalisation: contributions made by an exploration of carers' perspectives on personal budgets and the carer-service user relationship.

PubMed

Larkin, Mary

2015-01-01

This qualitative study aimed to explore an under-researched issue within the emerging body of research about carers and personalisation - the carer-service user relationship. It was carried out across 11 English local authorities between 2011 and 2012 and focused on the impact of a change in the service user's social care arrangements to a personal budget on this relationship. Using purposive sampling and explicit inclusion criteria, data were gathered through semi-structured in-depth interviews with 23 carers in long-term dyadic relationships with an adult in receipt of social care who had changed to a personal budget. The interviews explored carers' perceptions of the carer-service user relationship before and after the advent of the personal budget and changes that had occurred. The findings were thematically analysed and reflect the fact that in addition to the effects of the move to a personal budget on the carer-service user relationship, the interviewees talked at length about a range of other effects of this move. Just over half of those interviewed felt that the personal budget had enhanced the carer-service user relationship. The other effects were both positive and negative. Three quarters reported positive outcomes, such as feeling happier, healthier and having more control over their lives. Although two thirds experienced negative feelings about having less involvement in the service user's care, these feelings eased over time and if they had confidence in the quality of the care. Over half found administering the personal budget stressful. Further analysis of these findings showed the study contributes not only to existing knowledge about the carer-service user relationship within personalisation but also to knowledge about the effects of personalisation on carers more generally. It therefore simultaneously develops the emergent knowledge base about carers and personalisation. Recommendations based on this analysis are made about future practice and research. © 2014 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

Assessing responsiveness of health care services within a health insurance scheme in Nigeria: users' perspectives.

PubMed

Mohammed, Shafiu; Bermejo, Justo Lorenzo; Souares, Aurélia; Sauerborn, Rainer; Dong, Hengjin

2013-12-01

Responsiveness of health care services in low and middle income countries has been given little attention. Despite being introduced over a decade ago in many developing countries, national health insurance schemes have yet to be evaluated in terms of responsiveness of health care services. Although this responsiveness has been evaluated in many developed countries, it has rarely been done in developing countries. The concept of responsiveness is multi-dimensional and can be measured across various domains including prompt attention, dignity, communication, autonomy, choice of provider, quality of facilities, confidentiality and access to family support. This study examines the insured users' perspectives of their health care services' responsiveness. This retrospective, cross-sectional survey took place between October 2010 and March 2011. The study used a modified out-patient questionnaire from a responsiveness survey designed by the World Health Organization (WHO). Seven hundred and ninety six (796) enrolees, insured for more than one year in Kaduna State-Nigeria, were interviewed. Generalized ordered logistic regression was used to identify factors that influenced the users' perspectives on responsiveness to health services and quantify their effects. Communication (55.4%), dignity (54.1%), and quality of facilities (52.0%) were rated as "extremely important" responsiveness domains. Users were particularly contented with quality of facilities (42.8%), dignity (42.3%), and choice of provider (40.7%). Enrolees indicated lower contentment on all other domains. Type of facility, gender, referral, duration of enrolment, educational status, income level, and type of marital status were most related with responsiveness domains. Assessing the responsiveness of health care services within the NHIS is valuable in investigating the scheme's implementation. The domains of autonomy, communication and prompt attention were identified as priority areas for action to improve this responsiveness. For the Nigerian context, we suggest that health care providers in the NHIS should pay attention to these domains, and the associated characteristics of users, when delivering health care services to their clients. Policy makers, and the insurance regulatory agency, should consider the reform strategies of monitoring and quality assurance which focus on the domains of responsiveness to lessen the gap between users' expectations and their experiences with health services.

An analysis of the Research Team-Service User relationship from the Service User perspective: a consideration of 'The Three Rs' (Roles, Relations, and Responsibilities) for healthcare research organisations.

PubMed

Jordan, Melanie; Rowley, Emma; Morriss, Richard; Manning, Nick

2015-12-01

This article debates interview data from service users who engaged with the work of a Collaboration for Leadership in Applied Health Research and Care (CLAHRC). The evidence base, to date, concerning the nature of CLAHRC work at the frontline (i.e. What is it actually like to do CLAHRC work?) is meagre; thus, this article represents an original contribution to that literature. Further, this article analyses service users' participation in research - as members of the research team - and so contributes to the body of developing literature regarding involvement too. This article explores the nature of the Research Team-Service User relationship, plus associated roles, relations and responsibilities of collaborative health research. Qualitative social science research was undertaken in a health-care research organization utilizing interview method and a medical sociology and organizational sociology theoretical framework for analysis. Data utilized originate from a larger evaluation study that focuses on the CLAHRC as an iterative organization and explores members' experiences. There can be a disparity between initial expectations and actual experiences of involvement for service users. Therefore, as structured via 'The Three Rs' (Roles, Relations and Responsibilities), aspects of the relationship are evaluated (e.g. motivation, altruism, satisfaction, transparency, scope, feedback, communication, time). Regarding the inclusion of service users in health research teams, a careful consideration of 'The Three Rs' is required to ensure expectations match experiences. © 2014 John Wiley & Sons Ltd.

A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory.

PubMed

Tierney, Edel; McEvoy, Rachel; O'Reilly-de Brún, Mary; de Brún, Tomas; Okonkwo, Ekaterina; Rooney, Michelle; Dowrick, Chris; Rogers, Anne; MacFarlane, Anne

2016-06-01

There have been recent important advances in conceptualizing and operationalizing involvement in health research and health-care service development. However, problems persist in the field that impact on the scope for meaningful involvement to become a routine - normalized - way of working in primary care. In this review, we focus on current practice to critically interrogate factors known to be relevant for normalization - definition, enrolment, enactment and appraisal. Ours was a multidisciplinary, interagency team, with community representation. We searched EBSCO host for papers from 2007 to 2011 and engaged in an iterative, reflexive approach to sampling, appraising and analysing the literature following the principles of a critical interpretive synthesis approach and using Normalization Process Theory. Twenty-six papers were chosen from 289 papers, as a purposeful sample of work that is reported as service user involvement in the field. Few papers provided a clear working definition of service user involvement. The dominant identified rationale for enrolling service users in primary care projects was linked with policy imperatives for co-governance and emancipatory ideals. The majority of methodologies employed were standard health services research methods that do not qualify as research with service users. This indicates a lack of congruence between the stated aims and methods. Most studies only reported positive outcomes, raising questions about the balance or completeness of the published appraisals. To improve normalization of meaningful involvement in primary care, it is necessary to encourage explicit reporting of definitions, methodological innovation to enhance co-governance and dissemination of research processes and findings. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Developing inclusive partnerships: user-defined outcomes, networking and knowledge--a case study.

PubMed

Beresford, Peter; Branfield, Fran

2006-09-01

Two major developments have been associated with the reorientation of United Kingdom health and social care policy and provision in recent years, placing a new emphasis on: quality and 'outcome' measures; and service user (and public and patient) involvement. These issues have become central to health and social care, representing expressions of the shift in political and ideological interest in public policy. However, these two strands of development have tended to be treated as discrete discourses and have developed separately in policy. Nevertheless, it can hardly be assumed that what policy makers, service planners, providers and purchasers would value and prioritise as good quality would necessarily coincide with what service users would want. Developing effective partnership working needs to go beyond considerations of organisations and professional groupings, and fully involve service users as one of the key stakeholders. This paper describes the findings of three projects undertaken by Shaping Our Lives. These studies confirmed that service-user concepts of outcomes and quality may differ significantly from those currently employed; moreover, service users are able to offer a complex and sophisticated model of what outcome measures might look like if they were centrally involved in their definition and application. Nevertheless, service users currently have little impact in defining and influencing quality outcomes. The projects also highlight the importance of networking and knowledge sharing for service users and user organisations in their ability to influence policy definitions of quality, and a number of the barriers and obstacles which undermine this process. The paper concludes with two proposals which, considered together, offer the basis for taking forward effective and inclusive partnerships and developing measures for quality consistent with the rights and preferences of service users themselves. They are an essential complement to broader efforts and strategies to develop effective partnerships in health and social care.

Adult heavy and low users of dental services: treatment provided.

PubMed

Nihtilä, Annamari; Widström, Eeva; Elonheimo, Outi

2016-01-01

The aim of this study was to compare treatment provided to adult heavy and low users of dental services in the Finnish Public Dental Service (PDS) and to analyse changes in patients' oral health status. We assigned all adults who attended the PDS in Espoo in 2004 to a group of heavy users (n = 3,173) if they had made six or more dental visits and to a comparison group of low users (n = 22,820), if they had made three or fewer dental visits. Data were obtained from the patient register of the PDS. A sample of 320 patients was randomly selected from each group. Baseline information (year 2004) on age, sex, number and types of visits, oral health status and treatment provided was collected from treatment records. Both groups were followed-up for five years. Restorative treatment measures dominated the heavy and low users'treatments; 88.8% of heavy users and 79.6% low users had received restorations during the five-year period. Fixed prosthetic treatments were provided to just 2% of the heavy users and 0.8% of the low users. Emergency visits were more common for heavy users (74.8%) than for low users (21.6%) (p < 0.001). Fewer than half of the heavy (46.1%) or low (46.5%) users were examined twice. Typical for heavy use of oral health services was a cycle of repetitive repair or replacement of restorations, often as emergency treatment, a lack of proper examinations and preventive care; crown therapy was seldom used. Immediately after the major dental care reform in Finland, the PDS in Espoo had problems providing good quality dental care for the new adult patients. Older patients with lower social class background were not accustomed to regular dental care and the PDS did not actively propose proper comprehensive regular care for adults.

From Community to Meta-Community Mental Health Care.

PubMed

Bouras, Nick; Ikkos, George; Craig, Thomas

2018-04-20

Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces are challenging us to develop effective care pathways adjusted to the needs of service users and their carers. This discussion paper reviews the developments in community mental health care over the recent years and puts forward the concept of “Meta-Community Mental Health Care”. “Meta-Community Mental Health Care” embraces pluralism in understanding and treating psychiatric disorders, acknowledges the complexities of community provision, and reflects the realities and needs of the current era of care.

Co-production in practice: how people with assisted living needs can help design and evolve technologies and services.

PubMed

Wherton, Joseph; Sugarhood, Paul; Procter, Rob; Hinder, Sue; Greenhalgh, Trisha

2015-05-26

The low uptake of telecare and telehealth services by older people may be explained by the limited involvement of users in the design. If the ambition of 'care closer to home' is to be realised, then industry, health and social care providers must evolve ways to work with older people to co-produce useful and useable solutions. We conducted 10 co-design workshops with users of telehealth and telecare, their carers, service providers and technology suppliers. Using vignettes developed from in-depth ethnographic case studies, we explored participants' perspectives on the design features of technologies and services to enable and facilitate the co-production of new care solutions. Workshop discussions were audio recorded, transcribed and analysed thematically. Analysis revealed four main themes. First, there is a need to raise awareness and provide information to potential users of assisted living technologies (ALTs). Second, technologies must be highly customisable and adaptable to accommodate the multiple and changing needs of different users. Third, the service must align closely with the individual's wider social support network. Finally, the service must support a high degree of information sharing and coordination. The case vignettes within inclusive and democratic co-design workshops provided a powerful means for ALT users and their carers to contribute, along with other stakeholders, to technology and service design. The workshops identified a need to focus attention on supporting the social processes that facilitate the collective efforts of formal and informal care networks in ALT delivery and use.

Should the provision of home help services be contained?: Validation of the new preventive care policy in Japan

PubMed Central

2010-01-01

Background To maintain the sustainability of public long-term care insurance (LTCI) in Japan, a preventive care policy was introduced in 2006 that seeks to promote active improvement in functional status of elderly people who need only light care. This policy promotes the use of day care services to facilitate functional improvement, and contains the use of home help services that provide instrumental activity of daily living (IADL) support. However, the validity of this approach remains to be demonstrated. Methods Subjects comprised 241 people aged 65 years and over who had recently been certified as being eligible for the lightest eligibility level and had began using either home help or day care services between April 2007 and October 2008 in a suburban city of Tokyo. A retrospective cohort study was conducted ending October 2009 to assess changes in the LTCI eligibility level of these subjects. Cox's proportional hazards model was used to calculate the relative risk of declining in function to eligibility Level 4 among users of the respective services. Results Multivariate analysis adjusted for factors related to service use demonstrated that the risk of decline in functional status was lower for users of home help services than for users of day care services (HR = 0.55, 95% CI: 0.31-0.98). The same result was obtained when stratified by whether the subject lived with family or not. Furthermore, those who used two or more hours of home help services did not show an increase in risk of decline when compared with those who used less than two hours. Conclusions No evidence was obtained to support the effectiveness of the policy of promoting day care services and containing home help services for those requiring light care. PMID:20678189

Advancing the Big Five of user-oriented care and accounting for its variations.

PubMed

Kajonius, Petri; Kazemi, Ali

2016-01-01

Care process quality (i.e. how care is enacted by a care worker toward a client at the interpersonal level) is a strong predictor of satisfaction in a wide range of health care services. The purpose of this paper is to describe the basic elements of care process quality as user-oriented care. Specifically, the questions of how and why quality in user-oriented care varies were investigated in the context of elderly care. Two municipalities were selected for in-depth field studies. First, in each municipality, the authors interviewed and observed care workers' interactions with the older persons in both home care and nursing homes during two weeks (Study 1). Second, in an attempt to gain a deeper understanding of why process quality in terms of user-oriented care varies, the authors conducted interviews with care workers and care unit managers (Study 2). A new taxonomy for categorizing process quality variation, the Big Five of user-oriented care (task-focus, person-focus, affect, cooperation, and time-use), is proposed. In addition, the perceived reasons for process quality variation are reported in our own developed Quality Agents Model, suggesting that variations in care process evaluations may be explained from different perspectives at multiple levels (i.e., older person, care worker-, unit-, department-, and municipality level). The proposed taxonomy and model are useful for describing user-oriented care quality and the reasons for its variations. These findings are of relevance for future quality developments of elderly care services, but also may be adapted to applications in any other enterprise employing a user-oriented approach.

A proposal for a spiritual care assessment toolkit for religious volunteers and volunteer service users.

PubMed

Liu, Yi-Jung

2014-10-01

Based on the idea that volunteer services in healthcare settings should focus on the service users' best interests and providing holistic care for the body, mind, and spirit, the aim of this study was to propose an assessment toolkit for assessing the effectiveness of religious volunteers and improving their service. By analyzing and categorizing the results of previous studies, we incorporated effective care goals and methods in the proposed religious and spiritual care assessment toolkit. Two versions of the toolkit were created. The service users' version comprises 10 questions grouped into the following five dimensions: "physical care," "psychological and emotional support," "social relationships," "religious and spiritual care," and "hope restoration." Each question could either be answered with "yes" or "no". The volunteers' version contains 14 specific care goals and 31 care methods, in addition to the 10 care dimensions in the residents' version. A small sample of 25 experts was asked to judge the usefulness of each of the toolkit items for evaluating volunteers' effectiveness. Although some experts questioned the volunteer's capacity, however, to improve the spiritual care capacity and effectiveness provided by volunteers is the main purpose of developing this assessment toolkit. The toolkit developed in this study may not be applicable to other countries, and only addressed patients' general spiritual needs. Volunteers should receive special training in caring for people with special needs.

Implementation of Fee-Free Maternal Health-Care Policy in Ghana: Perspectives of Users of Antenatal and Delivery Care Services From Public Health-Care Facilities in Accra.

PubMed

Anafi, Patricia; Mprah, Wisdom K; Jackson, Allen M; Jacobson, Janelle J; Torres, Christopher M; Crow, Brent M; O'Rourke, Kathleen M

2018-01-01

In 2008, the government of Ghana implemented a national user fee maternal care exemption policy through the National Health Insurance Scheme to improve financial access to maternal health services and reduce maternal as well as perinatal deaths. Although evidence shows that there has been some success with this initiative, there are still issues relating to cost of care to beneficiaries of the initiative. A qualitative study, comprising 12 focus group discussions and 6 interviews, was conducted with 90 women in six selected urban neighborhoods in Accra, Ghana, to examine users' perspectives regarding the implementation of this policy initiative. Findings showed that direct cost of delivery care services was entirely free, but costs related to antenatal care services and indirect costs related to delivery care still limit the use of hospital-based midwifery and obstetric care. There was also misunderstanding about the initiative due to misinformation created by the government through the media.We recommend that issues related to both direct and indirect costs of antenatal and delivery care provided in public health-care facilities must be addressed to eliminate some of the lingering barriers relating to cost hindering the smooth operation and sustainability of the maternal care fee exemption policy.

Mental health services conceptualised as complex adaptive systems: what can be learned?

PubMed

Ellis, Louise A; Churruca, Kate; Braithwaite, Jeffrey

2017-01-01

Despite many attempts at promoting systems integration, seamless care, and partnerships among service providers and users, mental health services internationally continue to be fragmented and piecemeal. We exploit recent ideas from complexity science to conceptualise mental health services as complex adaptive systems (CASs). The core features of CASs are described and Australia's headspace initiative is used as an example of the kinds of problems currently being faced. We argue that adopting a CAS lens can transform services, creating more connected care for service users with mental health conditions.

Description and evaluation of a serious game intervention to engage low secure service users with serious mental illness in the design and refurbishment of their environment.

PubMed

Fitzgerald, M M; Kirk, G D; Bristow, C A

2011-05-01

Service user involvement in all levels of healthcare provision is the expectation of UK government policy. Involvement should not only include participation in the planning and delivery of health care but also the exercise of choice and opinions about that care. In practice, however, service user engagement is most often tokenistic, involving post hoc consultation over plans already committed to by services. This paper explores an Occupational Therapy-led initiative to use the Serious Game format to engage low secure service users with serious mental illness in the design, layout and refurbishment of their unit. Among other things how medication was to be dispensed on the new unit was explored by this game and led to significant replanning in response to service user involvement. The game format was found to be a useful tool in facilitating communication between professionals and a traditionally marginalized and powerless client group. It enabled service users to have a voice, it provided a format for that voice to be heard and made possible service-led change in the planning process. © 2010 Blackwell Publishing.

The response to challenging behaviour by care staff: emotional responses, attributions of cause and observations of practice.

PubMed

Bailey, B A; Hare, D J; Hatton, C; Limb, K

2006-03-01

Previous studies have attempted to apply Weiner's attributional model of helping behaviour to care staff who work with service users with intellectual disabilities and challenging behaviours by using studies based on vignettes. The aims of the current study were to investigate the application of Weiner's model to 'real' service users with intellectual disabilities and challenging behaviours and to observe the care staff's actual responses to challenging behaviours displayed by service users. Also, to compare care staff attributions, emotions, optimism, willingness to help and observed helping behaviours for self-injurious behaviours in comparison to other forms of challenging behaviours. A total of 27 care staff completed two sets of measures, one set regarding a self-injurious behaviour and the other regarding other forms of challenging behaviour. An additional 16 staff completed one set of measures. The measures focused on care staff attributions, emotions, optimism and willingness to help. Also, 16 of the care staff were observed interacting with the service users to collect data regarding their responses to challenging behaviours. For both self-injurious behaviours and other forms of challenging behaviour, associations were found between the care staff internal, stable and uncontrollable attribution scores and care staff negative emotion scores. However, no associations were found between the care staff levels of emotion, optimism and willingness to help. Some associations were found between the care staff levels of willingness to help and observed helping behaviours. There were significant differences between the care staff attribution scores with higher scores being obtained for uncontrollable and stable attributions for other forms of challenging behaviours. No significant differences were found between the care staff emotions, optimism, willingness to help and observed helping behaviours. The results did not provide support for Weiner's attributional model of helping behaviour. However, a preliminary model of negative care staff behaviour was derived from the exploratory analyses completed. This model proposes that there are associations between internal, stable and uncontrollable attributions and negative emotions in care staff and also between negative emotions and negative behaviours displayed by care staff in response to the actions of service users.

Satisfaction and burden of mental health personnel: data from healthcare services for substance users and their families.

PubMed

Hilgert, Juliana B; Bidinotto, Augusto B; Pachado, Mayra P; Fara, Letícia S; von Diemen, Lisia; De Boni, Raquel B; Bozzetti, Mary C; Pechansky, Flávio

2018-06-11

To evaluate satisfaction and burden of mental health personnel providing mental health services for substance users and their families. Five hundred twenty-seven mental health workers who provide treatment for substance users in five Brazilian states were interviewed. Data on sociodemographic characteristics and measures of satisfaction (SATIS-BR) and burden of mental health personnel (IMPACTO-BR) were collected. Type of mental health service and educational attainment were associated with degree of satisfaction and burden. Therapeutic community workers and those with a primary education level reported being more satisfied with the treatment offered to patients, their engagement in service activities, and working conditions. Workers from psychosocial care centers, psychosocial care centers focused on alcohol and other drugs, and social care referral centers (both general and specialized), as well as workers with a higher education, reported feeling overburdened. This study offers important information regarding the relationship of mental health personnel with their work. Care providers within this sample reported an overall high level of job satisfaction, while perceived burden differed by type of service and educational attainment. To our knowledge, this is the first study with a sample of mental health professionals working with substance users across five Brazilian states.

A service user co-facilitated intervention to reduce mental illness stigma among primary healthcare workers: Utilizing perspectives of family members and caregivers.

PubMed

Rai, Sauharda; Gurung, Dristy; Kaiser, Bonnie N; Sikkema, Kathleen J; Dhakal, Manoj; Bhardwaj, Anvita; Tergesen, Cori; Kohrt, Brandon A

2018-06-01

Service users' involvement as cofacilitators of mental health trainings is a nascent endeavor in low- and middle-income countries, and the role of families on service user participation in trainings has received limited attention. This study examined how caregivers perceive and facilitate service user's involvement in an antistigma program that was added to mental health Gap Action Program (mhGAP) trainings for primary care workers in Nepal. Service users were trained as cofacilitators for antistigma and mhGAP trainings delivered to primary care workers through the REducing Stigma among HealthcAre ProvidErs (RESHAPE) program. Key informant interviews (n = 17) were conducted with caregivers and service users in RESHAPE. Five themes emerged: (a) Caregivers' perceived benefits of service user involvement included reduced caregiver burden, learning new skills, and opportunities to develop support groups. (b) Caregivers' fear of worsening stigma impeded RESHAPE participation. (c) Lack of trust between caregivers and service users jeopardized participation, but it could be mitigated through family engagement with health workers. (d) Orientation provided to caregivers regarding RESHAPE needed greater attention, and when information was provided, it contributed to stigma reduction in families. (e) Time management impacted caregivers' ability to facilitate service user participation. Engagement with families allows for greater identification of motivational factors and barriers impacting optimal program performance. Caregiver involvement in all program elements should be considered best practice for service user-facilitated antistigma initiatives, and service users reluctant to include caregivers should be provided with health staff support to address barriers to including family. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Service user involvement in nurse education: a report on using online discussions with a service user to augment his digital story.

PubMed

Terry, Louise M

2012-02-01

Service user involvement is a key element within current pre- and post-registration nurse education in the U.K. but achieving this is challenging. Most service user involvement is through classroom visits. Digital stories, film and audio are alternatives but lack the interactivity and development of reflection that can be achieved through face-to-face contact. This report reviews the background to service user involvement in healthcare professional education then provides a reflective account of a novel initiative whereby a spinal-injured patient was involved in creating a digital story around some of his in-hospital experiences and then engaged in online discussions with post-registration nursing (degree) and practice educator (masters) students. These discussions provided a richer experience for the students enabling them to reflect more deeply on how nursing care is delivered and perceived by service users. The report concludes that digital stories can be used with repeated groups to inspire discussion and reflection. Augmenting such digital stories with online discussions with the service user whose story is told helps practitioners develop greater empathy, insight and understanding which are beneficial for improving service delivery and nursing care. Copyright © 2011 Elsevier Ltd. All rights reserved.

Frequent users of the Royal Flying Doctor Service primary clinic and aeromedical services in remote New South Wales: a quality study.

PubMed

Garne, David L; Perkins, David A; Boreland, Frances T; Lyle, David M

To examine activity patterns of the Royal Flying Doctor Service of Australia (RFDS) in far western New South Wales and to determine whether frequent use of RFDS services, particularly emergency evacuations, is a useful indicator of patients who may benefit from care planning and review. We conducted a retrospective audit of the RFDS South Eastern Section's Broken Hill patient database. Patients with a residential address in the study area who had accessed at least one RFDS medical service between 1 July 2000 and 30 June 2005 were included in the study. Number of evacuations, clinic consultations and remote consultations; clinic usage by frequent evacuees; number of primary diagnoses recorded for frequent evacuees; number of frequent users who might benefit from multidisciplinary care or specialist shared care. Between July 2000 and June 2005, the number of residents requiring evacuation or remote consultations declined by 26% and 19%, respectively, and the number of residents accessing clinics declined by 6%. (Over the same period, the population of the study area fell by about 24%.) Of the 78 patients who were identified as frequent users of the evacuation service (> or = 3 evacuations/year), 34 had three or more primary diagnoses recorded; 15 were infrequent or non-users of the clinics (< or = 3 attendances/year); 53 may have benefited from multidisciplinary care, and 41 from specialist shared care. Simple, practical clinical review systems can help health care organisations in rural and remote communities to achieve better outcomes by identifying patients who may benefit from planned care.

User satisfaction with primary health care by region in Brazil: 1st cycle of external evaluation from PMAQ-AB.

PubMed

Protasio, Ane Polline Lacerda; Gomes, Luciano Bezerra; Machado, Liliane Dos Santos; Valença, Ana Maria Gondim

2017-06-01

The National Program for Access and Quality Improvement in Primary Care (Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, PMAQ-AB) aimed to improve healthcare public service quality and satisfaction of health service users. This study's objective was to identify the main factors influencing user satisfaction with primary care (PC) services by region in Brazil. Using secondary data from the 1st Cycle of PMAQ-AB, logistic regression models were developed by region, with user satisfaction as the dependent variable, as defined by cluster analysis. Based on the obtained models, the health unit's ability to solve users' problems and feeling respected by the health providers were the most important factors for user satisfaction in all regions in Brazil. However, other important factors by region included the following: the health unit's hours of operation meeting the user's needs (Northeast); providers asking about family members (North); providers asking about other health needs (Midwest); users being seen without an appointment (South); and users asking questions after the appointment (Southeast). In conclusion, the factors influencing user satisfaction with PC vary according to region and are mainly associated with access quality, meeting users' needs, and work process organization.

Analysis of Human Resources and Services Administration-funded services for HIV-positive substance users: a study of Ryan White CARE Act Title III, Title IV, and Special Projects of National Significance providers.

PubMed

Tobias, Carol; Drainoni, Mari-Lynn; Wood, Starr

2004-10-01

In this study, 175 organizations providing health care and/or social services to HIV-positive substance users responded to a questionnaire to: (1) investigate how programs were configured to serve consumer needs and (2) identify potential innovative strategies to be explored in greater depth in a subsequent study. The results demonstrated wide variability in types of services provided, racial and ethnic diversity, methods of addressing cultural and linguistic needs, accessibility provisions, strategies for engagement and retention, strategies for coordination and integrations of care, most difficult barriers to care, and funding sources.

A study of the user's perception of economic value in nursing visits to primary care by the method of contingent valuation.

PubMed

Martín-Fernández, Jesús; Pérez-Rivas, Francisco Javier; Gómez-Gascón, Tomás; del Cura-González, Isabel; Tello Bernabé, Eugenia; Rodríguez-Martínez, Gemma; Polentinos-Castro, Elena; Domínguez-Bidagor, Julia; Ariza-Cardiel, Gloria; Conde-López, Juan Francisco; Beamud-Lagos, Milagros; Aguado-Arroyo, Oscar; Sanz-Bayona, Teresa; Gil-Lacruz, Ana Isabel

2011-10-03

The identification of the attribution of economic value that users of a health system assign to a health service could be useful in planning these services. The method of contingent valuation can provide information about the user's perception of value in monetary terms, and therefore comparable between services of a very different nature. This study attempts to extract the economic value that the subject, user of primary care nursing services in a public health system, attributes to this service by the method of contingent valuation, based on the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA). This is an economic study with a transversal design. The contingent valuation method will be used to estimate the user's willingness to pay (WTP) for the care received from the primary care nurse and the willingness to accept [compensation] (WTA), were this service eliminated. A survey that meets the requisites of the contingent valuation method will be constructed and pilot-tested. Subsequently, 600 interviews will be performed with subjects chosen by systematic randomized sampling from among those who visit nursing at twenty health centers with different socioeconomic characteristics in the Community of Madrid. The characteristics of the subject and of the care received that can explain the variations in WTP, WTA and in the WTP/WTA ratio expressed will be studied. A theoretical validation of contingent valuation will be performed constructing two explanatory multivariate mixed models in which the dependent variable will be WTP, and the WTP/WTA relationship, respectively. The identification of the attribution of economic value to a health service that does not have a direct price at the time of use, such as a visit to primary care nursing, and the definition of a profile of "loss aversion" in reference to the service evaluated, can be relevant elements in planning, enabling incorporating patient preferences to health policy decision-making.

A study of the user's perception of economic value in nursing visits to primary care by the method of contingent valuation

PubMed Central

2011-01-01

Background The identification of the attribution of economic value that users of a health system assign to a health service could be useful in planning these services. The method of contingent valuation can provide information about the user's perception of value in monetary terms, and therefore comparable between services of a very different nature. This study attempts to extract the economic value that the subject, user of primary care nursing services in a public health system, attributes to this service by the method of contingent valuation, based on the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA). Methods/Design This is an economic study with a transversal design. The contingent valuation method will be used to estimate the user's willingness to pay (WTP) for the care received from the primary care nurse and the willingness to accept [compensation] (WTA), were this service eliminated. A survey that meets the requisites of the contingent valuation method will be constructed and pilot-tested. Subsequently, 600 interviews will be performed with subjects chosen by systematic randomized sampling from among those who visit nursing at twenty health centers with different socioeconomic characteristics in the Community of Madrid. The characteristics of the subject and of the care received that can explain the variations in WTP, WTA and in the WTP/WTA ratio expressed will be studied. A theoretical validation of contingent valuation will be performed constructing two explanatory multivariate mixed models in which the dependent variable will be WTP, and the WTP/WTA relationship, respectively. Discussion The identification of the attribution of economic value to a health service that does not have a direct price at the time of use, such as a visit to primary care nursing, and the definition of a profile of "loss aversion" in reference to the service evaluated, can be relevant elements in planning, enabling incorporating patient preferences to health policy decision-making. PMID:21967306

Actual use of and satisfaction associated with rollators and "shopping carts" among frail elderly Japanese people using day-service facilities.

PubMed

Kitajima, Eiji; Moriuchi, Takefumi; Iso, Naoki; Sagari, Akira; Kikuchi, Yasuyuki; Higashi, Toshio

2017-07-01

Purpose This study aimed at clarifying the actual use of and satisfaction with rollators and "shopping carts" (wheeled walkers with storage) among frail elderly people, who were certified by a long-term care insurance system as users of facilities that provide day-service nursing care and rehabilitation. Methods We identified 1247 frail elderly people who used day-service facilities, and evaluated their actual use of, and satisfaction with, rollators and shopping carts. Results Forty-four (3.5%) individuals used rollators, and 53 (4.3%) used shopping carts. The shopping cart group contained more individuals who were certified as care level 1 (26.4%), than the rollator group (20.5%), and 52.8% of the shopping cart group was certified as care levels 1-3. The scores for "repairs and services" and "follow-up" from the Quebec User Evaluation of Satisfaction with assistive Technology second version (QUEST 2.0) survey were significantly higher in the rollator group than in the shopping cart group. Conclusions The QUEST 2.0 scores revealed that shopping cart users exhibit insufficient "repairs and services" and "follow-up" scores. As frail elderly people with poor care status accounted for >50% of the shopping cart group, these individuals urgently need walking aids that are tailored to their care status. Implications for Rehabilitation We conclude that walking aid fitting must be tailored to each persons care status, and suggest that a system should be established to allow occupational or physical therapists to provide this fitting Moreover, our analysis of the QUEST2.0 service scores revealed that repairs, services, and follow-up are insufficient to meet the needs of shopping cart users.

Does long-term care insurance affect the length of stay in hospitals for the elderly in Korea?: a difference-in-difference method.

PubMed

Hyun, Kyung-Rae; Kang, Sungwook; Lee, Sunmi

2014-12-21

This study examines the effects of long-term care insurance (LTCI) on the length of stay (LoS) of senior citizens under the national health insurance of Korea. The subjects include 3,903,448 people aged 65 and over as of July 1, 2008 when the LTCI was introduced in Korea. This study uses their panel data which traced the records of medical services and LTCI services for the same people from 2007 to 2010, and applies a difference-in-difference approach on LTCI users from levels 1, 2, and 3 who are the treatment group and non-LTCI users who are the control group. We found that the LoS of LTCI users is 1.27 days greater than that of non-LTCI users, but the LoS of level 1 and level 2 beneficiaries decreases by 8.35 and 2.84 days, respectively, whereas the LTCI does not reduce the LoS of level 3 beneficiaries. The reason why there is an effect on the LoS of level 1 and 2 beneficiaries is that these groups could choose to utilize institutional care services provided by the LTCI, and out-of-pocket costs of institutions are lower than that of hospitals. However, the reason why there is no effect on the LoS of level 3 beneficiaries is that they are not permitted to use the institutional care services in the Korean LTCI policy. Therefore, we recommend a modification in the LTCI system that facilitates the use of long-term care institutional services by level 3 beneficiaries without conflicting Korea's LTCI principle to promote home-based care services instead of the institutional care services.

Service user involvement in cancer care: the impact on service users

PubMed Central

Cotterell, Phil; Harlow, Gwen; Morris, Carolyn; Beresford, Peter; Hanley, Bec; Sargeant, Anita; Sitzia, John; Staley, Kristina

2011-01-01

Abstract Background  Service user involvement is embedded in the United Kingdom’s National Health Service, but knowledge about the impact of involvement on service users, such as the benefits and challenges of involvement, is scant. Our research addresses this gap. Objective  To explore the personal impact of involvement on the lives of service users affected by cancer. Design  We conducted eight focus groups with user groups supplemented by nine face‐to‐face interviews with involved individuals active at a local, regional and national level. Thematic analysis was conducted both independently and collectively. Setting and participants  Sixty‐four participants, engaged in involvement activities in cancer services, palliative care and research, were recruited across Great Britain. Results  We identified three main themes: (i) ‘Expectations and motivations for involvement’– the desire to improve services and the need for user groups to have a clear purpose, (ii) ‘Positive aspects of involvement’– support provided by user groups and assistance to live well with cancer and (iii) ‘Challenging aspects of involvement’– insensitivities and undervaluing of involvement by staff. Conclusions  This study identified that involvement has the capacity to produce varied and significant personal impacts for involved people. Involvement can be planned and implemented in ways that increase these impacts and that mediates challenges for those involved. Key aspects to increase positive impact for service users include the value service providers attach to involvement activities, the centrality with which involvement is embedded in providers’ activities, and the capacity of involvement to influence policy, planning, service delivery, research and/or practice. PMID:21029279

Use of an electronic patient portal among the chronically ill: an observational study.

PubMed

Riippa, Iiris; Linna, Miika; Rönkkö, Ilona; Kröger, Virpi

2014-12-08

Electronic patient portals may enhance effective interaction between the patient and the health care provider. To grasp the full potential of patient portals, health care providers need more knowledge on which patient groups prefer electronic services and how patients should be served through this channel. The objective of this study was to assess how chronically ill patients' state of health, comorbidities, and previous care are associated with their adoption and use of a patient portal. A total of 222 chronically ill patients, who were offered access to a patient portal with their health records and secure messaging with care professionals, were included in the study. Differences in the characteristics of non-users, viewers, and interactive users of the patient portal were analyzed before access to the portal. Patients' age, gender, diagnoses, levels of the relevant physiological measurements, health care contacts, and received physiological measurements were collected from the care provider's electronic health record. In addition, patient-reported health and patient activation were assessed by a survey. Despite the broad range of measures used to indicate the patients' state of health, the portal user groups differed only in their recorded diagnosis for hypertension, which was most common in the non-user group. However, there were significant differences in the amount of care received during the year before access to the portal. The non-user group had more nurse visits and more measurements of relevant physiological outcomes than viewers and interactive users. They also had fewer referrals to specialized care during the year before access to the portal than the two other groups. The viewers and the interactive users differed from each other significantly in the number of nurse calls received, the interactive users having more calls than the viewers. No significant differences in age, gender, or patient activation were detected between the user groups. Previous care received by the patient is an important predictor for the use of a patient portal. In a group of patients with a similar disease burden, demand for different types of health services and preferences related to the service channel seem to contribute to the choice to use the patient portal. Further research on patient portal functionalities and their potential to meet patient needs by complementing or substituting for traditional health care services is suggested.

Examining the relationship between ethnicity and the use of drug-related services: an ethnographic study of Nepali drug users in Hong Kong

PubMed Central

Tang, Wai-Man

2014-01-01

A recent survey has shown that Nepali drug users in Hong Kong tend to have a low rate of usage of day-care and residential rehabilitation services, but a high rate of usage of methadone services. Little is known about the reasons behind such a pattern. Therefore, in this study, a 12-month ethnographic examination has been implemented in three sites, including a day-care center, residential rehabilitation center, and methadone clinic, to explore the experiences of 20 Nepali drug users in their use of drug-related services in Hong Kong and to examine the relationship between ethnicity and the use of drug-related services. The result shows that the reason for this pattern of service use is related to the approach of the services and the cultural perception of the service providers about the service users. The day-care and residential rehabilitation services emphasize an integrated approach, but the staff tend to overlook the heterogeneity of their clients, for example, the differences in caste and sex, and fail to provide suitable services to them, whereas the methadone service follows a biomedical model, which seldom addresses the social characteristics of the service users, which in turn minimizes the opportunity for misunderstandings between the staff and the clients. This research shows that ethnicity is a significant factor in drug treatment and that culture-specific treatment that takes into consideration the treatment approach and the heterogeneity of the clients is strongly needed. PMID:25114609

Barriers to shared decision making in mental health care: qualitative study of the Joint Crisis Plan for psychosis.

PubMed

Farrelly, Simone; Lester, Helen; Rose, Diana; Birchwood, Max; Marshall, Max; Waheed, Waquas; Henderson, R Claire; Szmukler, George; Thornicroft, Graham

2016-04-01

Despite increasing calls for shared decision making (SDM), the precise mechanisms for its attainment are unclear. Sharing decisions in mental health care may be especially complex. Fluctuations in service user capacity and significant power differences are particular barriers. We trialled a form of facilitated SDM that aimed to generate patients' treatment preferences in advance of a possible relapse. The 'Joint Crisis Plan' (JCP) intervention was trialled in four mental health trusts in England between 2008 and 2011. This qualitative study used grounded theory methods to analyse focus group and interview data to understand how stakeholders perceived the intervention and the barriers to SDM in the form of a JCP. Fifty service users with psychotic disorders and 45 clinicians participated in focus groups or interviews between February 2010 and November 2011. Results suggested four barriers to clinician engagement in the JCP: (i) ambivalence about care planning; (ii) perceptions that they were 'already doing SDM'; (iii) concerns regarding the clinical 'appropriateness of service users' choices'; and (iv) limited 'availability of service users' choices'. Service users reported barriers to SDM in routine practice, most of which were addressed by the JCP process. Barriers identified by clinicians led to their lack of constructive engagement in the process, undermining the service users' experience. Future work requires interventions targeted at the engagement of clinicians addressing their concerns about SDM. Particular strategies include organizational investment in implementation of service users' choices and directly training clinicians in SDM communication processes. © 2015 John Wiley & Sons Ltd.

Integration and continuity of Care in health care network models for frail older adults

PubMed Central

Veras, Renato Peixoto; Caldas, Célia Pereira; da Motta, Luciana Branco; de Lima, Kenio Costa; Siqueira, Ricardo Carreño; Rodrigues, Renata Teixeira da Silva Vendas; Santos, Luciana Maria Alves Martins; Guerra, Ana Carolina Lima Cavaletti

2014-01-01

A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change. PMID:24897058

Advocacy of home telehealth care among consumers with chronic conditions.

PubMed

Lu, Ju-Fen; Chi, Mei-Ju; Chen, Ching-Min

2014-03-01

To describe use of home telehealth care as an alternative for chronic disease management from users' perspective. As the population ages, telehealth is increasingly being used to tackle problems related to the fast growing ageing population. Home telehealth care therefore poses challenges and offers opportunities for patients and healthcare providers. A qualitative approach was adopted with a purposeful sample of 20 patients residing in Taiwan. Patients who had received the service for three months and were willing to share their experiences were recruited. Data were collected by face-to-face interviews with semi-structured interview guideline (n = 8) and a focus group discussion (n = 12) in 2010. A qualitative content analysis was used. Four key themes were identified: perceived support and security, enhanced disease self-management, concerned with using the devices and worries about the cost by patients. Most users favoured using the service to control their chronic conditions because of its convenience and accessibility, and their condition could be measured daily to enhance their sense of security. Users could determine and understand changes in their condition and improve medical regimen compliance, and they were empowered to revise their lifestyles for better disease self-management. However, users were concerned about the utility of the service, because they were unfamiliar with the operating procedures and doubted its quality. As the service is still in stage of pilot testing, users worried about possible cost and reimbursement policy changes in the future. Most users perceived telehealth care was a convenient and useful model for healthcare-delivery. It increased the availability of health care and improved the self-care ability of patients. To advocate for home telehealth care, nurses must play an active role in providing consumers with proper training and support for any problems when adopting the system to foster patients' willingness to use this service. © 2013 John Wiley & Sons Ltd.

Copying Letters to Service Users with Learning Disabilities: Opinions of Service Users, Carers and Professionals Working within Learning Disability Services

ERIC Educational Resources Information Center

Hovey, Toni; Cheswick, Claire

2009-01-01

The NHS Plan, Department of Health (2000) made a commitment that patients should be able to receive copies of clinicians' letters about them as a right in order to improve communication and enable patients to participate in their care. In South Gloucestershire, the opinions of local service users with learning disabilities, their carers, and…

[Patients and quality of primary health care services. Survey of practitioners at the Bahía de Cádiz and La Janda health centers].

PubMed

Hernán García, M; Gutiérrez Cuadra, J L; Lineros González, C; Ruiz Barbosa, C; Rabadán Asensio, A

2002-10-31

To report the opinions of practitioners at health centers on dimensions of quality that affect user satisfaction. Cross-sectional study of focus groups (FG). Bahía de Cádiz and La Janda health centers in southwestern Spain. We studied 4 FG whose participants were staff members of the two health centers: FG1, physicians; FG2, user satisfaction service staff; FG3, social workers; FG4, nurses. The groups were based on the different functions of staff at the two centers. The analysis was based on variables in the SERCAL model (an adaptation of the SERVQUAL model for the Spanish health care system) of opinions regarding service quality: access, comfort (tangibles), personalized service (courtesy), competence, and loyalty. The data were analyzed with version N-Vivo of the NUDIST program. All dimensions of the theoretical model were identified by practitioners as constructs of users' perceptions of service quality. Users' and practitioners' views contrasted with and complemented each other to generate a model that could be validated. Access, personalized service and problem-solving (responsiveness) were key variables. Practitioners' opinions provided information of use in improving the quality model. Differences in opinion between users and practitioners merit further study based on an understanding of these groups' values and interests, and on the care provision context. Practitioners identified access, personalized service and problem-solving as features that influenced users' opinions of the quality of the health center.

Involving mental health service users in suicide-related research: a qualitative inquiry model.

PubMed

Lees, David; Procter, Nicholas; Fassett, Denise; Handley, Christine

2016-03-01

To describe the research model developed and successfully deployed as part of a multi-method qualitative study investigating suicidal service-users' experiences of mental health nursing care. Quality mental health care is essential to limiting the occurrence and burden of suicide, however there is a lack of relevant research informing practice in this context. Research utilising first-person accounts of suicidality is of particular importance to expanding the existing evidence base. However, conducting ethical research to support this imperative is challenging. The model discussed here illustrates specific and more generally applicable principles for qualitative research regarding sensitive topics and involving potentially vulnerable service-users. Researching into mental health service users with first-person experience of suicidality requires stakeholder and institutional support, researcher competency, and participant recruitment, consent, confidentiality, support and protection. Research with service users into their experiences of sensitive issues such as suicidality can result in rich and valuable data, and may also provide positive experiences of collaboration and inclusivity. If challenges are not met, objectification and marginalisation of service-users may be reinforced, and limitations in the evidence base and service provision may be perpetuated.

Portuguese Adaptation and Input for the Validation of the Views on Inpatient Care (VOICE) Outcome Measure to Assess Service Users'Perceptions of Inpatient Psychiatric Care.

PubMed

Palha, João; Palha, Filipa; Dias, Pedro; Gonçalves-Pereira, Manuel

2017-11-29

Patient satisfaction is an important measure of health care quality. Patients' views have seldom been considered in the construction of measures addressing satisfaction with inpatient facilities in psychiatry. The Views on Inpatient Care - VOICE - is a first service-user generated outcome measure relying solely on their perceptions of acute care, representing a valuable indicator of service users' perceived quality of care. The present study aimed to contribute to the validation of the Portuguese version of VOICE. The questionnaire was translated into Portuguese and applied to a sample of eighty-five female inpatients of a psychiatric institution. Data analysis focused on assessing reliability and exploring the impact of demographic and clinical variables on participants' satisfaction. Internal consistency of the questionnaire was high (α = 0.87). Participants' age and marital status were associated with differences in scores, with older patients and patients who were married or involved in a close relationship presenting higher satisfaction levels. The questionnaire demonstrated good internal consistency and acceptability, as well as construct validity. Further studies should expand the analysis of the psychometric properties of this measure e.g., test-retest reliability. The Portuguese version of VOICE is a promising tool to assess service users' perceptions of inpatient psychiatric care in Portugal.

Consumption of and satisfaction with health care among opioid users with chronic non-malignant pain.

PubMed

Hansen, A B; Skurtveit, S; Borchgrevink, P C; Dale, O; Romundstad, P R; Mahic, M; Fredheim, O M

2015-11-01

Although persons with chronic pain are frequent users of the health care system, they report poor satisfaction with health care services. Participants with persistent opioid use in Nord-Trøndelag Health Study (HUNT)3 report severe pain in spite of treatment. The aim of the study was to test the hypothesis that subjects with persistent opioid use have both a higher consumption of health care services and a poorer satisfaction than the remaining subjects reporting chronic pain. This cross-sectional study was based on linkage of self-reported data from the substudy (10,238 were invited, 6927 met the inclusion criteria) of health care use in HUNT3; a population-based health survey during the years 2006-2008 and the complete national registers of the Norwegian Prescription Database and the Cancer Registry of Norway. Patients with chronic pain are stratified according to the level of opioid use as persistent users of opioids, intermittent users, and persons not using opioids. Persons with chronic non-malignant pain reported a higher consumption of all health care services compared to the control group. Consumption of health care services increased with increasing level of opioid use. Persons with persistent opioid use were highly satisfied with all health care services, although less satisfied than persons without chronic pain. Combined with previous findings of high levels of pain in spite of opioid treatment, the present findings indicate that symptomatic relief is not a prerequisite for patient satisfaction. The study shows higher patient satisfaction compared to previous studies. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Exploring the Experiences of People with Intellectual Disabilities when Service Users Die

ERIC Educational Resources Information Center

Ryan, Karen; Guerin, Suzanne; Dodd, Philip; McEvoy, John

2011-01-01

Research is lacking on the effect of the deaths of fellow service users on people with intellectual disabilities. This qualitative study formed part of a project which aimed to describe the provision of palliative care to people with intellectual disabilities in Ireland and to assess the population's palliative care needs. We report on findings…

Home health care and patterns of subsequent VA and medicare health care utilization for veterans.

PubMed

Van Houtven, Courtney Harold; Jeffreys, Amy S; Coffman, Cynthia J

2008-10-01

The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HHC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched controls. We also consider crossover between the VA and Medicare. This is a retrospective study using propensity score and stratified analysis to control for selection bias on observable characteristics. We examined the full cohort of 2002 VA HHC users (n = 24,169) and a 2:1 sample of age- and race-based nonusers (n = 53,356). Utilization measures included VA and Medicare outpatient, inpatient, nursing home, and hospice use, as well as VA home-based primary care, respite care, and adult day health care. VA HHC users had a higher absolute probability of outpatient use by around 3%, of inpatient use by 12%, and nursing home use by 6% than their propensity-score-matched controls. Veterans who used HHC services had a higher rate of VA service use in the subsequent year than controls did, even after we adjusted for differences in observed health status, eligibility advantages, and supplemental insurance status. High utilization for VA home health users spilled over into high Medicare utilization.

The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi

PubMed Central

Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic

2016-01-01

The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P <  0.01) increase in the mean proportion of women who made at least one antenatal care (ANC) visit during pregnancy, a 12% (P < 0.05) increase in average ANC visits and an 11% (P < 0.05) increase in the mean proportion of pregnant women who delivered at the facilities. No effects were found for the proportion of pregnant women who made the first ANC visit in the first trimester and the proportion of women who made postpartum care visits. We conclude that user fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important. PMID:27175033

[Measurement of the importance of user satisfaction dimensions in healthcare provision].

PubMed

Murillo, Carles; Saurina, Carme

2013-01-01

Identifying users' perceptions of the quality of care is essential to improve health services delivery. The main objective of this article was to describe the application of a methodology to identify factors that facilitate the identification of areas for improvement. A questionnaire was applied in three health areas in Catalonia (Spain) (primary care [n=332], outpatient specialty care [n=410] and hospital emergency care [n=413]) to measure user satisfaction and assess the importance given to the aspects analyzed. The main areas for improvement in primary care identified by an importance-performance analysis involved the time devoted to patients as well as health professionals' willingness to listen to their views. In hospital emergency care, the main area of improvement was related to the hospital's physical conditions. The tools designed and implemented by the Catalan Health Service (Spain) have proved to be valid for the detection of priority areas to improve service delivery and promote regional equity. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

From Community to Meta-Community Mental Health Care

PubMed Central

Bouras, Nick; Ikkos, George; Craig, Thomas

2018-01-01

Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces are challenging us to develop effective care pathways adjusted to the needs of service users and their carers. This discussion paper reviews the developments in community mental health care over the recent years and puts forward the concept of “Meta-Community Mental Health Care”. “Meta-Community Mental Health Care” embraces pluralism in understanding and treating psychiatric disorders, acknowledges the complexities of community provision, and reflects the realities and needs of the current era of care. PMID:29677100

Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan.

PubMed

Feng, Mei; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yoshie, Satoru; Iijima, Katsuya; Yamamoto-Mitani, Noriko

2017-11-01

The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231. © 2017 Japan Geriatrics Society.

[Health services' utilization patterns in Catalonia, Spain].

PubMed

Medina, Carmen; Salvador, Xavier; Faixedas, M Teresa; Gallo, Pedro

2011-12-01

The purpose of this article is disclose services utilization patterns among the Catalan population with particular emphasis on primary care, specialised care, hospital care and emergency care. A number of logistic regression models were used to explain the utilization of the various types of services. Variables in the analysis included self-perceived need, lifestyles, and sociodemographic variables. Separate analyses were performed for male, female, adults, and children as well as for the general population. Women use all types of services more often than men. Children and people over 64 are more frequent users of primary care. Primary care is also associated to lower socioeconomic conditions. Young adults and the migrant population in general are found to be under users of services, except of emergency care services. The use of specialised care is associated to the better-off, to those with university level education attainment, individual private insurance, and those living in the city of Barcelona. Hospital care is largely associated to need variables. The use of health services is explained by self-perceived need as well as by demographic, socioeconomic and geographical factors. Copyright © 2011 Elsevier España S.L. All rights reserved.

EPA guidance on building trust in mental health services.

PubMed

Gaebel, W; Muijen, M; Baumann, A E; Bhugra, D; Wasserman, D; van der Gaag, R J; Heun, R; Zielasek, J

2014-02-01

To advance mental health care use by developing recommendations to increase trust from the general public and patients, those who have been in contact with services, those who have never been in contact and those who care for their families in the mental health care system. We performed a systematic literature search and the retrieved documents were evaluated by two independent reviewers. Evidence tables were generated and recommendations were developed in an expert and stakeholder consensus process. We developed five recommendations which may increase trust in mental health care services and advance mental health care service utilization. Trust is a mutual, complex, multidimensional and dynamic interrelationship of a multitude of factors. Its components may vary between individuals and over time. They may include, among others, age, place of residence, ethnicity, culture, experiences as a service user, and type of disorder. For mental health care services, issues of knowledge about mental health services, confidentiality, continuity of treatment, dignity, safety and avoidance of stigma and coercion are central elements to increase trust. Evidence-based recommendations to increase mutual trust of service users and psychiatrists have been developed and may help to increase mental health care service utilization. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use

PubMed Central

Pope, Charlene A.; Davis, Boyd H.; Wine, Leticia; Nemeth, Lynne S.; Axon, Robert N.

2018-01-01

Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving. PMID:29482411

Service user involvement for mental health system strengthening in India: a qualitative study.

PubMed

Samudre, Sandesh; Shidhaye, Rahul; Ahuja, Shalini; Nanda, Sharmishtha; Khan, Azaz; Evans-Lacko, Sara; Hanlon, Charlotte

2016-07-28

There is a wide recognition that involvement of service users and their caregivers in health system policy and planning processes can strengthen health systems; however, most evidence and experience has come from high-income countries. This study aimed to explore baseline experiences, barriers and facilitators to service user-caregiver involvement in the emerging mental health system in India, and stakeholders' perspectives on how greater involvement could be achieved. A qualitative study was conducted in Sehore district of Madhya Pradesh, India. In-depth interviews (n = 27) and a focus group discussion were conducted among service users, caregivers and their representatives at district, state and national levels and policy makers, service providers and mental health researchers. The topic guide explored the baseline situation in India, barriers and facilitators to service user and caregiver involvement in the following aspects of mental health systems: policy-making and planning, service development, monitoring and quality control, as well as research. Framework analysis was employed. Respondents spoke of the limited involvement of service users and caregivers in the current Indian mental health system. The major reported barriers to this involvement were (1) unmet treatment and economic needs arising from low access to mental health services coupled with the high burden of illness, (2) pervasive stigmatising attitudes operating at the level of service user, caregiver, community, healthcare provider and healthcare administrators, and (3) entrenched power differentials between service providers and service users. Respondents prioritised greater involvement of service users in the planning of their own individual-level mental health care before considering involvement at the mental health system level. A stepwise progression was endorsed, starting from needs assessment, through empowerment and organization of service users and caregivers, leading finally to meaningful involvement. Societal and system level barriers need to be addressed in order to facilitate the involvement of service users and caregivers to strengthen the Indian mental health system. Shifting from a largely 'provider-centric' to a more 'user-centric' model of mental health care may be a fundamental first step to sustainable user involvement at the system level.

A cluster randomised controlled trial of a staff-training intervention in residential units for people with long-term mental illness in Portugal: the PromQual trial.

PubMed

Cardoso, Graça; Papoila, Ana; Tomé, Gina; Killaspy, Helen; King, Michael; Caldas-de-Almeida, José Miguel

2017-11-01

This study aimed to assess the efficacy of a staff-training intervention to improve service users' engagement in activities and quality of care, by means of a cluster randomised controlled trial. All residential units with at least 12-h a day staff support (n = 23) were invited to participate. Quality of care was assessed with the Quality Indicator for Rehabilitative Care (QuIRC) filled online by the unit's manager. Half the units (n = 12) were randomly assigned to continue providing treatment as usual, and half (n = 11) received a staff-training intervention that focused on skills for engaging service users in activities, with trainers working alongside staff to embed this learning in the service. The primary outcome was service users' level of activity (measured with the Time Use Diary), reassessed at 4 and 8 months. Secondary outcomes were the quality of care provided (QuIRC), and service users' quality of life (Manchester Short Assessment of Quality of Life) reassessed at 8 months. Generalized linear mixed effect models were used to assess the difference in outcomes between units in the two trial arms. The trial was registered with Current Controlled Trials (Ref NCT02366117). Knowledge acquired by the staff during the initial workshops increased significantly (p ≤ 0.01). However, the intervention and comparison units did not differ significantly in primary and secondary outcomes at either follow-up. The intervention increased the level of knowledge of staff without leading to an improvement in service users' engagement in activities, quality of life, or quality of care in the units.

Traversing the network: a user-led Care Pathway approach to the management of Parkinson's disease in the community.

PubMed

Holloway, Margaret

2006-01-01

This article reports on a pilot study to develop and implement a Care Pathway framework for people with Parkinson's disease (PD) and their carers, to facilitate more comprehensive and integrated health and social care, with a streamlining of the transfer of core information around the system. The pathway is user-led, conceptualising the user/carer as the 'communications centre', resourced and supported in the management of their situation by the professionals to achieve their own integrated package of care. The Care Pathway tools, comprising of a local information pack, a Problems/Needs form, a Clinic Summary and a service record sheet, were designed by a working party consisting of service providers, a service user and carer and the researchers. The use of the framework was evaluated by following the progress of a convenience sample of 22 people with PD over a 12-month period. Beginning and end-point data on patient characteristics, social circumstances, severity of illness, and recent/current use of services were collected. The separate tools and the contribution of the framework to the management of the illness were evaluated through semi-structured interviews with participants and their carers and focused interviews with the participating neurologist and specialist nurse, conducted at the end of the 12-month period. Participants' situations showed very little change overall. The people with PD and their carers were generally enthusiastic about the Care Pathway, particularly the problems/needs form which they felt facilitated their active engagement in their own care. Very few service record forms had been used. The neurologist and specialist nurse were equally enthusiastic, and envisaged that full use of the framework with all service providers participating would greatly improve the overall care of their patients. In conclusion the Care Pathway framework is feasible within normal clinic procedures and improves patients' care. However, its effectiveness in contributing to the better management of the illness overall requires further testing.

[IMSS in numbers. Evaluation of the performance of health institutions in Mexico, 2004].

PubMed

2006-01-01

The evaluation of health institutions performance in Mexico during 2004 was done using 29 indicators that describe intra-hospital mortality rates, productivity of health services, availability of health resources, quality of care, security, investment and costs of health care and the satisfaction level by users of health services. This exercise describes the efficiency and organization of health services provided by the different health institutions and allows comparing and balancing the performance of each institution. Results indicate the differences in availability of resources, inequity in the financing health care services, and inefficiency in the use of resources but also describe the level of efficacy of certain institutions and the satisfaction level that different users have of health services. The evaluation of the performance of the entire health institutions should provide the means to improve all the process of health care and to increase the quality of care in all health institutions in the country.

Crisis resolution and home treatment: stakeholders' views on critical ingredients and implementation in England.

PubMed

Morant, Nicola; Lloyd-Evans, Brynmor; Lamb, Danielle; Fullarton, Kate; Brown, Eleanor; Paterson, Beth; Istead, Hannah; Kelly, Kathleen; Hindle, David; Fahmy, Sarah; Henderson, Claire; Mason, Oliver; Johnson, Sonia

2017-07-17

Crisis resolution teams (CRTs) can provide effective home-based treatment for acute mental health crises, although critical ingredients of the model have not been clearly identified, and implementation has been inconsistent. In order to inform development of a more highly specified CRT model that meets service users' needs, this study used qualitative methods to investigate stakeholders' experiences and views of CRTs, and what is important in good quality home-based crisis care. Semi-structured interviews and focus groups were conducted with service users (n = 41), carers (n = 20) and practitioners (CRT staff, managers and referrers; n = 147, 26 focus groups, 9 interviews) in 10 mental health catchment areas in England, and with international CRT developers (n = 11). Data were analysed using thematic analysis. Three domains salient to views about optimal care were identified. 1. The organisation of CRT care: Providing a rapid initial responses, and frequent home visits from the same staff were seen as central to good care, particularly by service users and carers. Being accessible, reliable, and having some flexibility were also valued. Negative experiences of some referral pathways, and particularly lack of staff continuity were identified as problematic. 2. The content of CRT work: Emotional support was at the centre of service users' experiences. All stakeholder groups thought CRTs should involve the whole family, and offer a range of interventions. However, carers often feel excluded, and medication is often prioritised over other forms of support. 3. The role of CRTs within the care system: Gate-keeping admissions is seen as a key role for CRTs within the acute care system. Service users and carers report that recovery is quicker compared to in-patient care. Lack of knowledge and misunderstandings about CRTs among referrers are common. Overall, levels of stakeholder agreement about the critical ingredients of good crisis care were high, although aspects of this were not always seen as achievable. Stakeholders' views about optimal CRT care suggest that staff continuity, carer involvement, and emotional and practical support should be prioritised in service improvements and more clearly specified CRT models.

Citizens advice in primary care: a qualitative study of the views and experiences of service users and staff.

PubMed

Burrows, J; Baxter, S; Baird, W; Hirst, J; Goyder, E

2011-10-01

To examine the views and experiences of staff and users of Citizens Advice Bureau (CAB) services located in general practice, and to identify key factors perceived as contributing to the intervention's effectiveness. A qualitative study in an urban and rural primary care setting in the UK. Semi-structured, face-to-face interviews (n = 22) with primary care and practice staff, CAB advisors and 12 service users. Key positive service features reported by all groups were: the confidential, non-stigmatizing and familiar environment of a general practitioner's (GP) surgery; the ability to make appointments and experienced advisor availability and continuity. Outcomes for service users were described as financial gain, managed debt, and beneficial social and mental health impacts. Perceived staff benefits were appropriate referral and better use of GP consultation time. Welfare advice in primary care has financial benefits and was perceived by participants to offer health and other benefits to patients and staff. However, while perceptions of gain from the intervention were evident, demonstration of measurable health improvement and well-being presents challenges. Further empirical work is needed in order to explore these complex cause-effect links and the cost-effectiveness of the intervention. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Towards developing new partnerships in public services: users as consumers, citizens and/or co-producers in health and social care in England and Sweden.

PubMed

Fotaki, Marianna

2011-01-01

The causes and effects of marketization of public services have been analysed extensively in the literature, but there is relatively little research on how those policies impact on the development of new forms of governance, and the role of users in these new arrangements. This study reviews examples of competition, freedom of choice and personalized care in health and social services in England and Sweden, in order to examine the type of relationships emerging between the user/consumer vis-à-vis market driven providers and various agencies of the state under the marketized welfare. The article focuses on the possible roles users might assume in new hybrid arrangements between markets, collaborations and steering. A user typology: namely, that of a consumer, citizen, co-producer and responsibilized agent in various governance arrangements, is then suggested. The article concludes by arguing that pro-market policies instead of meeting the alleged needs of post-modern users for individualized public services are likely to promote a new type of highly volatile and fragile partnerships, and create a new subordinated user who has no choice but to ‘choose’ services they have little control over.

What qualities are valued in residential direct care workers from the perspective of people with an intellectual disability and managers of accommodation services?

PubMed

Dodevska, G A; Vassos, M V

2013-07-01

To date, the descriptions of a 'good' direct care worker used to recruit workers for disability services have largely been drawn up by managerial professionals in charge of hiring supports for people with disabilities. However, previous research highlights that these professionals conceptualise a 'good' direct care worker differently from service users with an intellectual disability (ID), with professionals placing an emphasis on describing workers with a range of practical skills and knowledge and service users placing an emphasis on describing workers with interpersonal skills. The aim of this research was to replicate this finding using a methodological approach that rectifies some of the weaknesses of previous research in this field. Semi-structured interviews were conducted to explore the qualities that are valued in residential direct care workers (RDCWs) from the perspective of seven residents with ID and seven managers of accommodation services located in metropolitan Melbourne, Australia. Thematic and chi-squared analysis confirmed the findings of previous research with residents with an ID placing more of an emphasis on the interpersonal behaviours of RDCWs in their descriptions compared to the managers. The interpersonal skills of a potential worker along with their practical skills and knowledge must be considered when recruiting RDCWs. It is also implied that given the different conceptualisation of a 'good' direct care worker across service users and professionals, increased service user participation in the organisation of appropriate supports is warranted. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.

Listening to parents to improve health visiting practice.

PubMed

Morton, Alison; Hargreaves, Sharon; Taylor, Liz

2015-05-01

Listening to the "voice" of the service user is now widely accepted as central to the delivery of high quality healthcare. This paper presents an overview of the importance of service user engagement and personalised care in health visiting with a brief review of recent policy and research. A personalised approach to health visiting practice is recommended to improve service user experience and uptake of the health visiting service offer and this is considered most significant when engaging "hard to reach" groups. A project report on a service user experience strategy within the 0-19 service of a NHS Trust in England is presented which describes initiatives to develop a health visiting and school nursing service that listens to service users. A cyclical service user engagement model which incorporates continuous reviews and service reconfiguration is described with examples of service changes in response to expressed local needs.

Delivering Service Quality in Alcohol Treatment: A Qualitative Comparison of Public and Private Treatment Centres by Service Users and Service Providers

ERIC Educational Resources Information Center

Resnick, Sheilagh M.; Griffiths, Mark D.

2012-01-01

In the UK, quality of care has now been placed at the centre of the National Health Service (NHS) modernisation programme. To date, there has been little research on the service quality delivery of alcohol treatment services from the perspective of both the service user and service provider. Therefore, this qualitative study explored the…

ICT Services for Life Improvement for the Elderly.

PubMed

Sánchez-Rico, Alejandro; Garel, Pascal; Notarangelo, Isabella; Quintana, Marcos; Hernández, Gustavo; Asteriadis, Stylianos; Popa, Mirela; Vretos, Nicholas; Solachidis, Vassilis; Burgos, Marta; Girault, Ariane

2017-01-01

Integrated care ICT Platform to support patients, care-givers and health/social professionals in the care of dementia and Parkinson's disease with training, empowerment, sensor-based data analysis and cooperation services based on user-friendly interfaces.

Service users' experiences and views of aggressive situations in mental health care: a systematic review and thematic synthesis of qualitative studies.

PubMed

Gudde, Camilla Buch; Olsø, Turid Møller; Whittington, Richard; Vatne, Solfrid

2015-01-01

Aggressive situations occurring within mental health services can harm service users, staff, and the therapeutic environment. There is a consensus that the aggression phenomenon is multidimensional, but the picture is still unclear concerning the complex interplay of causal variables and their respective impact. To date, only a small number of empirical studies include users' views of relevant factors. The main objective of this review is to identify and synthesize evidence relating to service users' experiences and views of aggressive situations in mental health settings. We included qualitative studies of any design reporting on service users' own experiences of conditions contributing to aggressive situations in mental health care and their views on preventative strategies. Eligible articles were identified through an electronic database search (PsycINFO, PubMed, Ovid Nursing Database, Embase, and CINAHL), hand search, and cross-referencing. Extracted data were combined and interpreted using aspects of thematic synthesis. We reviewed 5,566 records and included 13 studies (ten qualitative and three mixed methods). Service users recognized that both their own mental state and negative aspects of the treatment environment affected the development of aggressive situations. Themes were derived from experiential knowledge and included calls to be involved in questions regarding how to define aggression and relevant triggers, and how to prevent aggressive encounters effectively. The findings suggest that incidents are triggered when users experience staff behavior as custodial rather than caring and when they feel ignored. The findings highlight the importance of staffs' knowledge and skills in communication for developing relationships based on sensitivity, respect, and collaboration with service users in order to prevent aggressive situations. An important factor is a treatment environment with opportunities for meaningful activities and a preponderance of trained staff who work continuously on the development of conditions and skills for collaborative interaction with users.

Service user engagement in healthcare education as a mechanism for value based recruitment: An evaluation study.

PubMed

Heaslip, Vanessa; Scammell, Janet; Mills, Anne; Spriggs, Ashley; Addis, Andrea; Bond, Mandy; Latchford, Carolyn; Warren, Angela; Borwell, Juliet; Tee, Stephen

2018-01-01

Within the United Kingdom (UK) there is an increasing focus on Values Based Recruitment (VBR) of staff working in the National Health Service (NHS) in response to public inquiries criticising the lack of person-centred care. All NHS employees are recruited on the basis of a prescribed set of values. This is extended to the recruitment of student healthcare professionals, yet there is little research of how to implement this. Involving Service Users in healthcare educational practice is gaining momentum internationally, yet involvement of service users in VBR of 'would be' healthcare professionals remains at an embryonic phase. Adult nurses represent the largest healthcare workforce in the UK, yet involvement of service users in their recruitment has received scant attention. This paper is an evaluation of the inclusion of service users in a VBR of 640 adult student nurses. This study used a participatory mixed methods approach, with service users as co-researchers in the study. The study consisted of mixed methods design. Quantitative data via an online questionnaire to ascertain candidates' perspectives (n=269 response rate of 42%), and academic/clinical nurses (n=35 response rate 34.65%). Qualitative data were gathered using focus groups and one to one interviews with service users (n=9). Data analysis included descriptive statistics and thematic analysis. 4 overarching themes were identified; increasing sense of humanness, substantiating care values; impact of involvement; working together and making it work, a work in progress. The findings from the study highlight that involving service users in VBR of student healthcare professionals has benefits to candidates, service users and local health services. Appreciating the perceptions of healthcare professionals is fundamental in the UK and internationally to implementing service users' engagement in service enhancement and delivery. Findings from this study identify there may be a dissonance between the policy, the nurses' thoughts and their practice. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Translating research into practice through user-centered design: An application for osteoarthritis healthcare planning.

PubMed

Carr, Eloise Cj; Babione, Julie N; Marshall, Deborah

2017-08-01

To identify the needs and requirements of the end users, to inform the development of a user-interface to translate an existing evidence-based decision support tool into a practical and usable interface for health service planning for osteoarthritis (OA) care. We used a user-centered design (UCD) approach that emphasized the role of the end-users and is well-suited to knowledge translation (KT). The first phase used a needs assessment focus group (n=8) and interviews (n=5) with target users (health care planners) within a provincial health care organization. The second phase used a participatory design approach, with two small group sessions (n=6) to explore workflow, thought processes, and needs of intended users. The needs assessment identified five design recommendations: ensuring the user-interface supports the target user group, allowing for user-directed data explorations, input parameter flexibility, clear presentation, and provision of relevant definitions. The second phase identified workflow insights from a proposed scenario. Graphs, the need for a visual overview of the data, and interactivity were key considerations to aid in meaningful use of the model and knowledge translation. A UCD approach is well suited to identify health care planners' requirements when using a decision support tool to improve health service planning and management of OA. We believe this is one of the first applications to be used in planning for health service delivery. We identified specific design recommendations that will increase user acceptability and uptake of the user-interface and underlying decision support tool in practice. Our approach demonstrated how UCD can be used to enable knowledge translation. Copyright © 2017 Elsevier B.V. All rights reserved.

Providing a USSD location based clinic finder in South Africa: did it work?

PubMed

Parsons, Annie Neo; Timler, Dagmar

2014-01-01

A new mHealth service, Clinic Finder, was designed to provide a location-based service for any cellphone user in South Africa dialing a dedicated USSD string to find the nearest public primary health care facility. The service was funded by a European Union grant to Cell-Life to support the National Department of Health. Clinic Finder's aims were to provide a reliable and accurate service, and to assess both the most effective means of advertising the service as well as interest in the service. Users dialing the USSD string are asked to agree to geo-location (Vodacom and MTN users) or asked to enter their province, town and street (virtual network users and those choosing not to geo-locate). The service provider, AAT, sends the data to Cell-Life where an SMS with details of the nearest public primary health care facility is sent to the user by Cell-Life's open-source Communicate platform. The service was advertised on 3 days in 2014 using two different means: a newspaper ad on 20 May 2014 and Please Call Me ads on 30 July 2014 and 14 August 2014. 28.2% of unique users on 20 May 2014, 10.5% of unique users on 30 July 2014 and 92.8% of unique users on 14 August 2014 who agreed to geo-location successfully received SMSs. However, only 4.2%, 0.5%, and 2.4% of unique users responding to each advertisement who did not geo-locate then received an SMS. A small survey of users following the 20 May 2014 newspaper ad found overall interest in the idea of Clinic Finder, though unsuccessful users were more likely to dislike the service. The overall experience of using location based services and USSD for Clinic Finder suggests a need in the field of mHealth for wider availability of data on service usability and effectiveness.

User fees for public health care services in Hungary: expectations, experience, and acceptability from the perspectives of different stakeholders.

PubMed

Baji, Petra; Pavlova, Milena; Gulácsi, László; Groot, Wim

2011-10-01

The introduction of user fees for health care services is a new phenomenon in Central-Eastern European Countries. In Hungary, user fees were first introduced in 2007, but abolished one year later after a referendum. The aim of our study is to describe the experiences and expectations of health system stakeholders in Hungary related to user fees as well as their approval of such fees. For our analysis we use both qualitative and quantitative data from focus-group discussions with health care consumers and physicians, and in-depth interviews with policy makers and health insurance representatives. Our findings suggest that the reasons behind the unpopularity of user fees might be (a) the rejection of the objectives of user fees defined by the government, (b) negative personal experiences with user fees, and (c) the general mistrust of the Hungarian population when it comes to the utilization of public resources. Successful policy implementation of user fees requires social consensus on the policy objectives, also there should be real improvements in health care provision noticeable for consumers, to assure the fees acceptance. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Secure and Efficient Two-Factor User Authentication Scheme with User Anonymity for Network Based E-Health Care Applications.

PubMed

Li, Xiong; Niu, Jianwei; Karuppiah, Marimuthu; Kumari, Saru; Wu, Fan

2016-12-01

Benefited from the development of network and communication technologies, E-health care systems and telemedicine have got the fast development. By using the E-health care systems, patient can enjoy the remote medical service provided by the medical server. Medical data are important privacy information for patient, so it is an important issue to ensure the secure of transmitted medical data through public network. Authentication scheme can thwart unauthorized users from accessing services via insecure network environments, so user authentication with privacy protection is an important mechanism for the security of E-health care systems. Recently, based on three factors (password, biometric and smart card), an user authentication scheme for E-health care systems was been proposed by Amin et al., and they claimed that their scheme can withstand most of common attacks. Unfortunate, we find that their scheme cannot achieve the untraceability feature of the patient. Besides, their scheme lacks a password check mechanism such that it is inefficient to find the unauthorized login by the mistake of input a wrong password. Due to the same reason, their scheme is vulnerable to Denial of Service (DoS) attack if the patient updates the password mistakenly by using a wrong password. In order improve the security level of authentication scheme for E-health care application, a robust user authentication scheme with privacy protection is proposed for E-health care systems. Then, security prove of our scheme are analysed. Security and performance analyses show that our scheme is more powerful and secure for E-health care systems when compared with other related schemes.

Acceptability of NHS 111 the telephone service for urgent health care: cross sectional postal survey of users’ views

PubMed Central

O’Cathain, Alicia

2014-01-01

Background. In 2010, a new telephone service, NHS 111, was piloted to improve access to urgent care in England. A unique feature is the use of non-clinical call takers who triage calls with computerized decision support and have access to clinical advisors when necessary. Aim. To explore users’ acceptability of NHS 111. Design. Cross-sectional postal survey. Setting. Four pilot sites in England. Method. A postal survey of recent users of NHS 111. Results. The response rate was 41% (1769/4265), with 49% offering written comments (872/1769). Sixty-five percent indicated the advice given had been very helpful and 28% quite helpful. The majority of respondents (86%) indicated that they fully complied with advice. Seventy-three percent was very satisfied and 19% quite satisfied with the service overall. Users were less satisfied with the relevance of questions asked, and the accuracy and appropriateness of advice given, than with other aspects of the service. Users who were autorouted to NHS 111 from services such as GP out-of-hours services were less satisfied than direct callers. Conclusion. In pilot services in the first year of operation, NHS 111 appeared to be acceptable to the majority of users. Acceptability could be improved by reassessing the necessity of triage questions used and auditing the accuracy and appropriateness of advice given. User acceptability should be viewed in the context of findings from the wider evaluation, which identified that the NHS 111 pilot services did not improve access to urgent care and indeed increased the use of emergency ambulance services. PMID:24334420

Integrated employee assistance program/managed behavioral health care benefits: relationship with access and client characteristics.

PubMed

Levy Merrick, Elizabeth S; Hodgkin, Dominic; Horgan, Constance M; Hiatt, Deirdre; McCann, Bernard; Azzone, Vanessa; Zolotusky, Galina; Ritter, Grant; Reif, Sharon; McGuire, Thomas G

2009-11-01

This study examined service user characteristics and determinants of access for enrollees in integrated EAP/behavioral health versus standard managed behavioral health care plans. A national managed behavioral health care organization's claims data from 2004 were used. Integrated plan service users were more likely to be employees rather than dependents, and to be diagnosed with adjustment disorder. Logistic regression analyses found greater likelihood in integrated plans of accessing behavioral health services (OR 1.20, CI 1.17-1.24), and substance abuse services specifically (OR 1.23, CI 1.06-1.43). Results are consistent with the concept that EAP benefits may increase access and address problems earlier.

Negotiating user preferences, discrimination, and demand for migrant labour in long-term care.

PubMed

Shutes, Isabel; Walsh, Kieran

2012-01-01

The restructuring of long-term care for older people has been marked both by the role of the market and by the role of migrant labor. This article develops the analysis of these processes at the microlevel of the provision of care. It draws on data collected as part of a cross-national comparative study on the employment of migrant care workers in residential care homes and home care services for older people in England and Ireland. The article examines, first, the ways in which divisions of race, ethnicity, and citizenship shape the preferences of service providers/employers and some service users as regards who provides care. Second, it examines how the institutional context of quasi-markets in long-term care shapes the negotiation of demand for migrant labor, the racialized preferences of individual users, alongside the rights of care workers to non-discrimination. It is argued that market-oriented policies for personalization, as well as for cost containment, raise implications for divisions of race, ethnicity, and citizenship in the provision of long-term care. At the same time, those divisions point to the limits of framing care in terms of the preferences of the individual as opposed to the social relations in which care is embedded.

Videotelephony-based services--the proven improvement of quality of life.

PubMed

Erkert, T

1998-01-01

As described above, the research activities showed very promising and fascinating results. It could be observed that the presumed acceptance problems of elderly technology users are not larger than in other groups. What is more: the elderly user of videotelephony-based services is a very pragmatic user. He or she accepts the new service offer as long as he or she sees the benefits. Decision makers in the social field should not be afraid of this client group! All of the users were willing to pay for the service--up to three times their current communication costs. It seems that there is a market for both the network providers and the telecommunication manufacturers. Private social service provider organisations were the first to realise the potential of the videotelephony-based social support and care services. Some of them are already developing service design schemes and are eagerly awaiting affordable technology. To ensure equal accessibility to these kind of services financial support is necessary to address the needs of socially disadvantaged user groups. Moreover, policy makers should concentrate on the definition of quality requirements for different issues. At the same time, neutral control institutions have to be set up to overcome prejudices and prevent misuse. All in all the authors still believe that picture-based social support and care services are one solution for the increasing problems resulting from demographical and social changes in many industrial societies. The technical evolution and the rapidly decreasing costs will lead to the implementation of picture-based social support and care services within a very short time. Some large application projects are currently underway throughout Europe. What is more: in Frankfurt/Germany, for instance, the first commercially available picture-based service will be introduced to the public in the spring of 1997.

StreetWise: developing a serious game to support forensic mental health service users' preparation for discharge: a feasibility study.

PubMed

Reynolds, L M; Davies, J P; Mann, B; Tulloch, S; Nidsjo, A; Hodge, P; Maiden, N; Simpson, A

2017-05-01

WHAT IS KNOWN ON THE SUBJECT?: Serious gaming can support learning and development. The use of serious games for skills development and the rehearsal of the management of events that cannot be replicated in real life is well established. Few serious games have been used in mental health services, and none in forensic mental health care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: How a serious game may be coproduced by forensic mental health service users and game developers The acceptability of the therapeutic use of serious gaming by forensic mental health service users and providers. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Computer games may be used by practitioners in their therapeutic work with forensic mental health service users. Mental health nurses to use serious games to creatively and safely bridge the gap for service users between receiving care in controlled environments and living more independent in the community. Introduction Assessment of users' skills and confidence to safely respond to risky community-based situations underpins discharge planning. Serious games have been used for skills development, and this study trialled their use in forensic mental health services. Aim The aim was to develop and test the acceptability and usability of an innovative serious game to support forensic mental health service users' preparation for discharge. Method A prototype serious game was developed by service users and researchers. Acceptability and usability testing was undertaken and service providers interviewed about the acceptability of serious gaming for forensic mental health services. Result A prototype game was produced and successfully trialled by service users. However, both service users and providers identified that work needed to be done to develop and test a game with greater complexity. Discussion The acceptability and usability of using serious games to support service users to develop skills needed for successful discharge was demonstrated. Implications for practice Mental health practitioners may use gaming to support their practice and work innovatively with other professions such as game developers to create new ways of working in forensic mental health services. © 2016 John Wiley & Sons Ltd.

Results of a quantitative survey to explore both perceptions of the purposes of follow-up and preferences for methods of follow-up delivery among service users, primary care practitioners and specialist clinicians after cancer treatment.

PubMed

Frew, G; Smith, A; Zutshi, B; Young, N; Aggarwal, A; Jones, P; Kockelbergh, R; Richards, M; Maher, E J

2010-12-01

To ascertain perceptions of reasons for follow-up after cancer treatment among service users (patients and carers), primary care practitioners and specialist clinicians (doctors and specialist nurses) and to identify levels of preference for different models of follow-up and the effect of an individual's experience on preferred models. A national survey designed to meet the needs of each key respondent group was carried out after a structured literature review, an extensive consultation process and a pilot scheme. Respondents were asked to assess their degree of preference for 10 pre-selected indications for follow-up. Eight models of follow-up were also identified and respondents were asked to state their experience and preference for each type. The questionnaire was distributed nationally via the 34 cancer networks in England and was available both online and in hard copy (postal). The uptake for the electronic format was in the main by primary care practitioners and specialist clinicians. Service users preferred the paper (postal) format. The survey was also publicised through the primary care and patient partnership forums at a Cancer Network Development event. In total, 2928 responses were received, comprising service users (21% of the sample), primary care practitioners (32%) and specialist clinicians (47%). Eighty-six per cent of responses were received from the 10 strategic health authorities in England, with the remaining 14% from Scotland, Wales and The Isle of Man. The responses from Scotland, Wales and the Isle of Man generally occurred where they interfaced with English cancer networks or had been engaged through word of mouth by colleagues. Among all respondents the main aims of cancer follow-up were considered to be: (1) to monitor for early complications after treatment; (2) to detect recurrences early; (3) to detect late effects of treatment. The most commonly experienced method of follow-up among all respondent groups was outpatient review with a doctor. This was considered to be the most preferred follow-up option among service users (86%). The least preferred option among service users was postal follow-up (32%). Primary care practitioners and specialist clinicians were more likely than service users to have experienced alternative methods of follow-up, such as telephone follow-up, self-triggered referral and non-specialist follow-up. These models were highly rated by those who had experience of them. There was a reasonable level of consensus between service users, primary care practitioners and specialist clinicians as to the reasons for follow-up. Service users seemed to have higher expectations of follow-up, particularly in relation to detecting recurrences early. As respondents were more likely to prefer a method of follow-up delivery that they had experienced than one they had not; there could be resistance to change from established methods to new methods without adequate explanation. This suggests that the communication of new methods could be critical to their successful introduction. Copyright © 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Human rights of drug users according to public health professionals in Brazil.

PubMed

Ventura, Carla A A; Mendes, Isabel A C; Trevizan, Maria A; Rodrigues, Driéli P

2013-03-01

Health is a basic human right, and drug use represents a severe influence on people's health. This qualitative study aimed to understand how health professionals in a public health-care team working with drug users in a city of the state of São Paulo, Brazil, perceive the human rights of these users and how these rights are being respected in health care. Data were collected through semistructured interviews with 10 health professionals at the service under analysis. A thematic analysis of the interviews reveals the professionals' difficulty to define the concept of human right and contextualize these rights in their work environment. A deeper understanding of the right to health, however, represents an important premise for a more humanized care practice in health services to drug users.

Improving Older Adults' Functional Ability through Service Use in a Home Care Program in Hong Kong

ERIC Educational Resources Information Center

Cheung, Chau-kiu; Ngan, Raymond Man-hung

2005-01-01

Objective: Despite past findings about the contribution of home care services to older users' functional ability, the effective processes and components of the services are not transparent. Such processes appear to rely on the actual use of component services of the home care program. Method: The study gathered 116 observations during 2 years…

Problems with measuring satisfaction with social care.

PubMed

Willis, Rosalind; Evandrou, Maria; Pathak, Pathik; Khambhaita, Priya

2016-09-01

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under-theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012-2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses. © 2015 John Wiley & Sons Ltd.

Design, Delivery and Evaluation of Teaching by Service Users and Carers

ERIC Educational Resources Information Center

Benbow, Susan Mary; Taylor, Louise; Mustafa, Nageen; Morgan, Kathleen

2011-01-01

Education influences individual health and social care professionals and the systems in which they work. We describe a postgraduate educational program that did this through involving service users and carers in designing and facilitating teaching programs. A module of teaching was designed and delivered in partnership with users and carers from…

Experiences of volunteering: a partnership between service users and a mental health service in the UK.

PubMed

Fegan, Colette; Cook, Sarah

2012-01-01

The aim of the study was to investigate how people with serious mental illness perceived the experience of volunteering for the health care organisation in which they had received a service. The study took a qualitative approach and in phase one, eleven service user volunteers were purposefully sampled and interviewed. In depth interviews were analysed using grounded theory. This paper describes the findings from phase one, and highlights the following themes to represent the volunteering experience: 1) rehearsing for a new direction; 2) treading carefully at first; 3) discovering my new self; and, 4) using my experience and extending relationships. These themes further support a tentative theoretical framework that considers supported volunteering to enhance recovery because it fosters positive risk taking and gives individuals a valued identity that integrates their mental health experience. In phase two, this framework will be tested with service users in more diverse volunteer positions. The findings of my study suggest that mental health services are in a unique position to build partnerships with service users to support their recovery and journeys toward employment by providing opportunities for volunteering.

Users' participation in nursing care: an element of the Theory of Goal Attainment.

PubMed

da Silva, Rodrigo Nogueira; Ferreira, Márcia de Assunção

2016-02-01

Users' participation in care has been acknowledged as a key factor to improve health services. To analyze the Theory of Goal Attainment and to discuss the explicit and implicit relations between the Theory and the phenomenon of users' participation in nursing care. Theoretical analysis of the Theory of Goal Attainment. The analysis phase of the Framework for Analysis and Evaluation of Nursing Theories was applied. Then, the explicit and implicit relations between the Theory and the phenomenon of users' participation were analyzed. Users' participation in nursing care is an element of the Theory of Goal Attainment, although limited to the goal setting and the means to achieve them. The choice for users' participation in care is a right defended in health policies around the world. The Theory of Goal Attainment is an appropriate guide to nurses in defense of users' participation in nursing care.

Important first encounter: Service user experience of pathways to care and early detection in first-episode psychosis.

PubMed

Jansen, Jens Einar; Pedersen, Marlene Buch; Hastrup, Lene Halling; Haahr, Ulrik Helt; Simonsen, Erik

2018-04-01

Long duration of untreated psychosis is associated with poor clinical and functional outcomes. However, few systematic attempts have been made to reduce this delay and little is known of service users' experience of early detection efforts. We explored service users' experience of an early detection service and transition to specialized treatment service, including pathway to care, understanding of illness and barriers to adequate assessment and treatment. In-depth interviews were conducted with 10 service users (median age 21, range 18-27, five males and five females) who were diagnosed with a first-episode non-affective psychosis and who were seen by an early detection team (TOP) and currently enrolled in a specialized early intervention service for this disorder (OPUS). Stigma and fear of the 'psychiatric system' were reported as significant barriers to help seeking, while family members were seen as a crucial support. Moreover, the impact of traumatic events on the experience and development of psychosis was highlighted. Finally, participants were relieved by the prospect of receiving help and the early detection team seemed to create a trusting relationship by offering a friendly, 'anti-stigmatized' space, where long-term symptomatology could be disclosed through accurate and validating questioning. Early detection services have two important functions. One is to make accurate assessments and referrals. The other is to instil hope and trust, and to facilitate further treatment by forming an early therapeutic alliance. The findings in this study provide important insights into the way in which early detection efforts and pathways to care are experienced by service users, with direct implications for improving psychiatric services. © 2015 Wiley Publishing Asia Pty Ltd.

Mental health recovery on care farms and day centres: a qualitative comparative study of users' perspectives.

PubMed

Iancu, Sorana C; Zweekhorst, Marjolein B M; Veltman, Dick J; van Balkom, Anton J L M; Bunders, Joske F G

2014-01-01

Mental health services increasingly incorporate the vision of recovery. This qualitative study analysed and compared experiences of recovery on prevocational services, in order to assess if users make progress towards recovery, relative to a staged recovery model. Data were collected through semi-structured interviews with participants on care farms (n = 14), work (n = 7) and creative projects (n = 5). The transition from past to current lives was described as a progressive, non-linear process, with different stages guided by different goals. Participants on creative projects lacked clear goals, presented less interest in peers and high need for emotional support. Participants on work projects aimed for occupational rehabilitation, but struggled with the patient culture of the peer community. Participants on care farms aimed for daytime occupations and closer contact with society. They experienced care farms as open, real-life work settings where they could exercise responsibility and connect with people. Participants progressed towards recovery, as care farms, work- and creative projects empowered them to leave behind inactive, isolated or disorganized living. In day centres, users focused on self-reflection and personal development (creative projects) or on occupational performance (work projects), whereas on care farms, users fulfilled worker roles in a real-life, open community environment. Organized as open communities in real-life settings, care farms facilitate the reflection on personal and social responsibility, and therefore have the potential to help users internalize worker identities and improve their motivation to progress towards recovery. Supervisors on care farms are regarded by users as close contacts within the social networks they develop on the service, a position that allows supervisors to actively engage and promote users' progress towards recovery. Elements of the farm environment (such as the "normal life", presence of family members and visitors, and nature) can serve as anchors for supporting the progress towards recovery.

The impact of health service variables on healthcare access in a low resourced urban setting in the Western Cape, South Africa.

PubMed

Scheffler, Elsje; Visagie, Surona; Schneider, Marguerite

2015-06-19

Health care access is complex and multi-faceted and, as a basic right, equitable access and services should be available to all user groups. The aim of this article is to explore how service delivery impacts on access to healthcare for vulnerable groups in an urban primary health care setting in South Africa. A descriptive qualitative study design was used. Data were collected through semi-structured interviews with purposively sampled participants and analysed through thematic content analysis. Service delivery factors are presented against five dimensions of access according to the ACCESS Framework. From a supplier perspective, the organisation of care in the study setting resulted in available, accessible, affordable and adequate services as measured against the DistrictHealth System policies and guidelines. However, service providers experienced significant barriers in provision of services, which impacted on the quality of care, resulting in poor client and provider satisfaction and ultimately compromising acceptability of service delivery. Although users found services to be accessible, the organisation of services presented them with challenges in the domains of availability, affordability and adequacy, resulting in unmet needs, low levels of satisfaction and loss of trust. These challenges fuelled perceptions of unacceptable services. Well developed systems and organisation of services can create accessible, affordable and available primary healthcare services, but do not automatically translate into adequate and acceptable services. Focussing attention on how services are delivered might restore the balance between supply (services) and demand (user needs) and promote universal and equitable access.

User-generated quality standards for youth mental health in primary care: a participatory research design using mixed methods

PubMed Central

Graham, Tanya; Rose, Diana; Murray, Joanna; Ashworth, Mark; Tylee, André

2014-01-01

Objectives To develop user-generated quality standards for young people with mental health problems in primary care using a participatory research model. Methods 50 young people aged 16–25 from community settings and primary care participated in focus groups and interviews about their views and experiences of seeking help for mental health problems in primary care, cofacilitated by young service users and repeated to ensure respondent validation. A second group of young people also aged 16–25 who had sought help for any mental health problem from primary care or secondary care within the last 5 years were trained as focus groups cofacilitators (n=12) developed the quality standards from the qualitative data and participated in four nominal groups (n=28). Results 46 quality standards were developed and ranked by young service users. Agreement was defined as 100% of scores within a two-point region. Group consensus existed for 16 quality standards representing the following aspects of primary care: better advertising and information (three); improved competence through mental health training and skill mix within the practice (two); alternatives to medication (three); improved referral protocol (three); and specific questions and reassurances (five). Alternatives to medication and specific questions and reassurances are aspects of quality which have not been previously reported. Conclusions We have demonstrated the feasibility of using participatory research methods in order to develop user-generated quality standards. The development of patient-generated quality standards may offer a more formal method of incorporating the views of service users into quality improvement initiatives. This method can be adapted for generating quality standards applicable to other patient groups. PMID:24920648

Restraining good practice: Reviewing evidence of the effects of restraint from the perspective of service users and mental health professionals in the United Kingdom (UK).

PubMed

Cusack, P; McAndrew, S; Cusack, F; Warne, T

2016-01-01

Safeguarding, balancing the concept of risk with the need for public protection and its implication for the lives of individuals, is an important facet of contemporary mental health care. Integral to safeguarding is the protection of human rights; the right to live free from torture, inhuman, or degrading treatment, and having the right to liberty, security, respect, and privacy. Professionals are required to recognise all of these rights when delivering care to vulnerable people. In the United Kingdom (UK) there has been growing public concern regarding abusive practices in institutions, with a number of unacceptable methods of restraint being identified as a feature of care, particularly in mental health care. In keeping with the service user movement, and following a review of the literature, this paper discusses the evidence regarding restraint from the perspectives of service users and professionals within mental health services and considers the implications for future practice and research. In reviewing the literature, findings revealed that restraint can be a form of abuse, it's inappropriate use often being a consequence of fear, neglect, and lack of using de-escalation techniques. Using restraint in this way can have negative implications for the well-being of service users and mental health professionals alike. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Working with the Mental Capacity Act: findings from specialist palliative and neurological care settings.

PubMed

Wilson, Eleanor; Seymour, Jane E; Perkins, Paul

2010-06-01

Since October 2007 staff across health and social care services in England and Wales have been guided by the Mental Capacity Act (2005) in the provision of care for those who may lack capacity to make some decisions for themselves. This paper reports on the findings from a study with 26 staff members working in three palliative and three neurological care centres. Semistructured interviews were used to gain an understanding of their knowledge of the Mental Capacity Act, the issue of capacity itself and the documentation processes associated with the introduction of the Act and in line with advance care planning. Within this setting advance care planning is a key part of care provision and the mental capacity of service users is a regular issue. Findings show that staff generally had a good understanding of issues around capacity but felt unclear about some of the terminology related to the Mental Capacity Act, impacting on their confidence to discuss issues with service users and complete the documentation. Many felt the Act and its associated documentation had aided record-keeping in an area staff already delivered well in practice. Advance care planning in the context of the Mental Capacity Act is not as well embedded in practice as providers would like and consideration needs to be given to how and when staff should approach these issues with service users.

The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi.

PubMed

Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic

2016-11-01

The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P <  0.01) increase in the mean proportion of women who made at least one antenatal care (ANC) visit during pregnancy, a 12% (P < 0.05) increase in average ANC visits and an 11% (P < 0.05) increase in the mean proportion of pregnant women who delivered at the facilities. No effects were found for the proportion of pregnant women who made the first ANC visit in the first trimester and the proportion of women who made postpartum care visits. We conclude that user fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

A comparison of data obtained from service providers and service users to assess the quality of maternity care.

PubMed

Hundley, V; Penney, G; Fitzmaurice, A; van Teijlingen, E; Graham, W

2002-06-01

to compare data obtained from two sources, service providers and service users, regarding the maternity services in Scotland. an audit of maternity services involving site visits, staff interviews and a cross-sectional survey of service users. lead professionals in every consultant-led maternity unit in Scotland and all 1639 women giving birth in Scotland during a ten-day period. structured group interviews with service providers and a questionnaire survey of recently delivered women. professionals' and women's responses were cross-tabulated and differences in proportions were tested for statistical significance using the chi-square test. a total of 1137 women completed the questionnaire (response rate 69%). Overall, there was good agreement between professionals' and women's perceptions of the aspects of care studied. However, there were disparities in some areas. For example, staff in eight units reported mechanisms to ensure early distribution of a free national pregnancy book; however, in six of these units less than 75% of women actually received this book prior to their first hospital visit. Eighteen units reported that they offer a postnatal 'reunion meeting'; in ten of these units, less than 50% of women were aware of the reunion meeting. Eighteen units reported a policy of each woman having a lead professional or care co-ordinator; in three of these units, less than 50% of women perceived that they had a care co-ordinator and for most women, the profession (midwife, general practitioner or obstetrician) of their perceived co-ordinator differed from that expected on the basis of staff reports. There was some evidence overall that unit policies had a direct influence on women's responses. this study demonstrates the importance of using a range of complementary methods of data collection and of ascertaining both service users' and providers' views when assessing the quality of care. Further research is required to explore differences in service provider's and women's perceptions and how this information can be used to improve the quality of maternity care. The finding that service provision may influence women's preferences has important implications for service planning, in particular the introduction of new models of care, and this needs further exploration. Copyright 2002 Elsevier Science Ltd.

What matters to users of services? An explorative study to promote shared decision making in health care

PubMed Central

Padgett, Kath; Rhodes, Christine; Lumb, Maureen; Morris, Penny; Sherwin, Sue; Symons, Jools; Tate, Joannie; Townend, Ken

2012-01-01

Abstract Background  Involving service users and carers in decisions about their health care is a key feature of health‐care practice. Professional health and social care students need to develop skills and attributes to best enable this to happen. Aims  The aims were to explore service user and carer perceptions of behaviours, attributes and context required to enable shared decision making; to compare these perceptions to those of students and academic staff with a view to utilizing the findings to inform the development of student assessment tools. Methods  A mixed methods approach was used including action learning groups (ALG) and an iterative process alongside a modified Delphi survey. Participants  The ALGs were from an existing service user and carer network. The survey was sent to sixty students, sixty academics and 30 service users from 16 different professional disciplines, spanning four Universities in England. Results  The collaborative enquiry process and survey identified general agreement that being open and honest, listening, showing respect, giving time and being up to date were important. The qualitative findings identified that individual interpretation was a key factor. An unexpected result was an insight into possible insecurities of students. Conclusions  The findings indicate that distilling rich qualitative information into a format for student assessment tools could be problematic as the individual context could be lost, it is therefore proposed that the information could be better used as a learning rather than assessment tool. Several of those involved identified how they valued the process and found it beneficial. PMID:22390320

What matters to users of services? An explorative study to promote shared decision making in health care.

PubMed

Padgett, Kath; Rhodes, Christine; Lumb, Maureen; Morris, Penny; Sherwin, Sue; Symons, Jools; Tate, Joannie; Townend, Ken

2014-06-01

Involving service users and carers in decisions about their health care is a key feature of health-care practice. Professional health and social care students need to develop skills and attributes to best enable this to happen. The aims were to explore service user and carer perceptions of behaviours, attributes and context required to enable shared decision making; to compare these perceptions to those of students and academic staff with a view to utilizing the findings to inform the development of student assessment tools. A mixed methods approach was used including action learning groups (ALG) and an iterative process alongside a modified Delphi survey. The ALGs were from an existing service user and carer network. The survey was sent to sixty students, sixty academics and 30 service users from 16 different professional disciplines, spanning four Universities in England. The collaborative enquiry process and survey identified general agreement that being open and honest, listening, showing respect, giving time and being up to date were important. The qualitative findings identified that individual interpretation was a key factor. An unexpected result was an insight into possible insecurities of students. The findings indicate that distilling rich qualitative information into a format for student assessment tools could be problematic as the individual context could be lost, it is therefore proposed that the information could be better used as a learning rather than assessment tool. Several of those involved identified how they valued the process and found it beneficial. © 2012 John Wiley & Sons Ltd.

Streaming primary urgent care: a prospective approach.

PubMed

Bickerton, Jane; Davies, Jacqueline; Davies, Helen; Apau, Daniel; Procter, Susan

2012-04-01

To identify the appropriate service provider attendees of emergency departments (EDs) and walk-in centres (WiCs) in North East London and to match this to local service provision and patient choice. An anonymous patient survey and a retrospective analysis of a random sample of patient records were performed. A nurse consultant, general practitioner (GP) and pharmacist used the presenting complaints in the patients' records to independently stream the patient to primary care services, non-National Health Services or ED. Statistical analysis of level of agreement was undertaken. A stakeholder focus group reviewed the results. Adult health consumers attending ED and urgent care services in North East London. The health user survey identified younger rather than older users (mean age of 35.6 years--SD 15.5), where 50% had not seen a health professional about their concern, with over 40% unable to obtain a convenient or emergency appointment with their GP. Over a third of the attendees were already receiving treatment and over 40% of these saw their complaint as an emergency. Over half of respondents expected to see a doctor, one-quarter expected to see a nurse and only 1% expected to see a pharmacist across both services, although WiCs are nurse-led services. More respondents expected a prescription from a visit to a WiC, whereas in the ED a third of respondents sought health advice or reassurance. A number of unscheduled care strategies are, or have just been, developed with the emphasis on moving demand into community-based services. Plurality of services provides service users with a range of alternative access points but can cause duplication of services and repeat attendance. Managing continued increase in emergency and unscheduled care is a challenge. The uncertainties in prospective decision making could be used to inform service development and delivery.

Toward Understanding Music Therapy as a Recovery-Oriented Practice within Mental Health Care: A Meta-Synthesis of Service Users' Experiences.

PubMed

Solli, Hans Petter; Rolvsjord, Randi; Borg, Marit

2013-01-01

The perspective of mental health recovery is increasingly shaping mental health care policies. Current texts in music therapy identify the importance of this critical and user-oriented perspective, but the relevance and implications for music therapy need to be outlined. This study explores service users' experiences of music therapy in mental health care, and the potential role of music therapy in the development of recovery-oriented service provision. We conducted a qualitative meta-synthesis of studies examining service users' experiences in music therapy; included were 14 studies with a total of 113 participants. Both first-hand account of participants and the researchers' representations of such statements were taken into account in the analysis. A taxonomy of four areas of users' experiences was identified: "having a good time;" "being together;" "feeling;" and "being someone." These core categories point towards music therapy as an arena that can be used by persons with mental health problems in their personal and social recovery process. Music therapy can contribute to the quality of mental health care by providing an arena for stimulation and development of strengths and resources that may contribute to growth of positive identity and hope for people with mental illness. The findings from this meta-synthesis indicate that the provision of music therapy closely resembles recognized benefits of a recovery-oriented practice. Awareness of users' self-determination and the development of a strength-based and contextual approach to music therapy that fosters mutual empowering relationships are recommended. © 2013 by the American Music Therapy Association.

Collaboration between traditional practitioners and primary health care staff in South Africa: developing a workable partnership for community mental health services.

PubMed

Campbell-Hall, Vicky; Petersen, Inge; Bhana, Arvin; Mjadu, Sithembile; Hosegood, Victoria; Flisher, Alan J

2010-09-01

The majority of the black African population in South Africa utilize both traditional and public sector Western systems of healing for mental health care. There is a need to develop models of collaboration that promote a workable relationship between the two healing systems. The aim of this study was to explore perceptions of service users and providers of current interactions between the two systems of care and ways in which collaboration could be improved in the provision of community mental health services. Qualitative individual and focus group interviews were conducted with key health care providers and service users in one typical rural South African health sub-district. The majority of service users held traditional explanatory models of illness and used dual systems of care, with shifting between treatment modalities reportedly causing problems with treatment adherence. Traditional healers expressed a lack of appreciation from Western health care practitioners but were open to training in Western biomedical approaches and establishing a collaborative relationship in the interests of improving patient care. Western biomedically trained practitioners were less interested in such an arrangement. Interventions to acquaint traditional practitioners with Western approaches to the treatment of mental illness, orientation of Western practitioners towards a culture-centred approach to mental health care, as well as the establishment of fora to facilitate the negotiation of respectful collaborative relationships between the two systems of healing are required at district level to promote an equitable collaboration in the interests of improved patient care.

Perspectives on medicine adherence in service users and carers with experience of legally sanctioned detention and medication: a qualitative study.

PubMed

Gault, Iris; Gallagher, Ann; Chambers, Mary

2013-01-01

To explore and analyze perceptions of service users and caregivers on adherence and nonadherence to medication in a mental health care context. Mental health medication adherence is considered problematic and legal coercion exists in many countries. This was a qualitative study aiming to explore perceptions of medication adherence from the perspective of the service user (and their caregiver, where possible). Eighteen mental health service users (and six caregivers) with histories of medication nonadherence and repeated compulsory admission were recruited from voluntary sector support groups in England. Data were collected between 2008 and 2010. Using qualitative coding techniques, the study analyzed interview and focus group data from service users, previously subjected to compulsory medication under mental health law, or their caregivers. The process of medication adherence or nonadherence is encapsulated in an explanatory narrative. This narrative constitutes participants' struggle to negotiate acceptable and effective routes through variable quality of care. Results indicated that service users and caregivers eventually accepted the reality of their own mental illness and their need for safety and treatment. They perceived the behavior of professionals as key in their recovery process. Professionals could be enabling or disabling with regard to adherence to medication. This study investigated service user and caregiver perceptions of medication adherence and compulsory treatment. Participants described a process perceived as variable and potentially doubly faceted. The behavior of professionals was seen as crucial in collaborative decision making on medication adherence.

Relocating from out-of-area treatments: service users' perspective.

PubMed

Rambarran, D D

2013-10-01

Asylum closures over recent decades resulted in mental health services being increasingly sited in the community. However, under provision of highly supported accommodation led to service users being placed away from their local area in 'out-of-area treatments' (OATs). OATs have raised major concerns in relation to enabling service users' recovery, owing to limitations in promoting autonomy, social dislocation and costs. In 2004, an OATs project was set up in a London Borough to address these concerns. In the first 4 years, the project succeeded in relocating 22 service users to less restrictive environments locally. This study aims to explore the outcome of relocation from service users' perspective. A qualitative methodology was utilized. Semi-structured interviews were carried out with seven service users who relocated. All seven service users shared a strong aspiration for independent living but there was associated loneliness. Five welcomed increased contact with family and friends, but lacked social confidence, inhibiting social inclusion. Service users with long-term and consistent care managers were more able to address fears. Five out of seven service users concluded that relocation increased their autonomy thus enhanced their quality of life. © 2012 John Wiley & Sons Ltd.

Experience of men in the context of Primary Health Care.

PubMed

de Oliveira, Patrícia Peres; dos Santos, Walquíria Jesusmara; Viegas, Selma Maria da Fonseca; da Silveira, Edilene Aparecida Araújo; Rodrigues, Andrea Bezerra

2015-01-01

To know the experience of male users' in the primary health care and to build data based theory that represents this experience. This is a qualitative study, in which was used the reference of Grounded Theory and Symbolic Interactionism, respectively, methodological and theoretical. We interviewed 33 male users of three units of primary health care. After comparative analysis of data was built the data based theory feeling excluded, which includes: living with prejudice; living with the limitations of infra-structure services; reflecting on the health service environment. The analysis showed the need for a change in logistics services and professionals' attitude guided in respectful and effective communication, the problem solving in readiness in attendance, in addressing gender issues. For to take care of men users of the Unified Health System and/or preserve their health, the construction of another rationality in health is imperative, based on reflection and respect for the autonomy and individuality of the male gender.

From good intentions to real life: introducing crisis resolution teams in Norway.

PubMed

Karlsson, Bengt; Borg, Marit; Kim, Hesook Suzie

2008-09-01

In Norway, as in most western countries, the adult services for people experiencing mental health problems have gone through major changes over the last decades. A report submitted to the Norwegian Parliament in 1997 summarized several areas of improvement in the provision of mental health-care to its population, and led to the introduction of a national mental health programme in 1998 for its implementation to be completed by 2008. The most significant recent development in Norway is 'Crisis Resolution/Home Treatment' (CRHT) teams that provide an alternative to acute hospital care services. The major aim of this study is to explore an emerging form of community mental health-care, and present a framework for establishment and examination of CRHT teams applying the user perspectives. An illustration of user experiences in an already established CRHT team provides a background for understanding implications of this form of service in relation to service users' needs in acute crises.

Labor and delivery service use: indigenous women's preference and the health sector response in the Chiapas Highlands of Mexico.

PubMed

Ibáñez-Cuevas, Midiam; Heredia-Pi, Ileana B; Meneses-Navarro, Sergio; Pelcastre-Villafuerte, Blanca; González-Block, Miguel A

2015-12-23

Mexico has undertaken important efforts to decrease maternal mortality. Health authorities have introduced intercultural innovations to address barriersfaced by indigenous women accessing professional maternal and delivery services. This study examines, from the perspective of indigenous women, the barriers andfacilitators of labor and delivery care services in a context of intercultural and allopathic innovations. This is an exploratory study using a qualitative approach of discourse analysis with grounded theory techniques. Twenty-five semi-structured interviews were undertaken with users and non-users of the labor and delivery services, as well as with traditional birth attendants (TBAs) in San Andrés Larráinzar, Chiapas in 2012. The interviewees identified barriers in the availability of medical personnel and restrictive hours for health services. Additionally, they referred to barriers to access (economic, geographic, linguistic and cultural) to health services, as well as invasive and offensive hospital practices enacted by health system personnel, which limited the quality of care they can provide. Traditional birth attendants participating in intercultural settings expressed the lack of autonomy and exclusion they experience by hospital personnel, as a result of not being considered part of the care team. As facilitators, users point to the importance of having their traditional birth attendants and families present during childbirth, to allow them to use their clothing during the attention, that the staff of health care is of the female sex and speaking the language of the community. As limiting condition users referred the different medical maneuvers practiced in the attention of the delivery (vaginal examination, episiotomy, administration of oxytocin, etc.). Evidence from the study suggests the presence of important barriers to the utilization of institutional labor and delivery services in indigenous communities, in spite of the intercultural strategies implemented. It is important to consider strengthening intercultural models of care, to sensitize personnel towards cultural needs, beliefs, practices and preferences of indigenous women, with a focus on human rights, gender equity and quality of care.

Dependence and resistance in community mental health care-Negotiations of user participation between staff and users.

PubMed

Femdal, I; Knutsen, I R

2017-10-01

WHAT IS KNOWN ON THE SUBJECT?: Implementation of user participation is described as a change from a paternalistic healthcare system to ideals of democratization where users' voices are heard in relational interplays with health professionals. The ideological shift involves a transition from welfare dependency and professional control towards more active service-user roles with associated rights and responsibilities. A collaborative relationship between users and professionals in mental health services is seen as important by both parties. Nevertheless, the health professionals find it challenging in practice to reorient their roles and to find productive ways to cooperate. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study illuminates how user participation is negotiated and involves multiple and shifting subject positions in the collaboration between users and professionals in community mental health care. By taking different positions, the relationship between users and professionals develops through dynamic interaction. This study challenges understandings of equality and implicit "truths" in user participation by illuminating subtle forms of power and dilemmas that arise in user-professional negotiations. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Instead of denying the appearance of power, it is important to question the execution of power in the interplay between users and professionals. Focusing on the negotiation processes between users and professionals is important for increasing reflection on and improving understanding of the dynamic in collaboration and speech. By focusing on negotiations, power can be used in productive ways in user-professional relationships. Introduction Implementation of user participation is considered important in today's mental health care. Research shows, however, that user participation lacks clarity and provokes uncertainty regarding shifting roles. Aim To investigate negotiation of user participation in a microstudy of interplay between users and health professionals in community mental health care. Method This qualitative study is based on semi-structured in-depth interviews, involving ten service users and ten professionals in community mental health care in Norway. The analysis is inspired by Willig's model for Foucauldian discourse analysis. Results The study illuminates the dynamic nature of user participation that arises through negotiation between users' and professionals' positions as change enablers, dependents, resisters, persuaders and knowledge holders. Discussion Discourses of user participation allow for different subject positions in mental health care. User participation also involves government and questions of power, as well as ambitions of change and control. Professionals act in different ways to make and keep users active, participating, enterprising and self-governing, and users respond and take part within the same discursive framework. Implications for practice Awareness of subjects' positions in discourses is important to increase reflection on the dynamic interplay in user-professional collaboration. © 2017 John Wiley & Sons Ltd.

End-user searching: impetus for an expanding information management and technology role for the hospital librarian.

PubMed Central

Klein, M S; Ross, F

1997-01-01

Using the results of the 1993 Medical Library Association (MLA) Hospital Libraries Section survey of hospital-based end-user search services, this article describes how end-user search services can become an impetus for an expanded information management and technology role for the hospital librarian. An end-user services implementation plan is presented that focuses on software, hardware, finances, policies, staff allocations and responsibilities, educational program design, and program evaluation. Possibilities for extending end-user search services into information technology and informatics, specialized end-user search systems, and Internet access are described. Future opportunities are identified for expanding the hospital librarian's role in the face of changing health care management, advances in information technology, and increasing end-user expectations. PMID:9285126

Empirical-Based Typology of Health Care Utilization by Medicare Eligible Veterans.

PubMed

Vaughan Sarrazin, Mary; Rosenthal, Gary E; Turvey, Carolyn L

2018-06-12

Up to 70 percent of patients who receive care through Veterans Health Administration (VHA) facilities also receive care from non-VA providers. Using applied classification techniques, this study sought to improve understanding of how elderly VA patients use VA services and complementary use of non-VA care. The study included 1,721,900 veterans age 65 and older who were enrolled in VA and Medicare during 2013 with at least one VA encounter during 2013. Outpatient and inpatient encounters and medications received in VA were classified, and mutually exclusive patient subsets distinguished by patterns of VA service use were derived empirically using latent class analysis (LCA). Patient characteristics and complementary use of non-VA care were compared by patient subset. Five patterns of VA service use were identified that were distinguished by quantity of VA medical and specialty services, medication complexity, and mental health services. Low VA Medical users tend to be healthier and rely on non-VA services, while High VA users have multiple high cost illnesses and concentrate their care in the VA. VA patients distinguished by patterns of VA service use differ in illness burden and the use of non-VA services. This information may be useful for framing efforts to optimize access to care and care coordination for elderly VA patients. © Health Research and Educational Trust.

An oral health intervention for people with serious mental illness (Three Shires Early Intervention Dental Trial): study protocol for a randomised controlled trial.

PubMed

Jones, Hannah F; Adams, Clive E; Clifton, Andrew; Simpson, Jayne; Tosh, Graeme; Liddle, Peter F; Callaghan, Patrick; Yang, Min; Guo, Boliang; Furtado, Vivek

2013-05-29

Oral health is an important part of general physical health and is essential for self-esteem, self-confidence and overall quality of life. There is a well-established link between mental illness and poor oral health. Oral health problems are not generally well recognized by mental health professionals and many patients experience barriers to treatment. This is the protocol for a pragmatic cluster randomised trial that has been designed to fit within standard care. Dental awareness training for care co-ordinators plus a dental checklist for service users in addition to standard care will be compared with standard care alone for people with mental illness. The checklist consists of questions about service users' current oral health routine and condition. Ten Early Intervention in Psychosis (EIP) teams in Nottinghamshire, Derbyshire and Lincolnshire will be cluster randomised (five to intervention and five to standard care) in blocks accounting for location and size of caseload. The oral health of the service users will be monitored for one year after randomisation. Current Controlled Trials ISRCTN63382258.

The evolving role of the personal support worker in home care in Ontario, Canada.

PubMed

Saari, Margaret; Patterson, Erin; Kelly, Shawna; Tourangeau, Ann E

2018-03-01

To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills. © 2017 John Wiley & Sons Ltd.

[Management systems of the quality of health care in Quebec hospitals].

PubMed

François, P

2001-03-31

The aim of this study was to take stock of the development of quality management systems in the Quebec health care services. The study relied on semi-guided interviews and on a documentary analysis. It concerned the structure and the activity of quality management in 4 Montreal university hospitals as well as on outside organizations dealing with quality of care. Quality management of the health care services is dealt with by council on health care accreditation and regional health and social services agencies. In hospitals, the quality of services is managed by structures created by the administration council and the top management: the piloting committee, the head of quality assurance, the executive committees and the multidisciplinary team or self-evaluation of the hospital, and development of plans for improvement. Other activities are management of complaints, users satisfaction evaluation and follow-up of indicators. This system of quality management of services is currently expanding. This change of paradigm leads to accepting the view of services users and to change quality management methods. Those methods have evolved from normative approach to a continuous quality improvement approach.

Individual psychological therapy in an acute inpatient setting: Service user and psychologist perspectives.

PubMed

Small, Catherine; Pistrang, Nancy; Huddy, Vyv; Williams, Claire

2018-01-18

The acute inpatient setting poses potential challenges to delivering one-to-one psychological therapy; however, there is little research on the experiences of both receiving and delivering therapies in this environment. This qualitative study aimed to explore service users' and psychologists' experiences of undertaking individual therapy in acute inpatient units. It focused on the relationship between service users and psychologists, what service users found helpful or unhelpful, and how psychologists attempted to overcome any challenges in delivering therapy. The study used a qualitative, interview-based design. Eight service users and the six psychologists they worked with were recruited from four acute inpatient wards. They participated in individual semi-structured interviews eliciting their perspectives on the therapy. Service users' and psychologists' transcripts were analysed together using Braun and Clarke's (2006, Qualitative Research in Psychology, 3, 77) method of thematic analysis. The accounts highlighted the importance of forming a 'human' relationship - particularly within the context of the inpatient environment - as a basis for therapeutic work. Psychological therapy provided valued opportunities for meaning-making. To overcome the challenges of acute mental health crisis and environmental constraints, psychologists needed to work flexibly and creatively; the therapeutic work also extended to the wider context of the inpatient unit, in efforts to promote a shared understanding of service users' difficulties. Therapeutic relationships between service users and clinicians need to be promoted more broadly within acute inpatient care. Psychological formulation can help both service users and ward staff in understanding crisis and working collaboratively. Practice-based evidence is needed to demonstrate the effectiveness of adapted psychological therapy models. Developing 'human' relationships at all levels of acute inpatient care continues to be an important challenge for clinical practice. Due to the distress of individuals and the constraints of the acute inpatient environment, psychologists need to be flexible and adaptable in delivering individual therapy. Making meaning and psychological formulation can give service users a sense of hope and empowerment, and can contribute to a shared understanding within the ward team of service users' difficulties. © 2018 The British Psychological Society.

Home Health Care and Patterns of Subsequent VA and Medicare Health Care Utilization for Veterans

ERIC Educational Resources Information Center

Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.

2008-01-01

Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…

Informing the development of services supporting self-care for severe, long term mental health conditions: a mixed method study of community based mental health initiatives in England

PubMed Central

2012-01-01

Background Supporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems. Methods A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together. Results Participants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health. Conclusions Service delivery components – e.g. peer support groups, personal planning – advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings. PMID:22769593

Perceptions of primary health care service users regarding dental team practices in Brazil.

PubMed

Baumgarten, Alexandre; Veiga, Rochelle Santos Da; Bulgarelli, Patricia Tavora; Diesel, Vitor Motta; Bulgarelli, Alexandre Favero

2018-05-01

The Unified Health System (SUS) is the Brazilian set of public health services that offers global access to health care and disease treatments for all citizens. These services have been evaluated by means of a national survey assessing the users' perceptions.AimTo explore and characterize the SUS users' perceptions regarding primary dental team practices in the five Brazilian geographical regions. Descriptive study. The sample consisted of 37 262 subjects. Data were collected by means of the Ministry of Health survey, conducted between 2012 and 2014. Variables used in the present study are associated with SUS users' perspectives of satisfaction, access, and use of services. The study utilized bivariate data analysis, and dichotomous variables were derived for analysis following 95% reliability.FindingsThis study observed similarities and proportionality of perceptions in the Brazilian territory. In most macro-regions, dental teams did not develop an active search for dental treatment absentees. However, the SUS users reported very good and good perceptions, which were homogeneously distributed across five Brazilian regions, thereby showing an overall positive perception of primary dental treatment.

Use of Adult Day Care Centers: Do They Offset Utilization of Health Care Services?

ERIC Educational Resources Information Center

Iecovich, Esther; Biderman, Aya

2013-01-01

Purpose: Based on the medical offset effect, the goal of the study was to examine the extent to which users and nonusers of adult day care centers (ADCC) differ in frequency of use of out-patient health services (visits to specialists) and in-patient health services (number of hospital admissions, length of hospitalizations, and visits to…

An Experimental Study of the Effects of Employer-Sponsored Child Care Services on Selected Employee Behaviors. Executive Summary.

ERIC Educational Resources Information Center

Dawson, Ann Gilman; And Others

This executive summary describes a study conducted to determine whether different kinds of employer-supported child care services had differing effects on service users. Turnover and attendance data on 891 randomly selected female employees were gathered from 39 companies and hospitals offering on-site or off-site child care, information and…

Usability evaluation of a web-based support system for people with a schizophrenia diagnosis.

PubMed

van der Krieke, Lian; Emerencia, Ando C; Aiello, Marco; Sytema, Sjoerd

2012-02-06

Routine Outcome Monitoring (ROM) is a systematic way of assessing service users' health conditions for the purpose of better aiding their care. ROM consists of various measures used to assess a service user's physical, psychological, and social condition. While ROM is becoming increasingly important in the mental health care sector, one of its weaknesses is that ROM is not always sufficiently service user-oriented. First, clinicians tend to concentrate on those ROM results that provide information about clinical symptoms and functioning, whereas it has been suggested that a service user-oriented approach needs to focus on personal recovery. Second, service users have limited access to ROM results and they are often not equipped to interpret them. These problems need to be addressed, as access to resources and the opportunity to share decision making has been indicated as a prerequisite for service users to become a more equal partner in communication with their clinicians. Furthermore, shared decision making has been shown to improve the therapeutic alliance and to lead to better care. Our aim is to build a web-based support system which makes ROM results more accessible to service users and to provide them with more concrete and personalized information about their functioning (ie, symptoms, housing, social contacts) that they can use to discuss treatment options with their clinician. In this study, we will report on the usability of the web-based support system for service users with schizophrenia. First, we developed a prototype of a web-based support system in a multidisciplinary project team, including end-users. We then conducted a usability study of the support system consisting of (1) a heuristic evaluation, (2) a qualitative evaluation and (3) a quantitative evaluation. Fifteen service users with a schizophrenia diagnosis and four information and communication technology (ICT) experts participated in the study. The results show that people with a schizophrenia diagnosis were able to use the support system easily. Furthermore, the content of the advice generated by the support system was considered meaningful and supportive. This study shows that the support system prototype has valuable potential to improve the ROM practice and it is worthwhile to further develop it into a more mature system. Furthermore, the results add to prior research into web applications for people with psychotic disorders, in that it shows that this group of end users can work with web-based and computer-based systems, despite the cognitive problems they experience.

Mental health service users' experiences of diabetes care by Mental Health Nurses: an exploratory study.

PubMed

Nash, M

2014-10-01

This paper is a report of a study exploring mental health service users' (MHSUs') experiences of diabetes care. Diabetes is a growing clinical concern in mental health nursing practice. However, little is known about MHSUs' experience of diabetes care. This is a descriptive qualitative study. Semi-structured telephone interviews were held between June and October 2011, with seven MHSUs who had diabetes. Participants reported experiences of stigma and diagnostic overshadowing (DO) when reporting symptoms of diabetes or when feeling unwell. Participants also encountered a split between their mental health and diabetes care needs, which resulted in a lack of holistic or integrated care. All participants mentioned experiencing complications of diabetes even to the extent of diabetic ketoacidosis. Mental health nurses (MHNs) must critically reflect on their attitudes towards service users that report physical symptoms to ensure that stigma and DO do not constitute barriers to appropriate screening and treatment. The complex relationship that exists between mental illness and diabetes requires MHNs to ensure physical and mental health care are wholly integrated and not split. Education needs are apparent so that symptoms and complications can be recognized and treated accordingly. © 2014 John Wiley & Sons Ltd.

Caregiving for mental health service users: A study exploring the perceptions of mental health service users and their caregivers in Cape Town, South Africa.

PubMed

Sibeko, Goodman; Milligan, Peter D; Temmingh, Henk; Lund, Crick; Stein, Dan J; Mall, Sumaya

2016-09-01

Our study explores perceptions of the caregiver support for mental health service users (MHSUs) in a low- to middle-income country setting. We conducted in-depth individual interviews with 16 MHSUs and their treatment partners/caregivers from a treatment partner and text-message intervention study. Treatment partners/caregivers felt obligated to care for MHSUs, but had a limited understanding of mental illness. They found supporting adherence to treatment difficult due to a number of factors including violence, food insecurity and substance abuse. Socioeconomic and environmental factors affecting the lives of MHSUs have impact on caregiver relationships with MHSUs in their care. © The Author(s) 2016.

Knowledge engineering as a support for building an actor profile ontology for integrating Home-Care systems.

PubMed

Gibert, Karina; Valls, Aida; Riaño, David

2008-01-01

One of the tasks towards the definition of a knowledge model for home care is the definition of the different roles of the users involved in the system. The roles determine the actions and services that can or must be performed by each type of user. In this paper the experience of building an ontology to represent the home-care users and their associated information is presented, in a proposal for a standard model of a Home-Care support system to the European Community.

Low-threshold support services for people with dementia within the scope of respite care in Germany - A qualitative study on different stakeholders' perspective.

PubMed

Hochgraeber, Iris; von Kutzleben, Milena; Bartholomeyczik, Sabine; Holle, Bernhard

2017-07-01

Low-threshold support services are provided within the basket of services of German long-term care insurance as a part of respite care to support family carers and people with dementia. This study investigates various stakeholders' (providers, coordinators, volunteers, family carers and people with dementia) perspectives on low-threshold support service regarding its organisation and conceptualisation as well as how stakeholders and users value low-threshold support service using a qualitative approach. Twelve guided interviews and group discussions were conducted with 31 participants. Organisation and conceptualisation are characterised by the lowness of the service thresholds, which is perceived to be quick and simple forms of support with no user requirements. Multiple barriers such as the challenging behaviour of people with dementia and their initial refusal as well as their holding low-threshold support service in low esteem can hinder the utilisation of these services. Low-threshold support service within the scope of the long-term care insurance law can be separated into two types: low-cost (non-professional) services and high-cost services with comprehensive training for 'employed' volunteers (professional). Both types are constantly developing within the landscape of the German long-term care system, and low-threshold support service appears to be adapted to diverse needs. Therefore, it is important to avoid replacing non-professional services with professional services.

Preserving the person: The ethical imperative of recovery-oriented practices.

PubMed

Atterbury, Kendall

2014-03-01

For more than a decade the principles of mental health recovery have been promoted as an alternative to traditional models of care. Recovery-oriented practices are those that recognize the strengths of service users and empower them within the mental health system. In contrast to a more hierarchical model of care in which service providers make decisions with a pronounced absence of input from service users, recovery-oriented practices emphasize shared decision-making, respect for service user goals, and the recognition of the full humanity of all persons in care relationships. Recovery-oriented care has yet to be embraced by the majority of service providers, however. There are several reasons for this failure but among them is the lack of attention given to the ethical ground of recovery. This article seeks to bring recovery into conversation with moral philosophy by arguing that recovery-oriented care is essentially linked to fundamental rights and values of personhood within a liberal democracy. By joining together a conception of personhood rooted in essential vulnerability and a Rawlsian perspective on justice, this article argues that recovery is not only a desirable approach to mental health practice but that it is ethically necessary. It argues that recovery practices are not exceptional interventions to be reserved for a few but that a recovery-orientation entails fundamental elements of justice and respect to which all persons are entitled.

Social Support and the Receipt of Home Care Services.

ERIC Educational Resources Information Center

Chappell, Neena L.

1985-01-01

Compares differences between elderly who use formal home care services and those who do not. Data revealed users as less healthy and less active and as receiving more assistance from both formal and informal sources. Suggests that formal and informal services complement rather than substitute for one another. (NRB)

["Responsiveness" in psychiatric outpatient care and in hostel management].

PubMed

Bramesfeld, A; Bisson, S; Wedegärtner, F; Bartusch, S; Blanchard, J

2010-11-01

Responsiveness is a concept developed by the World Health Organisation (WHO) to evaluate health system performance. It measures how well a health system meets its users' legitimate expectations in non-medical related service aspects. Responsiveness consists of the categories "patient orientation" and "respect for persons". It is operationalised by nine (8+1) domains. This project aims to explore the responsiveness concept as a possibility to evaluate the performance of mental health care. Face to face interviews with users of outpatient and hostel mental health services by means of a standardised instrument, developed by WHO were carried out. Overall responsiveness in outpatient care was rated by a lower proportion of users negative than responsiveness in hostel care (15 vs. 20%). Socio-demographic characteristics were related only to responsiveness ratings in hostel care when legal guardianship was considered. Domains indicated as most important (attention, participation) in out-patient care did not perform well there. In hostel care the domains attention and respect were rated as most important. These domains performed well. The results are in line with the literature and adequately reflect the realities in mental health care. The responsiveness concept offers a systematic approach for considering the categories "patient orientation" and "respect for persons" as quality criteria in mental health care. Evaluating mental health service provision using the concept of responsiveness, indicates where to launch reforms in health care. © Georg Thieme Verlag KG Stuttgart · New York.

Developing online accreditation education resources for health care services: An Australian Case Study.

PubMed

Pereira-Salgado, Amanda; Boyd, Leanne; Johnson, Matthew

2017-02-01

In 2013, 'National Safety and Quality Health Service Standards' accreditation became mandatory for most health care services in Australia. Developing and maintaining accreditation education is challenging for health care services, particularly those in regional and rural settings. With accreditation imminent, there was a need to support health care services through the process. A needs analysis identified limited availability of open access online resources for national accreditation education. A standardized set of online accreditation education resources was the agreed solution to assist regional and rural health care services meet compulsory requirements. Education resources were developed over 3 months with project planning, implementation and assessment based on a program logic model. Resource evaluation was undertaken after the first 3 months of resource availability to establish initial usage and stakeholder perceptions. From 1 January 2015 to 31 March 2015, resource usage was 20 272, comprising 12 989 downloads, 3594 course completions and 3689 page views. Focus groups were conducted at two rural and one metropolitan hospital (n = 16), with rural hospitals reporting more benefits. Main user-based recommendations for future resource development were automatic access to customizable versions, ensuring suitability to intended audience, consistency between resource content and assessment tasks and availability of short and long length versions to meet differing users' needs. Further accreditation education resource development should continue to be collaborative, consider longer development timeframes and user-based recommendations. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Heavy consumption of dental services among Finnish adults.

PubMed

Nihtilä, A; Widström, E; Elonheimo, O

2010-12-01

To compare treatment of heavy and low users of dental services among adults in the Public Dental Service (PDS) in one of the biggest cities in Finland and to identify reasons for heavy use and to suggest improvements to care provision. All adults who attended the PDS in Espoo (pop. 227,500) in 2004 were allocated to a group (n = 3,173) who had made six or more dental visits and a comparison group (n = 22,820) who had three or fewer dental visits. The data were obtained from the patient register of the PDS. A sample of 320 patients was randomly selected from each group. Information on age, gender, number and types of visits, oral health status, treatment provided and fees paid was collected from treatment records. 10.5% of the adults were found to be heavy users and their treatment made up 31.6% of all adult dental visits. The proportion of men was greater among heavy users and the heavy users were on average 6.6 years older than the low users. The mean total treatment time for heavy users was 5.5 hours and 2.0 hours for low users. Heavy users had more untreated and treated caries and more periodontal pockets than low users. Restorative, endodontic and prosthetic treatment needs characterised the heavy user group, while the low users most often received restorative and periodontal treatment only. Our study indicates that complicated treatment needs of heavy users and lack of experience among the caregivers in dealing with them resulted in high numbers of dental visits for individual patients. The PDS should offer appropriate continuing education for its oral health care teams and organize a referral system offering specialist care for difficult endodontic, periodontal and prosthetic treatments.

Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre.

PubMed

Kahan, Deborah; Poremski, Daniel; Wise-Harris, Deborah; Pauly, Daniel; Leszcz, Molyn; Wasylenki, Donald; Stergiopoulos, Vicky

2016-01-01

This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention. We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care. Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers. Interventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.

How online sexual health services could work; generating theory to support development.

PubMed

Baraitser, Paula; Syred, Jonathan; Spencer-Hughes, Vicki; Howroyd, Chris; Free, Caroline; Holdsworth, Gillian

2015-12-05

Online sexual health services are an emerging area of service delivery. Theory of change critically analyses programmes by specifying planned inputs and articulating the causal pathways that link these to anticipated outcomes. It acknowledges the changing and contested nature of these relationships. We developed two versions of a theory of change for an online sexual health service. The first articulated the theory presented in the original programme proposal and the second documented its development in the early stages of implementation through interviews with key programme stakeholders. The programme proposal described an autonomous and empowered user completing a sexual health check using a more convenient, accessible and discreet online service and a shift from clinic based to online care. The stakeholder interviews confirmed this and described new and more complex patterns of service use as the online service creates opportunities for providers to contact users outside of the traditional clinic visit and users move between online and clinic based care. They described new types of user/provider relationships which we categorised as: those influenced by an online retail culture; those influenced by health promotion outreach and surveillance and those acknowledging the need for supported access. This analysis of stakeholder views on the likely the impacts of online sexual health services suggests three areas for further thinking and research. 1. Co-development of clinic and online services to support complex patterns of service use. 2. Developing access to online services for those who could use them with support. 3. Understanding user experience of sexual health services as increasing user autonomy and choice in some situations; creating exclusion and a need for support in others and intrusiveness and a lack of control in still others. This work has influenced the evaluation of this programme which will focus on; mapping patterns of use to understand how users move between the online and clinic based services; barriers to use of online services among some populations and how to overcome these; understanding user perceptions of autonomy in relation to online services.

An Experimental Study of the Effects of Employer-Sponsored Child Care Services on Selected Employee Behaviors.

ERIC Educational Resources Information Center

Dawson, Ann Gilman; And Others

Described in this report is a study conducted to determine whether different kinds of employer-supported child care services had differing effects on the users of these services. Data were gathered on a year's attendance and turnover rates for 891 female employees who had used employer-provided child care. Subjects were randomly selected from 39…

The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial.

PubMed

Lloyd-Evans, Brynmor; Fullarton, Kate; Lamb, Danielle; Johnston, Elaine; Onyett, Steve; Osborn, David; Ambler, Gareth; Marston, Louise; Hunter, Rachael; Mason, Oliver; Henderson, Claire; Goater, Nicky; Sullivan, Sarah A; Kelly, Kathleen; Gray, Richard; Nolan, Fiona; Pilling, Stephen; Bond, Gary; Johnson, Sonia

2016-03-22

As an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users' experiences of care, service use, staff well-being, and team model fidelity. Twenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services' electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study's primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline differences and participant characteristics using linear random effects modelling. Qualitative investigations with participating CRT managers and staff and programme facilitators will explore the experiences of the service improvement programme. Our trial will show whether a theoretically underpinned and clearly defined package of resources are effective in supporting service improvement and improving outcomes for mental health crisis resolution teams. Current Controlled Trials ISRCTN47185233.

Cannabis use in palliative care - an examination of the evidence and the implications for nurses.

PubMed

Green, Anita J; De-Vries, Kay

2010-09-01

Examine the pharmaceutical qualities of cannabis including a historical overview of cannabis use. Discuss the use of cannabis as a clinical intervention for people experiencing palliative care, including those with life-threatening chronic illness such as multiple sclerosis and motor neurone disease [amyotrophic lateral sclerosis] in the UK. The non-medicinal use of cannabis has been well documented in the media. There is a growing scientific literature on the benefits of cannabis in symptom management in cancer care. Service users, nurses and carers need to be aware of the implications for care and treatment if cannabis is being used medicinally. A comprehensive literature review. Literature searches were made of databases from 1996 using the term cannabis and the combination terms of cannabis and palliative care; symptom management; cancer; oncology; chronic illness; motor neurone disease/amyotrophic lateral sclerosis; and multiple sclerosis. Internet material provided for service users searching for information about the medicinal use of cannabis was also examined. The literature on the use of cannabis in health care repeatedly refers to changes for users that may be equated with improvement in quality of life as an outcome of its use. This has led to increased use of cannabis by these service users. However, the cannabis used is usually obtained illegally and can have consequences for those who choose to use it for its therapeutic value and for nurses who are providing care. Questions and dilemmas are raised concerning the role of the nurse when caring and supporting a person making therapeutic use of cannabis. © 2010 Blackwell Publishing Ltd.

Factors associated with the use of home-visit nursing services covered by the long-term care insurance in rural Japan: a cross-sectional study.

PubMed

Kashiwagi, Masayo; Tamiya, Nanako; Sato, Mikiya; Yano, Eiji

2013-01-02

In Japan, there is a large increase in the number of elderly persons who potentially need home-visit nursing services (VNS). However, the number of persons using the VNS has increased only little in comparison to the number of individuals who use home social services, which are also covered by the Long-Term Care Insurance (LTCI) system. This cross-sectional study investigated the predictors of the VNS used under the LTCI system in Japan. We used 1,580 claim data from all the users of community-based services and 1,574 interview survey data collected in 2001 from the six municipal bodies in Japan. After we merged the two datasets, 1,276 users of community-based services under the LTCI were analyzed. Multiple logistic regression models stratified by care needs levels were used for analysis. Only 8.3% of the study subjects were VNS users. Even among study participants within the higher care-needs level, only 22.0% were VNS users. In the lower care level group, people with a higher care level (OR: 3.50, 95% CI: 1.50-8.93), those whose condition needed long term care due to respiratory or heart disease (OR: 4.31, 95% CI: 1.88-89.20), those whose period of needing care was two years or more (OR: 2.01, 95% CI: 1.14-3.48), those whose service plan was created by a medical care management agency (OR: 2.39, 95% CI: 1.31-4.33), those living with family (OR: 1.86, 95% CI: 1.00-3.42), and those who use home-help services (OR: 2.12, 95% CI: 1.17-3.83) were more likely to use the VNS. In the higher care level group, individuals with higher care level (OR: 3.63, 95% CI: 1.56-8.66), those with higher income (OR: 3.79, 95% CI: 1.01-14.25), and those who had regular hospital visits before entering the LTCI (OR: 2.36, 95% CI: 1.11-5.38) were more likely to use the VNS. Our results suggested that VNS use is limited due to management by non-medical care management agencies, due to no caregivers being around or a low income household. The findings of this study provide valuable insight for LTCI policy makers: the present provision of VNS should be reconsidered.

Involving older people in a multi-centre randomised trial of a complex intervention in pre-hospital emergency care: implementation of a collaborative model.

PubMed

Koniotou, Marina; Evans, Bridie Angela; Chatters, Robin; Fothergill, Rachael; Garnsworthy, Christopher; Gaze, Sarah; Halter, Mary; Mason, Suzanne; Peconi, Julie; Porter, Alison; Siriwardena, A Niroshan; Toghill, Alun; Snooks, Helen

2015-07-10

Health services research is expected to involve service users as active partners in the research process, but few examples report how this has been achieved in practice in trials. We implemented a model to involve service users in a multi-centre randomised controlled trial in pre-hospital emergency care. We used the generic Standard Operating Procedure (SOP) from our Clinical Trials Unit (CTU) as the basis for creating a model to fit the context and population of the SAFER 2 trial. In our model, we planned to involve service users at all stages in the trial through decision-making forums at 3 levels: 1) strategic; 2) site (e.g. Wales; London; East Midlands); 3) local. We linked with charities and community groups to recruit people with experience of our study population. We collected notes of meetings alongside other documentary evidence such as attendance records and study documentation to track how we implemented our model. We involved service users at strategic, site and local level. We also added additional strategic level forums (Task and Finish Groups and Writing Days) where we included service users. Service user involvement varied in frequency and type across meetings, research stages and locations but stabilised and increased as the trial progressed. Involving service users in the SAFER 2 trial showed how it is feasible and achievable for patients, carers and potential patients sharing the demographic characteristics of our study population to collaborate in a multi-centre trial at the level which suited their health, location, skills and expertise. A standard model of involvement can be tailored by adopting a flexible approach to take account of the context and complexities of a multi-site trial. Current Controlled Trials ISRCTN60481756. Registered: 13 March 2009.

Informed, advance refusals of treatment by people with severe mental illness in a randomised controlled trial of joint crisis plans: demand, content and correlates.

PubMed

Henderson, Claire; Farrelly, Simone; Flach, Clare; Borschmann, Rohan; Birchwood, Max; Thornicroft, Graham; Waheed, Waquas; Szmukler, George

2017-11-24

In the UK, crisis planning for mental health care should acknowledge the right to make an informed advance treatment refusal under the Mental Capacity Act 2005. Our aims were to estimate the demand for such treatment refusals within a sample of service users who had had a recent hospital admission for psychosis or bipolar disorder, and to examine the relationship between refusals, and service user characteristics. To identify refusals we conducted content analysis of Joint Crisis Plans, which are plans formulated by service users and their clinical team with involvement from an external facilitator, and routine care plans in sub-samples from a multi-centre randomised controlled trial of Joint Crisis Plans (plus routine mental health care) versus routine care alone (CRIMSON) in England. Factors hypothesised to be associated with refusals were identified using the trial data collected through baseline interviews of service users and clinicians and collection of routine clinical data. Ninety-nine of 221 (45%) of the Joint Crisis Plans contained a treatment refusal compared to 10 of 424 (2.4%) baseline routine care plans. No Joint Crisis Plans recorded disagreement with refusals on the part of clinicians. Among those with completed Joint Crisis Plans, adjusted analyses indicated a significant association between treatment refusals and perceived coercion at baseline (odds ratio = 1.21, 95% CI 1.02-1.43), but not with baseline working alliance or a past history of involuntary admission. We demonstrated significant demand for written treatment refusals in line with the Mental Capacity Act 2005, which had not previously been elicited by the process of treatment planning. Future treatment/crisis plans should incorporate the opportunity for service users to record a treatment refusal during the drafting of such plans. ISRCTN11501328 Registered 13th March 2008.

The effect of an occupational therapy mental health day treatment centre on the use of inpatient services in the Western Cape, South Africa.

PubMed

Engelbrecht, Riekie; Plastow, Nicola; Botha, Ulla; Niehaus, Djh; Koen, Liezl

2018-04-27

The aim of this study was to determine whether attendance at an occupational therapy-led day treatment centre for mental health care users affects the use of inpatient services in South Africa. A retrospective pre-test/post-test quasi-experimental study design was used to compare admissions and days spent in hospital during the 24 months before and after attendance at the centre, using the hospital's electronic records. Total population sampling yielded data for 44 mental health care users who made first contact with the service between July 2009 and June 2010. Data were compared using the Kruskal-Wallis test, Wilcoxon Signed Ranks test and Mann-Whitney U test. There was a significant decrease in the number of admissions (z = -4.093, p = 0.00) and the number of days spent in hospital (z = -4.730, p = 0.00). Participants were admitted to psychiatric care 33 times less in the 24 months' post-intervention, indicating a medium effect (r = 0.436). They also spend 2569 days less in hospital, indicating a large effect (r = 0.504). The findings suggest that an occupational therapy-led day treatment centre could be effective in reducing the use of inpatient mental health services in South Africa. Implications for Rehabilitation Attendance at an occupational therapy-led community day treatment centre decreases the number of admissions and number of days spent in hospital and is therefore beneficial to mental health care users and service providers. The study indicates that the successful implementation of a community day treatment centre for mental health care users on the grounds of a tertiary hospital by utilising existing resources is possible.

"It's Only Right that We Get Involved": Service-User Perspectives on Involvement in Learning Disability Services

ERIC Educational Resources Information Center

Hoole, Lucy; Morgan, Sally

2011-01-01

Promotion of service-user and carer involvement is part of the mainstream policy agenda in health and social care ["Crit Soc Policy 25" (2005) 164]. Much effort has been invested into involving people with learning disabilities in decisions regarding aspects of their lives through advocacy projects and the utilisation of person-centred planning…

Transition experiences of mental health service users, parents, and professionals in the United Kingdom: a qualitative study.

PubMed

Hovish, Kimberly; Weaver, Tim; Islam, Zoebia; Paul, Moli; Singh, Swaran P

2012-01-01

The aim of this study was to describe the experiences of child and adolescent mental health service (CAMHS) users, parents and professionals in relation to transition between CAMHS and adult mental health services (AMHS) in the United Kingdom. Young people were sampled from an observational study population of people reaching the transition boundary between CAMHS and AMHS. We thematically analyzed qualitative interviews with service users, parents and clinicians. Eleven service users were interviewed and linked interviews were completed with parents (n=6), and responsible clinicians in CAMHS (n=3) and AMHS (n=6). Informal and gradual preparation, transfer planning meetings, periods of parallel care, and consistency in key-workers promoted positive experiences of transition. Transfers between AMHS, changes of key-worker and waiting lists were viewed negatively. Other life transitions, including changes in housing, pregnancy, physical illness, and the involvement of parents or other services were sometimes powerful extraneous influences on transition experiences. The cumulative effect of multiple transitions is a complex and unsettling experience for many service users. Service user experiences are more likely to be positive if healthcare transition is a gradual process, tailored to the young person's needs and managed in the context of the other simultaneous practical, developmental and psychosocial transitions. Transfer planning meetings and parallel care were valued by all parties and should be standard practice at transition. CAMHS and AMHS need to work jointly to improve the transition process in these ways in order to enhance the outcomes for young people.

Lip service: Public mental health services and the care of Aboriginal and Torres Strait Islander peoples.

PubMed

Molloy, Luke; Lakeman, Richard; Walker, Kim; Lees, David

2018-06-01

The failure of public mental services in Australia to provide care deemed culturally safe for Aboriginal and Torres Strait Islander people has persisted despite several national reports and policies that have attempted to promote positive service change. Nurses represent the largest professional group practising within these services. This article reports on a multisited ethnography of mental health nursing practice as it relates to this group of mental health service users. It explores the beliefs and ideas that nurses identified about public mental health services and the services they provided to Aboriginal and Torres Strait Islander people. During the fieldwork, mental health nurses described the constricting effect of the biomedical paradigm of mental illness on their abilities to provide authentic holistic care focused on social and emotional well-being. Despite being the most numerous professional group in mental health services, the speciality of mental health nursing appears unable to change this situation and in many cases maintain this status quo to the potential detriment of their Aboriginal and Torres Strait Islander service users. © 2017 Australian College of Mental Health Nurses Inc.

Bibliotherapy for mental health service users Part 2: a survey of psychiatric libraries in the UK.

PubMed

Fanner, Deborah; Urqhuart, Christine

2009-06-01

UK health policy advocates a patient-centred approach to patient care. Library services could serve the rehabilitation needs of mental health service users through bibliotherapy (the use of written, audio or e-learning materials to provide therapeutic support). Part 2 of this two-part paper assesses the views of psychiatric libraries in the UK on providing access to service users and possible services provided. An e-mail questionnaire survey of psychiatric library members of the psychiatric lending co-operative scheme (n = 100) obtained a response rate of 55%, mostly from libraries based in hospitals. At present, libraries funded by the health service provide minimal facilities for service users. Librarians are uncertain about the benefits and practicalities of providing access to service users. In order to implement change, information providers across the National Health Service (NHS) will need to work collaboratively to overcome attitudinal and institutional barriers, including the key issue of funding.

Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions.

PubMed

Ferrer, Ana Paula Scoleze; Grisi, Sandra Josefina Ferraz Ellero

2016-09-01

Hospitalizations for ambulatory care-sensitive conditions (HACSC) are considered an indicator of the effectiveness of primary health care (PHC). High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501) users (guardians/caregivers) and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil), while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services). Sixty-five percent (65.2%) of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.

Adults with Learning Disabilities Experiences of Using Community Dental Services: Service User and Carer Perspectives

ERIC Educational Resources Information Center

Lees, Carolyn; Poole, Helen; Brennan, Michelle; Irvine, Fiona

2017-01-01

Background: The government alongside other health and social care organisation have identified the need to improve the care provided for people with learning disabilities. Materials and Methods: This service evaluation aimed to explore the experiences of people with learning disabilities and their carers who accessed community dental services…

Community outreach library services in the UK: a case study of Wirral Hospital NHS Trust (WHNT).

PubMed

Dowse, Frances Maria; Sen, Barbara

2007-09-01

The study evaluates the Community Outreach Library Service at Wirral Hospital National Health Service Trust (WHNT). It considers the information seeking behaviour and information needs of primary care staff, and service effectiveness in meeting those needs. A literature review established the current context and areas of best practice. The investigative case study used postal questionnaires to 250 primary care staff and an interview with the Community Outreach Librarian. Themes emerged from the literature regarding information seeking behaviour, information needs, and meeting user needs through effective service delivery. Outreach services have value in terms of improving information skills and providing services at point of need. Time is a major constraint for both users and service providers. Investment is needed from appropriate funding sources to support the provision and marketing of outreach library services. Librarians benefit from sharing best practice. The continued evaluation of outreach library services is recommended.

Developing and pilot testing M-health care application for pregnant and toddlers based on user experience

NASA Astrophysics Data System (ADS)

Lestantri, I. D.; Putrima; Sabiq, A.; Suherlan, E.

2018-03-01

Indonesia is the country number 4 as the largest smartphone user. In addition to functioning as a social media, the use of smartphones for other purposes has begun to develop in order to facilitate the work. Similarly in the field of maternal and child health. Most of the public, pregnant mothers and checking the development of children under five, were conducted to the Public Health Center. As a service center, Public Health Center need to improve its services. Among other things, it needs to be supported with technology. The high number of queues, the length of queue time and the traffic jam, prompted the need for the development of health applications, based on mobile. The role of the user is crucial to the successful implementation of a technology. This study aims to measure whether the application of M-Health Care application, as a prototype of the application developed to meet the needs of users. M-Health Care Application was developed with a prototyping approach. While for the measurement of M-Health Care Application done by using approach of USE Questionnaire. From result of data processing got result, usability measurement value equal to 88,3%. This indicates the M-Health Care application prototype is considered satisfactory for the user.The results of this measurement can be used as a reference for the next M-Health Care application development model based on user experience.

What does mental health nursing contribute to improving the physical health of service users with severe mental illness? A thematic analysis.

PubMed

Gray, Richard; Brown, Eleanor

2017-02-01

Authors have generally reported that mental health nurses (MHNs) have positive attitudes to providing physical health care to service users with severe mental illness. In the present study, we aimed to explore if this positive attitude translates to enhanced clinical practice by interviewing MHNs and the service users they work with. Semistructured interviews were completed with 15 service users and 18 MHNs from acute, rehabilitation, and community services. These were then transcribed and analysed using thematic analysis. Six themes emerged: (i) not the work of MHNs; (ii) the physical effects of psychiatric drugs are ignored; (iii) the need to upskill; (iv) keeping busy; (v) horrible hospital food/living on takeaways; and (vi) motivation to change. Our overarching meta-theme was of unmet physical health need among service users. © 2016 Australian College of Mental Health Nurses Inc.

'What makes an excellent mental health doctor?' A response integrating the experiences and views of service users with critical reflections of psychiatrists.

PubMed

Gunasekara, Imani; Patterson, Sue; Scott, James G

2017-11-01

While therapeutic relationships are appropriately recognised as the foundation of mental health service, service users commonly report suboptimal experiences. With shared understanding critical to improvement in practice, we explored service users' experiences and expectations of psychiatrists and consultations, engaging psychiatrists throughout the process. Using an iterative qualitative approach we co-produced a response to the question 'what makes an excellent mental health doctor?' Experiences and expectations of psychiatrists were explored in interviews with 22 service users. Data collection, analysis and interpretation were informed by consultation with peer workers. Findings were contextualised in formal consultations with psychiatrists. As 'masters of their craft', excellent mental health doctors engage authentically with service users as people (not diagnoses). They listen, validate experiences and empathise affectively and cognitively. They demonstrate phronesis, applying clinical knowledge compassionately. Psychiatrists share service users' aspiration of equitable partnership but competing demands and 'professional boundaries' constrain engagement. Consistent delivery of the person-centred, recovery-oriented care promoted by policy and sought by service users will require substantial revision of the structure and priorities of mental health services. The insights and experiences of service users must be integral to medical education, and systems must provide robust support to psychiatrists. © 2017 John Wiley & Sons Ltd.

Integrated Employee Assistance Program/Managed Behavioral Healthcare Benefits: Relationship with Access and Client Characteristics

PubMed Central

Merrick, Elizabeth S. Levy; Hodgkin, Dominic; Horgan, Constance M.; Hiatt, Deirdre; McCann, Bernard; Azzone, Vanessa; Zolotusky, Galina; Ritter, Grant; Reif, Sharon; McGuire, Thomas G.

2009-01-01

This study examined service user characteristics and determinants of access for enrollees in integrated EAP/behavioral health versus standard managed behavioral health care plans. A national managed behavioral health care organization’s claims data from 2004 were used. Integrated plan service users were more likely to be employees rather than dependents, and to be diagnosed with adjustment disorder. Logistic regression analyses found greater likelihood in integrated plans of accessing behavioral health services (OR 1.20, CI 1.17–1.24), and substance abuse services specifically (OR 1.23, CI 1.06–1.43). Results are consistent with the concept that EAP benefits may increase access and address problems earlier. PMID:19690952

Parents with mental illness - a qualitative study of identities and experiences with support services.

PubMed

Jones, M; Pietilä, I; Joronen, K; Simpson, W; Gray, S; Kaunonen, M

2016-10-01

WHAT IS KNOWN ON THE SUBJECT?: According to estimates more than half of adult mental health service users are parents, but their experiences are largely lacking from research literature. Parental mental illness can often be viewed from a risk perspective. Parents with mental illness and their families have unmet support needs. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Parents with mental illness want acknowledgement that they can be able and responsible. Many parents adopt an expert by experience identity. Fathers can feel their parental role is not recognized and mothers express fears of being judged if they discuss their illness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Adult mental health services need to recognize and support parental role of service users. Joint care planning and family oriented care should be promoted. Professionals should take advantage of the knowledge of these parents and they could be more actively engaged in service development. Introduction Parental mental illness is often viewed from a risk perspective. Despite this, being a parent can be both valuable and motivating. Research literature lacks the perspective of mothers and fathers, who have experienced mental illness. Aim This study explores how parents with mental illness construct their identities as mothers and fathers and their experiences with health and social care services. Method Three focus groups with 19 participants were conducted in Finland and Scotland. Methods of discourse analysis have been used in to analyse the interview data. Results Adult service users want their parenting role recognized and supported. Parents have knowledge and skills which can be utilized and many have adopted an expert by experience identity. Discussion Being able to see oneself as a 'good' parent can be challenging but important. Parents may require support, but want to be included in the planning of their care. Services could make more use of the knowledge and skills parents and families have, and joint working could lessen parents' anxieties. Implications for practice Mental health practitioners are in a key position in providing more family centred, resource focused care. Service user expertise should be acknowledged in clinical practice. © 2016 John Wiley & Sons Ltd.

Services used by perinatal substance-users with child welfare involvement: a descriptive study

PubMed Central

2010-01-01

Background Substance use during pregnancy often leads to involvement in the child welfare system, resulting in multiple social service systems and service providers working with families to achieve successful child welfare outcomes. The Vulnerable Infants Program of Rhode Island (VIP-RI) is a care coordination program developed to work with perinatal substance-users to optimize opportunities for reunification and promote permanency for substance-exposed infants. This paper describes services used by VIP-RI participants and child welfare outcomes. Methods Data collected during the first four years of VIP-RI were used to identify characteristics of program participants, services received, and child welfare outcomes: closed child welfare cases, reunification with biological mothers and identified infant permanent placements. Descriptive Results Medical and financial services were associated with positive child welfare outcomes. Medical services included family planning, pre- and post-natal care and HIV test counseling. Financial services included assistance with obtaining entitlement benefits and receiving tangible support such as food and clothing. Conclusions Findings from this study suggest services that address basic family needs were related to positive child welfare outcomes. The provision of basic services, such as health care and financial assistance through entitlement benefits and tangible donations, may help to establish a foundation so mothers can concentrate on recovery and parenting skills. Identification of services for perinatal substance users that are associated with more successful child welfare outcomes has implications for the child welfare system, treatment providers, courts and families. PMID:20807432

Services used by perinatal substance-users with child welfare involvement: a descriptive study.

PubMed

McCann, Kenneth J; Twomey, Jean E; Caldwell, Donna; Soave, Rosemary; Fontaine, Lynne Andreozzi; Lester, Barry M

2010-08-31

Substance use during pregnancy often leads to involvement in the child welfare system, resulting in multiple social service systems and service providers working with families to achieve successful child welfare outcomes. The Vulnerable Infants Program of Rhode Island (VIP-RI) is a care coordination program developed to work with perinatal substance-users to optimize opportunities for reunification and promote permanency for substance-exposed infants. This paper describes services used by VIP-RI participants and child welfare outcomes. Data collected during the first four years of VIP-RI were used to identify characteristics of program participants, services received, and child welfare outcomes: closed child welfare cases, reunification with biological mothers and identified infant permanent placements. DESCRIPTIVE RESULTS: Medical and financial services were associated with positive child welfare outcomes. Medical services included family planning, pre- and post-natal care and HIV test counseling. Financial services included assistance with obtaining entitlement benefits and receiving tangible support such as food and clothing. Findings from this study suggest services that address basic family needs were related to positive child welfare outcomes. The provision of basic services, such as health care and financial assistance through entitlement benefits and tangible donations, may help to establish a foundation so mothers can concentrate on recovery and parenting skills. Identification of services for perinatal substance users that are associated with more successful child welfare outcomes has implications for the child welfare system, treatment providers, courts and families.

Resettlement of individuals with learning disabilities into community care: a risk audit.

PubMed

Ellis, Roger; Hogard, Elaine; Sines, David

2013-09-01

This article describes a risk audit carried out on the support provided for 36 people with profound learning disabilities who had been resettled from hospital care to supported housing. The risks were those factors identified in the literature as associated with deleterious effects on quality of life. The audit was carried out with a specially designed tool that covered 24 possible risks and involved a support worker familiar with the service user choosing the most appropriate statement regarding each risk. Their judgements were verified by care managers and social needs assessors. Whilst one or more risks were identified for 32 of the 36 service users, the overall result showed relatively low risks for the group as a whole with 62 incidences (7%) from a possible 864, which nevertheless highlighted several areas that needed attention. The results of the audit have led to action plans for the provision and for the individual service users for whom risks were identified.

The Quest to Extend Health Services to Vulnerable Substance Users in Rio de Janeiro, Brazil in the Context of an Unfolding Economic Crisis.

PubMed

Krawczyk, Noa; Kerrigan, Deanna; Bastos, Francisco Inácio

2017-07-01

Calls to address crack-cocaine use in Brazil among homeless and street-frequenting populations who are in urgent need of health services have questioned the capacity of the Brazilian Unified Health System to attend to the nation's most marginalized citizens. In recent years, Brazil has launched several actions to escalate care for substance users, yet many obstacles hindering accessibility and effectiveness of services remain. Paradoxically, these actions have been implemented in the context of a growing economic crisis, and expanding services for a population of poor and stigmatized substance users while cutting other government programs tends to elicit harsh criticism from citizens. In consequence of such prospects, this commentary aims to discuss barriers marginalized substance users face in accessing health services that are at risk of worsening with government cutbacks. Using Rio de Janeiro as an example, we explore two primary issues: the resource-strained, under-staffed and decentralized nature of the Brazilian Unified Health System and the pervading stigma that bars vulnerable citizens from official structures and services. Abandoning initiated government efforts to increase access to health services would risk maintaining vulnerable citizens at the margins of public structures, inhibiting the opportunity to offer this population humane and urgently needed treatment and care.

The Quest to Extend Health Services to Vulnerable Substance Users in Rio de Janeiro, Brazil in the Context of an Unfolding Economic Crisis

PubMed Central

Krawczyk, Noa; Kerrigan, Deanna; Bastos, Francisco Inácio

2018-01-01

Calls to address crack-cocaine use in Brazil among homeless and street-frequenting populations who are in urgent need of health services have questioned the capacity of the Brazilian Unified Health System to attend to the nation’s most marginalized citizens. In recent years, Brazil has launched several actions to escalate care for substance users, yet many obstacles hindering accessibility and effectiveness of services remain. Paradoxically, these actions have been implemented in the context of a growing economic crisis, and expanding services for a population of poor and stigmatized substance users while cutting other government programs tends to elicit harsh criticism from citizens. In consequence of such prospects, this commentary aims to discuss barriers marginalized substance users face in accessing health services that are at risk of worsening with government cutbacks. Using Rio de Janeiro as an example, we explore two primary issues: the resource-strained, under-staffed and decentralized nature of the Brazilian Unified Health System and the pervading stigma that bars vulnerable citizens from official structures and services. Abandoning initiated government efforts to increase access to health services would risk maintaining vulnerable citizens at the margins of public structures, inhibiting the opportunity to offer this population humane and urgently needed treatment and care. PMID:27856941

[Sociodemographic characteristics and geographic variability associated with patient satisfaction in Primary Care].

PubMed

Pérez-Romero, S; Gascón-Cánovas, J J; Salmerón-Martínez, D; Parra-Hidalgo, P; Monteagudo-Piqueras, O

2016-01-01

Patient satisfaction with health services plays an important role in programs to improve the quality of care from the point of view of users. The objectives of this study were: To identify sociodemographic characteristics associated with patient satisfaction in the care provided by family doctors in Primary Health Care (PHC) centres, and describe the geographical variability of this phenomenon in the Spanish National Health Service. The data come from the European Health Survey (2009). Prevalence ratios (crude and adjusted) of the characteristics associated with both excellent satisfaction and dissatisfaction using Poisson regression, and their geographical variability are discussed. About one in every 3 users of the PHC believes that the care provided was excellent, while 6.7% were dissatisfied. There is a wide variability in the perception of satisfaction among the various regional health services, with prevalence ranging between 10.9% and 55.2%. Moreover, this assessment is closely related to age, level of self-perceived health, mental health, previous hospitalisation, chronic disease status, and limitations in daily activities. Satisfaction with the care provided by the PHC physician is relatively high. However, the distribution between regions and socio-demographic characteristics and health status of the user is heterogeneous. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

The role of boundary spanners in delivering collaborative care: a process evaluation.

PubMed

Hunt, Carianne M; Spence, Michael; McBride, Anne

2016-07-29

On average, people with schizophrenia and psychosis die 13-30 years sooner than the general population (World Psychiatry 10 (1):52-77, 2011). Mental and physical health care is often provided by different organisations, different practitioners and in different settings which makes collaborative care difficult. Research is needed to understand and map the impact of new collaborative ways of working at the primary/secondary care interface (PloS One 7 (5); e36468). The evaluation presented in this paper was designed to explore the potential of a Community and Physical Health Co-ordinator role (CPHC) (CPHCs were previously Care Co-ordinators within the Community Mental Health Team, Community in the title CPHC refers to Community Mental Health) and Multi-Disciplinary Team (MDT) meetings across primary and community care, with the aim of improving collaboration of mental and physical health care for service users with Severe Mental Illness (SMI). Data collection took place across five general practices (GPs) and a Community Mental Health Team (CMHT) in the Northwest of England, as part of a process evaluation. Semi-structured interviews were conducted with a purposive sample of GP staff (n= 18) and CMHT staff (n=4), a focus group with CMHT staff (n=8) and a survey completed by 13 CMHT staff, alongside cardiovascular risk data and MDT actions. Framework analysis was used to manage and interpret data. The results from the evaluation demonstrate that a CPHC role and MDT meetings are effective mechanisms for improving the collaboration and co-ordination of physical health care for SMI service users. The findings highlight the importance of embedding and supporting the CPHC role, with an emphasis on protected time and continuing professional roles and integrating multiple perspectives through MDT meetings. Considering the importance of physical health care for SMI service users and the complex environment, these are important findings for practitioners, researchers and policy makers in the field of primary care and mental health. There is an increasing focus on integration and collaborative working to ensure the delivery of quality care across the whole patient pathway, with a growing need for professionals to work together across service and professional boundaries. The introduction of a two pronged approach to collaboration has shown some important improvements in the management of physical health care for service users with SMI.

Extending specialist palliative care to all?

PubMed

Field, D; Addington-Hall, J

1999-05-01

How to extend palliative care services to all patients needing them is an issue currently exercising a range of bodies in contemporary Britain. This paper first considers the evidence regarding the needs of dying patients with long term conditions other than cancer and concludes that there is evidence to support their presumed need for palliative care. It then considers five potential barriers to extending specialist palliative care services to non-cancer patients in Britain. These are the skill base of current specialists in palliative care, difficulties in identifying candidates for specialist palliative care, the views of potential users of these services, resource implications and vested interests in present health service arrangements.

Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre

PubMed Central

Kahan, Deborah; Poremski, Daniel; Wise-Harris, Deborah; Pauly, Daniel; Leszcz, Molyn; Wasylenki, Donald; Stergiopoulos, Vicky

2016-01-01

Objectives This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention. Methods We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care. Results Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers. Conclusion Interventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users. PMID:28002491

Web-based Loansome Doc, librarians, and end users: results from a survey of the Southeast Region.

PubMed

Paden, S L; Batson, A L; Wallace, R L

2001-07-01

The study examines how Loansome Doc services are implemented and used by libraries in the Southeast Region and describe end users' experiences with and attitudes toward Loansome Doc. 251 active DOCLINE libraries and 867 Loansome Doc users were surveyed. Roughly one half of the libraries offered Loansome Doc services. Of those that did not, most indicated no plans to offer it in the future. The majority had a small number of end users and experienced minimal increases in interlibrary loan activity. Problems were relatively rare. Satisfaction with Loansome Doc was high among all types of libraries. End users were usually physicians or other health care professionals who requested articles for research and patient care. Most learned about Loansome Doc through PubMed or Internet Grateful Med. End users appeared to be largely self-taught or received informal instruction in Loansome Doc. Loansome Doc filled document requests in a timely manner, and end users reported being satisfied with the service. Greater promotion of what Loansome Doc is and how it can benefit libraries can increase the number of participating libraries. While satisfaction of Loansome Doc end users is high, satisfaction could be increased with more help on the PubMed screen, more library training, and faster delivery methods.

Service user and family member perspectives on services for mental health, substance use/addiction, and violence: a qualitative study of their goals, experiences and recommendations.

PubMed

Haskell, Rebecca; Graham, Kathryn; Bernards, Sharon; Flynn, Andrea; Wells, Samantha

2016-01-01

Mental health and substance use disorders (MSD) are significant public health concerns that often co-occur with violence. To improve services that address MSD and violence [MSD(V)], it is critical to understand the perspectives of those most affected, people who have sought help for MSD(V) (i.e., "service users"), especially those with co-occurring issues, as well as their family members. We conducted structured interviews with 73 service users and 41 family members of service users in two Ontario communities (one urban, one rural) regarding their goals related to help-seeking, positive and negative experiences, and recommendations for improving systems of care. Overall, participants expressed a need for services that: (1) are respectful, nonjudgmental, and supportive, help service users to feel more 'normal' and include education to reduce stigma; (2) are accessible, varied and publicly funded, thereby meeting individual needs and addressing equity concerns at a systems level; and (3) are coordinated, holistic and inclusive of family members who often support service users. The findings provide a rich understanding of how service users and their families perceive services for MSD(V) issues and identify key ways to better meet their needs.

Identifying new patient prospects: efficacy of usage segmentation. For some health care services, usage-based segmentation schemes can be wasteful and ineffective.

PubMed

Sarel, D; Marmorstein, H

1996-01-01

Even though there is intuitive appeal in identifying the user profile for a given service and then targeting similar nonusers, this approach can be very misleading when marketing health care services with low market penetration. If usage segmentation is employed without checking other indicators of latent demand and perceived barriers to use, significant misallocation of marketing resources is likely to occur. Confidentiality and embarrassment can be significant barriers to use by segments that are excellent patient prospects. In this study of mental and behavioral care, females and non-whites were found to be more concerned with confidentiality than were members of the user group. Lack of awareness can be a much bigger impediment to adoption than negative attitudes. Health care marketers need to design communications that not only increase awareness and familiarity for services with low market penetration, but also address other issues of concern to highly receptive segments.

[Centralization of health services in primary care in summer: Patients and professionals view during two consecutive years].

PubMed

Giménez, N; Martínez, J M; Clanchet, T

2015-01-01

The Spanish primary health care, gateway and pillar of the Health Care System has his resources increasingly constrained by current crisis. To know the opinion of users and professionals on two primary care centers which centralized in August 2011 and 2012 the attendance of seven primary care centers. Two questionnaires were designed: a telephone survey of a random sample of users and a self-completed questionnaire for health care professionals. The variables were scored on a scale of 1-10 (low to high). Cronbach's coefficient α>0,84. 1293 people responded (836 users and 357 professionals). Users rated, in 2011, the satisfaction with 6.7 points in August and 7.3 points the rest of the year (P<.001). And, in 2012, with 7.7 points in August and 8.1 points the rest of the year (P<.001). Health care professionals, rated their satisfaction with 6.8 points in 2011 and 7.3 points in 2012. The waiting time was the only variable best scores in August that the rest of the year. The perception of the solution given in consultation did not change. Satisfaction, marking, care and treatment were highest rated in the regular center than in the reference center (P<.001). The centralization of primary health care during periods of reduced demand could reduce costs while maintaining quality. The experience of centralizing primary care services during August was perceived as acceptable and improved over time. Users showed a slight, but significant, preference for their usual primary care center. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Disclosure of domestic violence in mental health settings: A qualitative meta-synthesis

PubMed Central

Trevillion, Kylee; Hughes, Bryony; Feder, Gene; Borschmann, Rohan; Oram, Siân

2014-01-01

Little is known about how psychiatric services respond to service users’ experiences of domestic violence. This qualitative meta-synthesis examined the healthcare experiences and expectations of mental health service users experiencing domestic violence. Twenty-two biomedical, social science, grey literature databases and websites were searched, supplemented by citation tracking and expert recommendations. Qualitative studies which included mental health service users (aged ≥ 16 years) with experiences of domestic violence were eligible for inclusion. Two reviewers independently extracted data from included papers and assessed quality. Findings from primary studies were combined using meta-synthesis techniques. Twelve studies provided data on 140 female and four male mental health service users. Themes were generally consistent across studies. Overarching theoretical constructs included the role of professionals in identifying domestic violence and facilitating disclosures, implementing personalized care and referring appropriately. Mental health services often failed to identify and facilitate disclosures of domestic violence, and to develop responses that prioritized service users’ safety. Mental health services were reported to give little consideration to the role of domestic violence in precipitating or exacerbating mental illness and the dominance of the biomedical model and stigma of mental illness were found to inhibit effective responses. Mental health services often fail to adequately address the violence experienced by mental health service users. This meta-synthesis highlights the need for mental health services to establish appropriate strategies and responses to domestic violence to ensure optimal care of this vulnerable population. PMID:25137109

The bond as a soft technology in the daily routine of the Family Health Strategy: perception of the user.

PubMed

Pozza Dos Santos, Bianca; Nizoli Nunes, Fernanda; Tuerlinckx Noguez, Patrícia; Roese, Adriana

2016-04-01

This study aimed to analyze the production of a bond between users and health care professionals in a Family Health Unit (FHU). This was a qualitative, descriptive study, with 33 hypertensive and/or diabetic users. Interviews were transcribed, analyzed and data were compared to the literature. The users who have been accessing the FHU for years stated that the bond with professionals has grown weak, it is a fragile bond. When it does exist, it is directed toward some professionals in the team. A disruption in the bond was also mentioned in some situations, owing to individual issues. Establishment of a bond between the user and the health care professionals in the reference FHU consists of a soft technology. Therefore, it impacts quality of health care and the prevention and management of chronic diseases. Establishment of a bond is essential for health care professionals to become references for the users of health care services.

Developing a typology of mobile phone usage in social care: A critical review of the literature.

PubMed

Saltiel, David; Steels, Stephanie; Fenney, Deborah

2017-07-31

The ways in which mobile phones have transformed the boundaries of time and space and the possibilities of communication have profoundly affected our lives. However, there is little research on the use of mobiles in social care though evidence is emerging that mobile phones can play an important role in delivering services. This paper is based on a scoping review of the international literature in this area. A typology of mobile interventions is suggested. While most mobile phone interventions remain unidirectional and sit within traditional social care service provider-service user relationships, a minority are bi- or multidirectional and contain within them the potential to transform these traditional relationships by facilitating a collective development of social networks and social capital. Such transformations are accompanied by a range of issues and dilemmas that have made many service providers reluctant to engage with new technologies. We suggest that our typology is a useful model to draw on when researching the use of mobile phones in social care to support and empower isolated, marginalised and vulnerable service users. © 2017 John Wiley & Sons Ltd.

Shifting the focus: outcomes of care for older people.

PubMed

Heath, Hazel; Phair, Lynne

2009-06-01

Internationally there is commitment to work towards eradicating the abuse of older people and to develop services that promote their equality, dignity and human rights. The emphasis on service users is gradually increasing and, along with this, the focus within health and social care policy, service provision and professional practice is shifting. In UK health and social care policy the emphasis on service structure and provision is being replaced by a focus on outcomes for service users, including outcomes which patients themselves evaluate. The focus of UK Adult Protection services is also shifting from intervention to prevention through developing greater understanding of the factors which contribute to abuse, changing attitudes towards entrenched poor care, identifying preventative services and safeguarding vulnerable adults. Nursing literature is also beginning to acknowledge the evolution of an outcomes focus. This paper discusses the shifting emphasis in UK health and social care in the safeguarding of vulnerable people and in nursing practice. It offers an overview of literature on outcomes. The paper then describes a research study which sought to identify outcomes of care for older people living in UK care homes. The outcomes framework developed through the research is offered, along with a discussion of the advantages of an outcome-focused approach to care and some of the remaining challenges. A case example is offered to illustrate an outcomes-focused approach. Finally, the paper draws conclusions on how shifting the focus of care delivery from traditional problem-orientated approaches and ritualized practice towards the outcomes of care that individual older people choose and evaluate for themselves offers potential towards eradicating abuse and neglect in formal care settings. © 2009 Blackwell Publishing Ltd.

[The admission to Nursing Homes and Home care services of elderly patients: analysis of the trend from 2008 to 2011 in a North Italian district].

PubMed

Caporale, Loretta; Czaplejewicz, Monika; Odasmini, Bruna

2014-01-01

The effects of the economic crisis impact on several aspects, included the use of health and social services. To analyze the effects of the economic recession on the request of in-home and long run social-health services. Retrospective research. The databases of a In-home Nursing Service, the Social Services and the Welfare area of a Social-Health Local Service in North of Italy have been consulted, with reference to the period between 31st December 2008 to 31st December 2011. From 2008 to 2011 the users supported by the In-Home Nursing Service increased by 30.3% while a decrease in the waiting lists for public and private nursing homes was observed. The users of In-Home Assistance Service decreased by 11%, as well as recipients of In-Home Meal Service (33%). Since 2008, the number of regional economic allowance beneficiaries dramatically increased; these allowances are dispensed as a support to In-Home Nursing Service and to social frailty. Profound changes of the offer and use of long term care services is evident. The endurance of this trend could impair the In-Home Nursing Services ability to answer to health needs of citizens. Health care professionals should strengthen the educational interventions to improve the level of patients'self care.

Service user experiences of specialist mental health supported accommodation: A systematic review of qualitative studies and narrative synthesis.

PubMed

Krotofil, Joanna; McPherson, Peter; Killaspy, Helen

2018-04-02

Specialist supported accommodation services have become a key component of most community-based mental healthcare systems. While mental health policies highlight the importance of service user involvement in service development and care planning, there are no comprehensive literature reviews synthesising services users' perspectives on, or experiences of, supported accommodation services. This systematic review was undertaken to fill this gap. We searched electronic databases (January 2015, updated June 2017), conducted hand searches and used forward-backward snowballing to identify 13,678 papers. We inspected the full-text of 110 papers and included 50 of these in the final review. Data extraction and quality assessments were conducted. We used narrative synthesis to develop a conceptual model of service users' experiences that included structural, process, relational and contextual factors, such as the characteristics of the service, relationships with staff and other service users, the intensity and nature of support, the physical environment, and social and community integration. The review highlights the complex interplay of individual, service-level and community factors in shaping the lived experience of service users and their impact on personal identity and recovery. Our approach addressed some of the widely reported limitations of the quantitative research in this field, providing a conceptual model relevant to service user experiences across supported accommodation service types, population groups and countries. © 2018 John Wiley & Sons Ltd.

Primary care quality: community health center and health maintenance organization.

PubMed

Shi, Leiyu; Starfield, Barbara; Xu, Jiahong; Politzer, Robert; Regan, Jerrilyn

2003-08-01

This study compares the primary health care quality of community health centers (CHCs) and health maintenance organizations (HMOs) in South Carolina to elucidate the quality of CHC performance relative to mainstream settings such as the HMO. Mail surveys were used to obtain data from 350 randomly selected HMO users. Surveys with follow-up interviews were conducted to obtain data from 540 randomly selected CHC users. A validated adult primary care assessment tool was used in both surveys. Multivariate analyses were performed to assess the association of health care setting (HMO versus CHC) with primary care quality while controlling for sociodemographic and health care characteristics. After controlling for sociodemographic and health care use measures, CHC patients demonstrated higher scores in several primary care domains (ongoing care, coordination of service, comprehensiveness, and community orientation) as well as total primary care performance. Users of CHC are more likely than HMO users to rate their primary health care provider as good, except in the area of ease of first contact. The positive rating of the CHC is particularly impressive after taking into account that many CHC users have characteristics associated with poorer ratings of care.

Factors associated with the amount of public home care received by elderly and intellectually disabled individuals in a large Norwegian municipality.

PubMed

Døhl, Øystein; Garåsen, Helge; Kalseth, Jorid; Magnussen, Jon

2016-05-01

This study reports an analysis of factors associated with home care use in a setting in which long-term care services are provided within a publicly financed welfare system. We considered two groups of home care recipients: elderly individuals and intellectually disabled individuals. Routinely collected data on users of public home care in the municipality of Trondheim in October 2012, including 2493 people aged 67 years or older and 270 intellectually disabled people, were used. Multivariate regression analysis was used to analyse the relationship between the time spent in direct contact with recipients by public healthcare personnel and perceived individual determinants of home care use (i.e. physical disability, cognitive impairment, diagnoses, age and gender, as well as socioeconomic characteristics). Physical disability and cognitive impairment are routinely registered for long-term care users through a standardised instrument that is used in all Norwegian municipalities. Factor analysis was used to aggregate the individual items into composite variables that were included as need variables. Both physical disability and cognitive impairment were strong predictors of the amount of received care for both elderly and intellectually disabled individuals. Furthermore, we found a negative interaction effect between physical disability and cognitive impairment for elderly home care users. For elderly individuals, we also found significant positive associations between weekly hours of home care and having comorbidity, living alone, living in a service flat and having a safety alarm. The reduction in the amount of care for elderly individuals living with a cohabitant was substantially greater for males than for females. For intellectually disabled individuals, receiving services involuntarily due to severe behavioural problems was a strong predictor of the amount of care received. Our analysis showed that routinely collected data capture important predictors of home care use and thus facilitate both short-term budgeting and long-term planning of home care services. © 2015 John Wiley & Sons Ltd.

Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China

PubMed Central

Zeng, Jiazhi; Shi, Leiyu; Zou, Xia; Chen, Wen; Ling, Li

2015-01-01

Objectives China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants’ experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China. Methods The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool—Adult Short Version (PCAT-AS), representing 10 primary care domains was used to collect information on migrants’ quality of primary care experiences. These domains include first contact (utilization), first contact (accessibility), ongoing care, coordination (referrals), coordination (information systems), comprehensiveness (services available), comprehensiveness (services provided), family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients’ perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores. Results After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49) reported the highest PCAT total scores, followed by municipal hospitals (25.02), community health centers/community health stations (24.24), and township health centers/rural health stations (24.18). Tertiary hospital users reported significantly better performance in first contact (utilization), first contact (accessibility), coordination (information system), comprehensiveness (service available), and cultural competence. Community health center/community health station users reported significantly better experience in the community orientation domain. Township health center/rural health station users expressed significantly better experience in the ongoing care domain. There were no statistically significant differences across settings in the ongoing care, comprehensiveness (services provided), and family-centeredness domains. Multiple linear regression models showed that factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P<0.001). Conclusions This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care. PMID:26474161

A 3-year study of high-cost users of health care.

PubMed

Wodchis, Walter P; Austin, Peter C; Henry, David A

2016-02-16

Characterizing high-cost users of health care resources is essential for the development of appropriate interventions to improve the management of these patients. We sought to determine the concentration of health care spending, characterize demographic characteristics and clinical diagnoses of high-cost users and examine the consistency of their health care consumption over time. We conducted a retrospective analysis of all residents of Ontario, Canada, who were eligible for publicly funded health care between 2009 and 2011. We estimated the total attributable government health care spending for every individual in all health care sectors. More than $30 billion in annual health expenditures, representing 75% of total government health care spending, was attributed to individual costs. One-third of high-cost users (individuals with the highest 5% of costs) in 2009 remained in this category in the subsequent 2 years. Most spending among high-cost users was for institutional care, in contrast to lower-cost users, among whom spending was predominantly for ambulatory care services. Costs were far more concentrated among children than among older adults. The most common reasons for hospital admissions among high-cost users were chronic diseases, infections, acute events and palliative care. Although high health care costs were concentrated in a small minority of the population, these related to a diverse set of patient health care needs and were incurred in a wide array of health care settings. Improving the sustainability of the health care system through better management of high-cost users will require different tactics for different high-cost populations. © 2016 Canadian Medical Association or its licensors.

An End-User Participatory Approach to Collaboratively Refine HIV Care Data, The New York State Experience.

PubMed

Swain, Carol-Ann; Sawicki, Steven; Addison, Diane; Katz, Benjamin; Piersanti, Kelly; Baim-Lance, Abigail; Gordon, Daniel; Anderson, Bridget J; Nash, Denis; Steinbock, Clemens; Agins, Bruce

2018-04-02

Existing data dissemination structures primarily rely on top-down approaches. Unless designed with the end user in mind, this may impair data-driven clinical improvements to Human Immunodeficiency Virus (HIV) prevention and care. In this study, we implemented a data visualization activity to create region-specific data presentations collaboratively with HIV providers, consumers of HIV care, and New York State (NYS) Department of Health AIDS Institute staff for use in local HIV care decision-making. Data from the NYS HIV Surveillance Registry (2009-2013) and HIV care facilities (2010-2015) participating in a Health Resources and Services Administration (HRSA) Systems Linkages and Access to Care project were used. Each data package incorporated visuals for: linkage to HIV care, retention in care and HIV viral suppression. End-users were vocal about their data needs and their capacity to interpret public health data. This experience suggests that data dissemination strategies should incorporate input from the end user to improve comprehension and optimize HIV care.

AdaFF: Adaptive Failure-Handling Framework for Composite Web Services

NASA Astrophysics Data System (ADS)

Kim, Yuna; Lee, Wan Yeon; Kim, Kyong Hoon; Kim, Jong

In this paper, we propose a novel Web service composition framework which dynamically accommodates various failure recovery requirements. In the proposed framework called Adaptive Failure-handling Framework (AdaFF), failure-handling submodules are prepared during the design of a composite service, and some of them are systematically selected and automatically combined with the composite Web service at service instantiation in accordance with the requirement of individual users. In contrast, existing frameworks cannot adapt the failure-handling behaviors to user's requirements. AdaFF rapidly delivers a composite service supporting the requirement-matched failure handling without manual development, and contributes to a flexible composite Web service design in that service architects never care about failure handling or variable requirements of users. For proof of concept, we implement a prototype system of the AdaFF, which automatically generates a composite service instance with Web Services Business Process Execution Language (WS-BPEL) according to the users' requirement specified in XML format and executes the generated instance on the ActiveBPEL engine.

[Oral health knowledge and practices among pregnant women using health services in São Luís, Maranhão, Brazil, 2007-2008].

PubMed

Lopes, Fernanda Ferreira; Ribeiro, Tafnes Valverde; Fernandes, Daniela Braga; Calixto, Nayra Rodrigues de Vasconcelos; Alves, Cláudia Maria Coêlho; Pereira, Antônio Luiz Amaral; Pereira, Adriana de Fátima Vasconcelos

2016-01-01

to describe characteristics of oral health care during prenatal check-ups and knowledge about oral health among pregnant women using public and private health services in São Luís, Maranhão, Brazil. this is a descriptive study of 300 women interviewed in public health services and a further 300 interviewed in private health services between August 2007 and July 2008. tooth brushing frequency was similar among users of public and private services (p=0.156), while flossing (64.0% and 47.0%; p<0.001) and mouthwashing (39.7% and 27.0%; p=0.001) was more frequent among private service users in relation to public service users; most users of public services (60.3%) and private services (65.7%) were unaware of the association between oral health and pregnancy. frequency of tooth brushing was similar among pregnant women in public and private services; the effects of pregnancy on oral health were not well known.

Effects of user fee exemptions on the provision and use of maternal health services: a review of literature.

PubMed

Hatt, Laurel E; Makinen, Marty; Madhavan, Supriya; Conlon, Claudia M

2013-12-01

User fee removal has been put forward as an approach to increasing priority health service utilization, reducing impoverishment, and ultimately reducing maternal and neonatal mortality. However, user fees are a source of facility revenue in many low-income countries, often used for purchasing drugs and supplies and paying incentives to health workers. This paper reviews evidence on the effects of user fee exemptions on maternal health service utilization, service provision, and outcomes, including both supply-side and demand-side effects. We reviewed 19 peer-reviewed research articles addressing user fee exemptions and maternal health services or outcomes published since 1990. Studies were identified through a USAID-commissioned call for evidence, key word search, and screening process. Teams of reviewers assigned criteria-based quality scores to each paper and prepared structured narrative reviews. The grade of the evidence was found to be relatively weak, mainly from short-term, non-controlled studies. The introduction of user fee exemptions appears to have resulted in increased rates of facility-based deliveries and caesarean sections in some contexts. Impacts on maternal and neonatal mortality have not been conclusively demonstrated; exemptions for delivery care may contribute to modest reductions in institutional maternal mortality but the evidence is very weak. User fee exemptions were found to have negative, neutral, or inconclusive effects on availability of inputs, provider motivation, and quality of services. The extent to which user fee revenue lost by facilities is replaced can directly affect service provision and may have unintended consequences for provider motivation. Few studies have looked at the equity effects of fee removal, despite clear evidence that fees disproportionately burden the poor. This review highlights potential and documented benefits (increased use of maternity services) as well as risks (decreased provider motivation and quality) of user fee exemption policies for maternal health services. Governments should link user fee exemption policies with the replacement of lost revenue for facilities as well as broader health system improvements, including facility upgrades, ensured supply of needed inputs, and improved human resources for health. Removing user fees may increase uptake but will not reduce mortality proportionally if the quality of facility-based care is poor. More rigorous evaluations of both demand- and supply-side effects of mature fee exemption programmes are needed.

Pharmaceutical Services in Primary Health Care: are pharmacists and users on the same page?

PubMed

Luz, Tatiana Chama Borges; Costa, Maria Emília Silva de Souza; Portes, Daniela Santana; Santos, Lucas Barbi Costa E; Sousa, Samuel Rodrigues Almeida E; Luiza, Vera Lucia

2017-08-01

This study investigated structural and organizational characteristics of the Pharmaceutical Services based on Primary Health Care (PHCPS) from the viewpoints of users and pharmacists. A mixed method design was applied, combining one-to-one semi-structured interviews with four pharmacists in charge of five public dispensing facilities and 69 users, with a secondary database analysis. Data were collected from February to August 2014 in Divinópolis, a municipality in Minas Gerais State. PHCPS were similar in terms of general activities performed and staff profile and background. While users were concerned about medicines' availability and improvements related to the PHCPS' conveniences and personnel, pharmacists pointed out problems regarding infrastructure to storage. Despite most users had low information on how to use their medicines, no pharmacists declared to participate in medicines dispensing activities. There was a low match between users and pharmacists viewpoints and advantages for concentrate medicines dispensing in a smaller number of facilities were not clear.

Cost Savings Effects of Olanzapine as Long Term Treatment for Bipolar Disorder

PubMed Central

Zhang, Yuting

2007-01-01

Newer and more expensive drugs account for most of the recent rapid growth of spending on prescription drugs in the past nine years. But if more expensive drugs can reduce the use of other types of health care services, total health care costs might fall. In this paper, I investigate the “drug-offset” hypothesis for an atypical antipsychotic drug, olanzapine, compared to lithium, to treat bipolar disorder. I use a propensity-score method to match on observed variables. Then, using various identification strategies, namely interrupted time series, differencing strategies, and an instrument-variable approach, I find that olanzapine does not reduce spending on other types of medical care services, compared with lithium. Olanzapine users spend $330 per month more than lithium users on non-drug health care services after drug treatment and $470 more per month on total health care spending, contradicting the “drug-offset” hypothesis in this case. JEL classification: H51; I1; I18; C1; C2 PMID:18806303

Developing and Using Vignettes to Explore the Relationship Between Risk Management Practice and Recovery-Oriented Care in Mental Health Services.

PubMed

Holley, Jessica; Gillard, Steven

2018-02-01

There is a lack of literature evaluating the development and use of vignettes to explore contested constructs in qualitative health care research where a conventional interview schedule might impose assumptions on the data collected. We describe the development and validation of vignettes in a study exploring mental health worker and service user understandings of risk and recovery in U.K. mental health services. Focus groups with mental health workers and service users explored study questions from experiential perspectives. Themes identified in the groups were combined with existing empirical literature to develop a set of vignettes. Feedback focus groups were conducted to validate and amend the vignettes. Following use in research interviews, results suggested that the vignettes had successfully elicited data on issues of risk and recovery in mental health services. Further research using creative, comparative methods is needed to fully understand how vignettes can best be used in qualitative health care research.

Understanding the dynamics of sustainable change: A 20-year case study of integrated health and social care.

PubMed

Klinga, Charlotte; Hasson, Henna; Andreen Sachs, Magna; Hansson, Johan

2018-06-04

Change initiatives face many challenges, and only a few lead to long-term sustainability. One area in which the challenge of achieving long-term sustainability is particularly noticeable is integrated health and social care. Service integration is crucial for a wide range of patients including people with complex mental health and social care needs. However, previous research has focused on the initiation, resistance and implementation of change, while longitudinal studies remain sparse. The objective of this study was therefore to gain insight into the dynamics of sustainable changes in integrated health and social care through an analysis of local actions that were triggered by a national policy. A retrospective and qualitative case-study research design was used, and data from the model organisation's steering-committee minutes covering 1995-2015 were gathered and analysed. The analysis generated a narrative case description, which was mirrored to the key elements of the Dynamic Sustainability Framework (DSF). The development of inter-sectoral cooperation was characterized by a participatory approach in which a shared structure was created to support cooperation and on-going quality improvement and learning based on the needs of the service user. A key management principle was cooperation, not only on all organisational levels, but also with service users, stakeholder associations and other partner organisations. It was shown that all these parts were interrelated and collectively contributed to the creation of a structure and a culture which supported the development of a dynamic sustainable health and social care. This study provides valuable insights into the dynamics of organizational sustainability and understanding of key managerial actions taken to establish, develop and support integration of health and social care for people with complex mental health needs. The service user involvement and regular reviews of service users' needs were essential in order to tailor services to the needs. Another major finding was the importance of continuously adapting the content of the change to suit its context. Hence, continuous refinement of the change content was found to be more important than designing the change at the pre-implementation stage.

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review

PubMed Central

Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Diadiou, Fatoumata; Bouliane, Danielle; Beaudin, Jérémie

2017-01-01

Objective The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Design Thematic analysis review of CM studies. Methods We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004–December 2015 period, then updated to July 2017, with the keywords ‘CM’ and ‘frequent use’. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir’s implementation of health innovations framework was used to organise results into four broad levels of factors: (1) environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Results Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. Conclusions CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts. PMID:29061623

Avatars and virtual agents – relationship interfaces for the elderly

PubMed Central

2017-01-01

In the Digital Era, the authors witness a change in the relationship between the patient and the care-giver or Health Maintenance Organization's providing the health services. Another fact is the use of various technologies to increase the effectiveness and quality of health services across all primary and secondary users. These technologies range from telemedicine systems, decision making tools, online and self-services applications and virtual agents; all providing information and assistance. The common thread between all these digital implementations, is they all require human machine interfaces. These interfaces must be interactive, user friendly and inviting, to create user involvement and cooperation incentives. The challenge is to design interfaces which will best fit the target users and enable smooth interaction especially, for the elderly users. Avatars and Virtual Agents are one of the interfaces used for both home care monitoring and companionship. They are also inherently multimodal in nature and allow an intimate relation between the elderly users and the Avatar. This study discusses the need and nature of these relationship models, the challenges of designing for the elderly. The study proposes key features for the design and evaluation in the area of assistive applications using Avatar and Virtual agents for the elderly users. PMID:28706725

How is a specialist depression service effective for persistent moderate to severe depressive disorder?: a qualitative study of service user experience.

PubMed

Thomson, Louise; Barker, Marcus; Kaylor-Hughes, Catherine; Garland, Anne; Ramana, Rajini; Morriss, Richard; Hammond, Emily; Hopkins, Gail; Simpson, Sandra

2018-06-15

A specialist depression service (SDS) offering collaborative pharmacological and cognitive behaviour therapy treatment for persistent depressive disorder showed effectiveness against depression symptoms versus usual community based multidisciplinary care in a randomised controlled trial (RCT) in specialist mental health services in England. However, there is uncertainty concerning how specialist depression services effect such change. The current study aimed to evaluate the factors which may explain the greater effectiveness of SDS compared to Treatment as Usual (TAU) by exploring the experience of the RCT participants. Qualitative audiotaped and transcribed semi-structured interviews were conducted 12-18 months after baseline with 21 service users (12 SDS, 9 TAU arms) drawn from all three sites. Inductive thematic analysis using a grounded approach contrasted the experiences of SDS with TAU participants. Four themes emerged in relation to service user experience: 1. Specific treatment components of the SDS: which included sub-themes of the management of medication change, explaining and developing treatment strategies, setting realistic expectations, and person-centred and holistic approach; 2. Individual qualities of SDS clinicians; 3. Collaborative team context in SDS: which included sub-themes of communication between healthcare professionals, and continuity of team members; 4. Accessibility to SDS: which included sub-themes of flexibility of locations, frequent consultation as reinforcement, gradual pace of treatment, and challenges of returning to usual care. The study uncovered important mechanisms and contextual factors in the SDS that service users experience as different from TAU, and which may explain the greater effectiveness of the SDS: the technical expertise of the healthcare professionals, personal qualities of clinicians, teamwork, gradual pace of care, accessibility and managing service transitions. Usual care in other specialist mental health services may share many of the features from the SDS. "Trial of the Clinical and Cost Effectiveness of a Specialist Expert Mood Disorder Team for Refractory Unipolar Depressive Disorder" was registered in www.ClinicalTrials.gov ( NCT01047124 ) on 12-01-2010 and the ISRCTN registry was registered in www.isrctn.com ( ISRCTN10963342 ) on 25-11-2015 (retrospectively registered).

[From normative aspects to the reality of the Unified Health System: revealing barriers that curtail access to the health care network].

PubMed

Sousa, Fabiana de Oliveira Silva; de Medeiros, Kátia Rejane; Gurgel Júnior, Garibaldi Dantas; de Albuquerque, Paulette Cavalcanti

2014-04-01

This article analyzes the conditions of comprehensive access to health care in Recife in the state of Pernambuco based on the trajectory experienced by users from primary health services through to specialist care. Quantitative and qualitative approaches were combined with triangulation of methods as the research technique. Systemic Arterial Hypertension was chosen as a core condition, as it is an ailment that requires attention at various levels of the city's health network. The research revealed various barriers of access in primary health care becoming more accentuated at other levels of care resulting in delays in timely care and consequently prolonging the suffering of the population. Structural problems such as a shortage of medical professionals in primary care, insufficient access to specialized consultations and exams, together with the inherent dynamics of the health services, are real obstacles that the user faces in the quest for continuous and comprehensive care in the Unified Health System (SUS). In addition to broadening and enhancing the availability of services, especially complementary exams, it is necessary to ensure communication between the departments of the SUS, in order to consolidate an articulated network, thereby improving health care.

Using willingness to pay to investigate regressiveness of user fees in health facilities in Tanzania.

PubMed

Bonu, Sekhar; Rani, Manju; Bishai, David

2003-12-01

The study uses data from the Tanzania Human Resources Development Survey (1994) on willingness to pay (WTP) for desired quality of health care at lower-level health facilities to assess potential regressiveness of user fees - a disproportionately higher negative effect of user fees on utilization of health services among the poor compared with the rich. Despite reports of extensive bypassing of the lower-level health facilities in Tanzania, the WTP for quality health care at these health facilities is surprisingly large. WTP was lower among the poor, female and elderly respondents. Almost one-quarter of the poorest 40% of the population was not willing to pay even when the quality of services met their expectations. The results suggest that: the utilization of health services at lower-level health facilities can be increased by improving the quality of care; and the implementation of uniform user charges in the public facilities may be regressive, adversely affecting utilization among the poor, women and the elderly. An effective system of exemptions and waivers will be required for the very poor who may not be able to pay even when quality of services is improved. The findings of the study have policy implications for the Tanzanian government's recent attempts to expand cost-sharing through community health funds at lower-level health facilities, being introduced since 1998.

Home care for older people in Sweden: a universal model in transition.

PubMed

Szebehely, Marta; Trydegård, Gun-Britt

2012-05-01

One aspect of universalism in Swedish eldercare services is that publicly financed and publicly provided services have been both affordable for the poor and attractive enough to be preferred by the middle class. This article identifies two trends in home care for older people in Sweden: a decline in the coverage of publicly funded services and their increasing marketisation. We explore the mechanisms behind these trends by reviewing policy documents and official reports, and discuss the distributional consequences of the changes by analysing two data sets from Statistics Sweden: the Swedish Level of Living surveys from 1988/1989 and 2004/2005 and a database on all users of tax deductions on household and care services in 2009. The analysis shows that the decline of tax-funded home care is not the result of changing eldercare legislation and was not intended by national policy-makers. Rather the decline was caused by a complex interplay of decision-making at central and local levels, resulting in stricter municipal targeting. The trend towards marketisation has been more clearly intended by national policy-makers. Legislative changes have opened up tax-funded services to private provision, and a customer-choice (voucher) model and a tax deduction for household- and care services have been introduced. As a result of declining tax-funded home-care services, older persons with lower education increasingly receive family care, while those with higher education are more likely to buy private services. The combination of income-related user fees, customer-choice models and the tax deduction has created an incentive for high-income older persons to turn to the market instead of using public home-care services. Thus, Swedish home care, as a universal welfare service, is now under threat and may become increasingly dominated by groups with less education and lower income which, in turn, could jeopardise the quality of care. © 2011 Blackwell Publishing Ltd.

The impact of patient and public involvement on UK NHS health care: a systematic review.

PubMed

Mockford, Carole; Staniszewska, Sophie; Griffiths, Frances; Herron-Marx, Sandra

2012-02-01

Patient and public involvement (PPI) has become an integral part of health care with its emphasis on including and empowering individuals and communities in the shaping of health and social care services. The aims of this study were to identify the impact of PPI on UK National Health Service (NHS) healthcare services and to identify the economic cost. It also examined how PPI is being defined, theorized and conceptualized, and how the impact of PPI is captured or measured. Seventeen key online databases and websites were searched, e.g. Medline and the King's Fund. UK studies from 1997 to 2009 which included service user involvement in NHS healthcare services. Date extraction Key themes were identified and a narrative analysis was undertaken. The review indicates that PPI has a range of impacts on healthcare services. There is little evidence of any economic analysis of the costs involved. A key limitation of the PPI evidence base is the poor quality of reporting impact. Few studies define PPI, there is little theoretical underpinning or conceptualization reported, there is an absence of robust measurement of impact and descriptive evidence lacked detail. There is a need for significant development of the PPI evidence base particularly around guidance for the reporting of user activity and impact. The evidence base needs to be significantly strengthened to ensure the full impact of involving service users in NHS healthcare services is fully understood.

Service users’ experiences and views of aggressive situations in mental health care: a systematic review and thematic synthesis of qualitative studies

PubMed Central

Gudde, Camilla Buch; Olsø, Turid Møller; Whittington, Richard; Vatne, Solfrid

2015-01-01

Background Aggressive situations occurring within mental health services can harm service users, staff, and the therapeutic environment. There is a consensus that the aggression phenomenon is multidimensional, but the picture is still unclear concerning the complex interplay of causal variables and their respective impact. To date, only a small number of empirical studies include users’ views of relevant factors. The main objective of this review is to identify and synthesize evidence relating to service users’ experiences and views of aggressive situations in mental health settings. Methods We included qualitative studies of any design reporting on service users’ own experiences of conditions contributing to aggressive situations in mental health care and their views on preventative strategies. Eligible articles were identified through an electronic database search (PsycINFO, PubMed, Ovid Nursing Database, Embase, and CINAHL), hand search, and cross-referencing. Extracted data were combined and interpreted using aspects of thematic synthesis. Results We reviewed 5,566 records and included 13 studies (ten qualitative and three mixed methods). Service users recognized that both their own mental state and negative aspects of the treatment environment affected the development of aggressive situations. Themes were derived from experiential knowledge and included calls to be involved in questions regarding how to define aggression and relevant triggers, and how to prevent aggressive encounters effectively. The findings suggest that incidents are triggered when users experience staff behavior as custodial rather than caring and when they feel ignored. Conclusion The findings highlight the importance of staffs’ knowledge and skills in communication for developing relationships based on sensitivity, respect, and collaboration with service users in order to prevent aggressive situations. An important factor is a treatment environment with opportunities for meaningful activities and a preponderance of trained staff who work continuously on the development of conditions and skills for collaborative interaction with users. PMID:26491343

Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review

PubMed Central

Hone, Thomas; Lee, John Tayu; Majeed, Azeem; Conteh, Lesong; Millett, Christopher

2017-01-01

Abstract Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients. PMID:28453713

Access to mental health care among women Veterans: is VA meeting women's needs?

PubMed

Kimerling, Rachel; Pavao, Joanne; Greene, Liberty; Karpenko, Julie; Rodriguez, Allison; Saweikis, Meghan; Washington, Donna L

2015-04-01

Patient-centered access to mental health describes the fit between patient needs and resources of the system. To date, little data are available to guide implementation of services to women veterans, an underrepresented minority within Department of Veteran Affairs (VA) health care. The current study examines access to mental health care among women veterans, and identifies gender-related indicators of perceived access to mental health care. A population-based sample of 6287 women veterans using VA primary care services participated in a survey of past year perceived need for mental health care, mental health utilization, and gender-related mental health care experiences. Subjective rating of how well mental health care met their needs was used as an indicator of perceived access. Half of all women reported perceived mental health need; 84.3% of those women received care. Nearly all mental health users (90.9%) used VA services, although only about half (48.8%) reported that their mental health care met their needs completely or very well. Gender related experiences (availability of female providers, women-only treatment settings, women-only treatment groups, and gender-related comfort) were each associated with 2-fold increased odds of perceived access, and associations remained after adjusting for ease of getting care. Women VA users demonstrate very good objective access to mental health services. Desire for, and access to specialized mental health services for women varies across the population and are important aspects of shared decision making in referral and treatment planning for women using VA primary care.

[Evaluation of a citizenship-oriented intervention: The Citizens' Project of the University of Recovery].

PubMed

Pelletier, Jean-François; Pouliot-Morneau, Denis; Houle, Janie; Bordeleau, Julie; Laroche, Sébastien; Rowe, Michael

Objectives The Global Model of Public Mental Health is "global" not only in the sense of having an international perspective, but in regarding service users as actors at all levels of public mental health exerting collective and organized influence on the social determinants of health, in addition to being recipients of care. Having access to appropriate health and mental health care when needed is a fundamental human right. Having a say over the manner in which care is provided, including partnership in decision making in care planning and ongoing care, has gained increasing support among recipients and providers of care. Over the past few decades in the Canadian province of Quebec, patient participation and partnership in decision-making has been promoted through successive Mental Health Action Plans (MHAP) and other policies. In these documents, participation and partnership are associated with the exercise of citizenship and the promotion of service users' rights, including the rights to participate in one's own care. In this article, using the case example of a citizenship-oriented intervention, namely the Projet citoyen, we discuss the results to a new measure of citizenship, which was developed from a service users' perspective.Methods Employing a mixed methods approach, two types of data were collected from users of mental health care. Quantitative data were generated from administration of a 23-item measure of citizenship with service users in the province of Quebec (N=802), and qualitative data were collected from four focus groups with another sample of 18 service users. They were presented with results from the administration of the measure, and asked to comment on them in regard to their own experience of citizenship.Results Among the five dimensions of the measure of citizenship, participants scored lowest on the 'involvement in the community' dimension, and higher on the other dimensions of 'basic needs,' 'respect by others,' 'self-determination,' and 'access to services.' In focus groups, participants said that there is still prejudice in society and discrimination towards people with mental illnesses that limit their right to participate in public debate and mental health programming. Public health interventions at this level may help to change attitudes and social representations, as they are inclusive of persons with lived experience of mental illness. Public discussion of citizenship issues in relation to mental health also represent an opportunity for participants to confront existing problems, as a first step toward collective action.Conclusion People's lived experience of regaining a sense of citizenship and of belonging to their local neighborhoods and communities, including the scientific micro-community, can help to foster an evolution of public health from disease management to health promotion and community inclusion. More research is needed to compare the sense of citizenship to the rest of the population and to see if specific interventions can have an enduring impact (e.g.: pre/post design).

Conceptions on pharmaceutical services in Brazilian primary health care

PubMed Central

Costa, Ediná Alves; Araújo, Patrícia Sodré; Penaforte, Thais Rodrigues; Barreto, Joslene Lacerda; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Alvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

2017-01-01

ABSTRACT OBJECTIVE To identify and discuss the conceptions of pharmaceutical services in Brazilian Primary Health Care, according to different subjects. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015), which is composed of an information survey in a representative sample of cities, stratified according to Brazilian regions, and a subsample of primary health care services. Municipal secretaries of health, those responsible for pharmaceutical services, and those responsible for medicine delivery in pharmacies/dispensing units of the selected services were interviewed. The questionnaires included one question about the understanding of the interviewee regarding pharmaceutical services. The content analysis technique was used to apprehend, in the statements, the meanings attributed to pharmaceutical services, which were subsequently classified into categories according to their main conceptions. RESULTS Among the wide diversity of conceptions on pharmaceutical services (PS), we highlight the ones focused on 1) logistic control of medicines with activities concerning guidance or information on their use and 2) guidance or information to users on the use of medicine. The findings reveal a shifting tendency from a medicine-focused conception to one that considers the users and their needs as the final recipient of these actions. However, the lack of references to conceptions regarding care management and integrality point out the slowness of this change; after all, this is a social and historical process that comprises the production of meanings that transcend legal, logistic, and technical arrangements in pharmaceutical services. CONCLUSIONS The diversity of conceptions expresses the several meanings attributed to pharmaceutical services; we also identified, in their reorientation process, a movement that reflects a gradual shift in the technical paradigm, from the focus on medicine logistics to a user-oriented approach of health services. PMID:29160453

[Factors associated with perception of improvement by users of Centers for Psychosocial Care in the South of Brazil].

PubMed

Franzmann, Uiasser Thomas; Kantorski, Luciane Prado; Jardim, Vanda Maria da Rosa; Treichel, Carlos Alberto Dos Santos; Oliveira, Michele Mandagará de; Pavani, Fabiane Machado

2017-08-07

This study aimed to investigate factors associated with perceived improvement among users of Centers for Psychosocial Care. This was a cross-sectional study of 1,493 users of Centers for Psychosocial Care in the South of Brazil. Users' perceived improvement was assessed by Perceived Change Scale - Patients (PCS-Patients). Associated factors were investigated using logistic regression guided by a hierarchical model, with statistical significance set at p < 0.05. Factors associated with the outcome were: state where the Center for Psychosocial Care was located, paid work, diagnosis of schizophrenia, age at diagnosis < 18 years, longer time attending the center, ease of access, and involvement in the evaluation. The factors that actually involve improvement in users include those pertaining to characteristics of the illness and aspects related to services in the implementation of mental health policies and their organization.

Psychiatric service users' experiences of emergency departments: a CERQual review of qualitative studies.

PubMed

Carstensen, Kathrine; Lou, Stina; Groth Jensen, Lotte; Konstantin Nissen, Nina; Ortenblad, Lisbeth; Pfau, Margarete; Vedel Ankersen, Pia

2017-05-01

There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users' experiences regarding general EDs is limited. To identify and summarize current, qualitative evidence regarding service users' experiences attending EDs. A secondary aim is to apply and test the newly developed CERQual approach to summarizing qualitative review findings. A systematic literature review of five databases based on PRISMA guidelines yielded 3334 unique entries. Screening by title/abstract identified 57 studies and, after full text assessment, nine studies were included. The included studies were critically appraised using CASP. Thematic synthesis was applied for data extraction and identification of findings. The CERQual approach was utilized to assess the confidence of the findings. The results of the review showed moderate confidence in the findings that service users experience meeting caring and judgmental ED staff, and that waiting times and a stressful environment are integral to their ED experiences. In contrast, low-to-very low confidence was seen in the findings that service users experience having their symptoms ignored and that EDs are used due to a lack of alternatives. A companion may improve service users experience and outcome of ED visits. Service users experience stress and discomfort in the ED. Service users highly appreciate knowing staff who can ease the discomfort. Overall, the results of this review speak in favour of integrated EDs where service users' needs are more likely to be recognized and accommodated.

The interface between child/adolescent and adult mental health services: results from a European 28-country survey.

PubMed

Signorini, Giulia; Singh, Swaran P; Marsanic, Vlatka Boricevic; Dieleman, Gwen; Dodig-Ćurković, Katarina; Franic, Tomislav; Gerritsen, Suzanne E; Griffin, James; Maras, Athanasios; McNicholas, Fiona; O'Hara, Lesley; Purper-Ouakil, Diane; Paul, Moli; Russet, Frederick; Santosh, Paramala; Schulze, Ulrike; Street, Cathy; Tremmery, Sabine; Tuomainen, Helena; Verhulst, Frank; Warwick, Jane; de Girolamo, Giovanni

2018-04-01

Transition-related discontinuity of care is a major socioeconomic and societal challenge for the EU. The current service configuration, with distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS), is considered a weak link where the care pathway needs to be most robust. Our aim was to delineate transitional policies and care across Europe and to highlight current gaps in care provision at the service interface. An online mapping survey was conducted across all 28 European Countries using a bespoke instrument: The Standardized Assessment Tool for Mental Health Transition (SATMEHT). The survey was directed at expert(s) in each of the 28 EU countries. The response rate was 100%. Country experts commonly (12/28) reported that between 25 and 49% of CAMHS service users will need transitioning to AMHS. Estimates of the percentage of AMHS users aged under 30 years who had has previous contact with CAMHS were most commonly in the region 20-30% (33% on average).Written policies for managing the interface were available in only four countries and half (14/28) indicated that no transition support services were available. This is the first survey of CAMHS transitional policies and care carried out at a European level. Policymaking on transitional care clearly needs special attention and further elaboration. The Milestone Study on transition should provide much needed data on transition processes and outcomes that could form the basis for improving policy and practice in transitional care.

Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment.

PubMed

Peiris, David; Brown, Alex; Howard, Michael; Rickards, Bernadette A; Tonkin, Andrew; Ring, Ian; Hayman, Noel; Cass, Alan

2012-10-28

Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment. Two theories informed the study: (1) 'candidacy', which explores "the ways in which people's eligibility for care is jointly negotiated between individuals and health services"; and (2) kanyini or 'holding', a Central Australian philosophy which describes the principle and obligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed. Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, and commitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld. Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is 'tractable' and 'navigable' to its users. Staff also described entrenched patient discrimination in hospitals and the need to expend considerable effort to reinstate care. This suggests that Aboriginal and Torres Strait Islander people are still constructed as 'non-ideal users' and are denied from being 'held' by hospital staff. Some new policy initiatives (workforce capacity strengthening, improving chronic care delivery systems and increasing specialist access) have potential to address barriers highlighted in this study. Few of these initiatives, however, capitalise on the unique mechanisms by which AMSs 'hold' their users and enhance their candidacy to health care. Kanyini and candidacy are promising and complementary theories for conceptualising health care access and provide a potential framework for improving systems of care.

Cost of health care utilization among homeless frequent emergency department users.

PubMed

Mitchell, Matthew S; León, Casey L K; Byrne, Thomas H; Lin, Wen-Chieh; Bharel, Monica

2017-05-01

Research demonstrates that homelessness is associated with frequent use of emergency department (ED) services, yet prior studies have not adequately examined the relationship between frequent ED use and utilization of non-ED health care services among those experiencing homelessness. There has also been little effort to assess heterogeneity among homeless individuals who make frequent use of ED services. To address these gaps, the present study used Medicaid claims data from 2010 to estimate the association between the number of ED visits and non-ED health care costs for a cohort of 6,338 Boston Health Care for the Homeless Program patients, and to identify distinct subgroups of persons in this cohort who made frequent use of ED services based on their clinical and demographic characteristics. A series of gamma regression models found more frequent ED use to be associated with higher non-ED costs, even after adjusting for demographic and clinical characteristics. Latent class analysis was used to examine heterogeneity among frequent ED users, and the results identified 6 characteristically distinct subgroups among these persons. The subgroup of persons with trimorbid illness had non-ED costs that far exceeded members of all 5 other subgroups. Study findings reinforce the connection between frequent ED use and high health care costs among homeless individuals and suggest that different groups of homeless frequent ED users may benefit from interventions that vary in terms of their composition and intensity. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Staff regard towards working with substance users: a European multi-centre study.

PubMed

Gilchrist, Gail; Moskalewicz, Jacek; Slezakova, Silvia; Okruhlica, Lubomir; Torrens, Marta; Vajd, Rajko; Baldacchino, Alex

2011-06-01

To compare regard for working with different patient groups (including substance users) among different professional groups in different health-care settings in eight European countries. A multi-centre, cross-sectional comparative study. Primary care, general psychiatry and specialist addiction services in Bulgaria, Greece, Italy, Poland, Scotland, Slovakia, Slovenia and Spain. A multi-disciplinary convenience sample of 866 professionals (physicians, psychiatrists, psychologists, nurses and social workers) from 253 services. The Medical Condition Regard Scale measured regard for working with different patient groups. Multi-factor between-subjects analysis of variance determined the factors associated with regard for each condition by country and all countries. Regard for working with alcohol (mean score alcohol: 45.35, 95% CI 44.76, 45.95) and drug users (mean score drugs: 43.67, 95% CI 42.98, 44.36) was consistently lower than for other patient groups (mean score diabetes: 50.19, 95% CI 49.71, 50.66; mean score depression: 51.34, 95% CI 50.89, 51.79) across all countries participating in the study, particularly among staff from primary care compared to general psychiatry or specialist addiction services (P<0.001). After controlling for sex of staff, profession and duration of time working in profession, treatment entry point and country remained the only statistically significant variables associated with regard for working with alcohol and drug users. Health professionals appear to ascribe lower status to working with substance users than helping other patient groups, particularly in primary care; the effect is larger in some countries than others. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

The Impact of Stakeholder Preferences on Service User Adherence to Treatments for Schizophrenia and Metabolic Comorbidities.

PubMed

Poremski, Daniel; Sagayadevan, Vathsala D/O; Wang, Peizhi; Lum, Alvin; Subramaniam, Mythily; Ann, Chong Siow

2016-01-01

To determine how stakeholder opinions of treatments influence service user decisions to adhere to courses of actions necessary to treat metabolic conditions. Qualitative open-ended interviews were conducted with 20 service providers, 25 service users, and 9 caregivers. Grounded theory was used to generate an understanding that linked preferences of care with adherence to follow-up treatments. Participants spoke about several considerations when discussing adherence: Resource limitations were the predominant consideration. Social considerations such as stigma and support surfaced in caregiver and service-user interviews. The influence of symptoms, especially their absence could reduce adherence, and organizational considerations related to the opinions they had about the qualifications of professionals. A rational patient model partially organizes our findings, but emotional components related to stigma and the opinion of service providers do not fit well into such a model. If service providers do not consider components of the decision making process which fall outside of the rational patient model, they may incorrectly be leveraging suboptimal values to bring about adherence to treatment plans. Being sensitive to the values of service users and their caregivers may allow service providers to better act on points that may bring about change in non-compliant service users with schizophrenia and metabolic comorbidities.

Assessing Family Planning Service Quality And User Experiences In Social Franchising Programme - Case Studies From Two Rural Districts In Pakistan.

PubMed

Azmat, Syed Khurram; Ali, Moazzam; Hameed, Waqas; Awan, Muhammad Ali

2018-01-01

Studies have documented the impact of quality family planning services on improved contraceptive uptake and continuation, however, relatively little is known about their quality of service provision especially in the context of social franchising. This study examined the quality of clinical services and user experiences among two models in franchised service providers in rural Pakistan. This facility-based assessment was carried out during May-June 2015 at the 20 randomly selected social franchise providers from Chakwal and Faisalabad. In our case, a franchise health facility was a private clinic (mostly) run by a single provider, supported by an assistant. Within the selected health facilities, a total 39 user-provider interactions were observed and same users were interviewed separately. Most of the health facilities were in the private sector. Comparatively, service providers at Greenstar Social Marketing/Population Services International (GSM/PSI) model franchised facilities had higher number of rooms and staff employed, with more providers' ownership. Quality of service indices showed high scores for both Marie Stopes Society (MSS) and GSM/PSI franchised providers. MSS franchised providers demonstrated comparative edge in terms of clinical governance, better method mix and they were more user-focused, while PSI providers offered broader range of non-FP services. Quality of counselling services were similar among both models. Service providers performed well on all indicators of interpersonal care however overall low scores were noted in technical care. For both models, service providers attained an average score of 6.7 (out of the maximum value of 8) on waste disposal mechanism, supplies 12.5 (out of the maximum value of 15), user-centred facility 2.7 (out of the maximum value of 4), and clinical governance 6.5 (out of the maximum value of 11) and respecting clients' privacy. The exit interviews yielded high user satisfaction in both service models. The findings seem suggesting that the MSS and GSM/PSI service providers were maintaining high quality standards in provision of family planning information, services, and commodities but overall there was not much difference between the two models in terms of quality and satisfaction. The results demonstrate that service quality and client satisfaction are an important determinant of use of clinical contraceptive methods in Pakistan.

Participatory planning of a primary care service for people with severe mental disorders in rural Ethiopia

PubMed Central

Mayston, Rosie; Alem, Atalay; Habtamu, Alehegn; Shibre, Teshome; Fekadu, Abebaw; Hanlon, Charlotte

2016-01-01

Little is understood about the feasibility and acceptability of primary care-based models of task-sharing care for people with severe mental disorders (SMDs) in low- and middle-income countries (LMICs). A participatory planning approach was adopted in preparation for the transition from hospital-delivered psychiatric care for SMD to a primary care-based, task-sharing model in a rural Ethiopian community. In this article, we present findings from community consultation meetings (n = 4), focus group discussions (n = 7) and in-depth interviews (n = 11) with key stakeholders (healthcare administrators and providers, caregivers, service-users and community leaders) which were carried out over a 2-year period in the context of ongoing dialogue with the community. The principle of local delivery of mental health services was agreed upon by all stakeholder groups. Key reasons for supporting local delivery were increased access for the majority due to proximity, reduced cost and reduced stress related to transportation. However, acceptance of the new service was qualified by concerns about the competence of staff to deliver a comprehensive and dependable service of equal quality to that currently provided at the hospital. Adequate training and support, as well as ensuring consistency of medication supply were identified as key components to ensure success. Encouragingly, our results suggest that there is significant support for the service change and an interest for the mobilization of community resources to support this. One of the study strengths was that we were able to present the different perspectives of multiple stakeholder groups. By nesting the study in an ongoing community-based cohort of people with SMD we were able to interview a more representative and empowered group of caregivers and service users than is often available in LMICs. Despite this, the extent to which service-users are able to express their opinions is likely limited by their marginalized role in rural Ethiopian society. PMID:26282860

FY 2002 Customer Satisfaction & Top 200 Users Survey Composite Report

DTIC Science & Technology

2002-11-01

Federal Government Benchmark 68.6% 71.1% DTIC Excels by +8.4 +11 *ACSI is the official service quality benchmark for the...care. § The American Customer Satisfaction Index (ACSI), the official service quality benchmark for the Federal Government, is currently 71.1%; DTIC...ACSI is the official service quality benchmark for the Federal GovernmentFig 1FY 20020Comparison of Customer Satisfaction (Customer Care

Using the results of a satisfaction survey to demonstrate the impact of a new library service model.

PubMed

Powelson, Susan E; Reaume, Renee D

2012-09-01

 In 2005, the University of Calgary entered into a contract to provide library services to the staff and physicians of Alberta Health Services Calgary Zone (AHS CZ), creating the Health Information Network Calgary (HINC).  A user satisfaction survey was contractually required to determine whether the new library service model created through the agreement with the University of Calgary was successful. Our additional objective was to determine whether information and resources provided through the HINC were making an impact on patient care.  A user satisfaction survey of 18 questions was created in collaboration with AHS CZ contract partners and distributed using the snowball or convenience sample method.  Six hundred and ninety-four surveys were returned. Of respondents, 75% use the HINC library services. More importantly, 43% of respondents indicated that search results provided by library staff had a direct impact on patient care decisions.  Alberta Health Services Calgary Zone staff are satisfied with the new service delivery model, they are taking advantage of the services offered, and using library provided information to improve patient care. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997-2006.

PubMed

Martin, Brook I; Turner, Judith A; Mirza, Sohail K; Lee, Michael J; Comstock, Bryan A; Deyo, Richard A

2009-09-01

Analysis of nationally representative survey data for spine-related health care expenditures, utilization and self-reported health status. To study trends from 1997 to 2006 in per-user expenditures for spine-related inpatient, outpatient, pharmacy, and emergency services; and to compare these trends to changes in health status. Although prior work has shown overall spine-related expenditures accounted for $86 billion in 2005, increasing 65% since 1997, the study did not report per-user expenditures. Understanding population-level per-user expenditure for specific services relative to changes in the health status may help assess the value of these services. We analyzed data from the Medical Expenditure Panel Survey, a multistage survey sample designed to produce unbiased national estimates of health care utilization and expenditure. Spine-related hospitalizations, outpatient visits, prescription medications and emergency department visits were identified using ICD-9-CM diagnosis codes. Regression analyses controlling for age, sex, comorbidity, and time (years) were used to examine trends from 1997 to 2006 in inflation-adjusted per-user expenditures, and utilization, and self-reported health status. An average of 1774 respondents with spine problems was surveyed per year; the proportion suggested an increase in the number of people who sought treatment for spine problems in the United States from 14.8 million in 1997 to 21.9 million in 2006. From 1997 to 2006, the mean adjusted per-user expenditures were the largest component of increasing total costs for inpatient hospitalizations, prescription medications, andemergency department visits, increasing 37% (from $13,040 in 1997 to $17,909 in 2006), 139% (from $166 to $397), and 84% (from $81 to $149), respectively. A 49% increase in the number of patients seeking spine-related care (from 12.2 million in 1997 to 18.2 million in 2006) was the largest contributing factor to increased outpatient expenditures. Population measures of mental health and work, social, and physical limitations worsened over time among people with spine problems. Expenditure increases for spine-related inpatient, prescription, and emergency services were primarily the result of increasing per-user expenditures, while those related to outpatient visits were primarily due to an increase in the number of users of ambulatory services.

Effects of a recovery management intervention on Chinese heroin users' community recovery through the mediation effect of enhanced service utilization

PubMed Central

Wu, F.; Fu, L.M.; Hser, Y.H.

2015-01-01

Background This study investigates whether a recovery management intervention (RMI) can improve the utilization of community drug treatment and wraparound services among heroin users in China and subsequently lead to positive recovery outcomes. Methods Secondary analysis was conducted drawing data from a randomized controlled trial; 100 heroin users with no severe mental health problems were recruited in two Shanghai districts (Hongkou and Yangpu) upon their release from compulsory rehabilitation facilities. A latent variable modeling approach was utilized to test whether the RMI influences heroin users' perceived motivation and readiness for treatment, enhances treatment and wraparound service participation, and, in turn, predicts better recovery outcomes. Results Enrollment in drug treatment and other social service utilization increased significantly as a result of RMI rather than an individual drug user's motivation and readiness for treatment. Increased service utilization thus led to more positive individual recovery outcomes. In addition to this mediation effect through service utilization, the RMI also improved participants' community recovery directly. Conclusions Findings suggest that better drug treatment enrollment, community service utilization and recovery outcomes can be potentially achieved among heroin users in China with carefully designed case management interventions. PMID:24990956

My care pathways - creating open innovation in healthcare.

PubMed

Lundberg, Nina; Koch, Sabine; Hägglund, Maria; Bolin, Peter; Davoody, Nadia; Eltes, Johan; Jarlman, Olof; Perlich, Anja; Vimarlund, Vivian; Winsnes, Casper

2013-01-01

In this paper we describe initial results from the Swedish innovation project "My Care Pathways" which envisions enabling citizens to track their own health by providing them with online access to their historical, current and prospective future events. We describe an information infrastructure and its base services as well as the use of this solution as an open source platform for open innovation in healthcare. This will facilitate the development of end-user e-services for citizens. We have technically enabled the information infrastructure in close collaboration with decision makers in three Swedish health care regions, and system vendors as well as with National eHealth projects. Close collaboration between heterogeneous actors made implementation in real practice possible. However, a number of challenges, mainly related to legal and business issues, persist when implementing our results. Future work should therefore target the development of business models for sustainable provision of end-user e-services in a public health care system such as the Swedish one. Also, a legal analysis of the development of third party provider (nonhealthcare based) personal health data e-services should be done.

Gerontechnology: Providing a Helping Hand When Caring for Cognitively Impaired Older Adults—Intermediate Results from a Controlled Study on the Satisfaction and Acceptance of Informal Caregivers

PubMed Central

Mitseva, Anelia; Peterson, Carrie Beth; Karamberi, Christina; Oikonomou, Lamprini Ch.; Ballis, Athanasios V.; Giannakakos, Charalampos; Dafoulas, George E.

2012-01-01

The incidence of cognitive impairment in older age is increasing, as is the number of cognitively impaired older adults living in their own homes. Due to lack of social care resources for these adults and their desires to remain in their own homes and live as independently as possible, research shows that the current standard care provisions are inadequate. Promising opportunities exist in using home assistive technology services to foster healthy aging and to realize the unmet needs of these groups of citizens in a user-centered manner. ISISEMD project has designed, implemented, verified, and assessed an assistive technology platform of personalized home care (telecare) for the elderly with cognitive impairments and their caregivers by offering intelligent home support services. Regions from four European countries have carried out long-term pilot-controlled study in real-life conditions. This paper presents the outcomes from intermediate evaluations pertaining to user satisfaction with the system, acceptance of the technology and the services, and quality of life outcomes as a result of utilizing the services. PMID:22536230

The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities.

PubMed

Ascoli, Micol; Palinski, Andrea; Owiti, John Arianda; De Jongh, Bertine; Bhui, Kamaldeep S

2012-09-28

Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering "culture" in the presentation and expression of mental distress. The narratives reveal an overall "culture of understanding cultural issues" and specific "cultures of care". These emerged as necessary foci of intervention to improve service user outcomes. Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.

The complex role of social care services in supporting the development of sustainable identities: Insights from the experiences of British South Asian women with intellectual disabilities.

PubMed

Malik, Kulsoom Jawaid; Unwin, Gemma; Larkin, Michael; Kroese, Biza Stenfert; Rose, John

2017-04-01

Carers and service users with intellectual disabilities from minority ethnic groups have typically been reported to be dissatisfied with the social care services they receive. However, service users themselves have rarely been asked directly about their experiences of social care. This paper aims to understand the meaning of social care services in the lives of South Asian women with intellectual disabilities, in the United Kingdom. 10 British South Asian women with mild-moderate intellectual disabilities were interviewed about their experiences of social care services. The transcripts were analysed using interpretative phenomenological analysis. The analysis produced three super-ordinate themes, which focus on how services facilitate the development of complex identities, how the participants explored their sense of being 'stuck' between cultures as they negotiated their journeys towards independence, and the triple disadvantage which they experienced as a consequence of the intersection between gender, ethnicity and disability. The participants were broadly satisfied with the role which services played in these domains, and appeared to find them valuable and helpful. The results suggest that the participants successfully managed complex identity issues, such as acculturation processes, with the support of services. It may be helpful to give more explicit consideration to the positive role which good services can play in supporting people with intellectual disabilities in the development of their identities and goals, alongside the more traditionally 'concrete' objectives of such social care. Engagement with families in 'positive risk-taking' is likely to be an important component of success. Copyright © 2017 Elsevier Ltd. All rights reserved.

Food choice by people with intellectual disabilities at day centres: A qualitative study.

PubMed

Cartwright, Luke; Reid, Marie; Hammersley, Richard; Blackburn, Chrissie; Glover, Lesley

2015-06-01

People with intellectual disabilities experience a range of health inequalities. It is important to investigate possible contributory factors that may lead to these inequalities. This qualitative study identified some difficulties for healthy eating in day centres. (1) Service users and their family carers were aware of healthy food choices but framed these as diets for weight loss rather than as everyday eating. (2) Paid carers and managers regarded the principle of service user autonomy and choice as paramount, which meant that they felt limited in their capacity to influence food choices, which they attributed to the home environment. (3) Carers used food as a treat, a reward and for social bonding with service users. (4) Service users' food choices modelled other service users' and carers' choices at the time. It is suggested that healthy eating should be made more of a priority in day care, with a view to promoting exemplarily behaviour that might influence food choice at home. © The Author(s) 2014.

Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review.

PubMed

Hone, Thomas; Lee, John Tayu; Majeed, Azeem; Conteh, Lesong; Millett, Christopher

2017-06-01

Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Ambulatory care pavilion takes its place out front by solving multiple needs.

PubMed

Saukaitis, C A

1994-09-01

In sum, this structure exemplifies the fact that high-tech tertiary care medical centers can be user-friendly to the ambulatory health care consumer by serving their routine needs conveniently and efficiently. Says Gerald Miller, president of Crozer-Chester: "The ambulatory care pavilion has enabled Crozer to successfully and efficiently merge physicians' offices with institutional-based services and inpatient services. We are pleased with how the pavilion positions our medical center for the next century.

Comparison of Homeless and Non-Homeless Problem Drug Users Recruited from Primary Care Safety-Net Clinics.

PubMed

Krupski, Antoinette; Graves, Meredith C; Bumgardner, Kristin; Roy-Byrne, Peter

2015-11-01

The present study of homeless non-treatment-seeking problem drug users was designed to complement and extend previous studies which focused exclusively on treatment-seeking homeless problem drug users. Data were available for 866 primary care patients with drug problems, 30% homeless and 70% housed. In the 2 years prior to baseline, homeless participants had less chronic medical co-morbidity than problem drug users who were housed yet were significantly more likely to have used emergency department services, to have used them more frequently, and at higher cost. Compared to their housed counterparts, homeless participants were also more likely to have been admitted to specialized chemical dependency treatment and/or detoxification services, to have been arrested for a felony or gross misdemeanor, and to report having psychiatric problems in the prior 30 days. Additional support may be necessary for homeless patients presenting in primary care to benefit from substance abuse treatment given their more severe drug use problems coupled with their co-morbid health, psychiatric, and psychosocial problems. Copyright © 2015 Elsevier Inc. All rights reserved.

[Voluntary help in dementia - predictors for utilisation and expected quality from a family caregiver's point of view].

PubMed

Grässel, E; Luttenberger, K; Römer, H; Donath, C

2010-09-01

Although support services are considered cost-effective in the relief of care-giving family members of dementia patients, there has been little research to date on the predictors of use and quality expectations. These two questions are examined for the first time based on cross-sectional data of 404 care-giving family members, users and non-users of voluntary help services. Quantitative data are evaluated using binary logistical regression analysis, qualitative data using content analysis. The rating of how helpful the use of a voluntary help service is in the personal situation was found to be the only significant predictor of use. With respect to quality, it is most important that the persons giving support be punctual and well-trained. To increase the rate of use, care-giving family members must be convinced of the relevant benefits of using a voluntary help service. In addition, attention must be paid to the professional organization and training of voluntary helpers. Georg Thieme Verlag KG Stuttgart, New York.

Cloud based intelligent system for delivering health care as a service.

PubMed

Kaur, Pankaj Deep; Chana, Inderveer

2014-01-01

The promising potential of cloud computing and its convergence with technologies such as mobile computing, wireless networks, sensor technologies allows for creation and delivery of newer type of cloud services. In this paper, we advocate the use of cloud computing for the creation and management of cloud based health care services. As a representative case study, we design a Cloud Based Intelligent Health Care Service (CBIHCS) that performs real time monitoring of user health data for diagnosis of chronic illness such as diabetes. Advance body sensor components are utilized to gather user specific health data and store in cloud based storage repositories for subsequent analysis and classification. In addition, infrastructure level mechanisms are proposed to provide dynamic resource elasticity for CBIHCS. Experimental results demonstrate that classification accuracy of 92.59% is achieved with our prototype system and the predicted patterns of CPU usage offer better opportunities for adaptive resource elasticity. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A model of user engagement in medical device development.

PubMed

Grocott, Patricia; Weir, Heather; Ram, Mala Bridgelal

2007-01-01

The purpose of this paper is to address three topical themes: user involvement in health services research; determining the value of new medical technologies in patient care pathways, furthering knowledge related to quality in health and social care; and knowledge exchange between manufacturers, health service supply chain networks and device users. The model is being validated in a case study in progress. The latter is a "proving ground" study for a translational research company. Medical devices play a pivotal role in the management of chronic diseases, across all care settings. Failure to engage users in device development inevitably affects the quality of clinical outcomes. A model of user engagement is presented, turning unmet needs for medical devices into viable commercial propositions. A case study investigating the perceptions of individuals with Epidermolysis Bullosa (EB), their lay and professional carers into unmet needs. EB is an inherited condition affecting the skin and mucosal linings that leads to blistering and wounds. Qualitative data are being collected to generate understanding of unmet needs and wound care products. These needs are being translated into new design concepts and prototypes. Prototypes will be evaluated in an n = 1 experimental design, generating quantitative outcomes data. There are generalisations from the case study, and the model outlined. New products for managing EB wounds can logically benefit other groups. The model is transferable to other clinical problems, which can benefit from research and technological advances that are integral to clinical needs and care.

Lay agency and the generation of public-private mix health care maps.

PubMed

Meneses, Consuelo Sampaio; Cecilio, Luiz Carlos de Oliveira; Andreazza, Rosemarie; Carapinheiro, Graça; Andrade, Maria da Graça Garcia; Santiago, Sílvia Maria; Araújo, Eliane Cardoso; Souza, Ana Lúcia Medeiros; Reis, Denizi Oliveira; Pinto, Nicanor Rodrigues da Silva; Spedo, Sandra Maria

2017-06-01

This paper discusses part of the results obtained from a study carried out in two cities of the so-called ABCD Paulista Region in the period 2010-2012, in an attempt to spot the existence of non-state regulatory rationale towards access and consumption of health care services. The first stage includes interviews carried out with strategic stakeholders (managers and politicians) and key workers players. The second stage collected the stories of 18 very frequent users of health care services. This study revealed the leading role played by users to produce "health care maps", with emphasis on the frequent use of public and private resources in their itineraries, circumventing or merging with government regulation to obtain the care they need. The different formats of public-private mix transcend the still prevailing "official" concepts about the clear distinction between the two systems, which reveals the importance of this theme to public health management.

Attendance in adult day care centers of cognitively intact older persons: reasons for use and nonuse.

PubMed

Iecovich, Esther; Biderman, Aya

2013-08-01

The article aims to (a) examine the reasons for nonuse of ADCC, and (b) explore the reasons for use of adult day care centers (ADCCs) among users. The sample includes 819 respondents of whom 417 are users of 13 day care centers and 402 are nonusers, matched by age, gender, and family physician in the southern region of Israel. Data collection includes interviews that used a structured questionnaire. The most frequent reasons for nonuse of ADCCs are accessibility barriers, characteristics of participants and of the ADCCs, "no need for this service," and personal difficulties. Those who use this service report that it improved their well-being, met their needs, enabled them to establish social relationships, and alleviated their family caregivers' burden. ADCCs should be more responsive to the needs of various constituencies of frail older adults and be more accessible to those who do not use this type of service.

Healthcare utilization and associated barriers experienced by wheelchair users: A pilot study.

PubMed

Stillman, Michael D; Bertocci, Gina; Smalley, Craig; Williams, Steve; Frost, Karen L

2017-10-01

More than twenty-five years after passage of the ADA, little remains known about the experiences of wheelchair users when attempting to access health care and how accessibility may influence health care utilization. To describe health care utilization among wheelchair users and characterize barriers encountered when attempting to obtain access to health care. An internet-based survey of wheelchair users was conducted. Measures included demographics, condition, socioeconomic status, health care utilization and receipt of preventive services within the past year, physical barriers encountered at outpatient facilities, and satisfaction with care. Four hundred thirty-two wheelchair users responded to the survey. Nearly all respondents (97.2%) had a primary care appointment within the past year and most reported 3-5 visits to both primary and specialty care providers. Most encountered physical barriers when accessing care (73.8% primary, 68.5% specialty). Participants received most preventive interventions at rates similar to national averages with the exception of Pap tests. Most participants remained clothed for their primary care evaluation (76.1%), and were examined seated in their wheelchair (69.7%). More than half of participants (54.1%) felt they received incomplete care, and 57% believed their physician had no more than a moderate understanding of their disability-specific medical concerns. Wheelchair users face persistent barriers to care, may receive less than thorough physical evaluations, receive fewer screenings for cervical cancer, and largely believe they receive incomplete care. Copyright © 2017 Elsevier Inc. All rights reserved.

Veterans Health Administration and Indian Health Service: healthcare utilization by Indian Health Service enrollees.

PubMed

Kramer, B Josea; Wang, Mingming; Jouldjian, Stella; Lee, Martin L; Finke, Bruce; Saliba, Debra

2009-06-01

The Veterans Health Administration (VHA) and Indian Health Service (IHS) have executed an agreement to share resources to improve access and health outcomes for American Indian and Alaska Native (AIAN) veterans. To describe the extent of dual use, health needs, and utilization patterns for IHS-enrollees served by VHA and IHS. Our objective is to fill those gaps in knowledge to inform strategic planning between these federal agencies. Secondary data analysis of linked and merged VHA and IHS centralized administrative data from FY02 and FY03. Of 64,746 IHS enrollees who used VHA and/or IHS, 25% accessed care at both healthcare organizations, whereas most used either the VHA (28%) or the IHS (46%). The proportion of dual users varied markedly by state. Like all other VHA users, these AIAN veterans have the same 3 most frequent diagnoses associated with healthcare encounters: posttraumatic stress disorder, hypertension, and diabetes. VHA-IHS dual users were more likely to receive primary care from IHS and to receive diagnostic and behavioral healthcare from VHA. Many dual users who had been diagnosed with diabetes, hypertension, and/or cardiovascular disease received overlapping attention in VHA and IHS. Strategies to improve outcomes for AIAN veterans should target those receiving care in both systems and include information sharing or coordination of clinical care to reduce the potential for duplication and for treatment conflicts. Strategies to improve access may differ regionally.

Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities.

PubMed

Wells, Kenneth B; Jones, Loretta; Chung, Bowen; Dixon, Elizabeth L; Tang, Lingqi; Gilmore, Jim; Sherbourne, Cathy; Ngo, Victoria K; Ong, Michael K; Stockdale, Susan; Ramos, Esmeralda; Belin, Thomas R; Miranda, Jeanne

2013-10-01

Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors. To compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients' mental health-related quality of life (HRQL) and services use. Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles. From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up. Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use. CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p < 0.05). Employment, use of antidepressants, and total contacts were not significantly affected (each p > 0.05). Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients.

Patient and professional user experiences of simple telehealth for hypertension, medication reminders and smoking cessation: a service evaluation

PubMed Central

Cottrell, Elizabeth; Cox, Tracey; O'Connell, Phil; Chambers, Ruth

2015-01-01

Objectives To establish patient and professional user satisfaction with the Advice & Interactive Messaging (AIM) for Health programme delivered using a mobile phone-based, simple telehealth intervention, ‘Florence’. Design A service evaluation using data extracted from Florence and from a professional user electronic survey. Setting 425 primary care practices across 31 Clinical Commissioning Groups in England. Participants 3381 patients registered on 1 of 10 AIM protocols between March 2013 and January 2014 and 77 professional users. Intervention The AIM programme offered 10 clinical protocols, in three broad groups: (1) hypertension diagnosis/monitoring, (2) medication reminders and (3) smoking cessation. Florence sent patients prompts to submit clinical information, educational messages and user satisfaction questions. Patient responses were reviewed by their primary healthcare providers. Primary outcome measures Patients and professional user experiences of using AIM, and within this, Florence. Results Patient activity using Florence was generally good at month 1 for the hypertension protocols (71–80%), but reduced over 2–3 months (31–60%). For the other protocols, patient activity was 0–39% at 3 months. Minimum target days of texting were met for half the hypertension protocols. 1707/2304 (74%) patients sent evaluative texts responded at least once. Among responders, agreement with the adapted friends and family statement generally exceeded preproject aspirations. Professional responders were generally positive or equivocal about the programme. Conclusions Satisfaction with AIM appeared optimal when patients were carefully selected for the protocol; professional users were familiar with the system, the programme addressed a problem with the previous service delivery that was identified by users and users took an active approach to achieve clinical goals. However, there was a significant decrease in patients’ use of Florence over time. Future applications may be optimised by identifying and addressing reasons for the waning use of the service and enhancing support during implementation of the service. PMID:25795698

Parent participation in decision-making in health-care services for children: an integrative review.

PubMed

Aarthun, Antje; Akerjordet, Kristin

2014-03-01

To describe and synthesize previous research on parents' perceptions of their participation in decision making in child health-care services. Health policy in the area of user involvement emphasizes parent participation in decision-making (DM), thus ensuring that services are provided in accordance with their child's needs and enhancing parents' control over their child's health-care services. A systematic literature search, covering the period January 2000 to February 2011, found 18 studies that met the inclusion criteria. The analysis process involved data extraction, reduction, comparison and synthesizing. Three themes emerged: (1) relational factors and interdependence, (2) personal factors and attitudes and (3) organisational factors. Parents highlighted the importance of the parent-health professional relationship, professionals' competence and the possibility of varying the degree of participation in decision making. Challenges involved asymmetry in authority and power, professionals' attitudes and competence and organisational shortcomings in health-care services. Health professionals need to become more aware of their critical role and responsibility in involving parents in DM. Health professionals' attitudes and competence can be improved by knowledge of user involvement and research and facilitating the inclusion of parents in decision making by influencing the culture, routines and resources in the health service. © 2012 John Wiley & Sons Ltd.

Exploring representations and experiences of case-management users: towards difficulties and solutions to leading qualitative interviews with older people with complex living conditions.

PubMed

Balard, Frédéric; Corre, Stéphanie Pin Le; Trouvé, Hélène; Saint-Jean, Olivier; Somme, Dominique

2013-01-01

By matching needs to resource services, case management could be a useful tool for improving the care of older people with complex living conditions. Collecting and analysing the users' experiences represents a good way to evaluate the effectiveness and efficiency of a case-management service. However, in the literature, fieldwork is very rarely considered and the users included in qualitative research seem to be the most accessible. This study was undertaken to describe the challenges of conducting qualitative research with older people with complex living conditions in order to understand their experiences with case-management services. Reflective analysis was applied to describe the process of recruiting and interviewing older people with complex living conditions in private homes, describing the protocol with respect to fieldwork chronology. The practical difficulties inherent in this type of study are addressed, particularly in terms of defining a sample, the procedure for contacting the users and conducting the interview. The users are people who suffer from a loss of autonomy because of cognitive impairment, severe disease and/or psychiatric or social problems. Notably, most of them refuse care and assistance. Reflective analysis of our protocol showed that the methodology and difficulties encountered constituted the first phase of data analysis. Understanding the experience of users of case management to analyse the outcomes of case-management services requires a clear methodology for the fieldwork.

Quantifying beliefs regarding telehealth: Development of the Whole Systems Demonstrator Service User Technology Acceptability Questionnaire.

PubMed

Hirani, Shashivadan P; Rixon, Lorna; Beynon, Michelle; Cartwright, Martin; Cleanthous, Sophie; Selva, Abi; Sanders, Caroline; Newman, Stanton P

2017-05-01

Introduction Telehealth (TH) is a potential solution to the increased incidence of chronic illness in an ageing population. The extent to which older people and users with chronic conditions accept and adhere to using assistive technologies is a potential barrier to mainstreaming the service. This study reports the development and validation of the Whole Systems Demonstrator (WSD) Service User Technology Acceptability Questionnaire (SUTAQ). Methods Questionnaires measuring the acceptability of TH, quality of life, well-being and psychological processes were completed by 478 users of TH. The 22 acceptability items were subject to principal components analysis (PCA) to determine sub-scales. Scale scores, relationships between scales and other patient-reported outcome measures (PROMs), and group differences on scales were utilised to check the reliability and validity of the measure. Results PCAs of SUTAQ items produced six TH acceptability scales: enhanced care, increased accessibility, privacy and discomfort, care personnel concerns, kit as substitution and satisfaction. Significant correlations within these beliefs and between these scales and additional PROMs were coherent, and the SUTAQ sub-scales were able to predict those more likely to refuse TH. Discussion The SUTAQ is an instrument that can be used to measure user beliefs about the acceptability of TH, and has the ability to discriminate between groups and predict individual differences in beliefs and behaviour. Measuring acceptability beliefs of TH users can provide valuable information to direct and target provision of services to increase uptake and maintain use of TH.

Experiences of attending day care services designed for people with dementia - a qualitative study with individual interviews.

PubMed

Strandenæs, Margit Gausdal; Lund, Anne; Rokstad, Anne Marie Mork

2018-06-01

Day care is assumed to promote independence in home-dwelling people with dementia, increase well-being and enhance social stimulation. Few studies have directly engaged people with dementia to better understand the benefits and impacts of such services. The aim of this study was to explore attendees' experiences with day care designed for people with dementia. This study had a qualitative descriptive design and included individual interviews with 17 users attending day care. The analysis was undertaken using content analyses. The participants reported that day care had a positive influence on their physical functioning, cognition, well-being, and situation at home because they were provided with social stimulation, meals, and activities. Day care contributed to the maintenance of a rhythm and structure in everyday life. Furthermore, the staff contributed to making the day care a safe place to be and enhanced a sense of belonging. This study reveals the positive impact of day care on the daily lives of people with dementia because this service contributes to the enhancement of activities and social support, prevents isolation, and enhances practical and cognitive functioning as experienced by the users. The staff has a major impact on the experience of the participants in the day care.

The importance of relationships in mental health care: A qualitative study of service users' experiences of psychiatric hospital admission in the UK

PubMed Central

Gilburt, Helen; Rose, Diana; Slade, Mike

2008-01-01

Background While a number of studies have looked at life on service users' experiences of life on psychiatric wards, no research exists that have approached these experiences from the user perspective since the introduction of community care. Methods This user-led study uses a participatory approach to develop an understanding of the processes and themes which define the user experience of hospitalisation. Nineteen service users who had all had inpatient stays in psychiatric hospitals in London were interviewed in the community. Results Relationships formed the core of service users' experiences. Three further codes, treatment, freedom and environment defined the role of hospital and its physical aspects. Themes of communication, safety, trust, coercion, and cultural competency contributed to the concept of relationships. Conclusion Relationships with an individual which comprised effective communication, cultural sensitivity, and the absence of coercion resulted in that person being attributed with a sense of trust. This resulted in the patient experiencing the hospital as a place of safety in terms of risk from other patients and staff. Barriers to positive relationships included ineffective and negative communication, a lack of trust, a lack of safety in terms of staff as ineffective in preventing violence, and as perpetrators themselves, and the use of coercion by staff. This unique perspective both acts as a source of triangulation with previous studies and highlights the importance of the therapeutic relationship in providing a safe and therapeutic milieu for the treatment of people with acute mental health problems. PMID:18439254

Reciprocity in therapeutic relationships: A conceptual review.

PubMed

Sandhu, Sima; Arcidiacono, Eleonora; Aguglia, Eugenio; Priebe, Stefan

2015-12-01

Reciprocity has generally been understood as a process of giving and taking, within an exchange of emotions or services, and has long been recognized as a central part of human life. However, an understanding of reciprocity in professional helping relationships has seldom received attention, despite movements in mental health care towards more collaborative approaches between service users and professionals. In this review, a systematic search of the published papers was conducted in order to explore how reciprocity is conceptualized and understood as part of the dyadic therapeutic relationship between professionals and service users. Eleven papers met our inclusion criteria and a narrative synthesis was used to synthesize the key concepts of reciprocity. The concepts of: 'dynamic equilibrium', 'shared affect', 'asymmetric alliance', and 'recognition as a fellow human being' were recurrent in understandings of reciprocity in professional contexts. These conceptualizations of reciprocity were also linked to specific behavioural and psychological processes. The findings suggest that reciprocity may be conceptualized and incorporated as a component of mental health care, with recurrent and observable processes which may be harnessed to promote positive outcomes for service users. To this end, we make recommendations for further research to progress and develop reciprocal processes in mental health care. © 2015 Australian College of Mental Health Nurses Inc.

[Strengthening primary health care: a strategy to maximize coordination of care].

PubMed

de Almeida, Patty Fidelis; Fausto, Márcia Cristina Rodrigues; Giovanella, Lígia

2011-02-01

To describe and analyze the actions developed in four large cities to strengthen the family health strategy (FHS) in Brazil. Case studies were carried out in Aracaju, Belo Horizonte, Florianópolis, and Vitória based on semi-structured interviews with health care managers. In addition, a cross-sectional study was conducted with questionnaires administered to a sample of FHS workers and services users. Actions needed to strengthen primary health care services were identified in all four cities. These include increasing the number of services offered at the primary health care level, removing barriers to access, restructuring primary services as the entry point to the health care system, enhancing problem-solving capacity (diagnostic and therapeutic support and networking between health units to organize the work process, training, and supervision), as well as improving articulation between surveillance and care actions. The cities studied have gained solid experience in the reorganization of the health care model based on a strengthening of health primary care and of the capacity to undertake the role of health care coordinator. However, to make the primary care level the customary entry point and first choice for users, additional actions are required to balance supplier-induced and consumer-driven demands. Consumer driven demand is the biggest challenge for the organization of teamwork processes. Support for and recognition of FHS as a basis for primary health care is still an issue. Initiatives to make FHS better known to the population, health care professionals at all levels, and civil society organizations are still needed.

A survey of accessibility and utilisation of chiropractic services for wheelchair-users in the United Kingdom: What are the issues?

PubMed

McKay, Naomi D; Langworthy, Jennifer

2011-09-13

People with physical disabilities experience barriers to healthcare across all services despite a legal and moral obligation to the contrary. Complementary medicine is considered as supplementary to conventional care and integration of these approaches is essential to achieve optimal care. This paper explores the utilisation of chiropractic services and practitioner experiences of treating wheelchair-users which appears under-reported. A 20 item questionnaire was posted to 250 randomly selected chiropractors registered with the General Chiropractic Council. Follow-up questionnaires were sent 7 days after the initial return date. Quantitative data were subjected to frequency analysis. The response rate was 64% (n = 161). The majority (66%) of chiropractors had been in practice less than 10 years and were practice owners (50%). Fifty-two percent of chiropractors sampled had treated a patient in a wheelchair in the previous 5 years. The majority (87%) had treated between 1 and 5 such patients. Patients with multiple sclerosis, stroke and cerebral palsy most commonly presented for treatment. The majority of patients' presenting complaint was musculoskeletal in origin, primarily for pain control. Only 13% of respondents worked in a fully accessible clinic. Impracticality of alterations was the most common reason for inaccessibility. Wheelchair-users seem to be an underserved patient group in relation to chiropractic services. Chiropractic management is primarily utilised for pain control in patients with physical disabilities in which mobility may be improved or maintained. Co-management of wheelchair-users with GPs appears to be desirable in order to achieve optimal patient care however more research is required regarding the efficacy of chiropractic treatment for a range of disabling conditions. Physical access was identified as a key barrier to accessing care.

Measuring school health center impact on access to and quality of primary care.

PubMed

Gibson, Erica J; Santelli, John S; Minguez, Mara; Lord, Alyssa; Schuyler, Ashley C

2013-12-01

School health centers (SHC) that provide comprehensive health care may improve access and quality of care for students; however, published impact data are limited. We evaluated access and quality of health services at an urban high school with a SHC compared with a school without a SHC, using a quasiexperimental research design. Data were collected at the beginning of the school year, using a paper and pencil classroom questionnaire (n = 2,076 students). We measured SHC impact in several ways including grade by school interaction terms. Students at the SHC school were more likely to report having a regular healthcare provider, awareness of confidential services, support for health services in their school, and willingness to utilize those services. Students in the SHC school reported higher quality of care as measured by: respect for their health concerns, adequate time with the healthcare provider, understandable provider communications, and greater provider discussion at their last visit on topics such as sexual activity, birth control, emotions, future plans, diet, and exercise. Users of the SHC were also more likely to report higher quality of care, compared with either nonusers or students in the comparison school. Access to comprehensive health services via a SHC led to improved access to health care and improved quality of care. Impact was measureable on a school-wide basis but was greater among SHC users. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

The Sitter Service in Scotland: A Study of the Costs and Benefits. Insight.

ERIC Educational Resources Information Center

Wilson, Valerie; Hall, Stuart; Rankin, Nicola; Davidson, Julia; Schad, Dominic

This report presents the findings of an examination of the costs, benefits, and characteristics of Sitter Services, a program in Scotland offering child care in the child's home to parents working atypical hours or respite care for families of children with developmental disabilities. The study also explored users' and providers' knowledge of the…

Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees.

PubMed

Li, Qijuan; Keohane, Laura M; Thomas, Kali; Lee, Yoojin; Trivedi, Amal N

2017-07-01

Several policy proposals advocate introducing copayments for home health care in the Medicare program. To our knowledge, no prior studies have assessed this cost-containment strategy. To determine the association of home health copayments with use of home health services. A difference-in-differences case-control study of 18 Medicare Advantage (MA) plans that introduced copayments for home health care between 2007 and 2011 and 18 concurrent control MA plans. The study included 135 302 enrollees in plans that introduced copayment and 155 892 enrollees in matched control plans. Introduction of copayments for home health care between 2007 and 2011. Proportion of enrollees receiving home health care, annual numbers of home health episodes, and days receiving home health care. Copayments for home health visits ranged from $5 to $20 per visit, which were estimated to be associated with $165 (interquartile range [IQR], $45-$180) to $660 (IQR, $180-$720) in out-of-pocket spending for the average user of home health care. The increased copayment for home health care was not associated with the proportion of enrollees receiving home health care (adjusted difference-in-differences, -0.15 percentage points; 95% CI, -0.38 to 0.09), the number of home health episodes per user (adjusted difference-in-differences, 0.01; 95% CI, -0.01 to 0.03), and home health days per user (adjusted difference-in-differences, -0.19; 95% CI, -3.02 to 2.64). In both intervention and control plans and across all levels of copayments, we observed higher disenrollment rates among enrollees with greater baseline use of home health care. We found no evidence that imposing copayments reduced the use of home health services among older adults. More intensive use of home health services was associated with increased rates of disenrollment in MA plans. The findings raise questions about the potential effectiveness of this cost-containment strategy.

Gamification in Healthcare: Perspectives of Mental Health Service Users and Health Professionals.

PubMed

Hopia, Hanna; Raitio, Katja

2016-12-01

The purpose of this descriptive qualitative study is to explore the perceptions and experiences that mental health service users (n = 10) and healthcare professionals (n = 32) have regarding the use of gamification in mental health care. Data was gathered by interviews. The mental health service users described promoting and retarding factors in the use of gamification, while professionals described the requirements for using gamification and changes occurring in the work culture. Additional research is needed on how game-playing elements could be integrated as a systematic part of mental health practice and how the digital skills of professionals could be effectively developed.

The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities

PubMed Central

2012-01-01

Introduction Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. Results These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes. Conclusion Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery. PMID:23020856

The professional psychiatric/mental health nurse: skills, competencies and supports required to adopt recovery-orientated policy in practice.

PubMed

Cusack, E; Killoury, F; Nugent, L E

2017-03-01

WHAT IS KNOWN ON THE SUBJECT?: Nationally and internationally there has been a movement away from the traditional medical model towards a more holistic recovery-oriented approach to mental health care delivery. At every level of service provision the emphasis is firmly on recovery and on facilitating active partnership working and involvement of service users, their carers and family members. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to identify on a national level specific areas of care that are addressed most or least by psychiatric and mental health nurses in care planning for mental health service users in Ireland. In addition, this is the first study to identify nationally how the recovery approach is being implemented by psychiatric and mental health nurses in relation to current recovery-orientated policy. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental healthcare staff require more education on the recovery concept and this needs to be multidisciplinary team wide. Further research is required to establish how best to develop a shared approach to working with service users and their families within the mental healthcare environment. Further investigation is required to help determine how funding could be allocated appropriately for education and training and service development nationally. Introduction The restructuring of national mental health policy to an integrated recovery ethos demands a clarification in the psychiatric/mental health nurse's role, skills and competencies. Aim/Question To explore the psychiatric/mental health nurse's role and identify skills, competencies and supports required to adopt recovery-orientated policy in practice. Method An exploratory mixed methods study in multiple health services in Ireland with N = 1249 psychiatric/mental health nurses. Data collection used a survey, focus groups and written submissions. Data analysis used descriptive statistics and thematic analysis. Results The medical profession use a symptom-focused approach to mental healthcare delivery. Nurses viewed this as a primary inhibitor to recovery-orientated practice. Professional development in prevention and earlier intervention within primary care environments requires development. Nurses require research support to measure the effectiveness of the mental health interventions they provide. Implications and conclusion The effective implementation of the recovery approach requires a multitude of strategies and narrative threads in an overall medical assessment. Nurses need support from medics in providing consistency of assessments/documentation of required psychosocial interventions. A greater range of specialist services provided by nurses including psychosocial interventions and health promotion is fundamental to quality care and improving service user outcomes in primary care. © 2016 John Wiley & Sons Ltd.

Quality of Life and Unmet Need in People with Psychosis in the London Borough of Haringey, UK

PubMed Central

Lambri, Maria; Chakraborty, Apu; Leavey, Gerard; King, Michael

2012-01-01

Objectives. Deinstitutionalization of long-term psychiatric patients produced various community-based residential care facilities. However, inner-city areas have many patients with severe mental illness (SMI) as well as deprivation, unemployment, and crime. This makes meeting their community needs complex. We undertook a needs assessment of service provision and consonance between service users' evaluation of need and by care workers. Design. Cross-sectional study with random sample of SMI service users in four housing settings: rehabilitation units; high-supported; medium-supported; low-supported housing. Setting. London Borough of Haringey. Outcome Measures. 110 SMI service users and 110 keyworkers were interviewed, using Camberwell Assessment of Need; SF-36; Lancashire Quality-of-Life profile; demographic and clinical information. Results. People in “low-support” and “high-support” housing had similar symptom scores, though low support had significantly lower quality of life. Quality of life was positively predicted by self-reported mental-health score and negatively predicted by unmet-need score in whole sample and in medium-support residents. Residents' and care-workers' assessments of need differed considerably. Conclusions. Although patients' housing needs were broadly met, those in low-supported housing fared least well. Attendance to self-reported mental health and unmet social needs to quality of life underpins planning of residential services for those with SMI. Social and personal needs of people in supported housing may be underestimated and overlooked; service providers need to prioritise these if concept of “recovery” is to advance. PMID:23213300

Perceptions of antenatal care services by pregnant women attending government health centres in the Buea Health District, Cameroon: a cross sectional study.

PubMed

Edie, Gregory Edie Halle Ekane; Obinchemti, Thomas Egbe; Tamufor, Emmanuel Njuma; Njie, Martin Mafany; Njamen, Theophile Nana; Achidi, Eric Akum

2015-01-01

User'sperception of quality of ANC services crucially impacts continuity of use of these services and hence pregnancy outcome. However in our community, ANC user's perceptions of quality are not known. An observational analytic cross-sectional study was carried out amongst pregnant women attending selected government health centres in the Buea Health District. We recruited 385 consenting pregnant women for the study. Demographic and clinical data were collected using structured questionnaires. The data was entered into Microsoft Excel and exported toEpi-Info (Version 3.5.1) for analysis. Geographical accessibility and perceived quality of care were the predominant reasons for choosing or changing a site for ANC. One third of respondents (30.1%) attended a health centre out of their catchment health area with Buea Town health centre receiving the highest proportion of women out of the health area (56.8% of attendees). Knowledge about antenatal care varied and majority of respondents (96.4%) were satisfied with the antenatal services received. However, there were elements of dissatisfaction with health centre services, poor sitting facilities, amenities, few health education talks and poor nursing skills. High educational level (high school and university) (X(2) = 8.714; p = 0.01) and first time pregnancy(X(2)= 4.217; p= 0.04) were significantly associated with poor satisfaction. Policy makers should implement changes in the health care delivery system taking into account the users' preferences, more so in the light of increasing female education in Cameroon.

Ambiguity in practice? Carers' roles in personalised social care in England.

PubMed

Glendinning, Caroline; Mitchell, Wendy; Brooks, Jenni

2015-01-01

Carers play an ambiguous role within the personalisation paradigm currently shaping adult social care practice in England. Although carers have rights to assessments and support in their own right, these rights sit uneasily alongside the practices of assessment, support planning and personal budget (PB) allocation for older and disabled people. This paper reports how 14 dyads of older and learning disabled people with cognitive and/or communication impairments and their carers viewed the roles - desired and actual - played by carers in PBs. Interviews with carers and with older and disabled people were conducted during 2012 as part of a wider study into carers' roles in assessment, support planning and managing PBs. The interviews complemented a survey of reported practice in two English regions - interviews with adult social care services senior managers and focus groups with front-line care managers. Talking Mats(©) were used to support interviews with some service users. Interviews were transcribed and data analysed using the Framework approach. The interviews indicated that carers played important roles in service users' assessments and support planning, but were less likely to report receiving assessments or support of their own. While carers had the potential to benefit from PBs and support arrangements for service users, this did not reflect practice that aimed to enhance choice and control for carers. The paper draws on Twigg's typology of service conceptualisations of family carers and concludes that, despite the important social rights won by carers in England, current practice continues to regard carers primarily as a resource or a co-worker, rather than a co-client. © 2014 John Wiley & Sons Ltd.

Digital chat reference in health science libraries: challenges in initiating a new service.

PubMed

Dee, Cheryl R; Newhouse, Joshua D

2005-01-01

Digital reference service adds a valuable new dimension to health science reference services, but the road to implementation can present questions that require carefully considered decisions. This article incorporates suggestions from the published literature, provides tips from interviews with practicing academic health science librarians, and reports on data from students' exploration of academic health science library Web sites' digital reference services. The goal of this study is to provide guidelines to plan new services, assess user needs, and select software, and to showcase potential benefits of collaboration and proactive and user-friendly marketing. In addition, tips for successful operation and evaluation of services are discussed.

Service user involvement in research may lead to contrary rather than collaborative accounts: findings from a qualitative palliative care study.

PubMed

Forbat, Liz; Hubbard, Gill

2016-04-01

The aim of this study was to explore what data emerge when former carergivers (co-researchers) are trained to interview current care-givers about their experiences. Despite a trend of involving service users in conducting research interviews, there have been few examinations of how and whether a common service user identity has an impact on the data generated. Four co-researchers were recruited, trained and supported to conduct qualitative interviews with 11 current carers of people receiving palliative services. Conversation analysis was used to examine the conversational characteristics of the research interviews. Data were collected in 2010-2011. Conversation analysis identified that interactional difficulties were evident across the data. When co-researchers talked about their own experiences as carers, interviewees frequently changed the topic of conversation, thereby closing-down opportunities for further disclosure or elaboration from the interviewee about the original topic. Conversation analysis identifies how caregiving identities are co-constructed and points where there is agreement and disagreement in the co-construction. © 2015 John Wiley & Sons Ltd.

ERMHAN: A Context-Aware Service Platform to Support Continuous Care Networks for Home-Based Assistance

PubMed Central

Paganelli, Federica; Spinicci, Emilio; Giuli, Dino

2008-01-01

Continuous care models for chronic diseases pose several technology-oriented challenges for home-based continuous care, where assistance services rely on a close collaboration among different stakeholders such as health operators, patient relatives, and social community members. Here we describe Emilia Romagna Mobile Health Assistance Network (ERMHAN) a multichannel context-aware service platform designed to support care networks in cooperating and sharing information with the goal of improving patient quality of life. In order to meet extensibility and flexibility requirements, this platform has been developed through ontology-based context-aware computing and a service oriented approach. We also provide some preliminary results of performance analysis and user survey activity. PMID:18695739

The Use of Smartphones in Norwegian Social Care Services.

PubMed

Hansen, Linda Iren Mihaila; Fruhling, Ann; Fossum, Mariann

2016-01-01

This study aims to understand how smartphone technology was perceived by social workers responsible for piloting social services software and the experiences of involving end-users as co-developers. The pilot resulted in an improved match between the smartphone software and workflow as well as mutual learning experiences among the social workers, clients, and the vendor. The pilot study revealed several graphical user interface (GUI) and functionality challenges. Implementing an ICT social service smartphone application may further improve efficiencies for social workers serving citizens, however; this study validates the importance to study end-users' experiences with communication and the real-time use of the system in order reap the anticipated benefits of ICT capabilities for smart phone social service applications.

Serving women who use drugs in Delhi, India: challenges and achievements.

PubMed

Sarin, Enisha; Selhore, Elizabeth

2008-04-01

Sharan and Sahara, two NGOs working in Delhi, India, in the field of drug use and HIV/AIDS, present some key challenges as well as lessons learned in working with women who use drugs. Although there is no official estimate of the number of women drug users in Delhi, outreach reports indicate a hidden population of women users in the slums and streets of Delhi. A rapid situation assessment (RSA) conducted in 2000 by Sharan found urban poor women using drugs in Delhi with multiple issues related to their health, livelihoods, and relationships that put them at risk of severe health problems including HIV. The findings of the RSA led to intensified and focused intervention for women users by Sahara and Sharan. This is a discussion on a gender specific intervention ongoing in Delhi by delineating the particular achievements and challenges faced in working with women who use drugs. The article also looks at broader challenges that are outside the scope of this particular intervention but which nevertheless affect the well being of women who use drugs. Out of the 3700 women who have been rehabilitated in Sahara, 40% have found employment, while another 10% have been reintegrated into their families. There is however, an overdependence on its services that impedes their successful transition to mainstream life. One of the biggest limitations in the design of drug treatment interventions in Delhi is that there is a lack of diverse treatment options for women users. Only indoor detoxification and rehabilitation facilities are available for women; even these not offering a quality of care commensurate with the needs of the women. Lack of mental health care in drug treatment centres is felt to be a huge gap in services. Finally, NGOs like Sharan and Sahara are obliged to take up the entire continuum of care services which limits their ability to provide optimal care and services to women who use drugs. Lack of funds and lack of understanding among funding agencies about issues of women users are additional limitations in service provision. A multi-sectoral response is a viable response to the multi-dimensional problem of women drug use.

Impact of full mental health and substance abuse parity for children in the Federal Employees Health Benefits Program.

PubMed

Azrin, Susan T; Huskamp, Haiden A; Azzone, Vanessa; Goldman, Howard H; Frank, Richard G; Burnam, M Audrey; Normand, Sharon-Lise T; Ridgely, M Susan; Young, Alexander S; Barry, Colleen L; Busch, Alisa B; Moran, Garrett

2007-02-01

The Federal Employees Health Benefits Program implemented full mental health and substance abuse parity in January 2001. Evaluation of this policy revealed that parity increased adult beneficiaries' financial protection by lowering mental health and substance abuse out-of-pocket costs for service users in most plans studied but did not increase rates of service use or spending among adult service users. This study examined the effects of full mental health and substance abuse parity for children. Employing a quasiexperimental design, we compared children in 7 Federal Employees Health Benefits plans from 1999 to 2002 with children in a matched set of plans that did not have a comparable change in mental health and substance abuse coverage. Using a difference-in-differences analysis, we examined the likelihood of child mental health and substance abuse service use, total spending among child service users, and out-of-pocket spending. The apparent increase in the rate of children's mental health and substance abuse service use after implementation of parity was almost entirely due to secular trends of increased service utilization. Estimates for children's mental health and substance abuse spending conditional on this service use showed significant decreases in spending per user attributable to parity for 2 plans; spending estimates for the other plans were not statistically significant. Children using these services in 3 of 7 plans experienced statistically significant reductions in out-of-pocket spending attributable to the parity policy, and the average dollar savings was sizeable for users in those 3 plans. In the remaining 4 plans, out-of-pocket spending also decreased, but these decreases were not statistically significant. Full mental health and substance abuse parity for children, within the context of managed care, can achieve equivalence of benefits in health insurance coverage and improve financial protection without adversely affecting health care costs but may not expand access for children who need these services.

Primary care assessment from a male population perspective.

PubMed

Silva, Abiúde Nadabe E; Silva, Simone Albino da; Silva, Ana Roberta Vilarouca da; Araújo, Telma Maria Evangelista de; Rebouças, Cristiana Brasil Almeida; Nogueira, Lídya Tolstenko

2018-01-01

to evaluate the quality of primary health care from the perspective of the male population. a cross-sectional descriptive-evaluative study conducted at the family health units of Teresina, Piauí, Brazil, with the male population being interviewed through the Primary Care Assessment Tool (PCAT). 301 participants with mean age of 51.34 years, married, incomplete elementary school and monthly income between one and two minimum wages. The evaluation was positive for the following care domains: utilization, information system and longitudinality. The features access, comprehensiveness of care, service available and service provided, family centeredness and community orientation obtained a negative evaluation. the features of primary care are unsatisfactory, indicating the need to expand access to services offered and to qualify care for male users.

Capturing your charity care: 5 recommendations.

PubMed

Stern, Hal T

2007-09-01

To identify all charity care patients, hospitals should: Communicate with patients at the point of service. Make qualification for charity care as simple as possible. Use electronic databases to check patient ability to pay. Use predictive modeling techniques. Identify the frequent users of the emergency department.

Associated and mediating variables related to quality of life among service users with mental disorders.

PubMed

Fleury, Marie-Josée; Grenier, Guy; Bamvita, Jean-Marie

2018-02-01

This study aimed to identify variables associated with quality of life (QoL) and mediating variables among 338 service users with mental disorders in Quebec (Canada). Data were collected using nine standardized questionnaires and participant medical records. Quality of life was assessed with the Satisfaction with Life Domains Scale. Independent variables were organized into a six-block conceptual framework. Using structural equation modeling, associated and mediating variables related to QoL were identified. Lower seriousness of needs was the strongest variable associated with QoL, followed by recovery, greater service continuity, gender (male), adequacy of help received, not living alone, absence of substance use or mood disorders, and higher functional status, in that order. Recovery was the single mediating variable linking lower seriousness of needs, higher service continuity, and reduced alcohol use with QoL. Findings suggest that greater service continuity creates favorable conditions for recovery, reducing seriousness of needs and increasing QoL among service users. Lack of recovery-oriented services may affect QoL among alcohol users, as substance use disorders were associated directly and negatively with QoL. Decision makers and mental health professionals should promote service continuity, and closer collaboration between primary care and specialized services, while supporting recovery-oriented services that encourage service user involvement in their treatment and follow-up. Community-based organizations should aim to reduce the seriousness of needs particularly for female service users and those living alone.

Assessment of child and adult users of the degree of orientation of Primary Healthcare in the city of Rio de Janeiro, Brazil.

PubMed

Harzheim, Erno; Pinto, Luiz Felipe; Hauser, Lisiane; Soranz, Daniel

2016-05-01

In the first half of 2014, 6,675 adults and caregivers of children using Primary Care (PC) services in Rio de Janeiro were interviewed using the Primary Care Assessment Tool - PCATool-Brazil. The aim was to arrive at an accurate overview of the extent to which PC services in all of the Planning Areas (PA) of the Rio de Janeiro City Health Department (CHD) - Municipal Health Secretariat have the essential and derivative attributes. This was a cross-sectional study of random, independent samples of the service users (children and adults). Results were measured using the scores assigned to PC attributes. In the opinion of adults and children using PC services, Type A Units - Municipal Healthcare Centers and Family Clinics staffed only with Family Health Teams, performed better than Type B units. The scores for the attributes "first contact accessibility", "comprehensive service - services provided", "community orientation" and "family orientation" still need to be improved. On the other hand "coordinated care" and "continuity" are on their way to quality scores, being always rated at around 6.0 or even higher.

Attitudes towards poverty, organizations, ethics and morals: Israeli social workers' shared decision making.

PubMed

Levin, Lia; Schwartz-Tayri, Talia

2017-06-01

Partnerships between service users and social workers are complex in nature and can be driven by both personal and contextual circumstances. This study sought to explore the relationship between social workers' involvement in shared decision making with service users, their attitudes towards service users in poverty, moral standards and health and social care organizations' policies towards shared decision making. Based on the responses of 225 licensed social workers from health and social care agencies in the public, private and third sectors in Israel, path analysis was used to test a hypothesized model. Structural attributions for poverty contributed to attitudes towards people who live in poverty, which led to shared decision making. Also, organizational support in shared decision making, and professional moral identity, contributed to ethical behaviour which led to shared decision making. The results of this analysis revealed that shared decision making may be a scion of branched roots planted in the relationship between ethics, organizations and Stigma. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review.

PubMed

Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Diadiou, Fatoumata; Bouliane, Danielle; Beaudin, Jérémie

2017-10-22

The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Thematic analysis review of CM studies. We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004-December 2015 period, then updated to July 2017, with the keywords 'CM' and 'frequent use'. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir's implementation of health innovations framework was used to organise results into four broad levels of factors: (1) ,environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

REFOCUS Trial: protocol for a cluster randomised controlled trial of a pro-recovery intervention within community based mental health teams.

PubMed

Slade, Mike; Bird, Victoria; Le Boutillier, Clair; Williams, Julie; McCrone, Paul; Leamy, Mary

2011-11-23

There is a consensus about the importance of 'recovery' in mental health services, but the evidence base is limited. A two centre, cluster randomised controlled trial. Participants are community-based mental health teams, and service users aged 18-65 years with a primary clinical diagnosis of psychosis. In relation to the REFOCUS Manual researchintorecovery.com/refocus, which describes a 12-month, pro-recovery intervention based on the REFOCUS Model, the objectives are: (1) To establish the effectiveness of the intervention described in the REFOCUS Manual; (2) To validate the REFOCUS Model; (3) To establish and optimise trial parameters for the REFOCUS Manual; and (4) To understand the relationship between clinical outcomes and recovery outcomes. The hypothesis for the main study is that service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) compared to service users receiving care from control teams. The hypothesis for the secondary study is that black service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) and client satisfaction (as measured by the CSQ) compared to Black service users receiving care from control teams. The intervention comprises treatment as usual plus two components: recovery-promoting relationships and working practices. The control condition is treatment as usual. The primary outcme is the Process of Recovery Questionnaire (QPR). Secondary outcomes are satisfaction, Goal setting - Personal Primary Outcome, hope, well-being, empowerment, and quality of life. Primary outcomes for the secondary study will be QPR and satisfaction. Cost data will be estimated, and clinical outcomes will also be reported (symptomatology, need, social disability, functioning). 29 teams (15 intervention and 14 control) will be randomised. Within each team, 15 services users will be randomly chosen, giving a total sample of 435 service users (225 in intervention and 210 in control). Power for the main study: 336 service users will give power to detect a medium effect size of 0.4 (alpha 0.05, power = 0.8) on both QPR sub-scales. Power for the secondary study: 89 participants will give power to detect an effect size of 0.67 on both QPR sub-scales and on CSQ. A range of approaches are used to minimise bias, although service users and clinicians cannot be blinded. This cluster-RCT will evaluate a pro-recovery intervention in community mental health teams. ISRCTN: ISRCTN02507940.

REFOCUS Trial: protocol for a cluster randomised controlled trial of a pro-recovery intervention within community based mental health teams

PubMed Central

2011-01-01

Background There is a consensus about the importance of 'recovery' in mental health services, but the evidence base is limited. Methods/Design A two centre, cluster randomised controlled trial. Participants are community-based mental health teams, and service users aged 18-65 years with a primary clinical diagnosis of psychosis. In relation to the REFOCUS Manual researchintorecovery.com/refocus, which describes a 12-month, pro-recovery intervention based on the REFOCUS Model, the objectives are: (1) To establish the effectiveness of the intervention described in the REFOCUS Manual; (2) To validate the REFOCUS Model; (3) To establish and optimise trial parameters for the REFOCUS Manual; and (4) To understand the relationship between clinical outcomes and recovery outcomes. The hypothesis for the main study is that service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) compared to service users receiving care from control teams. The hypothesis for the secondary study is that black service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) and client satisfaction (as measured by the CSQ) compared to Black service users receiving care from control teams. The intervention comprises treatment as usual plus two components: recovery-promoting relationships and working practices. The control condition is treatment as usual. The primary outcme is the Process of Recovery Questionnaire (QPR). Secondary outcomes are satisfaction, Goal setting - Personal Primary Outcome, hope, well-being, empowerment, and quality of life. Primary outcomes for the secondary study will be QPR and satisfaction. Cost data will be estimated, and clinical outcomes will also be reported (symptomatology, need, social disability, functioning). 29 teams (15 intervention and 14 control) will be randomised. Within each team, 15 services users will be randomly chosen, giving a total sample of 435 service users (225 in intervention and 210 in control). Power for the main study: 336 service users will give power to detect a medium effect size of 0.4 (alpha 0.05, power = 0.8) on both QPR sub-scales. Power for the secondary study: 89 participants will give power to detect an effect size of 0.67 on both QPR sub-scales and on CSQ. A range of approaches are used to minimise bias, although service users and clinicians cannot be blinded. Discussion This cluster-RCT will evaluate a pro-recovery intervention in community mental health teams. Trial registration ISRCTN: ISRCTN02507940 PMID:22112008

Cultural competence in mental health care: a review of model evaluations

PubMed Central

Bhui, Kamaldeep; Warfa, Nasir; Edonya, Patricia; McKenzie, Kwame; Bhugra, Dinesh

2007-01-01

Background Cultural competency is now a core requirement for mental health professionals working with culturally diverse patient groups. Cultural competency training may improve the quality of mental health care for ethnic groups. Methods A systematic review that included evaluated models of professional education or service delivery. Results Of 109 potential papers, only 9 included an evaluation of the model to improve the cultural competency practice and service delivery. All 9 studies were located in North America. Cultural competency included modification of clinical practice and organizational performance. Few studies published their teaching and learning methods. Only three studies used quantitative outcomes. One of these showed a change in attitudes and skills of staff following training. The cultural consultation model showed evidence of significant satisfaction by clinicians using the service. No studies investigated service user experiences and outcomes. Conclusion There is limited evidence on the effectiveness of cultural competency training and service delivery. Further work is required to evaluate improvement in service users' experiences and outcomes. PMID:17266765

Day Care: Old Think and New Think.

ERIC Educational Resources Information Center

Morgan, Gwen G.

In this paper, old and new ways of thinking about day care are described as "oldthink" and "newthink." Major points of oldthink are that: (1) day care is a social service; (2) day care users are recipients, or at best, clients; (3) day care must be limited to low-income families; (4) licensing should protect children in day…

Public, patient and carers' views on palliative and end-of-life care in India.

PubMed

Ramasamy Venkatasalu, M; Sirala Jagadeesh, N; Elavally, S; Pappas, Y; Mhlanga, F; Pallipalayam Varatharajan, R

2018-06-01

To systematically review the existing evidence on the Indian public, patient and carers' perspectives on palliative and end-of-life care. With a growing population of terminally ill people across the world, there is also an increasing awareness among international health policy makers of the need to improve the quality of life for terminally ill patients. Understanding service users' (patients, family and public) perspectives is crucial in developing and sustaining successful community-centred palliative nursing policies and service models especially in countries like India with diverse population. An integrative review was performed on five databases, using hand searches of key journals and reference citation tracking for empirical studies published in English from 1990 to 2015. A thematic analysis framework was used to analyse and identify key themes. Analysis of the six eligible studies revealed five themes. Themes describe how social, economic, cultural, religious, spiritual and traditional factors influenced the palliative and end-of-life care perspectives and experiences among Indians. They also illustrated preferences relating to place of care, as well as benefits and challenges of family caregiving during the last days of life. Although we found minimal evidence on user perspectives, nurses need to aware of those unique components of context-specific palliative and end-of-life care practices in India - socioeconomic, cultural and religious factors - on their nursing encounters. Nurses need to advocate same in policy development to enable accessibility and utility of palliative and end-of-life care services, which are scant in India. Nurses can be central in gathering the contextual evidence that advocate users' perspectives to inform further studies and national palliative care policies in India. Emerging policies in nursing education need to focus on integrating family-centred palliative and end-of-life care within curricula, whereas nursing practice may promote nurse-led community models to address the patchy palliative and end-of-life service provision in India. © 2017 International Council of Nurses.

Involving mental health service users in quality assurance

PubMed Central

Weinstein, Jenny

2006-01-01

Abstract Objective  This study compares the process and outcomes of two approaches to engaging mental health (MH) service users in the quality assurance (QA) process. Background  QA plays a significant role in health and care services, including those delivered in the voluntary sector. The importance of actively, rather than passively, involving service users in evaluation and service development has been increasingly recognized during the last decade. Design  This retrospective small‐scale study uses document analysis to compare two QA reviews of a MH Day Centre, one that took place in 1998 as a traditional inspection‐type event and one that took place in 2000 as a collaborative process with a user‐led QA agenda. Setting and participants  The project was undertaken with staff, volunteers and service users in a voluntary sector MH Day Centre. Intervention  The study compares the management, style, evaluation tools and service user responses for the two reviews; it considers staff perspectives and discusses the implications of a collaborative, user‐led QA process for service development. Results  The first traditional top–down inspection‐type QA event had less ownership from service users and staff and served the main purpose of demonstrating that services met organizational standards. The second review, undertaken collaboratively with a user‐led agenda focused on different priorities, evolving a new approach to seeking users’ views and achieving a higher response rate. Conclusions  Because both users and staff had participated in most aspects of the second review they were more willing to work together and action plan to improve the service. It is suggested that the process contributed to an evolving ethos of more effective quality improvement and user involvement within the organization. PMID:16677189

Health Care Robotics: A Progress Report

NASA Technical Reports Server (NTRS)

Fiorini, Paolo; Ali, Khaled; Seraji, Homayoun

1997-01-01

This paper describes the approach followed in the design of a service robot for health care applications. Under the auspices of the NASA Technology Transfer program, a partnership was established between JPL and RWI, a manufacturer of mobile robots, to design and evaluate a mobile robot for health care assistance to the elderly and the handicapped. The main emphasis of the first phase of the project is on the development on a multi-modal operator interface and its evaluation by health care professionals and users. This paper describes the architecture of the system, the evaluation method used, and some preliminary results of the user evaluation.

Service user perspectives on the experience of illness and pathway to care in first-episode psychosis: a qualitative study within the TOP project.

PubMed

Jansen, Jens Einar; Wøldike, Peter Michael; Haahr, Ulrik Helt; Simonsen, Erik

2015-03-01

Delays in initiating treatment are associated with poor clinical and functional outcomes, yet there remains unclarity as to what facilitates and what acts as barriers to accessing appropriate support for first-episode psychosis. To explore this we examined service users' views of their illness trajectory and help-seeking behavior. To describe service-users' experiences with and understanding of their illness and pathway to care, including their need for treatment, the role of their relatives and experience with the treatment service. In-depth interviews were conducted with eleven randomly selected service users (median age 20, range 15-24, 6 males, 5 females) diagnosed with a first-episode psychosis and currently enrolled in treatment for this disorder. Fear of stigma, lack of knowledge about mental illness and normalisation of symptoms were barriers to accessing appropriate treatment, while support from significant others and information accessed by internet were reported as important elements in seeking appropriate treatment. The findings regarding barriers to treatment are in accordance with themes found in earlier studies and serve to validate these. Our study highlights the need to include psychological factors such as normalisation of symptoms and fear of stigma when attempting to reduce DUP in early psychosis, in addition to initiatives to reduce service delays. Also, a greater use of the potentials inherent in Internet and social media platforms seems important in this regard.

Good practice in social care: the views of people with severe and complex needs and those who support them.

PubMed

Gridley, Kate; Brooks, Jenni; Glendinning, Caroline

2014-11-01

This paper reports findings drawn from a study of good practice in English social care for adults with disability and older people with severe and complex needs. People with severe and complex needs are a relatively small proportion of adult social care service users, but they are growing in numbers and have resource-intensive needs. The study involved qualitative research with adults with disability and older people with severe and complex needs, family carers and members of specialist organisations (n = 67), focusing on the features of social care services they considered to be good practice. Data were collected between August 2010 and June 2011. The approach to data collection was flexible, to accommodate participants' communication needs and preferences, including face-to-face and telephone interviews, Talking Mats(©) sessions and a focus group. Data were managed using Framework and analysed thematically. Features of good practice were considered at three levels: (i) everyday support; (ii) service organisation; and (iii) commissioning. Findings relating to the first two of these are presented here. Participants emphasised the importance of person-centred ways of working at all levels. Personalisation, as currently implemented in English social care, aims to shift power from professionals to service users through the allocation of personal budgets. This approach focuses very much on the role of the individual in directing his/her own support arrangements. However, participants in this study also stressed the importance of ongoing professional support, for example, from a specialist key worker or case manager to co-ordinate diverse services and ensure good practice at an organisational level. The paper argues that, despite the recent move to shift power from professionals to service users, people with the most complex needs still value support from professionals and appropriate organisational support. Without these, they risk being excluded from the benefits that personalisation, properly supported, could yield. © 2014 John Wiley & Sons Ltd.

Fee-for-Service Health Care Expenditures: Evidence of Selection Effects among Subscribers Who Choose HMOs. Health Insurance Experiment Series.

ERIC Educational Resources Information Center

Buchanan, Joan; Cretin, Shan

Although competition among health plans has been encouraged as a means to control health care expenditures, some fee-for-service (FFS) insurers attribute part of their increased average expenditures to favorable selection of low users into newly offered health maintenance organization (HMO) plans. To test this hypothesis, the health care…

Using archetypes to design services for high users of healthcare.

PubMed

Vaillancourt, Samuel; Shahin, Ilan; Aggarwal, Payal; Pomedli, Steve; Hayden, Leigh; Pus, Laura; Bhattacharyya, Onil

2014-01-01

A subset of people with complex health and social needs account for the majority of healthcare costs in Ontario. There is broad agreement that better solutions for these patients could lead to better health outcomes and lower costs, but we have few tools to design services around their diverse needs. Predictive modelling may help determine numbers of high users, but design methods such as user archetypes may offer important ways of understanding how to meet their needs. We studied a range of patient profiles and interviews with frequent emergency department users to develop four archetypes of patients with complex needs to orient the service design process. These can be refined and adapted for use within initiatives like Health Links to help provide more appropriate cost-effective care.

Getting ready for user involvement in a systematic review

PubMed Central

Smith, Elizabeth; Donovan, Sheila; Beresford, Peter; Manthorpe, Jill; Brearley, Sally; Sitzia, John; Ross, Fiona

2009-01-01

Abstract Objective  This paper aims to support the critical development of user involvement in systematic reviews by explaining some of the theoretical, ethical and practical issues entailed in ‘getting ready’ for user involvement. Background  Relatively few health or social care systematic reviews have actively involved service users. Evidence from other research contexts shows that user involvement can have benefits in terms of improved quality and outcomes, hence there is a need to test out different approaches in order to realize the benefits of user involvement and gain a greater understanding of any negative outcomes. Design  Setting up a service‐user reference group for a review of user involvement in nursing, midwifery and health visiting research involved conceptualizing user involvement, developing a representation framework, identifying and targeting service users and creating a sense of mutuality and reciprocity. Setting and participants  Recruitment was undertaken across England by two researchers. Members from 24 national consumer organizations were selected to participate in the review. Main variables studied  Learning was gained about finding ways of navigating consumer networks and organizations, how best to communicate our goals and intentions and how to manage selection and ‘rejection’ in circumstances where we had stimulated enthusiasm. Results and conclusions  Involving service users helped us to access information, locate the findings in issues that are important to service users and to disseminate findings. User involvement is about relationships in social contexts: decisions made at the early conceptual level of research design affect service users and researchers in complex and personal ways. PMID:19236632

Client satisfaction and quality of health care in rural Bangladesh.

PubMed Central

Mendoza Aldana, J.; Piechulek, H.; al-Sabir, A.

2001-01-01

OBJECTIVE: To assess user expectations and degree of client satisfaction and quality of health care provided in rural Bangladesh. METHODS: A total of 1913 persons chosen by systematic random sampling were successfully interviewed immediately after having received care in government health facilities. FINDINGS: The most powerful predictor for client satisfaction with the government services was provider behaviour, especially respect and politeness. For patients this aspect was much more important than the technical competence of the provider. Furthermore, a reduction in waiting time (on average to 30 min) was more important to clients than a prolongation of the quite short (from a medical standpoint) consultation time (on average 2 min, 22 sec), with 75% of clients being satisfied. Waiting time, which was about double at outreach services than that at fixed services, was the only element with which users of outreach services were dissatisfied. CONCLUSIONS: This study underscores that client satisfaction is determined by the cultural background of the people. It shows the dilemma that, though optimally care should be capable of meeting both medical and psychosocial needs, in reality care that meets all medical needs may fail to meet the client's emotional or social needs. Conversely, care that meets psychosocial needs may leave the clients medically at risk. It seems important that developing countries promoting client-oriented health services should carry out more in-depth research on the determinants of client satisfaction in the respective culture. PMID:11436472

The Generic Short Patient Experiences Questionnaire (GS-PEQ): identification of core items from a survey in Norway

PubMed Central

2011-01-01

Background Questionnaires are commonly used to collect patient, or user, experiences with health care encounters; however, their adaption to specific target groups limits comparison between groups. We present the construction of a generic questionnaire (maximum of ten questions) for user evaluation across a range of health care services. Methods Based on previous testing of six group-specific questionnaires, we first constructed a generic questionnaire with 23 items related to user experiences. All questions included a "not applicable" response option, as well as a follow-up question about the item's importance. Nine user groups from one health trust were surveyed. Seven groups received questionnaires by mail and two by personal distribution. Selection of core questions was based on three criteria: applicability (proportion "not applicable"), importance (mean scores on follow-up questions), and comprehensiveness (content coverage, maximum two items per dimension). Results 1324 questionnaires were returned providing subsample sizes ranging from 52 to 323. Ten questions were excluded because the proportion of "not applicable" responses exceeded 20% in at least one user group. The number of remaining items was reduced to ten by applying the two other criteria. The final short questionnaire included items on outcome (2), clinician services (2), user involvement (2), incorrect treatment (1), information (1), organisation (1), and accessibility (1). Conclusion The Generic Short Patient Experiences Questionnaire (GS-PEQ) is a short, generic set of questions on user experiences with specialist health care that covers important topics for a range of groups. It can be used alone or with other instruments in quality assessment or in research. The psychometric properties and the relevance of the GS-PEQ in other health care settings and countries need further evaluation. PMID:21510871

Predictors for increasing eligibility level among home help service users in the Japanese long-term care insurance system.

PubMed

Kamiya, Kuniyasu; Sasou, Kenji; Fujita, Makoto; Yamada, Sumio

2013-01-01

This cross-sectional study described the prevalence of possible risk factors for increasing eligibility level of long-term care insurance in home help service users who were certified as support level 1-2 or care level 1-2 in Japan. Data were collected from October 2011 to November 2011. Variables included eligibility level, grip strength, calf circumference (CC), functional limitations, body mass index, memory impairment, depression, social support, and nutrition status. A total of 417 subjects (109 males and 308 females, mean age 83 years) were examined. There were 109 subjects with memory impairment. When divided by cut-off values, care level 2 was found to have higher prevalence of low grip strength, low CC, and depression. Some potentially modifiable factors such as muscle strength could be the risk factors for increasing eligibility level.

Transition to adult services for young people with mental health needs: A systematic review.

PubMed

Paul, Moli; Street, Cathy; Wheeler, Nicola; Singh, Swaran P

2015-07-01

Young people's transition from child and adolescent (CAMHS) to adult mental health services (AMHS). To systematically review evidence on the effectiveness of different models of CAMHS-AMHS transitional care, service user and staff perspectives, and facilitators of/barriers to effective CAMHS-AMHS transition. A systematic search in May 2012 of Medline, PsycINFO, CINAHL, EMBASE, AMED, Health Business Elite, HMIC, Cochrane Database, Web of Science and ASSIA; ancestral searches; and consultation with experts in the field. Qualitative, quantitative and mixed-methods primary research on the CAMHS-AMHS health-care transition of young people (aged 16-21 years) with mental health problems. Two reviewers independently completed a standardised data extraction form and critically evaluated identified documents using a validated appraisal tool for empirical studies with varied methodologies. A total of 19 studies of variable quality were identified. None were randomised or case-controlled trials. Studies incorporating service user/carer perspectives highlighted the need to tackle stigma and provide accessible, age-appropriate services. Parents/carers wanted more involvement with AMHS. Transitional care provision was considered patchy and often not prioritised within mental health services. There was no clear evidence of superior effectiveness of any particular model. High-quality evidence of transitional care models is lacking. Data broadly support the development of programmes that address the broader transitional care needs of 'emerging adults' and their mental health needs but further evaluation is necessary. Developing robust transitional mental health care will require the policy-practice gap to be addressed and development of accessible, acceptable, responsive, age-appropriate provision. © The Author(s) 2014.

WASH and gender in health care facilities: The uncharted territory.

PubMed

Kohler, Petra; Renggli, Samuel; Lüthi, Christoph

2017-11-08

Health care facilities in low- and middle-income countries are high-risk settings, and face special challenges to achieving sustainable water, sanitation, and hygiene (WASH) services. Our applied interdisciplinary research conducted in India and Uganda analyzed six dimensions of WASH services in selected health care facilities, including menstrual hygiene management. To be effective, WASH monitoring strategies in health care facilities must include gender sensitive measures. We present a novel strategy, showing that applied gender sensitive multitool assessments are highly productive in assessments of WASH services and facilities from user and provider perspectives. We discuss its potential for applications at scale and as an area of future research.

The Personal Emergency Response System as a Technology Innovation in Primary Health Care Services: An Integrative Review.

PubMed

Stokke, Randi

2016-07-14

Most western countries are experiencing greater pressure on community care services due to increased life expectancy and changes in policy toward prioritizing independent living. This has led to a demand for change and innovation in caring practices with an expected increased use of technology. Despite numerous attempts, it has proven surprisingly difficult to implement and adopt technological innovations. The main established technological innovation in home care services for older people is the personal emergency response system (PERS), which is widely adopted and used throughout most western countries aiming to support "aging safely in place." This integrative review examines how research literature describes use of the PERS focusing on the users' perspective, thus exploring how different actors experience the technology in use and how it affects the complex interactions between multiple actors in caring practices. The review presents an overview of the body of research on this well-established telecare solution, indicating what is important for different actors in regard to accepting and using this technology in community care services. An integrative review, recognized by a systematic search in major databases followed by a review process, was conducted. The search resulted in 33 included studies describing different actors' experiences with the PERS in use. The overall focus was on the end users' experiences and the consequences of having and using the alarm, and how the technology changes caring practices and interactions between the actors. The PERS contributes to safety and independent living for users of the alarm, but there are also unforeseen consequences and possible improvements in the device and the integrated service. This rather simple and well-established telecare technology in use interacts with the actors involved, creating changes in daily living and even affecting their identities. This review argues for an approach to telecare in which the complexity of practice is accounted for and shows how the plug-and-play expectations producers tend to generate is a simplification of the reality. This calls for a recognition that place and actors matter, as does a sensitivity to technology as an integrated part of complex caring practices.

Long-term care-service use and increases in care-need level among home-based elderly people in a Japanese urban area.

PubMed

Koike, Soichi; Furui, Yuji

2013-04-01

The objective of this study was to examine the effects of home-based long-term care insurance services on an increase in care need levels and discuss its policy implications. We analyzed care need certification and long-term care service use data for 3006 non-institutionalized elderly persons in a Tokyo ward effective as of October 2009 and 2010. Individual care need assessment intervals and their corresponding changes in care need level were calculated from data at two data acquisition points of care need assessment. Those who had been certified but did not use any long-term care insurance service were defined as the control group. The Cox proportionate hazard model was used to determine whether the use of a long-term care insurance service is associated with increased care need level. After adjusting for sex, age, and care need level, the hazard ratio for the probability of increased care need level among service users was calculated as 0.75 (95% confidence interval, 0.64-0.88; p < 0.001). Home-based long-term care service use may prevent an increase in care need level. Administrative data on care need certification and services use could be an effective tool for evaluating the long-term care insurance system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

[Satisfaction of Users with Spinal Cord Injury in relation to the Service of Promotion of Personal Autonomy of the Balearic Islands, Spain].

PubMed

Capó-Juan, Miguel Ángel; Fiol-Delgado, Rosa Mª; Alzamora-Perelló, Mª Magdalena; Bosch-Gutiérrez, Marta; Serna-López, Lucía; Bennasar-Veny, Miguel; Aguiló-Pons, Antonio; De Pedro-Gómez, Joan E

2016-11-10

Public Service Promotion of Personal Autonomy aims to provide care to users with severe physical and/or physical-mental disabilities, including people with spinal cord injury. These users are in a chronic phase and thus they require educational-therapeutic measures of physiotherapy. This study is meant to determine the satisfaction of people with spinal cord injury who attend this service. A descriptive, cross-sectional, quantitative study in the Public Service Promotion of Personal Autonomy after a sixteen-month therapeutic monitoring process was carried out, which began in March 2015. The final study sample was 25 people with spinal cord injury (17 men and 8 women). At the end of therapeutic intervention, users responded to the SERVQHOS questionnaire, which consists in nineteen questions that aim to measure the quality of the care services provided. A statistical analysis was conducted, calculating averages and standard deviations or frecuencies and percentages. The best valued external factor was the staff appearance with 4,5 on average and the worst scored external factor was the ease of access and / or signposting of the center with 2,6 on average. On the other hand, the best valued internal factor was the kindness of the staff with 4,8 on average and the worst scored factor was the speed in which the users receive what they requested with 4,2 on average. We concluded that the quality offered is determined by internal factors (kindness, trust, willingness to help) and weaknesses are related to structural factors of the center (external factors).

Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study.

PubMed

Singh, Swaran P; Paul, Moli; Ford, Tamsin; Kramer, Tami; Weaver, Tim; McLaren, Susan; Hovish, Kimberly; Islam, Zoebia; Belling, Ruth; White, Sarah

2010-10-01

Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS. We identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced. Of 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health. For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMHS.

Racial and Ethnic Service Use Disparities Among Homeless Adults With Severe Mental Illnesses Receiving ACT

PubMed Central

Horvitz-Lennon, Marcela; Zhou, Dongli; Normand, Sharon-Lise T.; Alegría, Margarita; Thompson, Wes K.

2013-01-01

Objective Case management–based interventions aimed at improving quality of care have the potential to narrow racial and ethnic disparities among people with chronic illnesses. The aim of this study was to assess the equity effects of assertive community treatment (ACT), an evidence-based case management intervention, among homeless adults with severe mental illness. Methods This study used baseline, three-, and 12-month data for 6,829 black, Latino, and white adults who received ACT services through the ACCESS study (Access to Community Care and Effective Services and Support). Zero-inflated Poisson random regression models were used to estimate the adjusted probability of use of outpatient psychiatric services and, among service users, the intensity of use. Odds ratios and rate ratios (RRs) were computed to assess disparities at baseline and over time. Results No disparities were found in probability of use at baseline or over time. Compared with white users, baseline intensity of use was lower for black users (RR=.89; 95% confidence interval [CI]=.83–.96) and Latino users (RR=.65; CI=.52–.81]). Intensity did not change over time for whites, but it did for black and Latino users. Intensity increased for blacks between baseline and three months (RR=1.11, CI=1.06–1.17]) and baseline and 12 months (RR=1.17, CI=1.11–1.22]). Intensity of use dropped for Latinos between baseline and three months (RR=.83, CI=.70–.98). Conclusions Receipt of ACT was associated with a reduction in service use disparities for blacks but not for Latinos. Findings suggest that ACT’s equity effects differ depending on race-ethnicity. PMID:21632726

Perceptions of Mexican women regarding barriers in mental Heath Services in primary care.

PubMed

Galván, Jorge; Saavedra, Nayelhi; Bartolo, Feliciano; Berenzon, Shoshana

2017-08-31

The recent mental health care reforms in Mexico call for the regular evaluation of the services provided. This involves analyzing the opinions of those who utilize them on a daily basis, particularly women, since they are the main health service users. This study explores the barriers to mental health care perceived by a group of women attending primary care centers. A qualitative methodological approach was chosen. The participants were purposively selected, using the snowball technique. Semi-structured interviews were analyzed using the thematic analysis. Three sets of factors representing barriers to care were identified in the participants' discourse. The first is linked to systemic barriers such as a lack of familiarity with the way the service operates, and irregularities in the consultations and appointment schedules that are not always geared to women's needs. The second concerns the social stigma associated with emotional and/or mental disorders and their care while the third involves the characteristics of psychologists and their professional work. In order to overcome some of the barriers identified, users should be given information on the work of mental health professionals, which would help dispel certain misconceptions and sensitize them to the importance of this type of treatment in achieving overall health. There is also a need to make psychologists aware of the living conditions and socio-cultural context of the women who attend these health facilities.

Measuring functional service quality using SERVQUAL in a high-dependence health service relationship.

PubMed

Clark, W Randy; Clark, Leigh Anne

2007-01-01

Although there is a growing concern about health care quality, little research has focused on how to measure quality in long-term care settings. In this article, we make the following observations: (1) most users of the SERVQUAL instrument reassess customers' expectations each time they measure quality perceptions; (2) long-term care relationships are likely to be ongoing, dependent relationships; (3) because of this dependence, customers in the long-term care setting are likely to reduce their expectations when faced with poor service quality; (4) by using this "settled" expectations level, service providers may make biased conclusions of quality improvements. We recommend various methods for overcoming or minimizing this "settling" effect and propose modifications to the SERVQUAL gap 5 measure to assess quality in a long-term care setting.

Leaving machismo behind.

PubMed

Eschen, A; Castano, F

1999-01-01

A study, which was conducted in Colombia's five largest cities, determined men's, women's, and health care provider's knowledge, attitudes, and needs regarding sexual and reproductive health services for men. Data were collected through 60 focus groups, 720 surveys of service users and nonusers, 45 interviews with health care staff, and 5 couple's life histories. The study found that, due to the inadequate service facilities offered to men, it was difficult for men to achieve the goal of being responsible about their own and their partner's sexual and reproductive health. Only 9 of the 14 health care facilities surveyed rendered services such as vasectomy, health care promotion or prevention, and educational programs aimed at men. According to providers, one reason for lack of services is the low utilization rate even if such services are available. In addition, existing services focus on disease management rather than preventive protocols. The AVSC will work with health care facilities, the Ministry of Health, and health insurance companies in establishing sexual and reproductive health services for men in Bogota, Cali, and Medellin.

PhotoExam: adoption of an iOS-based clinical image capture application at Mayo Clinic.

PubMed

Wyatt, Kirk D; Willaert, Brian N; Pallagi, Peter J; Uribe, Richard A; Yiannias, James A; Hellmich, Thomas R

2017-12-01

Mayo Clinic developed an internal iOS-based, point-of-care clinical image capture application for clinicians. We aimed to assess the adoption and utilization of the application at Mayo Clinic. Metadata of 22,784 photos of 6417 patients taken by 606 users over 8040 clinical encounters between 3/1/2015 and 10/31/2015 were analyzed. A random sample of photos from 100 clinical encounters was assessed for quality using a five-item rubric. Use of traditional medical photography services before and after application launch were compared. The largest group of users was residents/fellows, accounting for 31% of users but only 18% of all photos. Attending physicians accounted for 29% of users and 30% of photos. Nurses accounted for 14% of users and 28% of photos. Surgical specialties had the most users (36% of users), followed by dermatology (14% of users); however, dermatology accounted for 54% of all photos, and surgery accounted for 26% of photos. Images received an average of 91% of possible points on the quality scoring rubric. Most frequent reasons for missing points were the location on the body not clearly being demonstrated (19% of encounters) and the perspective/scale not being clearly demonstrated (12% of encounters). There was no discernible pre-post effect of the application's launch on use of traditional medical photography services. Point-of-care clinical photography is a growing phenomenon with potential to become the new standard of care. Patient and provider attitudes and the impact on patient outcomes remain unclear. © 2017 The International Society of Dermatology.

Identifying Frequent Users of an Urban Emergency Medical Service Using Descriptive Statistics and Regression Analyses.

PubMed

Norman, Chenelle; Mello, Michael; Choi, Bryan

2016-01-01

This retrospective cohort study provides a descriptive analysis of a population that frequently uses an urban emergency medical service (EMS) and identifies factors that contribute to use among all frequent users. For purposes of this study we divided frequent users into the following groups: low- frequent users (4 EMS transports in 2012), medium-frequent users (5 to 6 EMS transports in 2012), high-frequent users (7 to 10 EMS transports in 2012) and super-frequent users (11 or more EMS transports in 2012). Overall, we identified 539 individuals as frequent users. For all groups of EMS frequent users (i.e. low, medium, high and super) one or more hospital admissions, receiving a referral for follow-up care upon discharge, and having no insurance were found to be statistically significant with frequent EMS use (P<0.05). Within the diagnostic categories, 41.61% of super-frequent users had a diagnosis of "primarily substance abuse/misuse" and among low-frequent users a majority, 53.33%, were identified as having a "reoccurring (medical) diagnosis." Lastly, relative risk ratios for the highest group of users, super-frequent users, were 3.34 (95% CI [1.90-5.87]) for obtaining at least one referral for follow-up care, 13.67 (95% CI [5.60-33.34]) for having four or more hospital admissions and 5.95 (95% CI [1.80-19.63]) for having a diagnoses of primarily substance abuse/misuse. Findings from this study demonstrate that among low- and medium-frequent users a majority of patients are using EMS for reoccurring medical conditions. This could potentially be avoided with better care management. In addition, this study adds to the current literature that illustrates a strong correlation between substance abuse/misuse and high/super-frequent EMS use. For the subgroup analysis among individuals 65 years of age and older, we did not find any of the independent variables included in our model to be statistically significant with frequent EMS use.

Case management for high-intensity service users: towards a relational approach to care co-ordination.

PubMed

McEvoy, Phil; Escott, Diane; Bee, Penny

2011-01-01

This study is based on a formative evaluation of a case management service for high-intensity service users in Northern England. The evaluation had three main purposes: (i) to assess the quality of the organisational infrastructure; (ii) to obtain a better understanding of the key influences that played a role in shaping the development of the service; and (iii) to identify potential changes in practice that may help to improve the quality of service provision. The evaluation was informed by Gittell's relational co-ordination theory, which focuses upon cross-boundary working practices that facilitate task integration. The Assessment of Chronic Illness Care Survey was used to assess the organisational infrastructure and qualitative interviews with front line staff were conducted to explore the key influences that shaped the development of the service. A high level of strategic commitment and political support for integrated working was identified. However, the quality of care co-ordination was variable. The most prominent operational factor that appeared to influence the scope and quality of care co-ordination was the pattern of interaction between the case managers and their co-workers. The co-ordination of patient care was much more effective in integrated co-ordination networks. Key features included clearly defined, task focussed, relational workspaces with interactive forums where case managers could engage with co-workers in discussions about the management of interdependent care activities. In dispersed co-ordination networks with fewer relational workspaces, the case managers struggled to work as effectively. The evaluation concluded that the creation of flexible and efficient task focused relational workspaces that are systemically managed and adequately resourced could help to improve the quality of care co-ordination, particularly in dispersed networks. © 2010 Blackwell Publishing Ltd.

Consumers of eldercare in Sweden: the semblance of choice.

PubMed

Meinow, Bettina; Parker, Marti G; Thorslund, Mats

2011-11-01

In Sweden and other countries, the benefits of user choice and market forces are often voiced in relation to the provision of medical care and social services. Policy makers increasingly view people as customers and consumers of care services. Among very old people-the most frequent care users-how many have the capacity necessary to find information and make decisions concerning providers of medical and social services? Using a nationally representative sample of Swedes aged 77+ (SWEOLD) in 2002 this study describes the prevalence of cognitive, physical and sensory resources associated with the capacity to make and carry out informed choices concerning medical and social care providers. Results showed that one third of a nationally representative sample of persons aged 77+ scored low on a cognitive test or they were so cognitively impaired that they could not be interviewed directly. Another 22% scored poorly on a test of the ability to find and process information. A further 32% had adequate cognition but had limitations in sensory function or mental vitality or were unable to go outside on their own. A total of 10% did not report any of the measured problems. In general, care utilisation increases with age. As health problems increase, physical and cognitive abilities decline. Results suggest that those elderly people who are most dependent on care services and who could benefit most from a "good choice", are also those who have the highest prevalence of cognitive and physical limitations associated with the capacity to act as a rational consumer of care services. Copyright © 2011 Elsevier Ltd. All rights reserved.

A new face for private providers in developing countries: what implications for public health?

PubMed

Palmer, Natasha; Mills, Anne; Wadee, Haroon; Gilson, Lucy; Schneider, Helen

2003-01-01

The use of private health care providers in low- and middle-income countries (LMICs) is widespread and is the subject of considerable debate. We review here a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardized primary care services at relatively low cost. The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. In a case study of cost and quality of services, the clinics were popular with service users and run at a cost per visit comparable to public sector primary care clinics. However, their current role in tackling important public health problems was limited. The implications for public health policy of the emergence of this new model of private provider are discussed. It is argued that encouraging the use of such clinics by those who can afford to pay for them might not help to improve care available for the poorest population groups, which are an important priority for the government. Encouraging such providers to compete for government funding could, however, be desirable if the range of services presently offered, and those able to access them, could be broadened. However, the constraints to implementing such a system successfully are notable, and these are acknowledged. Even without such contractual arrangements, these companies provide an important lesson to the public sector that acceptability of services to users and low-cost service delivery are not incompatible objectives.

A new face for private providers in developing countries: what implications for public health?

PubMed Central

Palmer, Natasha; Mills, Anne; Wadee, Haroon; Gilson, Lucy; Schneider, Helen

2003-01-01

The use of private health care providers in low- and middle-income countries (LMICs) is widespread and is the subject of considerable debate. We review here a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardized primary care services at relatively low cost. The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. In a case study of cost and quality of services, the clinics were popular with service users and run at a cost per visit comparable to public sector primary care clinics. However, their current role in tackling important public health problems was limited. The implications for public health policy of the emergence of this new model of private provider are discussed. It is argued that encouraging the use of such clinics by those who can afford to pay for them might not help to improve care available for the poorest population groups, which are an important priority for the government. Encouraging such providers to compete for government funding could, however, be desirable if the range of services presently offered, and those able to access them, could be broadened. However, the constraints to implementing such a system successfully are notable, and these are acknowledged. Even without such contractual arrangements, these companies provide an important lesson to the public sector that acceptability of services to users and low-cost service delivery are not incompatible objectives. PMID:12764496

Patterns of dental services and factors that influence dental services among 64-65-year-old regular users of dental care in Denmark.

PubMed

Christensen, Lisa B; Rosing, Kasper; Lempert, Susanne M; Hede, Børge

2016-03-01

To describe the pattern of dental services provided to 64-65-year-old Danes who are regular users of dental care over a 5-year period, to analyse whether this pattern is associated with socio-demographic and/or socioeconomic factors, and if different uses of dental services are related to dental status and caries experience. Finally, to discuss the future planning of dental services aimed at the increasing population of elderly citizens. [Correction made on 21 March 2014, after first online publication: The sentence 'Data on elderly's dental service are scarce, although increased use is seen and more teeth are present in this age group.' was removed.] A cross-sectional study of all aged 64-65 (n = 37 234) who received a dental examination in 2009 was conducted. Clinical data comprised dental services received under the National Health Insurance reimbursement scheme, dental status and DMFT. Geographical, socio-demographic and socioeconomic data derived from public registers. Almost all received restorations, while periodontal treatment was received by <50% during 5 years. Heavy use of dental services was dominated by periodontal services. Periodontal services were most prevalent in the capital and the most affluent areas. Relatively more extractions were related to low income and persons in least affluent areas. Total number of services was highest among women, persons with ≥20 teeth, persons living in the capital, and where the ratio user per dentist was low. For future planning of dental care for elderly, dental status, geographical and social area-based factors and to some degree gender, income, and education must be taken into consideration as all these factors seem to influence the future demand for dental services. © 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Experts by experience; the views of service user educators providing feedback on medical students' work based assessments.

PubMed

Muir, Delia; Laxton, Julie Clare

2012-02-01

Assessment tools were designed to provide health and social care students with multi-sourced, interprofessional feedback in practice. This includes feedback from service users. Third year medical students at the University of Leeds were given accesses to 4 assessment tools whilst in practice. Completed assessments were then sent to the university where service users and carers worked with university tutors to give further feedback and comment on the overall development of students. Three service users then took part in a focus group and one provided written feedback. Four key themes were identified from the focus group: • Preparation and support • The design of the tools • The process of using the tools in practice • Feedback. We found that the project provided both challenges and rewards for all involved. The service user educators involved were able to bring a different and valuable perspective to formative feedback. The combination of their personal and professional experiences, along with the preparation they had received, helped bridge the gap between service users in practice and university based tutors. The findings from this study went on to inform a review of the assessment tools and revised versions are now being used. Copyright © 2011 Elsevier Ltd. All rights reserved.

Parental participation in the habilitation process--evaluation from a user perspective.

PubMed

Granat, T; Lagander, B; Börjesson, M C

2002-11-01

To develop a national instrument for evaluation of parental participation: (1) to obtain a functional measure of quality from a user perspective; (2) as part of quality development in child habilitation services departments; (3) to create common grounds for the evaluation of important aspects of the habilitation process based on the opinions of users and care professionals; (4) to enable evaluation of individual service departments from a more general viewpoint and to highlight areas for improvement; and (5) to enable comparisons of individual service departments in the future against those of others via benchmarking. The Measurement of Processes of Care (MPOC) was deemed to be the method that corresponded most closely with these formulated aims. A shortened version, MPOC 20, had already been produced and was awaiting publication. This shortened version measures the same important aspects of habilitation as the original MPOC. It also has a new scale, with verbal clarification for each step. This makes it more user friendly, as the results are easier to interpret. MPOC 20 was modified to become MPOC 28. This questionnaire was sent out in 11 of 26 counties in Sweden. The target group for the questionnaires was families with children up to 18 years of age who had been in contact with a habilitation services department for at least 1 year. The sample group comprised 4013 randomly selected families. A total of 3391 (84.5%) returned the questionnaire, and 2458 (61%) had responded to the questions. Twelve particular questions that can be regarded as fundamental to the habilitation processes emerged from the questionnaire in the regression analysis. These are measures of good quality in the habilitation process as perceived by the parents and are important in their overall satisfaction with habilitation services. Apart from the specific information category, these questions represented all the factors, i.e. enabling/partnership, general information, co-ordinated/comprehensive care and respectful/supportive care. MPOC 28 can be useful as an analytical tool for comparisons over time and for measuring changes in the way in which parents rank the various question areas linked to their overall level of satisfaction with the habilitation services in general.

The Professional Development Plan of a Health Care Workforce as a Qualitative Indicator of the Health Care System's Well-Being

ERIC Educational Resources Information Center

Saiti, Anna; Mylona, Vasiliki

2015-01-01

The quality of a health care system is heavily dependent on a capable and skillful health care workforce so as to guarantee the delivery of quality health care services to its user groups. Hence, only through continuous training and development can the health care workforce follow rapid scientific progress while equitably balancing investment…

Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services?

PubMed

Dunn, Matthew; Henshaw, Richard; McKay, Fiona H

2016-07-01

To understand health service access and needs of people who use performance and image enhancing drugs (PIED) in regional Queensland. Semi-structured interviews were conducted with 21 people (n = 19 men) who reported the use of a range of PIEDs, including anabolic-androgenic steroids, human chorionic gonadotropin, growth hormone, clenbuterol, tamoxifen, insulin and peptides. Participants reported accessing a range of services, including needle and syringe programs and pharmacies, for sterile injecting equipment. While PIEDs users attributed some stigma to needle and syringe programs, they were seen as an important service for injecting equipment. Participants reported receiving either positive care from health-care providers, such as general practitioners (GP), or having negative experiences due to the stigma attached with PIED use. Few participants reported disclosing their PIED use to their GP not only because of the concerns that their GP would no longer see them but also because they felt their GP was not knowledgeable about these substances. Participants in the study reported no difficulty in accessing health services based on living in a regional area, with their concern focused more upon how they were viewed and treated by service staff. [Dunn M, Henshaw R, Mckay F. H. Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services? Drug Alcohol Rev 2016;35:377-382]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

[Comparison of level of satisfaction of users of home care: integrated model vs. dispensaries model].

PubMed

Gorina, Marta; Limonero, Joaquín T; Peñart, Xavier; Jiménez, Jordi; Gassó, Javier

2014-01-01

To determine the level of satisfaction of users that receive home health care through two different models of primary health care: integrated model and dispensaries model. cross-sectional, observational study. Two primary care centers in the province of Barcelona. The questionnaire was administered to 158 chronic patients over 65 years old, of whom 67 were receiving health care from the integrated model, and 91 from the dispensaries model. The Evaluation of Satisfaction with Home Health Care (SATISFAD12) questionnaire was, together with other complementary questions about service satisfaction of home health care, as well as social demographic questions (age, sex, disease, etc). The patients of the dispensaries model showed more satisfaction than the users receiving care from the integrated model. There was a greater healthcare continuity for those patients from the dispensaries model, and a lower percentage of hospitalizations during the last year. The satisfaction of the users from both models was not associated to gender, the health perception,or independence of the The user satisfaction rate of the home care by primary health care seems to depend of the typical characteristics of each organisational model. The dispensaries model shows a higher rate of satisfaction or perceived quality of care in all the aspects analysed. More studies are neede to extrapolate these results to other primary care centers belonging to other institutions. Copyright © 2013 Elsevier España, S.L. All rights reserved.

[What's a framework without its frame?].

PubMed

Delorme, André; Gilbert, Michel

2014-01-01

In 2005, the Québec Ministry of Health launched a major reform of its Mental Health services. This reform aimed both the type of services (collaborative care; community care) and the structure (shift to primary care venues) in which these services where offered. Any major reform must be supported by different means. This article will review which means are best suited to do this and up to what point these where used to support the implementation of the reform. It will also help in preparing for the upcoming launch of the next Mental Health Plan of Action by the Québec Ministry of Health. The authors exchanged on several occasions on their observations and thoughts on the subject. Any major health reform must be supported by different means. Some are related to legislation or government policies, but these alone are insufficient. Others means include academic and continuing development actions, service accreditation or certification and user participation in policy and implementation stages of service delivery. If some means of support are easily invested, some are neglected. An effort should be made to use all available means to support the upcoming Plan of Action. User involvement seems particularly promising.

Child and adolescent experience of and satisfaction with psychiatric care: a critical review of the research literature.

PubMed

Biering, P

2010-02-01

This review paper contributes to better understanding of child and adolescent perception of quality of psychiatric care and should therefore be of interests for those who are concerned with the development and improvement of psychiatric care. * The review shows that the concept of patient satisfaction in child and adolescent psychiatric care is still underdeveloped and that few valid instruments have been developed to measure the concept. * The review helps to clarify the concept of adolescent satisfaction with psychiatric care by indentifying the universal components of the concept. * The paper concludes that children's perception of quality of care differs from their parents' and that quality assessment of children and adolescents needs to be heeded. Abstract Users' perspectives ought to be a determining factor for assessing the quality of psychiatric care and hence their perspectives need to be thoroughly understood. There is a lack of comprehensive knowledge of how children and adolescents perceive the quality of their psychiatric care. Therefore, the purpose of this paper is to critically review and synthesize findings from research on youth experience and satisfaction with psychiatric care. The review finds that knowledge about youth perception of quality of care is scattered and that few researchers consider previous findings. There are few valid instruments to measure child and adolescent patient satisfaction and few studies have considered these users' perceptions. These few studies indicate that adolescents' satisfaction has three universal components: satisfaction with environment and the organization of services; with user-caregiver relationship; and with treatment outcome. However, instruments that only use these factors lack sensitivity, while instruments that measure specific components of services capture differences in satisfaction between user groups. The review shows that parents and children have different mental care needs, and that the assessments by children and adolescents of their psychiatric care should be heeded.

Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: a descriptive study.

PubMed

Ganle, John K; Parker, Michael; Fitzpatrick, Raymond; Otupiri, Easmon

2014-11-01

Inequities in accessibility to, and utilisation of maternal healthcare services impede progress towards attainment of the maternal health-related Millennium Development Goals. The objective of this study is to examine the extent to which maternal health services are utilised in Ghana, and whether inequities in accessibility to and utilization of services have been eliminated following the implementation of a user-fee exemption policy, that aims to reduce financial barriers to access, reduce inequities in access, and improve access to and use of birthing services. We analyzed data from the 2007 Ghana Maternal Health Survey for inequities in access to and utilization of maternal health services. In measuring the inequities, frequency tables and cross-tabulations were used to compare rates of service utilization by region, residence and selected socio-demographic variables. Findings show marginal increases in accessibility to and utilisation of skilled antenatal, delivery and postnatal care services following the policy implementation (2003-2007). However, large gradients of inequities exist between geographic regions, urban and rural areas, and different socio-demographic, religious and ethnic groupings. More urban women (40%) than rural, 53% more women in the highest wealth quintile than women in the lowest, 38% more women in the best performing region (Central Region) than the worst (Upper East Region), and 48% more women with at least secondary education than those with no formal education, accessed and used all components of skilled maternal health services in the five years preceding the survey. Our findings raise questions about the potential equity and distributional benefits of Ghana's user-fee exemption policy, and the role of non-financial barriers or considerations. Exempting user-fees for maternal health services is a promising policy option for improving access to maternal health care, but might be insufficient on its own to secure equitable access to maternal health services in Ghana. Ensuring equity in access will require moving beyond user-fee exemption to addressing wider issues of supply and demand factors and the social determinants of health, including redistributing healthcare resources and services, and redressing the positional vulnerability of women in their communities.

Disparities in the quality of HIV care when using US Department of Health and Human Services indicators.

PubMed

Althoff, Keri N; Rebeiro, Peter; Brooks, John T; Buchacz, Kate; Gebo, Kelly; Martin, Jeffrey; Hogg, Robert; Thorne, Jennifer E; Klein, Marina; Gill, M John; Sterling, Timothy R; Yehia, Baligh; Silverberg, Michael J; Crane, Heidi; Justice, Amy C; Gange, Stephen J; Moore, Richard; Kitahata, Mari M; Horberg, Michael A

2014-04-01

We estimated US Department of Health and Human Services (DHHS)-approved human immunodeficiency virus (HIV) indicators. Among patients, 71% were retained in care, 82% were prescribed treatment, and 78% had HIV RNA ≤200 copies/mL; younger adults, women, blacks, and injection drug users had poorer outcomes. Interventions are needed to reduce retention- and treatment-related disparities.

Younger Children's (Three to Five Years) Perceptions of Being in a Health-Care Situation

ERIC Educational Resources Information Center

Stålberg, Anna; Sandberg, Anette; Söderbäck, Maja

2016-01-01

Younger children are common users of health-care services. Their perspective on a health-care situation and their ways of communication differ from that of adults. There is a shortness of research of younger children's perceptions of health-care situations. The knowledge that exists indicates the importance of involving the child's perspective to…

Immigrant women's experiences of maternity-care services in Canada: a systematic review using a narrative synthesis.

PubMed

Higginbottom, Gina M A; Morgan, Myfanwy; Alexandre, Mirande; Chiu, Yvonne; Forgeron, Joan; Kocay, Deb; Barolia, Rubina

2015-02-11

Canada's diverse society and its statutory commitment to multiculturalism means that a synthesis of knowledge related to the healthcare experiences of immigrants is essential to realise the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for the tailoring of services to user needs. We therefore assessed the experiences of immigrant women accessing maternity-care services in Canada. In particular, we investigated the experiences of immigrant women in Canada in accessing and navigating maternity and related healthcare services from conception to 6 months postpartum in Canada. Our focus was on (a) the accessibility and acceptability of maternity-care services for immigrant women and (b) the effects of the perceptions and experiences of these women on their birth and postnatal outcomes. We conducted a systematic review using a systematic search and narrative synthesis of peer-reviewed and non-peer-reviewed reports of empirical research, with the aim of providing stakeholders with perspectives on maternity-care services as experienced by immigrant women. We partnered with key stakeholders ('integrated knowledge users') to ensure the relevancy of topics and to tailor recommendations for effective translation into future policy, practice and programming. Two search phases and a three-stage selection process for published and grey literature were conducted prior to appraisal of literature quality and narrative synthesis of the findings. Our knowledge synthesis of maternity care among immigrants to Canada provided a coherent evidence base for (a) eliciting a better understanding of the factors that generate disparities in accessibility, acceptability and outcomes during maternity care; and (b) improving culturally based competency in maternity care. Our synthesis also identified pertinent issues in multiple sectors that should be addressed to configure maternity services and programs appropriately. Although immigrant women in Canada are generally given the opportunity to obtain necessary services, they face many barriers in accessing and utilising these services. These barriers include lack of information about or awareness of the services, insufficient supports to access these services and discordant expectations between the women and their service providers. PROSPERO registration number: CRD42012002185 .

Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology.

PubMed

Tuomainen, H; Schulze, U; Warwick, J; Paul, M; Dieleman, G C; Franić, T; Madan, J; Maras, A; McNicholas, F; Purper-Ouakil, D; Santosh, P; Signorini, G; Street, C; Tremmery, S; Verhulst, F C; Wolke, D; Singh, S P

2018-06-04

Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014-19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals. Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians. Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers. "MILESTONE study" registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.

Improving service user self-management: development and implementation of a strategy for the Richmond Response and Rehabilitation Team.

PubMed

Sanders, Julie; Fitzpatrick, Joanne M

2017-01-01

Community rapid response and rehabilitation teams are used to prevent avoidable hospital admissions for adults living with multiple long-term conditions and to support early hospital discharge by providing short-term intensive multidisciplinary support. Supporting self-management is an important service intervention if desired outcomes are to be achieved. A Care Quality Commission inspection of the Richmond Response and Rehabilitation Team in 2014 identified that self-management plans were not routinely developed with service users and reported this as requiring improvement. This quality improvement project aimed to develop and implement a self-management strategy for service users and for 90% of service users to have a personalised self-management plan within 3 months. The quality improvement intervention used the Plan-Do-Study-Act model comprising: (1) the development of a self-management plan, (2) staff education to support service users to self-manage using motivational interviewing techniques, (3) piloting the self-management plan with service users, (4) implementation of the self-management plan and (5) monthly audit and feedback. Evaluation involved an audit of the number and quality of self-management plans developed with service users and a survey of staff knowledge and confidence to support service users to self-manage. Following implementation of the intervention, the number of self-management plans developed in collaboration with service users increased from 0 to 187 over a 4-week period. Monthly audit data confirmed that this improvement has been sustained. Results indicated that staff knowledge and confidence improved after an education intervention. Quality improvement methods facilitated development and operationalisation of a self-management strategy by a community rapid response and rehabilitation team. The next phase of the project is to evaluate the impact of the self-management strategy on key service outcomes including self-efficacy, unplanned and emergency hospital admissions and early discharges.

[Information needs of the health and diseases in users of healthcare services in Primary Care at Salamanca, Spain].

PubMed

Bernad Vallés, Mercedes; Maderuelo Fernández, José Ángel; Moreno González, Pilar

2016-01-01

To learn, interpret and understand the information needs of health and disease in users of the healthcare services of the urban Primary Care of Salamanca. Qualitative research corresponding an exploratory qualitative/structural perspective. Primary Care. Urban area, Salamanca in 2007. Ten discussion groups, 2 composed of members of health-related associations and 8 primary care users, involved a total of 83 people. The structural variables considered are: gender, age, educational level and membership or not associations. Generate information to achieve information saturation in the discussion groups. Upon obtaining their informed consent, all subjects in the study participated in videotaped conversations, which were transcribed verbatim. Four researchers categorized the content, intentionality of discourse and developed the concept map. After categorization, triangulation and coding, content obtained was analysed with the NudistQ6 program. Informative content suggest four information needs: health and prevention, early diagnosis, first aid and disease. Different intentions (information needs, watching, claim and improvement) and needs profiles are detected as structural variables. Major information needs are relate to diagnosis, prognosis and therapeutic options. There is agreement between the groups that the information transmitted to the patient must be intelligible, updated and coordinated among the different professionals and care levels. Participants require information of a clinical nature to exercise their right to autonomy translating tendency to empower users as part of the social change. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

User-Centered Collaborative Design and Development of an Inpatient Safety Dashboard.

PubMed

Mlaver, Eli; Schnipper, Jeffrey L; Boxer, Robert B; Breuer, Dominic J; Gershanik, Esteban F; Dykes, Patricia C; Massaro, Anthony F; Benneyan, James; Bates, David W; Lehmann, Lisa S

2017-12-01

Patient safety remains a key concern in hospital care. This article summarizes the iterative participatory development, features, functions, and preliminary evaluation of a patient safety dashboard for interdisciplinary rounding teams on inpatient medical services. This electronic health record (EHR)-embedded dashboard collects real-time data covering 13 safety domains through web services and applies logic to generate stratified alerts with an interactive check-box function. The technological infrastructure is adaptable to other EHR environments. Surveyed users perceived the tool as highly usable and useful. Integration of the dashboard into clinical care is intended to promote communication about patient safety and facilitate identification and management of safety concerns. Copyright © 2017 The Joint Commission. All rights reserved.

Effects of a recovery management intervention on Chinese heroin users' community recovery through the mediation effect of enhanced service utilization.

PubMed

Wu, F; Fu, L M; Hser, Y H

2015-09-01

This study investigates whether a recovery management intervention (RMI) can improve the utilization of community drug treatment and wraparound services among heroin users in China and subsequently lead to positive recovery outcomes. Secondary analysis was conducted drawing data from a randomized controlled trial; 100 heroin users with no severe mental health problems were recruited in two Shanghai districts (Hongkou and Yangpu) upon their release from compulsory rehabilitation facilities. A latent variable modeling approach was utilized to test whether the RMI influences heroin users' perceived motivation and readiness for treatment, enhances treatment and wraparound service participation, and, in turn, predicts better recovery outcomes. Enrollment in drug treatment and other social service utilization increased significantly as a result of RMI rather than an individual drug user's motivation and readiness for treatment. Increased service utilization thus led to more positive individual recovery outcomes. In addition to this mediation effect through service utilization, the RMI also improved participants' community recovery directly. Findings suggest that better drug treatment enrollment, community service utilization and recovery outcomes can be potentially achieved among heroin users in China with carefully designed case management interventions. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Mental health care technologies for treating crack users].

PubMed

Nasi, Cintia; de Oliveira, Gustavo Costa; Lacchini, Annie Jeanninne Bisso; Schneider, Jacó Fernando; de Pinho, Leandro Barbosa

2015-03-01

The aim of this study was to identify mental health care technologies for treating crack users in a Psychosocial Care Center for Alcohol and other Drugs (CAPsad, as per its acronym in Portuguese). A qualitative, evaluative case study was developed in a CAPSad, using fourth generation evaluation. Data collection occurred from January to March 2013 by means of semi-structured interviews applied to 36 subjects, these being health care professionals, patients, patients' relatives and managers. Data analysis identified the category strategies in mental health work. Results showed that recovery programs should provide spaces for dialogue, aiming to clarify the process of psychiatric internment to the user and family, and involve these in the therapy, implementing educational practices and ongoing consideration of mental health activities. In conclusion, it is important to discuss the technologies used in everyday care services, in light of the complexity of crack use.

[National Policy of Humanization and education of health care professionals: integrative review].

PubMed

Barbosa, Guilherme Correa; Meneguim, Silmara; Lima, Silvana Andréa Molina; Moreno, Vania

2013-01-01

The National Policy of Humanization aims at innovations in health production, management and care with emphasis on permanent education for workers in the Unified Public Health System and training of university students in the health care field. This study aimed to know, through an integrative review of the literature, the scientific production about the National Policy of Humanization and education of health care professionals, from 2002 to 2010. Ten articles were analyzed in thematic strand through three axes: humanization and users caring, humanization and the work process, humanization and training. The articles point to the need to overcome the biological conception, valuing cultural aspects of users. The work process is marked by the devaluation of workers and by users deprived of their rights. The training of health professionals is grounded in health services where the prevailing standards are practices that hinder innovative attitudes.

Out-of-pocket payments for health care services in Bulgaria: financial burden and barrier to access.

PubMed

Atanasova, Elka; Pavlova, Milena; Moutafova, Emanuela; Rechel, Bernd; Groot, Wim

2013-12-01

In recent years, Bulgaria has increasingly relied on out-of-pocket payments as one of the main sources of health care financing. However, it is largely unknown whether the official patient charges, combined with informal payments, are affordable for the population. Our study aimed to explore the scale of out-of-pocket payments for health care services and their affordability. Data were collected in two nationally representative surveys, conducted in Bulgaria in 2010 and 2011, using face-to-face interviews based on a standardized questionnaire. To select respondents, a multi-stage random probability method was used. The questionnaire included questions on the out-of-pocket payments for health care services used by the respondent during the preceding 12 months. In total, 75.7% (2010) and 84.0% (2011) of outpatient service users reported to have paid out-of-pocket, with 12.6% (2010) and 9.7% (2011) of users reporting informal payments. Of those who had used inpatient services, 66.5% (2010) and 63.1% (2011) reported to have made out-of-pocket payments, with 31.8% (2010) and 18.3% (2011) reporting to have paid informally. We found large inability to pay indicated by the need to borrow money and/or forego services. Regression analysis showed that the inability to pay is especially pronounced among those with poor health status and chronic diseases and those on low household incomes. The high level of both formal and informal out-of-pocket payments for health care services in Bulgaria poses a considerable burden for households and undermines access to health services for poorer parts of the population.

The relevance of netnography to the harness of Romanian health care electronic word-of-mouth.

PubMed

Bratucu, R; Gheorghe, I R; Radu, A; Purcarea, V L

2014-09-15

Nowadays, consumers use the computer mediated communication to make purchase decisions on a large variety of products and services. Since health care services are archetypal by nature, consumers in this field are one of the most encountered users of electronic word-of-mouth. The objective of this paper is to explain and support the necessity of adopting a different qualitative method when electronic word of mouth is harnessed on health care dedicated forums, that is, netnography.

The relevance of netnography to the harness of Romanian health care electronic word-of-mouth

PubMed Central

Bratucu, R; Gheorghe, IR; Radu, A; Purcarea, VL

2014-01-01

Abstract Nowadays, consumers use the computer mediated communication to make purchase decisions on a large variety of products and services. Since health care services are archetypal by nature, consumers in this field are one of the most encountered users of electronic word-of-mouth. The objective of this paper is to explain and support the necessity of adopting a different qualitative method when electronic word of mouth is harnessed on health care dedicated forums, that is, netnography. PMID:25408755

[Community diagnosis using qualitative techniques of expectations and experiences in a health area in need of social transformation].

PubMed

Ramos Ruiz, Juan Andrés; Pérez Milena, Alejandro; Enguix Martínez, Natalia; Alvarez Nieto, Carmen; Martínez Fernández, M Luz

2013-01-01

To know the views, experiences and expectations of care provided by the Andalusian Public Health System (SSPA) of users of an urban area in need of social transformation (ZNTS). Qualitative methodology (exploratory study). Urban basic health zone (16,000 inhabitants, 40% ZNTS). Purposive sampling of users of SSPA and community leaders. Homogeneity criteria: age. Heterogeneity criteria: sex, frequency, active/pensioner, level cultural/economic. Conversational techniques recorded by videotape and moderated by a sociologist (user dicussion groups and in-depth interviews for community leaders). transcription of speeches, coding, categories triangulation and final outcome. Seven groups (43 participants, 58% ZNTS) and 6 leaders. They want continuity of care and choice of professionals, but not the medical change without information and attention's discontinuity primary care/hospital. There's bad physical accesibility by the urban environment in the ZNTS and is criticized admission services and paperwork; the programmed appointment and the electronic prescriptions are improvements but asking more hospital referrals and reviews. There's good appreciation of the professionals (primary care-closer, hospital-greater technical capacity). It needs to improve nursing education and speed of emergency assistance. There's a lack of leadership in the system organization, very fragmented. They know a range of services focusing on the demand for care; other health activities not spread to the users. The SSPA should incorporate the views and expectations of communities in social risk to a real improvement in the quality of care. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Coproduction without Experts: A Study of People Involved in Community Health and Well-Being Service Delivery

ERIC Educational Resources Information Center

Ledger, Alison; Slade, Bonnie

2015-01-01

Coproduction (equal professional-public involvement in service delivery) has been widely promoted as a means of revolutionising health and social care. Service providers/professionals are tasked with working more in partnership with service users/clients, recognising their experiences and knowledge as critical to the success of the interaction.…

[Gender violence and other factors associated with emotional distress in female users of public health services in Mexico].

PubMed

Valdez-Santiago, Rosario; Juárez-Ramírez, Clara; Salgado-de Snyder, V Nelly; Agoff, Carolina; Avila-Burgos, Leticia; Híjar, Martha C

2006-01-01

To identify and describe the factors associated with emotional distress in a national sample of women users of public health services in Mexico, such a Secretaria de Salud (SSA), Instituto Mexicano del Seguro Social (IMSS), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE). This research study was conducted using the database of the National Survey of Violence against Women that consisted of the responses of a total of 26 042 female users of health care services provided by the Mexican government health agencies. The Personal Health Scale (ESP per its initials in Spanish) was used to assess emotional distress. To measure violence a 19-item scale which explores different types of violence as well as severity was used. The relationship between emotional distress and gender violence was determined through a binary logistic regression model, as were economic status and demographic variables. One of the most important findings of this study is the high prevalence of emotional distress (15.3%) among women seeking health care services from the public sector and the relationship of such emotional distress with the experience of marital physical, psychological, and sexual violence. Factors associated with emotional distress among female users of health care services were age (26 and older); activity (laborer); working hours (71 hours a week or more); alcohol intake (greater intake); abuse during childhood (frequency and types of abuse); severity of marital violence (severe violence); socioeconomic status (very low SES); and type of dwelling (urban). The principal predictor of emotional distress was intimate partner abuse, especially in severe expression. The next predictor was violence in childhood. Taking into consideration these predictors it is recommended to use screening instruments to identify emotional distress and gender violence in health setting. It is important to design and implement attention and reference programs in public health services for women suffering from emotional distress and gender violence.

More than just a bed: mental health service users' experiences of self-referral admission.

PubMed

Olsø, Turid Møller; Gudde, Camilla Buch; Moljord, Inger Elise Opheim; Evensen, Gretha Helen; Antonsen, Dag Øivind; Eriksen, Lasse

2016-01-01

Several community mental health centres and mental hospitals in Norway now allow users with a diagnosis of severe mental illness to self-refer for admission. This give a group of service users who are well-known to service providers the opportunity to refer themselves for short inpatient stays without contacting their doctor, a duty doctor or emergency department. Evidence on self-referral admissions is lacking. To explore service users' experiences of having the opportunity to refer themselves for a short inpatient stay. Forty-two qualitative semi-structured interviews were undertaken between 2010 and 2014 in a group of 28 service users with serious mental illness and with or without substance abuse problems. All respondents had a contract which allowed them to self-refer for inpatient treatment. Systematic text condensation was applied in the analyses. Self-referral inpatient admission is more than just a bed. It was perceived as a new, unconventional health service, which differed substantially from earlier experiences of inpatient care and was characterised by different values and treatment principles. The differences were related to the content, quality and organisation of treatment. Having the option to decide about admission for oneself and having access to services focusing on individual needs seem to enhance service users' confidence, both in the services they use and in their own ability to cope with everyday life. Self-referral inpatient admission is a concrete example of how a user involvement policy can be implemented in mental health services. It is important to emphasise that the self-referral admission process described here is an offer in development and that we are awaiting findings from a larger RCT study. More evidence is needed to determine what aspects of the service are helpful to service users, the long-term effects, appropriateness and cost-effectiveness, and how the service can be integrated into the mental health system.

Psychiatric stigma and discrimination in South Africa: perspectives from key stakeholders.

PubMed

Egbe, Catherine O; Brooke-Sumner, Carrie; Kathree, Tasneem; Selohilwe, One; Thornicroft, Graham; Petersen, Inge

2014-07-04

Stigma and discrimination against people with mental illness remain barriers to help seeking and full recovery for people in need of mental health services. Yet there is scarce research investigating the experiences of psychiatric stigma on mental health service users in low- and middle-income countries (LMICs). The aim of this study was therefore to explore the experiences of psychiatric stigma by service users in order to inform interventions to reduce such stigma and discrimination in one LMIC, namely South Africa. Participants comprised a total of 77 adults aged above 18 years, made up of service providers including professional nurses (10), lay counsellors (20), auxiliary social workers (2); and service users (45). Psychiatric stigma was found to be perpetuated by family members, friends, employers, community members and health care providers. Causes of psychiatric stigma identified included misconceptions about mental illness often leading to delays in help-seeking. Experiencing psychiatric stigma was reported to worsen the health of service users and impede their capacity to lead and recover a normal life. Media campaigns and interventions to reduce stigma should be designed to address specific stigmatizing behaviours among specific segments of the population. Counselling of families, caregivers and service users should include how to deal with experienced and internalized stigma.

Psychiatric stigma and discrimination in South Africa: perspectives from key stakeholders

PubMed Central

2014-01-01

Background Stigma and discrimination against people with mental illness remain barriers to help seeking and full recovery for people in need of mental health services. Yet there is scarce research investigating the experiences of psychiatric stigma on mental health service users in low- and middle-income countries (LMICs). The aim of this study was therefore to explore the experiences of psychiatric stigma by service users in order to inform interventions to reduce such stigma and discrimination in one LMIC, namely South Africa. Methods Participants comprised a total of 77 adults aged above 18 years, made up of service providers including professional nurses (10), lay counsellors (20), auxiliary social workers (2); and service users (45). Results Psychiatric stigma was found to be perpetuated by family members, friends, employers, community members and health care providers. Causes of psychiatric stigma identified included misconceptions about mental illness often leading to delays in help-seeking. Experiencing psychiatric stigma was reported to worsen the health of service users and impede their capacity to lead and recover a normal life. Conclusion Media campaigns and interventions to reduce stigma should be designed to address specific stigmatizing behaviours among specific segments of the population. Counselling of families, caregivers and service users should include how to deal with experienced and internalized stigma. PMID:24996420

To Use or Not to Use

PubMed Central

Washington, Donna L; Yano, Elizabeth M; Simon, Barbara; Sun, Su

2006-01-01

BACKGROUND AND OBJECTIVE Effects of advances in Department of Veterans Affairs (VA) women's health care on women veterans' health care decision making are unknown. Our objective was to determine why women veterans use or do not use VA health care. DESIGN AND PARTICIPANTS Cross-sectional survey of 2,174 women veteran VA users and VA-eligible nonusers throughout southern California and southern Nevada. MEASUREMENTS VA utilization, attitudes toward care, and socio-demographics. RESULTS Reasons cited for VA use included affordability (67.9%); women's health clinic (WHC) availability (58.8%); quality of care (54.8%); and convenience (47.9%). Reasons for choosing health care in non-VA settings included having insurance (71.0%); greater convenience of non-VA care (66.9%); lack of knowledge of VA eligibility and services (48.5%); and perceived better non-VA quality (34.5%). After adjustment for socio-demographics, health characteristics, and VA priority group, knowledge deficits about VA eligibility and services and perceived worse VA care quality predicted outside health care use. VA users were less likely than non-VA users to have after-hours access to nonemergency care, but more likely to receive both general and gender-related care from the same clinic or provider, to use a WHC for gender-related care, and to consider WHC availability very important. CONCLUSIONS Lack of information about VA, perceptions of VA quality, and inconvenience of VA care, are deterrents to VA use for many women veterans. VA WHCs may foster VA use. Educational campaigns are needed to fill the knowledge gap regarding women veterans' VA eligibility and advances in VA quality of care, while VA managers consider solutions to after-hours access barriers. PMID:16637939

Managing leg ulceration in intravenous drug users.

PubMed

Geraghty, Jemell

2015-09-01

Chronic venous leg ulceration is a long-term condition commonly associated with lower-limb injecting and chronic venous hypertension caused by collapsed veins, incompetent valves, deep vein thrombosis and reflux. It is not usually a medical emergency, but intravenous (IV) drug users with leg ulcers can attend emergency departments (EDs) with a different primary complaint such as pain or because they cannot access local primary care or voluntary services. Leg ulceration might then be identified during history taking, so it is important that ED nurses know how to assess and manage these wounds. This article explains how to assess and manage chronic venous leg ulcers in patients with a history of IV drug use, and highlights the importance of referral to specialist services when required, and to local primary care or voluntary services, before discharge to prevent admission and re-attendance.

Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data.

PubMed

Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Warland, Andrew; Westbrook, Johanna

2018-02-01

To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care. Longitudinal cohort study using routinely collected client management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016. Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used. By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer. Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults' care choices. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

The impact of risk management practice upon the implementation of recovery-oriented care in community mental health services: a qualitative investigation.

PubMed

Holley, Jessica; Chambers, Mary; Gillard, Steven

2016-08-01

Recovery-oriented care has become guiding principle for mental health policies and practice in the UK and elsewhere. However, a pre-existing culture of risk management practice may impact upon the provision of recovery-oriented mental health services. To explore how risk management practice impacts upon the implementation of recovery-oriented care within community mental health services. Semi-structured interviews using vignettes were conducted with eight mental health worker and service user dyads. Grounded theory techniques were used to develop explanatory themes. Four themes arose: (1) recovery and positive risk taking; (2) competing frameworks of practice; (3) a hybrid of risk and recovery; (4) real-life recovery in the context of risk. In abstract responses to the vignettes, mental health workers described how they would use a positive-risk taking approach in support of recovery. In practice, this was restricted by a risk-averse culture embedded within services. Mental health workers set conditions with which service users complied to gain some responsibility for recovery. A lack of strategic guidance at policy level and lack of support and guidance at practice level may result in resistance to implementing ROC in the context of RMP. Recommendations are made for policy, training and future research.

New labour and reform of the English NHS: user views and attitudes.

PubMed

Wallace, Andrew; Taylor-Gooby, Peter

2010-06-01

The British National Health Service has undergone significant restructuring in recent years. In England this has taken a distinctive direction where the New Labour Government has embraced and intensified the influence of market principles towards its vision of a 'modernized' NHS. This has entailed the introduction of competition and incentives for providers of NHS care and the expansion of choice for patients. To explore how users of the NHS perceive and respond to the market reforms being implemented within the NHS. In addition, to examine the normative values held by NHS users in relation to welfare provision in the UK. Qualitative interviews using a quota sample of 48 recent NHS users in South East England recruited from three local health economies. Some NHS users are exhibiting an ambivalent or anxious response to aspects of market reform such as patient choice, the use of targets and markets and the increasing presence of the private sector within the state healthcare sector. This has resulted in a sense that current reforms, are distracting or preventing NHS staff from delivering quality of care and fail to embody the relationships of care that are felt to sustain the NHS as a progressive public institution. The best way of delivering such values for patients is perceived to involve empowering frontline staffs who are deemed to embody the same values as service users, thus problematizing the current assumptions of reform frameworks that market-style incentives will necessarily gain public consent and support.

[User's perceived quality in an internal medicine service after a five-year period application of a user's satisfaction survey].

PubMed

García-Aparicio, J; Herrero-Herrero, J; Corral-Gudino, L; Jorge-Sánchez, R

2010-01-01

To evaluate the quality perceived by users of the 'Los Montalvos' Internal Medicine Service (Salamanca, Spain), over its first five years of operation. A cross-sectional study was carried out from February 2004 to January 2009. All in-patients (6,997) were given a survey model SERVQHOS at the time of discharge, which was anonymous and voluntary. We collected 2,435 surveys. Participation was 34.8%. Except for the item regarding accessibility, the other questions of the survey were perceived "as expected" or above expectations by over 85% of the users. A total of 90.6% of patients who completed the survey were satisfied with the care received, and 83.9% would recommend the hospital to others. The variables with higher predictive capability, in relation to overall satisfaction, were "personalised care', and the interests of staff to solve problems. The easy access to the hospital' was seen by 33.6% as below expectations. After introducing several improvement measures, the percentage of dissatisfaction regarding accessibility was 24.8% (p=0.02). Nine out of ten patients surveyed were satisfied or very satisfied with the care received, and would recommend the hospital to others. The variables more strongly associated with overall satisfaction were those related to service personnel. After identifying deficiencies and implementing measures to improve, the survey detected an increase in the level of satisfaction. Copyright 2009 SECA. Published by Elsevier Espana. All rights reserved.

Development and testing of a scale for assessing the quality of home nursing.

PubMed

Chiou, Chii-Jun; Wang, Hsiu-Hung; Chang, Hsing-Yi

2016-03-01

To develop a home nursing quality scale and to evaluate its psychometric properties. This was a 3-year study. In the first year, 19 focus group interviews with caregivers of people using home nursing services were carried out in northern, central and southern Taiwan. Content analysis was carried out and a pool of questionnaire items compiled. In the second year (2007), study was carried out on a stratified random sample selected from home nursing organizations covered by the national health insurance scheme in southern Taiwan. The study population was the co-resident primary caregivers of home care nursing service users. Item analysis and exploratory factor analysis were carried out on data from 365 self-administered questionnaires collected from 13 selected home care organizations. In the third year (2008), a random sample of participants was selected from 206 hospital-based home care nursing organizations throughout Taiwan, resulting in completion of 294 questionnaires from 27 organizations. Confirmatory factor analysis was then carried out on the scale, and the validity and reliability of the scale assessed. The present study developed a reliable and valid home nursing quality scale from the perspective of users of home nursing services. The scale comprised three factors: dependability, communication skills and service usefulness. This scale is of practical value for the promotion of long-term community care aging in local policies. The scale is ready to be used to assess the quality of services provided by home care nursing organizations. © 2015 Japan Geriatrics Society.

Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan

PubMed Central

Steinhardt, Laura C; Aman, Iqbal; Pakzad, Iqbalshah; Kumar, Binay; Singh, Lakhwinder P; Peters, David H

2011-01-01

Background User fees for primary care tend to suppress utilization, and many countries are experimenting with fee removal. Studies show that additional inputs are needed after removing fees, although well-documented experiences are lacking. This study presents data on the effects of fee removal on facility quality and utilization in Afghanistan, based on a pilot experiment and subsequent nationwide ban on fees. Methods Data on utilization and observed structural and perceived overall quality of health care were compared from before-and-after facility assessments, patient exit interviews and catchment area household surveys from eight facilities where fees were removed and 14 facilities where fee levels remained constant, as part of a larger health financing pilot study from 2005 to 2007. After a national user fee ban was instituted in 2008, health facility administrative data were analysed to assess subsequent changes in utilization and quality. Results The pilot study analysis indicated that observed and perceived quality increased across facilities but did not differ by fee removal status. Difference-in-difference analysis showed that utilization at facilities previously charging both service and drug fees increased by 400% more after fee removal, prompting additional inputs from service providers, compared with facilities that previously only charged service fees or had no change in fees (P = 0.001). Following the national fee ban, visits for curative care increased significantly (P < 0.001), but institutional deliveries did not. Services typically free before the ban—immunization and antenatal care—had immediate increases in utilization but these were not sustained. Conclusion Both pilot and nationwide data indicated that curative care utilization increased following fee removal, without differential changes in quality. Concerns raised by non-governmental organizations, health workers and community leaders over the effects of lost revenue and increased utilization require continued effort to raise revenues, monitor health worker and patient perceptions, and carefully manage health facility performance. PMID:22027924

[Expectations and user experiences of older Roma women with health services in primary care].

PubMed

Ramos-Morcillo, Antonio Jesús; Ruzafa-Martínez, María; Fernández-Salazar, Serafín; Del-Pino-Casado, Rafael

2015-04-01

To know the expectations and user experiences of older Roma women with health services in primary care (PC). Phenomenological qualitative study. Using focus groups (4-9 women/group) and semistructured interviews. Audio recorded from March to November 2011. Performed in Úbeda and Linares (Spain). Roma women over 50years. A purposive sample stratified by age and area of residence was carried out. Woman were recruited through community leaders. Process of qualitative content analysis: coding, triangulation, obtain and verify results. Supported whit the software Nvivo 8. Three focus groups and four interviews were conducted, including 23 women. The expectations for the PC are focus exclusively on their physician, being invisible other professionals. They look for a relationship with their physician based on trust. In their user experience with the PC coexist three types of user: who goes to their appointments, demands attention only in acute disease and does not attend appointments and reviews. There are socio-cultural factors related to accessibility. Older Roma women set their expectations and experiences with health service in PC around the binomial disease/physician. Expect attention based on trust and a high instrumentalization. A speech with signs of change directed towards a more active and demanding participation in PC services is observed. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees

PubMed Central

Li, Qijuan; Keohane, Laura M.; Thomas, Kali; Lee, Yoojin; Trivedi, Amal N.

2017-01-01

Importance Several policy proposals advocate introducing copayments for home health care in the Medicare program. To our knowledge, no prior studies have assessed this cost-containment strategy. Objective To determine the association of home health copayments with use of home health services. Design, Setting, and Participants A difference-in-differences case-control study of 18 Medicare Advantage (MA) plans that introduced copayments for home health care between 2007 and 2011 and 18 concurrent control MA plans. The study included 135 302 enrollees in plans that introduced copayment and 155 892 enrollees in matched control plans. Exposures Introduction of copayments for home health care between 2007 and 2011. Main Outcomes and Measures Proportion of enrollees receiving home health care, annual numbers of home health episodes, and days receiving home health care. Results Copayments for home health visits ranged from $5 to $20 per visit, which were estimated to be associated with $165 (interquartile range [IQR], $45-$180) to $660 (IQR, $180-$720) in out-of-pocket spending for the average user of home health care. The increased copayment for home health care was not associated with the proportion of enrollees receiving home health care (adjusted difference-in-differences, −0.15 percentage points; 95% CI, −0.38 to 0.09), the number of home health episodes per user (adjusted difference-in-differences, 0.01; 95% CI, −0.01 to 0.03), and home health days per user (adjusted difference-in-differences, −0.19; 95% CI, −3.02 to 2.64). In both intervention and control plans and across all levels of copayments, we observed higher disenrollment rates among enrollees with greater baseline use of home health care. Conclusions and Relevance We found no evidence that imposing copayments reduced the use of home health services among older adults. More intensive use of home health services was associated with increased rates of disenrollment in MA plans. The findings raise questions about the potential effectiveness of this cost-containment strategy. PMID:28492826

Support workers in social care in England: a scoping study.

PubMed

Manthorpe, Jill; Martineau, Stephen; Moriarty, Jo; Hussein, Shereen; Stevens, Martin

2010-05-01

This paper reports the findings of a scoping study designed to describe the evidence base with regard to support workers in social care in the United Kingdom and to identify gaps in knowledge. Multiple bibliographic databases were searched for studies published since 2003. The results revealed that the support worker role, though not well-defined, could be characterised as one aimed at fostering independence among service users, undertaking tasks across social and health-care, and not being trained in, or a member of, a specific profession. The studies identified were predominantly small-scale qualitative projects which considered issues such as role clarity, training and pay, worker satisfaction, service user views and the amount of time support workers are able to spend with service users compared to other staff. The review concluded that the research base lacks longitudinal studies, there is definitional confusion and imprecision, and there is limited evidence about employment terms and conditions for support workers or about their accountability and performance. The desirability and value of training and how it is resourced need further analysis. It is concluded that moves to self-directed support or personalisation and the increased reliance on and use of support workers, in the form of personal assistants, call for closer scrutiny of the role.

A dignified approach to improving the patient experience: promoting privacy, dignity and respect through collaborative training.

PubMed

Chadwick, Angelina

2012-07-01

Globally there is a plethora of literature surrounding patients' privacy, dignity and respect, consequently highlighting the need for healthcare professionals to ensure such basic human rights are upheld when delivering care. For qualified practitioners this is further emphasised through the professional bodies and their varying codes of practice. To ensure privacy, dignity and respect move from rhetoric to reality in professional practice many pre-registration programmes promote service user involvement. Evidence suggests that involving service users in the delivery of educational programmes by directly telling their own stories enhances patient centred care. However given a number of recent patient surveys and/or audits reporting the lack of privacy, dignity and respect in health and social care settings there seems to be a growing need to reaffirm practitioners' knowledge, skills and values once qualified and practising in healthcare organisations. This paper reports on a project in a UK NHS Mental health Trust where service users, in collaboration with Trust staff, planned and delivered a series of privacy and dignity workshops to healthcare practitioners with the aim of improving the patient experience. Although the project took place within a Mental Health Trust the issues of privacy, dignity and respect apply to all healthcare sectors. Copyright © 2012 Elsevier Ltd. All rights reserved.

If they get sick, they are in trouble: health care restructuring, user charges, and equity in Vietnam.

PubMed

Sepehri, Ardeshir; Chernomas, Robert; Akram-Lodhi, A Haroon

2003-01-01

The transition from a centrally planned economy in the 1980s and the implementation of a series of neoliberal health policy reform measures in 1989 affected the delivery and financing of Vietnam's health care services. More specifically, legalization of private medical practice, liberalization of the pharmaceutical industry, and introduction of user charges at public health facilities have effectively transformed Vietnam's near universal, publicly funded and provided health services into a highly unregulated private-public mix system, with serious consequences for Vietnam's health system. Using Vietnam's most recent household survey data and published facility-based data, this article examines some of the problems faced by Vietnam's health sector, with particular reference to efficiency, access, and equity. The data reveal four important findings: self-treatment is the dominant mode of treatment for both the poor and nonpoor; there is little or no regulation to protect patients from financial abuse by private medical providers, pharmacies, and drug vendors; in the face of a dwindling share of the state health budget in public hospital revenues and low salaries, hospitals increasingly rely on user charges and insurance premiums to finance services, including generous staff bonuses; and health care costs, especially hospital costs, are substantial for many low- and middle-income households.

HOBE+, a case study: a virtual community of practice to support innovation in primary care in Basque Public Health Service.

PubMed

Abos Mendizabal, Galder; Nuño Solinís, Roberto; Zaballa González, Irune

2013-11-05

A virtual professional community of practice (VCoP), HOBE+, has been set up to foster and facilitate innovation in primary care. It is aimed at all primary care professionals of the Basque Public Health Service (Osakidetza) in the provinces of Biscay and Araba. HOBE + is a VCoP that incorporates innovation management from the generation of ideas to their implementation in primary care practice. We used a case study method, based on the data provided by the technology platform that supports the VCoP, and from a survey completed by HOBE + users. The target population was all primary care staff (including all professional categories) from Araba and Biscay provinces of the Basque Country (Spain), who represent the target users of the VCoP. From a total of 5190 professionals across all the professional categories invited to join, 1627 (31.3%) actually registered in the VCoP and, during the study period, 90 (5.5% of the registered users) participated actively in some way. The total number of ideas proposed by the registered users was 133. Of these, 23 ideas (17.2%) are being implemented. Finally, 80% of the users who answered the satisfaction survey about their experience with HOBE + considered the initiative useful in order to achieve continuous improvement and real innovation in clinical and managerial processes. The experience shows that it is possible to create a virtual CoP for innovation in primary care where professionals from different professional categories propose ideas for innovation that are ultimately implemented.This manuscript objectives are to assess the process of developing and implementing a VCoP open to all primary care professionals in Osakidetza, including the take-up, participation and use of this VCoP in the first 15 months after its launch in October 2011. In addition, the usefulness of the VCoP was assessed through a survey gathering the opinions of the professionals involved.

HOBE+, a case study: a virtual community of practice to support innovation in primary care in Basque Public Health Service

PubMed Central

2013-01-01

Background A virtual professional community of practice (VCoP), HOBE+, has been set up to foster and facilitate innovation in primary care. It is aimed at all primary care professionals of the Basque Public Health Service (Osakidetza) in the provinces of Biscay and Araba. HOBE + is a VCoP that incorporates innovation management from the generation of ideas to their implementation in primary care practice. Methods We used a case study method, based on the data provided by the technology platform that supports the VCoP, and from a survey completed by HOBE + users. The target population was all primary care staff (including all professional categories) from Araba and Biscay provinces of the Basque Country (Spain), who represent the target users of the VCoP. Results From a total of 5190 professionals across all the professional categories invited to join, 1627 (31.3%) actually registered in the VCoP and, during the study period, 90 (5.5% of the registered users) participated actively in some way. The total number of ideas proposed by the registered users was 133. Of these, 23 ideas (17.2%) are being implemented. Finally, 80% of the users who answered the satisfaction survey about their experience with HOBE + considered the initiative useful in order to achieve continuous improvement and real innovation in clinical and managerial processes. Conclusions The experience shows that it is possible to create a virtual CoP for innovation in primary care where professionals from different professional categories propose ideas for innovation that are ultimately implemented. This manuscript objectives are to assess the process of developing and implementing a VCoP open to all primary care professionals in Osakidetza, including the take-up, participation and use of this VCoP in the first 15 months after its launch in October 2011. In addition, the usefulness of the VCoP was assessed through a survey gathering the opinions of the professionals involved. PMID:24188617

IMS: a new technology to develop a telemedicine system.

PubMed

Uceda, J D; Elena, M; Blasco, S; Tarrida, C L; Quero, J M

2008-01-01

The emergent IMS (Internet Protocol Multimedia Subsystem) technology appears to improve the current communication technologies. Its characteristics, such as Quality of Service (QoS), make it an advantageous system for innovative applications. Providing integrated services to users is one of the main reasons for the existence of IMS. Operators provide the technology as an open source, to be able to use services developed by researchers. Combining and integrating them, users will receive completely new services. Our proposal of use for IMS is the development of a telemedicine platform, designed to support not only remote biological signal monitoring, but value-added services for diagnosis and medical care, both of these working in real time.

Experiences and preferences of users with major mental disorders regarding helpful care in situations of mental crisis.

PubMed

Gudde, Camilla Buch; Olsø, Turid Møller; Antonsen, Dag Øivind; Rø, Marit; Eriksen, Lasse; Vatne, Solfrid

2013-03-01

To examine the experiences of and preferences for helpful care in situations of mental crisis from the perspective of people with major mental disorders. Qualitative individual interviews with 19 users with major mental disorder, 13 men and six women, aged 22-60 years. Analysis was conducted with systematic text condensation. The main tendencies among a majority of the users are a clear understanding of their own problems and ways of handling these, and the desire for early help from providers whom they know well and who are open to dialogue and reflection. A clear majority perceived a high threshold for contacting the mental health system due to negative experiences and lack of user involvement in treatment planning and implementation. The findings challenge traditional views of professionalism and describe important implications for mental health services from the user's perspective. Our study provides a clear indication of the importance of becoming an active participant in one's own life, and the need for deeper understanding among the professionals in relation to user experiences and preferences for helpful care in periods of mental health crisis in order to optimize the care.

[Issues, dilemmas and managerial strategies of potential ethical risks associated with the implementation of patient partnership practices in psychiatry: a case study].

PubMed

Lierville, Anne-Lise; Grou, Christine; Pelletier, Jean-François

2015-01-01

In terms of health and social services, the territory of the province of Quebec is covered by four large 'integrated university health networks,' which are involved in the coordination of care delivery and medical training. The francophone components of the public mental health system for Montreal are thus primarily linked to the Integrated University Health Network of University of Montreal. In 2010, the Faculty of Medicine of the University of Montreal has included in its development strategy a firm commitment to the development and implementation of the 'patient partner expertise' in research, training and care in order to make this expertise no less than the brand of the Faculty. This commitment applies to all medical specialties that are taught at University of Montreal, including in psychiatry. More recently, the Institut universitaire en santé mentale de Montréal (IUSMM) has endorsed a new clinical vision that promotes full citizenship, which implies that service users and carers are considered as full partners with a specific expertise to be fully deployed. The objective of this paper is to examine, from an ethical point of view, the challenges that may be associated with involving such lay persons in various levels of mental health care planning and delivery, and in research. This study is mainly based on a review of the institutional processes that are in place at the IUSMM to promote service users' participation in care planning and delivery, and in research. The focus is on the practicalities and conditions for the exercise of such an active participation, as some questions and concerns emerged through a series of interviews with different stakeholders. These issues are addressed and discussed through the lenses of the ethical values that were formalized at IUSMM. Despite a firm institutional commitment at IUSMM to implement its new citizenship-oriented clinical vision through greater service users' involvement, little is known about the possible negative impacts of their participation, on themselves and for regular employees. There is a consensus on the symbolic value of recognizing the potential of service users as contributors, as a peer workers or peer research assistants. This is an historic advance compared to a time when they were considered only as more or less passive recipients of services or as a simple research subjects. Some risk factors were nonetheless identified: isolation, emotional fatigue, possible relapse, insecurity, sometimes tensed relations with health or research professionals and misunderstanding. In organizational terms, among the pitfalls, the study highlighted the need for more cautious preparatory steps, guidance and support for service users and for professionals as well, and the importance of a global and integrated governance strategy. This study points to three main recommendations to better anticipate and manage possible risks associated with more or less improvised service users' active participation, as lay persons, in complex planning and service delivery and in research. The first would be directed towards professionals for them to reflect on the quality of the doctor-patient relationship in their facility as to see how service users can help to improve this relationship, but among a variety of stakeholders and without being the sole responsible for such an improvement, or for the lack of improvement thereof. The second recommendation would propose to draw an objective evaluative assessment of participatory approaches at the organizational level, promoting a real return of experience and in light of the issues raised by these practices. The third would recommend an update of the organizational ethical values when introducing practices that change the current paradigms of the provision of care and services and of research.

Exploring Working Relationships in Mental Health Care via an E-Recovery Portal: Qualitative Study on the Experiences of Service Users and Health Providers.

PubMed

Strand, Monica; Gammon, Deede; Eng, Lillian Sofie; Ruland, Cornelia

2017-11-14

The quality of working relationships between service users and health providers is fundamental in the processes of recovery in mental health. How Internet-based interventions will influence these relationships for persons with long-term care needs, and the measures that can be taken to maintain and enhance working relationships through Internet, is still not well understood. The aim of this study was to gain insights into how service users and health providers experience their working relationships when they are offered the option of supplementing ongoing collaboration with an e-recovery portal. In this exploratory and descriptive study, an e-recovery portal was used by service users and their health providers in 2 mental health communities in Norway for at least 6 months and at most 12 months (2015-2016). The portal consists of secure messaging, a peer support forum, and a toolbox of resources for working with life domains including status, goals and activities, network map, crisis plan, and exercises. The portal was owned and managed by the service user while health providers could remotely access parts of the service user-generated content. The participants could use the portal in whatever way they wished, to suit their collaboration. Data from 6 focus groups, 17 individual interviews, and an interview with 1 dyad about their experiences of use of the portal over the study period were inductively coded and thematically analyzed. The thematic analysis resulted in 2 main themes: (1) new relational avenues and (2) out of alignment, illustrated by 8 subthemes. The first main theme is about dyads who reported new and enriching ways of working together through the portal, particularly related to written communication and use of the goal module. Illustrative subthemes are ownership, common ground, goals and direction, and sense of presence and availability. The second main theme illuminates the difficulties that arose when service users' and health providers' expectations for portal use were not aligned, and the consequences of not addressing these difficulties. Illustrative subthemes are initiative and responsibility, waiting for the other, feeling overwhelmed, and clarifications and agreements. The degree to which dyads benefited from using the e-recovery portal appeared to be mainly associated with the degree to which the dyads' relations were open and flexible before the portal was introduced. For those who experienced frustrations, the portal may have both exposed and added to suboptimal working relationships. Use of the goal module appeared to strengthen the person-centered nature of collaboration. A key question is how health providers balance between enabling service users' greater control over their care, without relinquishing responsibility for the quality of the working relationship, also when using an e-recovery portal. Implications for implementation are discussed. ©Monica Strand, Deede Gammon, Lillian Sofie Eng, Cornelia Ruland. Originally published in JMIR Mental Health (http://mental.jmir.org), 14.11.2017.

Virtualized healthcare delivery: understanding users and their usage patterns of online medical consultations.

PubMed

Jung, Changmi; Padman, Rema

2014-12-01

Virtualization of healthcare delivery via patient portals has facilitated the increasing interest in online medical consultations due to its benefits such as improved convenience and flexibility, lower cost, and time savings. Despite this growing interest, adoption by both consumers and providers has been slow, and little is known about users and their usage and adoption patterns. To learn characteristics of online healthcare consumers and understand their patterns of adoption and usage of online clinical consultation services (or eVisits delivered via the portal) such as adoption time for portal users, whether adoption hazard changes over time, and what factors influence patients to become early/late adopters. Using online medical consultation records between April 1, 2009 and May 31, 2010 from four ambulatory practices affiliated with a major healthcare provider, we conduct simple descriptive analysis to understand the users of online clinical consults and their usage patterns. Multilevel Logit regression is employed to measure the effect of patient and primary care provider characteristics on the likelihood of eVisit adoption by the patient, and survival analysis and Ordered Logit regression are applied to study eVisit adoption patterns that delineate elements describing early or late adopters. On average, eVisit adopters are younger and predominantly female. Their primary care providers participate in the eVisit service, highlighting the importance of physician's role in encouraging patients to utilize the service. Patients who are familiar with the patient portal are more likely to use the service, as are patients with more complex health issues. Younger and female patients have higher adoption hazard, but gender does not affect the decision of adopting early vs. late. These adopters also access the patient portal more frequently before adoption, indicating that they are potentially more involved in managing their health. The majority of eVisits are submitted during business hours, with female physicians responding faster (from submission to reply), on average. This study addresses virtualization of primary care delivery via patient portals and online clinical consultations and examines factors that distinguish eVisit adopters from patient portal users. Among many delineating characteristics, it is particularly significant that familiarity with the patient portal service and participation of primary care provider are found to be key elements that motivate patients to become an eVisit user and early/late adopter. These findings can be used by provider organizations to design and implement strategies to improve uptake of online medical consultations to complement traditional office visits. Offering such alternative channels of care delivery may potentially improve access, efficiency and outcomes for both patients and providers alike. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Western Cape Primary Care Assessment Tool (PCAT) study: Measuring primary care organisation and performance in the Western Cape Province, South Africa (2013)

PubMed Central

Sayed, Abdul-Rauf; le Grange, Cynthia; Bhagwan, Susheela; Manga, Nayna; Hellenberg, Derek

2016-01-01

Background Major health sector reform and the need for baseline measures of performance to determine impact. Aim Baseline audit of primary healthcare (PHC) performance. Setting Cape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa. Method The South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study. Results Data from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance ‘acceptable to good’). 11.5% users scored access ‘acceptable to good’; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers. Conclusion Gaps between users’ experience and providers’ assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research. PMID:27247157

[The user oriented hospital - chances and challenges for the healthcare industry].

PubMed

Borchers, Uwe; Evans, Michaela

2011-01-01

Hardly any other part of the healthcare sector is under such a pressure to change as the hospital sector. Hospitals are high-performers in coping with complex changes in modernising patient care, process design, quality, cost-effectiveness and service orientation. But, what really makes value to the patient? Currently, this question is raised with new seriousness. Those hospitals which consequently align their portfolio to value based and 'patient driven' healthcare delivery will succeed by both quality and cost-effectiveness. We receive such messages from the USA. In Germany there are on-going and admonishing pleas since the end of the 1990s not to lose sight of the patients' needs while designing new concepts for healthcare delivery. Future challenges imply not only the renaissance of patient centred care, but also demand for a comprehensive user orientation as a key factor to successful hospital modernisation. This is particularly true of concepts of structured, integrated and regional healthcare delivery. But a consequent alignment of healthcare with value for patients clearly exceeds the focus on integrating hospital and outpatient care. In designing new services of coordinated regional healthcare, hospitals gain strategic options for a single-source healthcare delivery. In terms of business development, user orientation does not only yield important impulses for stronger patient centred care, but also opens up chances for better quality and competitive advantages. Nevertheless, it requires a new understanding of innovation processes which considers value for patients and quality of results and outcome as a relevant scale for measuring effects of change management. Finally, the methods of the assessment of user oriented healthcare delivery are an essential challenge for the evaluation of cooperative healthcare services. Copyright © 2011. Published by Elsevier GmbH.

Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users.

PubMed

Klein, Jonathan D; Handwerker, Lisa; Sesselberg, Tracy S; Sutter, Erika; Flanagan, Erinn; Gawronski, Beth

2007-08-01

To evaluate whether quality of care provided to adolescents enrolled in a community-based managed care plan was better for those who also received some care at school-based health centers (SBHCs). The Young Adult Health Care Survey (YAHCS) was administered to 374 adolescents (commercially insured, Medicaid-insured, and SBHC users) to assess risk behaviors, provision of preventive screening and counseling, and quality of care. SBHC users were most likely to report that their provider told them their discussions were confidential, and that they received screening/counseling on sexually transmitted diseases (STDs), HIV/AIDS, condom use, and birth control. Commercially insured adolescents were least likely to report discussion of sexual health issues. SBHC users had the highest mean YAHCS quality measure scores for screening/counseling on pregnancy/STDs, diet and exercise, and helpfulness of counseling provided; Medicaid-insured teens had the lowest scores on four of seven measures. Regression models controlled for demographics, use of screener, and site of care showed that use of a screener had a significant impact on six of seven quality measure models. Younger age predicted screening for risk behaviors; being female, African-American, and an SBHC user predicted screening on pregnancy/STDs. SBHCs may increase adolescents' access to confidential care, and SBHC providers may be more likely than those in other settings to screen and counsel patients about sexual health. Overall quality of preventive care reported by commercially insured adolescents may be better in some health content areas and worse in others compared with care reported by Medicaid-insured youth and SBHC users.

Military Sexual Trauma

MedlinePlus

... associated with MST among users of VA health care are depression and other mood disorders, and substance use disorders. Fortunately, people can recover from experiences of trauma, and VA has effective services to help Veterans do ... VA health care system has a designated MST Coordinator who serves ...

Suicides in Users of Mental Health Care Services: Treatment Characteristics and Hindsight Reflections

ERIC Educational Resources Information Center

Huisman, Annemiek; Kerkhof, Ad J. F. M.; Robben, Paul B. M.

2011-01-01

The current study aims to describe the patient and treatment characteristics of a sample of 505 suicides by mental health care patients, and to determine how clinicians view the care provided and what they learned. The results indicate that the quality of mental health care for suicidal patients could be improved by focusing on communication among…

Residential staff responses to adolescent self-harm: The helpful and unhelpful.

PubMed

Johnson, Dan R; Ferguson, Kirstin; Copley, Jennifer

2017-07-01

Adolescent self-harm is prevalent in residential and secure care and is the cause of distress to those harming themselves, to the staff caring for them and for other young people living with them. This article sought service user views on what staff supports were effective and what were counter-productive in order to improve the care offered to young people. Seven young people living in residential or secure care were interviewed. Thematic analysis was used to elicit key themes. Global themes of safety and care were elicited. The young people understood and accepted that the role of staff was to provide these. Within these themes, they noted numerous responses that had both helpful and unhelpful effects, including increased observation, removal of means and extra collaborative support. Service users made numerous recommendations to increase the helpful effects of staff support. Young people provided informed and helpful guidance on how best to care for them. Their views can help mental health professionals and care staff increase their helpful responses making them more effective and less counter-productive. This study is a rare representation of the views of young people in residential and secure care and how to respond to their self-harm behaviour.

Patient involvement in rheumatology outpatient service design and delivery: a case study.

PubMed

de Souza, Savia; Galloway, James; Simpson, Carol; Chura, Radka; Dobson, Joanne; Gullick, Nicola J; Steer, Sophia; Lempp, Heidi

2017-06-01

Patient involvement is increasingly recognized as important within the UK National Health Service to ensure that services delivered are relevant to users' needs. Organizations are encouraged to work with service users to achieve excellence in care. Patient education can improve health outcomes and reduce health-care costs. Mobile technologies could play a vital role in this. Patient-centred development of innovative strategies to improve the experience of rheumatology outpatients. The Group Rheumatology Initiative Involving Patients (GRIIP) project was set up in 2013 as a joint venture between patients, clinicians, academics and management at a London hospital. The project saw (i) the formation of an independent patient group which provided suggestions for service improvement - outcomes included clearer signs in the outpatient waiting area, extended phlebotomy opening hours and better access to podiatry; (ii) a rolling patient educational evening programme initiated in 2014 with topics chosen by patient experts - feedback has been positive and attendance continues to grow; and (iii) a mobile application (app) co-designed with patients launched in 2015 which provides relevant information for outpatient clinic attendees and data capture for clinicians - downloads have steadily increased as users adopt this new technology. Patients can effectively contribute to service improvement provided they are supported, respected as equals, and the organization is willing to undergo a cultural change. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

User Needs in the Development of a Health App Ecosystem for Self-Management of Cystic Fibrosis: User-Centered Development Approach.

PubMed

Floch, Jacqueline; Zettl, Annabel; Fricke, Lena; Weisser, Tina; Grut, Lisbet; Vilarinho, Thomas; Stav, Erlend; Ascolese, Antonio; Schauber, Cornelia

2018-05-08

Digital self-management in cystic fibrosis (CF) is foreseen as a means toward better understanding of the disease and its treatment and better adherence to the treatment. Mobile apps hold the potential to provide access to information, motivate, and strengthen compliance. However, to deliver high-quality apps, the development should be based on thorough knowledge about user needs. Empirical research on the user-centered development of mobile apps for health care is, however, still limited. The aim of this research is to develop and evaluate an app ecosystem for self-management in CF. It targets not only those directly affected by CF but also parents and health care professionals involved in the treatment. This paper covers the first step of the design process that aims to analyze the context and the user requirements. The primary research question is as follows: what digital support has the potential to usefully support persons with CF and their caregivers in the CF care? To answer this question, we address two preliminary questions: what important factors in everyday life affect the care of persons with CF? and how is the CF care delivered today and what are the limitations of CF care services? The overall research adopts a user-centered design approach in which future users are involved in the development process from the very beginning to ensure that the apps developed best suit the potential users. The research presented in the paper follows an interpretative case study research strategy seeking to understand the concerns and needs of persons with CF and their caregivers. Data were collected through semistructured qualitative interviews involving 74 participants in seven European countries and from internet forums. The results of the analysis phase show a strong need for individuality of the digital support, as well as for its adaptability to different contexts. The paper presents the concerns and needs of the participants in the study and extracts a set of relevant features for a self-management app ecosystem. Education, enzyme dosage calculation, nutrition management, treatment organization, health diary, treatment follow-up, practical guidelines for treatment, communication with doctors, and communication with peers are foreseen as useful features. The results indicate the readiness for self-management in the CF care even in countries that provide well-functioning health care services for CF care. The large diversity of user requirements identified reflects the crucial role user integration plays in developing apps for a chronic condition such as CF. The need for personalization stemming from the individuality of the patients and the need for communication with health care professionals support the idea of an app ecosystem for the self-management of CF. ©Jacqueline Floch, Annabel Zettl, Lena Fricke, Tina Weisser, Lisbet Grut, Thomas Vilarinho, Erlend Stav, Antonio Ascolese, Cornelia Schauber. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 08.05.2018.

An assessment of primary care attributes from the perspective of female healthcare users1

PubMed Central

Lima, Eliane de Fátima Almeida; Sousa, Ana Inês; Primo, Cândida Caniçali; Leite, Francielie Marabotti Costa; Lima, Rita de Cassia Duarte; Maciel, Ethel Leonor Nóia

2015-01-01

OBJECTIVE: this study sought to assess the quality of the Family Health Strategy (FHS) and investigated the association between primary care attributes (PCAs) and the sociodemographic characteristics of users. METHOD: a total of 215 female FHS users were interviewed for this descriptive and cross-sectional study. The Primary Care Assessment Tool (PCATool), Adult Edition was used, and the results were analyzed using Fisher's exact tests, Pearson's chi-square tests and logistic regressions. RESULTS: the lowest average score corresponded to the dimension "accessibility" (1.80), and the highest score corresponded to "access" (8.76). The results corresponding to the attributes "longitudinality", "coordination", "comprehensiveness", and "orientation" were not significant. No association was found between the participants' sociodemographic characteristics and the essential, derivative, and general attributes (p>0.05). CONCLUSION: several attributes must be improved across all the investigated services from the perspective of female FHS users. PMID:26155006

A robust uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care.

PubMed

Wen, Fengtong

2013-12-01

User authentication plays an important role to protect resources or services from being accessed by unauthorized users. In a recent paper, Das et al. proposed a secure and efficient uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care. This scheme uses three factors, e.g. biometrics, password, and smart card, to protect the security. It protects user privacy and is believed to have many abilities to resist a range of network attacks, even if the secret information stored in the smart card is compromised. In this paper, we analyze the security of Das et al.'s scheme, and show that the scheme is in fact insecure against the replay attack, user impersonation attacks and off-line guessing attacks. Then, we also propose a robust uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care. Compared with the existing schemes, our protocol uses a different user authentication mechanism to resist replay attack. We show that our proposed scheme can provide stronger security than previous protocols. Furthermore, we demonstrate the validity of the proposed scheme through the BAN (Burrows, Abadi, and Needham) logic.

Shared decision-making in mental health care-A user perspective on decisional needs in community-based services.

PubMed

Grim, Katarina; Rosenberg, David; Svedberg, Petra; Schön, Ulla-Karin

2016-01-01

Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

Saving babies' lives project impact and results evaluation (SPiRE): a mixed methodology study.

PubMed

Widdows, Kate; Reid, Holly E; Roberts, Stephen A; Camacho, Elizabeth M; Heazell, Alexander E P

2018-01-30

Reducing stillbirth and early neonatal death is a national priority in the UK. Current evidence indicates this is potentially achievable through application of four key interventions within routine maternity care delivered as the National Health Service (NHS) England's Saving Babies' Lives care bundle. However, there is significant variation in the degree of implementation of the care bundle between and within maternity units and the effectiveness in reducing stillbirth and improving service delivery has not yet been evaluated. This study aims to evaluate the impact of implementing the care bundle on UK maternity services and perinatal outcomes. The Saving Babies' Lives Project Impact and Results Evaluation (SPiRE) study is a multicentre evaluation of maternity care delivered through the Saving Babies' Lives care bundle using both quantitative and qualitative methodologies. The study will be conducted in twenty NHS Hospital Trusts and will include approximately 100,000 births. It involves participation by both service users and care providers. To determine the impact of the care bundle on pregnancy outcomes, birth data and other clinical measures will be extracted from maternity databases and case-note audit from before and after implementation. Additionally, this study will employ questionnaires with organisational leads and review clinical guidelines to assess how resources, leadership and governance may affect implementation in diverse hospital settings. The cost of implementing the care bundle, and the cost per stillbirth avoided, will also be estimated as part of a health economic analysis. The views and experiences of service users and service providers towards maternity care in relation to the care bundle will be also be sought using questionnaires. This protocol describes a pragmatic study design which is necessarily limited by the availability of data and limitations of timescales and funding. In particular there was no opportunity to prospectively gather pre-intervention data or design a phased implementation such as a stepped-wedge study. Nevertheless this study will provide useful practice-based evidence which will advance knowledge about the processes that underpin successful implementation of the care bundle so that it can be further developed and refined. www.clinicaltrials.gov NCT03231007 (26th July 2017).

Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility.

PubMed

Newcomer, Robert J; Ko, Michelle; Kang, Taewoon; Harrington, Charlene; Hulett, Denis; Bindman, Andrew B

2016-03-01

Individuals who receive long-term services and supports (LTSS) are among the most costly participants in the Medicare and Medicaid programs. To compare health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care. Retrospective cohort analysis of California dually eligible adult Medicaid and Medicare beneficiaries who initiated Medicaid LTSS, identified as HCBS or extended nursing facility care, in 2006 or 2007. Propensity score matching for demographic, health, and functional characteristics resulted in a subsample of 34,660 users who initiated Medicaid HCBS versus extended nursing facility use. Those with developmental disabilities or in managed care plans were excluded. Average monthly adjusted acute, postacute, long-term, and total Medicare and Medicaid expenditures for the 12 months following initiation of either HCBS or extended nursing facility care. Those initiating extended nursing facility care had, on average, $2919 higher adjusted total health care expenditures per month compared with those who initiated HCBS. The difference was primarily attributable to spending on LTSS $2855. On average, the monthly LTSS expenditures were higher for Medicare $1501 and for Medicaid $1344 when LTSS was provided in a nursing facility rather than in the community. The higher cost of delivering LTSS in a nursing facility rather than in the community was not offset by lower acute and postacute spending. Medicare and Medicaid contribute similar amounts to the LTSS cost difference and both could benefit financially by redirecting care from institutions to the community.

Understanding readmission to psychiatric hospital in Australia from the service users' perspective: a qualitative study.

PubMed

Duhig, Michael; Gunasekara, Imani; Patterson, Sue

2017-01-01

Inpatient care is integral to balanced mental health systems, contributing to containment of risk associated with psychiatric crises and affording opportunities for treatment. However, psychiatric wards are not always safe and service users are often dissatisfied with the experience. Hence, and because inpatient care is the most costly component of mental health systems, minimising duration of admission and reducing risk of readmission are clinical and strategic priorities internationally. With (primarily quantitative) research to date focused on explaining readmission in terms of characteristics of individuals and services, understanding of the 'revolving door phenomenon' remains limited. Considering verstehen critical to addressing this messy problem, we examined readmission from the service users' perspective. Using grounded theory techniques, we inductively analysed data from interviews with 13 people readmitted to inpatient care within 28 days of discharge. Participants, including eight men, were recruited in 2013 from three psychiatric wards at a metropolitan hospital in Australia. Analysis supported description of readmission as a process, fundamentally related to insufficiency of internal, interpersonal and/or environmental resources to maintain community tenure. For the people in this study, admission to hospital was either the default coping mechanism or the culmination of counter-productive attempts to manage stressful circumstances. Readmission can appropriately be understood as one representation of a fundamental social malaise and the struggle of some people to survive in an apparently inhospitable world. The findings indicate that neither locating the 'problem of readmission' within an individual and promoting self-governance/self-control/self-regulation, nor identifying failures of specific services or sectors are likely to support the economic and ethical imperative of reducing psychiatric admissions. The findings of the study and limitations related to its conduct in a particular setting provide fertile ground for further research and design of interventions to break the readmission cycle. However, balanced, mental health services alone are insufficient; systems of care must become 'recovery oriented'. © 2015 John Wiley & Sons Ltd.

Rethinking place and the social work office in the delivery of children's social work services.

PubMed

Stanley, Nicky; Larkins, Cath; Austerberry, Helen; Farrelly, Nicola; Manthorpe, Jill; Ridley, Julie

2016-01-01

Limited attention has been given to the concept of place in social work research and practice. This paper draws on the national evaluation of social work practices (SWPs) in England undertaken between 2009 and 2012. SWPs were pilot organisations providing independent social work services for children in out-of-home care in five sites. One factor distinguishing some of these pilots was their attention to place. The evaluation employed a mixed methods approach and we use data from interviews with 121 children and young people in out-of-home care, 19 birth parents and 31 interviews with SWP staff which explored their views and experiences of the SWP offices. Children and young people were alert to the stigma which could attach to social work premises and appreciated offices which were planned and furnished to appear less institutional and more 'normal'. Daily interactions with staff which conveyed a sense of recognition and value to service users also contributed to a view of some SWP offices as accessible and welcoming places. Both children and parents appreciated offices that provided fun activities that positioned them as active rather than passive. Staff valued opportunities for influencing planning decisions about offices and place was seen to confer a value on them as well as on service users. However, not all the SWPs were able to achieve these aspects of place, and engaging children and families in place was less likely when the service user population was widely dispersed. Recognising the importance of place and how place is constructed through relationships between people as well as through the physical environment appeared to be key to creating offices that combated the stigma attached to out-of-home care. Those leading and managing children's services should explore ways of involving local communities in planning social work offices and turn attention to making these offices accessible, welcoming, places. © 2015 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

Involving consumers in assessing service quality: benefits of using a qualitative approach.

PubMed Central

Powell, J; Lovelock, R; Bray, J; Philp, I

1994-01-01

Although important to users, practice standards rarely incorporate users' views of care provided. These views are a valuable source of information, even though there are limits to their value. To improve the standards of care in a 20 bed hospital elderly care unit caring for acute medical conditions a qualitative approach was used. Patients' and carers' perceptions of care and problems with the process of care in the unit were elicited with a specially designed semistructured interview schedule in 83 separate tape recorded interviews with a research nurse in patients' homes. In all, 50 patients and 35 carers were interviewed between 6 June 1991 and 28 May 1992. Of the 50 patients, 33 were female; seven patients were aged less than 80 years, 16, 80-85; 21, 86-90; and six over 90. A total of 16 patients lived with spouses or other carers, two with non-carers, and 32 lived alone, 18 of whom received informal care. Content analysis of the interviews disclosed patients' and carers' general satisfaction with individualised professional care and planning of follow up services on discharge but dissatisfaction in the lack of information about and involvement in treatment and care and about specific staff notes. These findings have prompted remedial changes in clinical practice in the unit; they have also formed the structure of a criterion based survey of practice. The authors conclude that the qualitative approach suited elderly users and also provided the basis for the findings to be incorporated into a continuous audit cycle through a process of feedback and standard setting. PMID:10140234

What Do Our Users Want? Perspectives on Understanding and Meeting User Needs for Multi-Mission Data Services

NASA Technical Reports Server (NTRS)

McGuire, Robert E.; Candey, Robert M.; Bilitza, D.

2006-01-01

The Sun-Earth Connection Active Archive (SECAA) project of NASA's Space Physics Data Facility operates a range of unique and heavily used multi-mission data services in support of the large-scale science objectives of the Great Observatory, including services such as CDAWeb, the CDAWeb Plus client, SSCWeb, OMNIweb and the CDF data format. In developing and operating these services, we have encountered and continue to struggle with a wide range of issues such as balancing scope and functionality with simplicity and ease of use, understanding the effectiveness of our choices and identifying areas most important for further improvement. In this paper, we will review our key services and then discuss some of our observations and new approaches to understanding and meeting user data service requirements. Some observations are obvious but may still have substantial implications; e.g. functionality without information content is of little user interest, which has led to our recent emphasis on development of web services interfaces, so the content and functionality we already serve is readily and fully available as a building block for new services. Some observations require careful design and tradeoffs; e.g. users will complain when they are offered interfaces with limited options but users are also easily intimidated and become lost when offered extensive options for customization. Some observations remain highly challenging; e.g. a comprehensive multi-mission, multi-source view of all data and services available easily produces a daunting list, but a more selective view can easily lead users to overlook available and relevant data. It is often difficult to obtain and meaningfully interpret measures of true productive usage and overall user satisfaction, even with a variety of techniques including statistics, citations, case studies, user feedback and advisory committees. Most of these issues will apply to and may even be more acute for distributed implementation architectures.

Diabetes management using modern information and communication technologies and new care models.

PubMed

Spanakis, Emmanouil G; Chiarugi, Franco; Kouroubali, Angelina; Spat, Stephan; Beck, Peter; Asanin, Stefan; Rosengren, Peter; Gergely, Tamas; Thestrup, Jesper

2012-10-04

Diabetes, a metabolic disorder, has reached epidemic proportions in developed countries. The disease has two main forms: type 1 and type 2. Disease management entails administration of insulin in combination with careful blood glucose monitoring (type 1) or involves the adjustment of diet and exercise level, the use of oral anti-diabetic drugs, and insulin administration to control blood sugar (type 2). State-of-the-art technologies have the potential to assist healthcare professionals, patients, and informal carers to better manage diabetes insulin therapy, help patients understand their disease, support self-management, and provide a safe environment by monitoring adverse and potentially life-threatening situations with appropriate crisis management. New care models incorporating advanced information and communication technologies have the potential to provide service platforms able to improve health care, personalization, inclusion, and empowerment of the patient, and to support diverse user preferences and needs in different countries. The REACTION project proposes to create a service-oriented architectural platform based on numerous individual services and implementing novel care models that can be deployed in different settings to perform patient monitoring, distributed decision support, health care workflow management, and clinical feedback provision. This paper presents the work performed in the context of the REACTION project focusing on the development of a health care service platform able to support diabetes management in different healthcare regimes, through clinical applications, such as monitoring of vital signs, feedback provision to the point of care, integrative risk assessment, and event and alarm handling. While moving towards the full implementation of the platform, three major areas of research and development have been identified and consequently approached: the first one is related to the glucose sensor technology and wearability, the second is related to the platform architecture, and the third to the implementation of the end-user services. The Glucose Management System, already developed within the REACTION project, is able to monitor a range of parameters from various sources including glucose levels, nutritional intakes, administered drugs, and patient's insulin sensitivity, offering decision support for insulin dosing to professional caregivers on a mobile tablet platform that fulfills the need of the users and supports medical workflow procedures in compliance with the Medical Device Directive requirements. Good control of diabetes, as well as increased emphasis on control of lifestyle factors, may reduce the risk profile of most complications and contribute to health improvement. The REACTION project aims to respond to these challenges by providing integrated, professional, management, and therapy services to diabetic patients in different health care regimes across Europe in an interoperable communication platform.

Nonemergency medical transportation and health care visits among chronically ill urban and rural medicaid beneficiaries.

PubMed

Thomas, Leela V; Wedel, Kenneth R

2014-01-01

Inaccessibility to health care services due to lack of transportation affects the most vulnerable segments of the society. The effect of Medicaid-provided nonemergency medical transportation (NEMT) in Oklahoma on health care visits for the management of chronic illnesses is examined. Analyses of claims data show that African Americans are the highest users of NEMT. Medicaid beneficiaries who use NEMT services are significantly more likely to make the recommended number of annual visits for the management of chronic conditions than those who do not use NEMT. Increased use of NEMT by making the services more accommodating and convenient for beneficiaries is proposed.

[User embracement in the Family Health Strategy in Brazil: an integrative review].

PubMed

Garuzi, Miriane; Achitti, Maria Cecília de Oliveira; Sato, Cintia Ayame; Rocha, Suelen Alves; Spagnuolo, Regina Stella

2014-02-01

To review the literature regarding the application of the notion of user embracement and to identify the contributions of this concept for primary health care practices in Brazil. We carried out an integrative review of the literature regarding primary health care. The following databases were searched: LILACS, SciELO, and MEDLINE, covering the period from 2006 to 2010. The following search terms were used in LILACS and SciELO: "acolhimento" and "programa saúde da família" and "saúde". For MEDLINE, the terms "user embracement" and "family health program" and "health" were used. The review was performed in November 2010. We identified 21 articles meeting the inclusion criteria, all of which described studies carried out in Brazil. The articles were divided into three empirical categories: integration and embracement; primary care work process; and evaluation of services. These are complementary categories that converge to two main views of embracement: the first sees embracement as a means of reorganizing the primary health care environment, and the second sees embracement as an attitude towards users. The review also shows that embracement may be a management tool that supports the Unified Health System and is associated with the principles of comprehensiveness and universality. Embracement is able to create a bond between health care workers and users. It promotes self-care, a better understanding of disease, as well as user co-responsibility for treatment. In addition, it facilitates universal access, strengthens multiprofessional and intersectoral work, qualifies care, humanizes practices, and encourages actions to combat prejudice. Nevertheless, the perspective of health care users regarding embracement deserves more attention and should be the focus of future studies.

Design of RCSS

PubMed Central

Strum, David P.; Vargas, Luis G.; May, Jerrold H.

1997-01-01

Abstract The plans for Resource Coordination for Surgical Services system (RCSS) incorporate a distributed objectbase with a coordinating server. User-centered information screens are customized for each geographic location in surgical services. User interfaces are designed to mimic paper lists and worksheets used by health care providers. Patient-specific and site-specific data will be entered and maintained by providers at each geographic location, but also rebroadcast and displayed for all providers. Although RCSS is primarily a communications system, it will also support review of surgical utilization and operative scheduling. PMID:9067878

Quality of service provision assessment in the healthcare information and telecommunications infrastructures.

PubMed

Babulak, Eduard

2006-01-01

The continuous increase in the complexity and the heterogeneity of corporate and healthcare telecommunications infrastructures will require new assessment methods of quality of service (QoS) provision that are capable of addressing all engineering and social issues with much faster speeds. Speed and accessibility to any information at any time from anywhere will create global communications infrastructures with great performance bottlenecks that may put in danger human lives, power supplies, national economy and security. Regardless of the technology supporting the information flows, the final verdict on the QoS is made by the end user. The users' perception of telecommunications' network infrastructure QoS provision is critical to the successful business management operation of any organization. As a result, it is essential to assess the QoS Provision in the light of user's perception. This article presents a cost effective methodology to assess the user's perception of quality of service provision utilizing the existing Staffordshire University Network (SUN) by adding a component of measurement to the existing model presented by Walker. This paper presents the real examples of CISCO Networking Solutions for Health Care givers and offers a cost effective approach to assess the QoS provision within the campus network, which could be easily adapted to any health care organization or campus network in the world.

Experiences of Nursing Personnel Using PDAs in Home Health Care Services in Norwegian Municipalities

PubMed Central

Hansen, Linda M.; Fossum, Mariann; Söderhamn, Olle; Fruhling, Ann

2012-01-01

Although nursing personnel have used personal digital assistants (PDAs) to support home health care services for the past ten years, little is known about their experiences. This study was conducted to examine experiences of nursing personnel using a specialized home health care computer software application called Gerica. In addition, this research analyzed how well this application aligned with the workflow of the nursing personnel in their daily care of patients. The evaluation methods included user observations and learnability testing. Nursing personnel from two different municipalities were observed while performing real tasks in natural settings. This study shows that the nursing personnel were satisfied with the PDA user interface and the Gerica software; however, they identified areas for improvement. For example, the nursing personnel were concerned about trusting the reliability of the PDA in order to eliminate the need for handwritten documentation. Solutions to meet these shortcomings for nursing managers and vendors are discussed. PMID:24199073

The comfort factor: assessing patient satisfaction with Opti-Free vs other contact lens cleaning products.

PubMed

Yeaton, K

1994-01-01

Many patients cite comfort as a primary factor in their success or failure with soft contact lenses. In an effort to further meet the needs of these patients, eye-care professionals must place more emphasis on dispensing a lens type and lens-care system that maximize patient satisfaction and thus provide a higher quality of service. This study delineated patient-defined quality and comfort as they relate to lens-care solutions. Five hundred ninety-nine U.S. practices were each asked to switch 25 of their patients to Opti-Free Lens Care from their currently used lens-care system (52% ReNu Multi-Purpose Solution, 20% AOSept System) for 2 weeks. Data were collected from 14,455 patients who completed the post-trial interview. At the time of the callback interview, 81% of respondents (78% ReNu users, 82% AOSept users) were using the Opti-Free System. Of these patients, 85% (84% previous ReNu users, 87% previous AOSept users) rated Opti-Free Lens Care more comfortable than or as comfortable as their previous system. These findings demonstrate differences in patient comfort among Opti-Free, AOSept, and ReNu. Eye-care professionals should consider relative comfort when dispensing lens-care systems, as this may affect patient-defined quality.

Development and evaluation of theory-based diabetes support services.

PubMed

Guo, Sophie Huey-Ming; Lin, Yung-Hsiu; Chen, Rong-Rong; Kao, Shu-Fen; Chang, Her-Kun

2013-01-01

Technology-enabled support services for diabetes can fulfill patient demand to care for diabetes independently. Patients benefit from such services after greater adoption of the services in healthcare systems. Unfortunately, conventional service development fails to thoroughly understand patient care support, making it difficult to achieve the desired design, and posing substantial challenges in adopting these services. Thus, previously developed services in many cases are not as patients expected, as evidenced by their low acceptance among patients. To solve this problem, adequate strategies must be developed by incorporating theoretical knowledge as a solid foundation in order to improve service design. This study develops technology-enabled diabetes support services based on the self-care theory. A set of self-care service scenarios is also established and combined with theoretical concepts. The developed services consist of a nurse-led consultation service and a mobile application service. Additionally, user acceptance is confirmed by assessing patient perceptions of the diabetes support services in a group of patients with diabetes (N=27). Results of analysis reveal that patients respond favorably toward the services. Patient preference and perceived ease of use attest to their intention to use the services. Greater adoption of the services can be anticipated, owing to a higher levels of preference and higher perceived ease of use. This study demonstrated that the self-care theory can be linked to nursing informatics research and chronic care clinical practices.

Managing preconceived expectations: mental health service users experiences of going home from hospital: a grounded theory study.

PubMed

Keogh, B; Callaghan, P; Higgins, A

2015-11-01

What is known on the subject? The time of discharge from a mental health hospital can be challenging for mental health service users, with high rates of readmission in the immediate months following discharge. Although some research exists that explores service users' perspectives of being discharged, little evidence exists that explores the processes influencing or used by service users' to adapt to the transition from in-patient acute mental health service. What this papers adds to existing knowledge? The findings of this grounded theory study demonstrates the strategies service users used to managed their own, as well as their social audiences, preconceived expectations arising from their new identity as 'psychiatric patients' following their discharge from hospital. While there is a move to develop recovery-orientated mental health services, key indicators of recovery-oriented practices were often absent from service users' experiences of service provision. What are the implications for practice? Nurses and other mental health professionals need to recognize their contribution to the architecture of stigma that transcends the physical structures of hospital or ward and are entrenched within attitudes, interactions and practices. The findings of this study can provide guidance to those working with service users and help them to understand the complexities of their experiences when using mental health services, which go far beyond the management of their symptoms. Following a period of hospitalization, the transition to home can result in increased vulnerability and a source of stress for mental health service users. Readmission rates have been suggested as one indicator of the success of the transition from hospital to community care. Despite knowledge of some of the factors that impact on service users following discharge, no coherent model or theoretical framework could be located in the literature, which explains or aides an in-depth understanding of the transition from hospital to community for service users. The aim of this study was to develop a grounded theory that explored service users' experiences of going home from hospital. This qualitative study used grounded theory, and a total of 35 interviews were conducted with 31 service users. The core category was 'Managing Preconceived Expectations', which had seven subcategories, describes how the participants were negatively perceived by themselves and others following their admission and discharge from hospital. This theory presents the strategies that the participants used to manage this new identity. This theory demonstrates that although there has been a move to adopt recovery-orientated services, key indicators of recovery were often absent for service users being admitted and subsequently discharged. © 2015 John Wiley & Sons Ltd.

A Distributed Ambient Intelligence Based Multi-Agent System for Alzheimer Health Care

NASA Astrophysics Data System (ADS)

Tapia, Dante I.; RodríGuez, Sara; Corchado, Juan M.

This chapter presents ALZ-MAS (Alzheimer multi-agent system), an ambient intelligence (AmI)-based multi-agent system aimed at enhancing the assistance and health care for Alzheimer patients. The system makes use of several context-aware technologies that allow it to automatically obtain information from users and the environment in an evenly distributed way, focusing on the characteristics of ubiquity, awareness, intelligence, mobility, etc., all of which are concepts defined by AmI. ALZ-MAS makes use of a services oriented multi-agent architecture, called flexible user and services oriented multi-agent architecture, to distribute resources and enhance its performance. It is demonstrated that a SOA approach is adequate to build distributed and highly dynamic AmI-based multi-agent systems.

Financing geriatric programs in community health centers.

PubMed Central

Yeatts, D E; Ray, S; List, N; Duggar, B

1991-01-01

There are approximately 600 Community and Migrant Health Centers (C/MHCs) providing preventive and primary health care services principally to medically underserved rural and urban areas across the United States. The need to develop geriatric programs within C/MHCs is clear. Less clear is how and under what circumstances a comprehensive geriatric program can be adequately financed. The Health Resources and Services Administration of the Public Health Service contracted with La Jolla Management Corporation and Duke University Center on Aging to identify successful techniques for obtaining funding by examining 10 "good practice" C/MHC geriatric programs. The results from this study indicated that effective techniques included using a variety of funding sources, maintaining accurate cost-per-user information, developing a marketing strategy and user incentives, collaborating with the area agency on aging and other community organizations, and developing special services for the elderly. Developing cost-per-user information allowed for identifying appropriate "drawing card" services, negotiating sound reimbursement rates and contracts with other providers, and assessing the financial impact of changing service mixes. A marketing strategy was used to enhance the ability of the centers to provide a comprehensive package of services. Collaboration with the area agency on aging and other community organizations and volunteers in the aging network was found to help establish referral networks and subsequently increase the number of elderly patients served. Finally, development of special services for the elderly, such as adult day care, case management, and health education, was found to increase program visibility, opportunities to work with the network of services for the aging, and clinical utilization. PMID:1908588

Effect of primary health care reforms in Turkey on health service utilization and user satisfaction.

PubMed

Hone, Thomas; Gurol-Urganci, Ipek; Millett, Christopher; Başara, Berrak; Akdağ, Recep; Atun, Rifat

2017-02-01

Strengthening primary health care (PHC) is considered a priority for efficient and responsive health systems, but empirical evidence from low- and middle-income countries is limited. The stepwise introduction of family medicine across all 81 provinces of Turkey (a middle-income country) between 2005 and 2010, aimed at PHC strengthening, presents a natural experiment for assessing the effect of family medicine on health service utilization and user satisfaction.The effect of health system reforms, that introduced family medicine, on utilization was assessed using longitudinal, province-level data for 12 years and multivariate regression models adjusting for supply-side variables, demographics, socio-economic development and underlying yearly trends. User satisfaction with primary and secondary care services was explored using data from annual Life Satisfaction Surveys. Trends in preferred first point of contact (primary vs secondary, public vs. private), reason for choice and health services issues, were described and stratified by patient characteristics, provider type, and rural/urban settings.Between 2002 and 2013, the average number of PHC consultations increased from 1.75 to 2.83 per person per year. In multivariate models, family medicine introduction was associated with an increase of 0.37 PHC consultations per person (P < 0.001), and slower annual growth in PHC and secondary care consultations. Following family medicine introduction, the growth of PHC and secondary care consultations per person was 0.08 and 0.30, respectively, a year. PHC increased as preferred provider by 9.5% over 7 years with the reasons of proximity and service satisfaction, which increased by 14.9% and 11.8%, respectively. Reporting of poor facility hygiene, difficulty getting an appointment, poor physician behaviour and high costs of health care all declined (P < 0.001) in PHC settings, but remained higher among urban, low-income and working-age populations. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A cluster randomised controlled trial of a manualised cognitive behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities.

PubMed

Willner, P; Rose, J; Jahoda, A; Stenfert Kroese, B; Felce, D; MacMahon, P; Stimpson, A; Rose, N; Gillespie, D; Shead, J; Lammie, C; Woodgate, C; Townson, J K; Nuttall, J; Cohen, D; Hood, K

2013-05-01

Anger is a frequent problem for many people with intellectual disabilities, and is often expressed as verbal and/or physical aggression. Cognitive-behaviour therapy (CBT) is the treatment of choice for common mental health problems, but CBT has only recently been adapted for people with intellectual disabilities. Anger is the main psychological presentation in which controlled trials have been used to evaluate CBT interventions for people with intellectual disabilities but these do not include rigorous randomised studies. To evaluate (1) the impact of a staff-delivered manualised CBT anger management intervention on (a) reported anger among people with mild to moderate intellectual disabilities, and (b) anger coping skills, aggression, mental health, quality of life and costs of health and social care; (2) factors that influence outcome; and (3) the experience of service users, lay therapists and service managers. A cluster randomised controlled trial based on 30 day centres (15 intervention and 15 control). Intention-to-treat comparisons of outcomes used a two-level linear regression model to allow for clustering within centres with baseline outcome levels as a covariate. Comparison of cost data used non-parametric bootstrapping. Qualitative analysis used interpretative phenomenological analysis and thematic analysis. Recruited day centres had four-plus service users with problem anger who were prepared to participate, two-plus staff willing to be lay therapists, a supportive manager and facilities for group work, and no current anger interventions. A total of 212 service users with problem anger were recruited. Thirty-three were deemed ineligible (30 could not complete assessments and three withdrew before randomisation). Retention at follow-up was 81%, with 17 withdrawals in each arm. Two to four staff per centre were recruited as lay therapists. Eleven service users, nine lay therapists and eight managers were interviewed. The manualised intervention comprised 12 weekly 2-hour group sessions supplemented by 'homework'. Lay therapists received training and ongoing supervision from a clinical psychologist. Treatment fidelity, group attendance and resources used in intervention delivery were monitored. The primary outcome was the service user-rated Provocation Index (PI), a measure of response to hypothetical situations that may provoke anger. Secondary trial outcomes were the key worker-rated PI; the service user- and key worker-rated Profile of Anger Coping Skills (PACS); the service user-rated PACS imaginal provocation test (PACS-IPT), a measure of response to actual situations known to provoke anger; aggression; mental health; self-esteem; quality of life; and health and social care resource use. Assessments were administered before randomisation and at 16 weeks and 10 months after randomisation. Fourteen treatment groups were delivered, each with 12 sessions lasting an average of 114 minutes, with a mean of 4.9 service users and 2.0 lay therapists. The mean hourly cost per service user was £ 25.26. The mean hourly excess cost over treatment as usual was £ 12.34. There was no effect of intervention on the primary outcome - self-rated PI. There was a significant impact on the following secondary outcomes at the 10-month follow-up: key worker-rated PI, self-rated PACS-IPT and self- and key worker-rated PACS. Key workers and home carers reported significantly lower aggression at 16 weeks, but not at 10 months. There was no impact on mental health, self-esteem, quality of life or total cost of health and social care. Service users, key workers and service managers were uniformly positive. The intervention was effective at changing anger coping skills and staff-rated anger. Impact on self-rated anger was equivocal. With hindsight there are reasons, from an analysis of factors influencing outcomes, to think that self-rated PI was not a well-chosen primary outcome. Widespread implementation of manualised lay therapist-led but psychologist-supervised anger management CBT for people with mild to moderate intellectual disabilities is recommended.

Day Care and Federal Funding: Current Problems and Possible Solutions.

ERIC Educational Resources Information Center

Dail, Paula W.

The current policy of consolidating funding for all Title XX programs into block grants presents problems for day care users who increasingly must begin to explore alternatives to federally funded day care services. The block grants are problematic because they (1) are undesignated and can be used as the state wills, (2) have no matching fund…

Barriers in access to home care services among ethnic minority and Dutch elderly--a qualitative study.

PubMed

Suurmond, Jeanine; Rosenmöller, Doenja L; El Mesbahi, Hakima; Lamkaddem, Majda; Essink-Bot, Marie-Louise

2016-02-01

Ethnic minority elderly have a high prevalence of functional limitations and chronic conditions compared to Dutch elderly. However, their use of home care services is low compared to Dutch elderly. Explore the barriers to access to home care services for Turkish, Moroccan Surinamese and ethnic Dutch elderly. Qualitative semi-structured group interviews and individual interviews. The Netherlands. Seven group interviews (n=50) followed by individual interviews (n=5) were conducted, in the preferred language of the participants. Results were ordered and reported according to a framework of access to health care services. This framework describes five dimensions of accessibility to generate access to health care services, from the perspective of the users: ability to perceive health needs, ability to seek health care, ability to reach, ability to pay and ability to engage. This study shows that while barriers are common among all groups, several specific barriers in access to home care services exist for ethnic minority elderly. Language and communication barriers as well as limited networks and a preference for informal care seem to mutually enforce each other, resulting in many barriers during the navigation process to home care. In order to provide equal access to home care for all who need it, the language and communication barriers should be tackled by home care services and home care nurses. Copyright © 2015 Elsevier Ltd. All rights reserved.

Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam.

PubMed

Thanh, Duong Cong; Moland, Karen Marie; Fylkesnes, Knut

2012-11-25

Seeking and utilisation of HIV prevention, treatment, care, and support services for people living with HIV is often hampered by HIV-related stigma. The study aimed to explore the perceptions and experiences regarding treatment, care, and support amongst people living with HIV in Viet Nam, where the HIV epidemic is concentrated among injecting drug users, sex workers, and men who have sex with men. In-depth interviews and focus group discussions were conducted during September 2007 in 6 districts in Hai Phong with a very high HIV prevalence among injecting drug users. The information obtained was analysed and merged within topic areas. Illustrative quotes were selected. Stigma and discrimination against people living with HIV in the community and healthcare settings was commonly reported, and substantially hampered the seeking and the utilisation of HIV-related services. The informants related the high level of stigma to the way the national HIV preventive campaigns played on fear, by employing a "scare tactic" mainly focusing on drug users and sex workers, who were defined as "social evils" in the anti-drug and anti-prostitution policy. There was a strong exclusion effect caused by the stigma, with serious implications, such as loss of job opportunities and isolation. The support and care provided by family members was experienced as vital for the spirit and hope for the future among people living with HIV. A comprehensive care and support programme is needed. The very high levels of stigma experienced seem largely to have been created by an HIV preventive scare tactic closely linked to the "social evil" approach in the national policy on drug and prostitution. In order to reduce the stigma and create more effective interventions, this tactic will have to be replaced with approaches that create better legal and policy environments for drug users and sex workers.

[Poverty and disease: users of the primary care social services of a primary care center].

PubMed

Doz Mora, J F; Mengual, L; Torné, M; Bonilla, P

1994-06-15

To find the individual and socio-family characteristics of that sector of the population which uses Primary Care Social Services (PCSS) at the Primary Care Centre (PCC) and the social problems which occasion demand. A retrospective descriptive study, based on checking over social work case files. A PCC situated in Barcelona's second industrial belt, serving a population with a low socio-economic level. The population group under study were the users with social work files open from January 1st 1985 to July 31st 1991 (a total of 690 case histories). A representative sample of 296 was selected. In comparison with the population of the basic Health Area, the user population of the PCSS at the PCC was predominantly women, and had an older average age, a higher proportion of divorce/separation and widowhood, and, in the labour context, higher unemployment and retirement. A high proportion of one-parent families (12.8%) was found. Analysis of the work situation showed that 50% of the workers were temporary and 75% of the unemployed received no benefit. 51% of the retired people received the minimum pension and 11% received no pension. Monthly family income, recorded for 46.5% of the cases, was 75,362 pesetas (SD 37,643). The most common problems were those related to the "HEALTH" section (61%). The user population of the PCSS at the PCC is, in socio-economic terms, deteriorated, a condition closely related to the development of chronic illnesses. Tackling health inequalities from Primary Care is under discussion.

Health services analysis as a tool for evidence-based policy decisions: the case of the Ministry of Health and Social Security in Mexico.

PubMed

Kroeger, Axel; Hernandez, Juan Manuel

2003-12-01

To describe the strengths and weaknesses of two Mexican health care providers for poor populations [Ministry of Health (MoH) and Social Security (SS)] in order to facilitate policy decisions about the future of the two systems. In four Mexican states we conducted (i) a household interview survey in 10 724 households; (ii) a user satisfaction survey in 1319 households; (iii) a satisfaction survey of 236 health workers; (iv) in-depth interviews with 190 health workers; (v) 188 focus-group discussions with different population groups; (vi) a document analysis. Both systems serve populations with similar characteristics of poverty. The availability of resources was better in the MoH system; SS care was better concerning process indicators (family planning, antenatal care; in-service delivery of drugs, staff productivity, user satisfaction and staff motivation), efficiency and effectiveness (reduction of morbidity and mortality). Possible explanatory factors for the better performance of the SS system were strong supervision, regular communication, joint data analysis and annual population surveys. Better service organization makes a difference regarding efficiency and effectiveness. Policy-makers, deciding on which kind of health services are best for the poor, should take into account health services' analyses.

Assessment of the responsiveness of a public health service from the perspective of older adults

PubMed Central

Melo, Denise da Silva; Martins, René Duarte; de Jesus, Renata Patrícia Freitas Soares; Samico, Isabella Chagas; Santo, Antônio Carlos Gomes do Espírito

2017-01-01

ABSTRACT OBJECTIVE To assess the quality of health care of older adults using as a parameter the assessment of the responsiveness of the service. METHODS This is a descriptive cross-sectional study conducted in a reference unit of the Brazilian Unified Health System at the outpatient level. The sample was probabilistic and had 385 older adults; data collection occurred in 2014. The domains assessed were: choice, autonomy, confidentiality, dignity, communication, physical facilities, and fast service. To this end, we used Pearson correlation test and Fisher’s exact test. RESULTS The domains of dignity, confidentiality, and communication reached the highest level of adequate responsiveness. On the other hand, freedom of choice and fast service received the worst assessments. Participation in decision-making regarding treatment was significantly lower among the older adults who had no education. In addition, the older adults that self-reported as black receive a lower quality of care regarding clear explanation and respected privacy in the appointment, when compared to users of any other race. CONCLUSIONS Although most domains studied have receive a positive assessment, we have found a need for an equal care by the health professionals, regardless of race, education level, or any other adjective characteristic of older adults, users of public health services. PMID:28678911

Integrating care for frequent users of emergency departments: implementation evaluation of a brief multi-organizational intensive case management intervention.

PubMed

Kahan, Deborah; Leszcz, Molyn; O'Campo, Patricia; Hwang, Stephen W; Wasylenki, Donald A; Kurdyak, Paul; Wise Harris, Deborah; Gozdzik, Agnes; Stergiopoulos, Vicky

2016-04-27

Addressing the needs of frequent users of emergency departments (EDs) is a health system priority in many jurisdictions. This study describes stakeholder perspectives on the implementation of a multi-organizational brief intervention designed to support integration and continuity of care for frequent ED users with mental health and addictions problems, focusing on perceived barriers and facilitators to early implementation in a large urban centre. Coordinating Access to Care from Hospital Emergency Departments (CATCH-ED) is a brief case management intervention bridging hospital, primary and community care for frequent ED users experiencing mental illness and addictions. To examine barriers and facilitators to early implementation of this multi-organizational intervention, between July and October 2012, 47 stakeholders, including direct service providers, managers and administrators participated in 32 semi-structured qualitative interviews and one focus group exploring their experience with the intervention and factors that helped or hindered successful early implementation. Qualitative data were analyzed using thematic analysis. Stakeholders valued the intervention and its potential to support continuity of care for this population. Service delivery system factors, including organizational capacity and a history of collaborative relationships across the healthcare continuum, and support system factors, such as training and supervision, emerged as key facilitators of program implementation. Operational challenges included early low program referral rates, management of a multi-organizational initiative, variable adherence to the model among participating organizations, and scant access to specialty psychiatric resources. Factors contributing to these challenges included lack of dedicated staff in the ED and limited local system capacity to support this population, and insufficient training and technical assistance available to participating organizations. A multi-organizational brief intervention is an acceptable model to support integration of hospital, primary and community care for frequent ED users. The study highlights the importance of early implementation evaluation to identify potential solutions to implementation barriers that may be applicable to many jurisdictions.

[Local government and public dental health services: an analysis of inequality in use].

PubMed

Soares, Felipe Fagundes; Chaves, Sônia Cristina Lima; Cangussu, Maria Cristina Teixeira

2015-03-01

The aim of this study was to identify factors associated with the use of primary and specialized public dental health services and private services. A population-based household survey was conducted in two cities of Bahia State, Brazil. Key informants provided data on socioeconomic variables and use of dental health services. Organization of the local public dental health service was ranked as worse versus better. Univariate and multivariate polytomous logistic regression was performed. Of the total of 1,290 individuals, 38.76% used private services, 33.80% used public primary care, and 17.29% used both primary care and the Center for Dental Specialties. Less use of both primary care and specialized public services was associated with lower education (OR = 1.47; 95%CI: 1.03-2.10) and worse organization of services (OR = 1.74; 95%CI: 1.22-2.48), when compared to the exclusive use of primary care. The study showed inequality in the use of dental services, even when comparing more homogeneous groups, namely users of public services.

Healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions: a qualitative systematic review protocol.

PubMed

Ekberg, Stuart; Bradford, Natalie; Herbert, Anthony; Danby, Susan; Yates, Patsy

2015-11-01

The objective of this review is to identify and synthesize the best international qualitative evidence on healthcare users' experiences of communication with healthcare professionals about children who have life-limiting conditions. For the purposes of this review, "healthcare users" will be taken to include children who have life-limiting conditions and their families. The question to be addressed is:What are healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions? The prospect of the death of a child from an incurable medical condition is harrowing, yet finding a way to discuss this prospect is crucial to maximize the quality of life for such children and their families. High-quality communication is well recognized as a core skill health care professionals need to maximize the quality of care they provide. This skill is valued by service users, who consistently rate it as one of the highest priorities for the care they receive. Evidence suggests, however, that healthcare professionals can feel ill-equipped or uncomfortable communicating with and about such children. Therefore, it is important to understand what represents high-quality communication and what is involved in accomplishing this within pediatric palliative care.In recent decades there has been an increased focus on providing palliative care for children who have life-limiting conditions. These are conditions for which no cure is available and for which the probable outcome is premature death. Palliative care may also be appropriate for children who have life-threatening conditions; these are conditions where there is not only a high probability of premature death but also a chance of long-term survival into adulthood Although pediatric palliative care is underpinned by the same philosophy as adult palliative care, children who have life-limiting conditions and their families have particular needs that distinguish them from users of adult palliative care. For example, at a physical level children are more likely than adults to have non-malignant conditions that follow trajectories in which children oscillate between feeling relatively well and acutely unwell. The social dynamic of their care is also radically different, particularly given the role of parents or guardians in making surrogate decisions about their child's care. Such factors warrant considering pediatric palliative care as distinct from palliative care more generally.Although the particular circumstances of children who have life-limiting conditions have led to development of pediatric palliative care, the particular provisions of this care differs among countries. One aspect of variation is the age range of patients. Pediatric palliative care is usually provided to neonates, infants, children, adolescents and young adults, but international variations in the definitions of these age ranges, particularly for adolescents and young adults, means pediatric palliative care is provided to different age groups in different countries. This review therefore adopts a pragmatic rather than an age-based definition of a pediatric palliative care, considering all studies relating to service users who are being cared for by pediatric rather than adult healthcare services.In catering for the unique needs of children who have life-limiting conditions and their families, pediatric palliative care aims to achieve pain and symptom management, enhanced dignity and quality of life, and psychosocial and spiritual care. It also seeks to incorporate care for patients' broader families and facilitating access to appropriate services and support. High-quality communication is crucial for achieving these aims. It enables healthcare users and providers to make decisions that underpin the care that is provided and the quality of the life that is possible for patients and their families.Although both users and providers recognize the value of high-quality communication with and about children who have life-limiting conditions, this does not mean that these stakeholders necessarily share the same perspective of what constitutes high-quality communication and the best way of accomplishing this. Focusing on healthcare users' experiences of communication with healthcare professionals about children who have life-limiting conditions, the present review will explore the subjective impact of professionals' communication on the people for whom they provide care.It may be necessary to consider a range of contextual factors to understand healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions. For instance, age, developmental stage, cognitive capacity, emotional and social strengths, and family dynamics can influence a child's level of involvement in discussions about their condition and care. Although there are factors that appear more consistent across the range of pediatric palliative care users, such as parents' preferences for being treated by healthcare professionals as partners in making decisions about the care of their child, there is not always such consistency. Nor is it clear whether such findings can be generalized across different cultural contexts. In appraising existing research, this systematic review will therefore consider the relationship between the context of individual studies and their reported findings.The primary aim of this review is to identify, appraise and synthesize existing qualitative evidence of healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions. The review will consider relevant details of these findings, particularly whether factors like age are relevant for understanding particular experiences of communication. An outcome of this review will be the identification of best available qualitative evidence that can be used to inform professional practice, as well as an identification of priorities for future research in pediatric palliative care.A preliminary search in MEDLINE and CINAHL found primary studies exploring healthcare users' experiences of aspects of communicating with healthcare professionals about children who have life-limiting conditions. A search was also conducted for existing systematic reviews in PubMed, CINAHL, EMBASE, PsycINFO, the Cochrane Database of Systematic Reviews, the JBI Database of Systematic Reviews and Implementation Reports, and PROSPERO. No systematic reviews on this topic were found.

Breaking the Glass Ceiling: Increasing the Meaningful Involvement of Women Living With HIV/AIDS (MIWA) in the Design and Delivery of HIV/AIDS Services.

PubMed

Carter, Allison; Greene, Saara; Nicholson, Valerie; O'Brien, Nadia; Sanchez, Margarite; de Pokomandy, Alexandra; Loutfy, Mona; Kaida, Angela

2015-01-01

The meaningful involvement of women living with HIV/AIDS (MIWA) is a key feature of women-centred HIV care, yet little is known about transforming MIWA from principle to practice. Drawing on focus group data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), we explored HIV-positive women's meaningful involvement in the design and delivery of HIV/AIDS services in British Columbia, Canada. In this article, we highlight the benefits and tensions that emerge as women traverse multiple roles as service users and service providers within their care communities, and the impact this has on their access to care and overall health.

Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health

PubMed Central

2013-01-01

Background The last decade has seen widespread retreat from user fees with the intention to reduce financial constraints to users in accessing health care and in particular improving access to reproductive, maternal and newborn health services. This has had important benefits in reducing financial barriers to access in a number of settings. If the policies work as intended, service utilization rates increase. However this increases workloads for health staff and at the same time, the loss of user fee revenues can imply that health workers lose bonuses or allowances, or that it becomes more difficult to ensure uninterrupted supplies of health care inputs. This research aimed to assess how policies reducing demand-side barriers to access to health care have affected service delivery with a particular focus on human resources for health. Methods We undertook case studies in five countries (Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe). In each we reviewed financing and HRH policies, considered the impact financing policy change had made on health service utilization rates, analysed the distribution of health staff and their actual and potential workloads, and compared remuneration terms in the public sectors. Results We question a number of common assumptions about the financing and human resource inter-relationships. The impact of fee removal on utilization levels is mostly not sustained or supported by all the evidence. Shortages of human resources for health at the national level are not universal; maldistribution within countries is the greater problem. Low salaries are not universal; most of the countries pay health workers well by national benchmarks. Conclusions The interconnectedness between user fee policy and HRH situations proves difficult to assess. Many policies have been changing over the relevant period, some clearly and others possibly in response to problems identified associated with financing policy change. Other relevant variables have also changed. However, as is now well-recognised in the user fee literature, co-ordination of health financing and human resource policies is essential. This appears less well recognised in the human resources literature. This coordination involves considering user charges, resource availability at health facility level, health worker pay, terms and conditions, and recruitment in tandem. All these policies need to be effectively monitored in their processes as well as outcomes, but sufficient data are not collected for this purpose. PMID:24053731

Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health.

PubMed

McPake, Barbara; Witter, Sophie; Ensor, Tim; Fustukian, Suzanne; Newlands, David; Martineau, Tim; Chirwa, Yotamu

2013-09-22

The last decade has seen widespread retreat from user fees with the intention to reduce financial constraints to users in accessing health care and in particular improving access to reproductive, maternal and newborn health services. This has had important benefits in reducing financial barriers to access in a number of settings. If the policies work as intended, service utilization rates increase. However this increases workloads for health staff and at the same time, the loss of user fee revenues can imply that health workers lose bonuses or allowances, or that it becomes more difficult to ensure uninterrupted supplies of health care inputs.This research aimed to assess how policies reducing demand-side barriers to access to health care have affected service delivery with a particular focus on human resources for health. We undertook case studies in five countries (Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe). In each we reviewed financing and HRH policies, considered the impact financing policy change had made on health service utilization rates, analysed the distribution of health staff and their actual and potential workloads, and compared remuneration terms in the public sectors. We question a number of common assumptions about the financing and human resource inter-relationships. The impact of fee removal on utilization levels is mostly not sustained or supported by all the evidence. Shortages of human resources for health at the national level are not universal; maldistribution within countries is the greater problem. Low salaries are not universal; most of the countries pay health workers well by national benchmarks. The interconnectedness between user fee policy and HRH situations proves difficult to assess. Many policies have been changing over the relevant period, some clearly and others possibly in response to problems identified associated with financing policy change. Other relevant variables have also changed.However, as is now well-recognised in the user fee literature, co-ordination of health financing and human resource policies is essential. This appears less well recognised in the human resources literature. This coordination involves considering user charges, resource availability at health facility level, health worker pay, terms and conditions, and recruitment in tandem. All these policies need to be effectively monitored in their processes as well as outcomes, but sufficient data are not collected for this purpose.

Reaching out to people struggling with their lives: a discourse analysis of answers from Internet-based services in Norway and Sweden

PubMed Central

Andersen, Anders Johan W; Svensson, Tommy

2012-01-01

The Internet has enlarged the scope of human communication, opening new avenues for connecting with people who are struggling with their lives. This article presents a discourse analysis of 101 responses to 98 questions that were posted on 14 different Internet-based mental health services in Norway and Sweden. We aimed to examine and describe the dominant understandings and favored recommendations in the services’ answers, and we reflected upon the social consequences of those answers. The services generally understood life struggles as an abnormal state of mind, life rhythms, or self-reinforcing loops. Internet-based mental health services primarily counsel service users to seek help, talk to health care professionals face-to-face, and discuss their life struggles openly and honestly. They also urge service users to take better care of themselves and socialize with other people. However, such answers might enhance the individualization of life problems, masking social origin and construction. Consequently, the services are challenged to include social explanations in their answers and strengthen their responsibility to amplify peoples’ messages at a societal level. Potentially, such answers could strengthen democratic structures and put pressure on social equity. PMID:23049282

Contribution of the voluntary sector to mental health crisis care in England: protocol for a multimethod study.

PubMed

Newbigging, Karen; Mohan, John; Rees, James; Harlock, Jenny; Davis, Alex

2017-11-08

Timely access to the right kind of support for people experiencing a mental health crisis can be problematic. The voluntary sector (VS) plays a key role in providing support and enabling access, but there is a knowledge gap concerning its contribution and interface with public services in mental health crisis care. This study aims to address this. The study has three empirical elements: (1) a national survey of voluntary sector organisations (VSOs) in England and national stakeholder interviews to develop a typology of organisations and interventions provided by VSOs; (2) detailed mapping of VS services in two regions through interviews and extending the national survey; (3) four case studies, identified from the regional mapping, of VS mental health crisis services and their interface with National Health Service (NHS) and local authority services, at both a system and individual level. Data collection will involve interviews with commissioners; VSO and NHS or local authority providers; and focus groups with people who have experience of VSO crisis support, both service users and carers; and mapping the crisis trajectory of 10 service users in each study site through narrative interviews with service users and informal carers to understand the experience of VSO crisis care and its impact. The University of Birmingham Humanities and Social Sciences Ethical Review Committee granted ethical approval (reference ERN_16-1183) for the national and regional elements of the study. Ethical review by the Health Research Authority will be required for the case study research once the sites have been identified from the first two elements of the study. A range of methods including a policy seminar, publication in academic journals and a tool kit for commissioners and practitioners will be produced to maximise the impact of the findings on policy and practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Contribution of the voluntary sector to mental health crisis care in England: protocol for a multimethod study

PubMed Central

Newbigging, Karen; Mohan, John; Rees, James; Harlock, Jenny; Davis, Alex

2017-01-01

Introduction Timely access to the right kind of support for people experiencing a mental health crisis can be problematic. The voluntary sector (VS) plays a key role in providing support and enabling access, but there is a knowledge gap concerning its contribution and interface with public services in mental health crisis care. This study aims to address this. Methods and analysis The study has three empirical elements: (1) a national survey of voluntary sector organisations (VSOs) in England and national stakeholder interviews to develop a typology of organisations and interventions provided by VSOs; (2) detailed mapping of VS services in two regions through interviews and extending the national survey; (3) four case studies, identified from the regional mapping, of VS mental health crisis services and their interface with National Health Service (NHS) and local authority services, at both a system and individual level. Data collection will involve interviews with commissioners; VSO and NHS or local authority providers; and focus groups with people who have experience of VSO crisis support, both service users and carers; and mapping the crisis trajectory of 10 service users in each study site through narrative interviews with service users and informal carers to understand the experience of VSO crisis care and its impact. Ethics and dissemination The University of Birmingham Humanities and Social Sciences Ethical Review Committee granted ethical approval (reference ERN_16–1183) for the national and regional elements of the study. Ethical review by the Health Research Authority will be required for the case study research once the sites have been identified from the first two elements of the study. A range of methods including a policy seminar, publication in academic journals and a tool kit for commissioners and practitioners will be produced to maximise the impact of the findings on policy and practice. PMID:29122807

Burden reduction of caregivers for users of care services provided by the public long-term care insurance system in Japan.

PubMed

Umegaki, Hiroyuki; Yanagawa, Madoka; Nonogaki, Zen; Nakashima, Hirotaka; Kuzuya, Masafumi; Endo, Hidetoshi

2014-01-01

We surveyed the care burden of family caregivers, their satisfaction with the services, and whether their care burden was reduced by the introduction of the LTCI care services. We randomly enrolled 3000 of 43,250 residents of Nagoya City aged 65 and over who had been certified as requiring long-term care and who used at least one type of service provided by the public LTCI; 1835 (61.2%) subjects returned the survey. A total of 1015 subjects for whom complete sets of data were available were employed for statistical analysis. Analysis of variance for the continuous variables and χ(2) analysis for that categorical variance were performed. Multiple logistic analysis was performed with the factors with p values of <0.2 in the χ(2) analysis of burden reduction. A total of 68.8% of the caregivers indicated that the care burden was reduced by the introduction of the LTCI care services, and 86.8% of the caregivers were satisfied with the LTCI care services. A lower age of caregivers, a more advanced need classification level, and more satisfaction with the services were independently associated with a reduction of the care burden. In Japanese LTCI, the overall satisfaction of the caregivers appears to be relatively high and is associated with the reduction of the care burden. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Two complementary personal medication management applications developed on a common platform: case report.

PubMed

Ross, Stephen E; Johnson, Kevin B; Siek, Katie A; Gordon, Jeffry S; Khan, Danish U; Haverhals, Leah M

2011-07-12

Adverse drug events are a major safety issue in ambulatory care. Improving medication self-management could reduce these adverse events. Researchers have developed medication applications for tethered personal health records (PHRs), but little has been reported about medication applications for interoperable PHRs. Our objective was to develop two complementary personal health applications on a common PHR platform: one to assist children with complex health needs (MyMediHealth), and one to assist older adults in care transitions (Colorado Care Tablet). The applications were developed using a user-centered design approach. The two applications shared a common PHR platform based on a service-oriented architecture. MyMediHealth employed Web and mobile phone user interfaces. Colorado Care Tablet employed a Web interface customized for a tablet PC. We created complementary medication management applications tailored to the needs of distinctly different user groups using common components. Challenges were addressed in multiple areas, including how to encode medication identities, how to incorporate knowledge bases for medication images and consumer health information, how to include supplementary dosing information, how to simplify user interfaces for older adults, and how to support mobile devices for children. These prototypes demonstrate the utility of abstracting PHR data and services (the PHR platform) from applications that can be tailored to meet the needs of diverse patients. Based on the challenges we faced, we provide recommendations on the structure of publicly available knowledge resources and the use of mobile messaging systems for PHR applications.

Tobacco use and health insurance literacy among vulnerable populations: implications for health reform.

PubMed

Braun, Robert T; Hanoch, Yaniv; Barnes, Andrew J

2017-11-15

Under the Affordable Care Act (ACA), millions of Americans have been enrolling in the health insurance marketplaces. Nearly 20% of them are tobacco users. As part of the ACA, tobacco users may face up to 50% higher premiums that are not eligible for tax credits. Tobacco users, along with the uninsured and racial/ethnic minorities targeted by ACA coverage expansions, are among those most likely to suffer from low health literacy - a key ingredient in the ability to understand, compare, choose, and use coverage, referred to as health insurance literacy. Whether tobacco users choose enough coverage in the marketplaces given their expected health care needs and are able to access health care services effectively is fundamentally related to understanding health insurance. However, no studies to date have examined this important relationship. Data were collected from 631 lower-income, minority, rural residents of Virginia. Health insurance literacy was assessed by asking four factual questions about the coverage options presented to them. Adjusted associations between tobacco use and health insurance literacy were tested using multivariate linear regression, controlling for numeracy, risk-taking, discount rates, health status, experiences with the health care system, and demographics. Nearly one third (31%) of participants were current tobacco users, 80% were African American and 27% were uninsured. Average health insurance literacy across all participants was 2.0 (SD 1.1) out of a total possible score of 4. Current tobacco users had significantly lower HIL compared to non-users (-0.22, p < 0.05) after adjustment. Participants who were less educated, African American, and less numerate reported more difficulty understanding health insurance (p < 0.05 each.) CONCLUSIONS: Tobacco users face higher premiums for health coverage than non-users in the individual insurance marketplace. Our results suggest they may be less equipped to shop for plans that provide them with adequate out-of-pocket risk protection, thus placing greater financial burdens on them and potentially limiting access to tobacco cessation and treatment programs and other needed health services.

Health system reform in rural China: voices of healthworkers and service-users.

PubMed

Zhou, Xu Dong; Li, Lu; Hesketh, Therese

2014-09-01

Like many other countries China is undergoing major health system reforms, with the aim of providing universal health coverage, and addressing problems of low efficiency and inequity. The first phase of the reforms has focused on strengthening primary care and improving health insurance coverage and benefits. The aim of the study was to explore the impacts of these reforms on healthworkers and service-users at township level, which has been the major target of the first phase of the reforms. From January to March 2013 we interviewed eight health officials, 80 township healthworkers and 80 service-users in eight counties in Zhejiang and Yunnan provinces, representing rich and poor provinces respectively. Thematic analysis identified key themes around the impacts of the health reforms. We found that some elements of the reforms may actually be undermining primary care. While the new health insurance system was popular among service-users, it was criticised for contributing to fast-growing medical costs, and for an imbalance of benefits between outpatient and inpatient services. Salary reform has guaranteed healthworkers' income, but greatly reduced their incentives. The essential drug list removed perverse incentives to overprescribe, but led to falls in income for healthworkers, and loss of autonomy for doctors. Serious problems with drug procurement also emerged. The unintended consequences have included a brain drain of experienced healthworkers from township hospitals, and patients have flowed to county hospitals at greater cost. In conclusion, in the short term resources must be found to ensure rural healthworkers feel appropriately remunerated and have more clinical autonomy, measures for containment of the medical costs must be taken, and drug procurement must show increased transparency and accountability. More importantly the study shows that all countries undergoing health reforms should elicit the views of stakeholders, including service-users, to avoid and address unintended consequences. Copyright © 2014. Published by Elsevier Ltd.

Validation of Warwick-Edinburgh Mental Well-being Scale (WEMWBS) in a population of people using Secondary Care Mental Health Services.

PubMed

Bass, Malcolm; Dawkin, Mathew; Muncer, Steven; Vigurs, Scott; Bostock, Janet

2016-08-01

The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) is a relatively new measure and to date has been validated in a number of populations, including student, general and adolescent samples across the UK. There is increasing interest in measuring the mental well-being of users of secondary care mental health services and therefore it is apt to validate WEMWBS for this population. To investigate the validity of WEMWBS in a secondary care mental health service user population. Data was collected from two NHS Trusts and one charity. Analyses are based on 1180 completed WEMWBS. WEMWBS scores for this population are significantly lower than those in a general population (Mean 34.9, SD 13.8). Overall the data analyses supported the use of WEMWBS in this population sample. The Rasch analysis found that the majority of the items can be seen as measuring one dimension. The confirmatory factor analysis supports a one factor solution and thus, measures a single underlying concept. The findings from this study show WEMWBS to be a valid and reliable measure for this population sample.

Validity and test-retest reliability of the self-completion adult social care outcomes toolkit (ASCOT-SCT4) with adults with long-term physical, sensory and mental health conditions in England.

PubMed

Rand, Stacey; Malley, Juliette; Towers, Ann-Marie; Netten, Ann; Forder, Julien

2017-08-18

The Adult Social Care Outcomes Toolkit (ASCOT-SCT4) is a multi-attribute utility index designed for the evaluation of long-term social care services. The measure comprises eight attributes that capture aspects of social care-related quality of life. The instrument has previously been validated with a sample of older adults who used home care services in England. This paper aims to demonstrate the instrument's test-retest reliability and provide evidence for its validity in a diverse sample of adults who use publicly-funded, community-based social care in England. A survey of 770 social care service users was conducted in England. A subsample of 100 services users participated in a follow-up interview between 7 and 21 days after baseline. Spearman rank correlation coefficients between the ASCOT-SCT4 index score and the EQ-5D-3 L, the ICECAP-A or ICECAP-O and overall quality of life were used to assess convergent validity. Data on variables hypothesised to be related to the ASCOT-SCT4 index score, as well as rating of individual attributes, were also collected. Hypothesised relationships were tested using one-way ANOVA or Fisher's exact test. Test-retest reliability was assessed using the intra-class correlation coefficient for the ASCOT-SCT4 index score at baseline and follow-up. There were moderate to strong correlations between the ASCOT-SCT4 index and EQ-5D-3 L, the ICECAP-A or ICECAP-O, and overall quality of life (all correlations ≥ 0.3). The construct validity was further supported by statistically significant hypothesised relationships between the ASCOT-SCT4 index and individual characteristics in univariate and multivariate analysis. There was also further evidence for the construct validity for the revised Food and drink and Dignity items. The test-retest reliability was considered to be good (ICC = 0.783; 95% CI: 0.678-0.857). The ASCOT-SCT4 index has good test-retest reliability for adults with physical or sensory disabilities who use social care services. The index score and the attributes appear to be valid for adults receiving social care for support reasons connected to underlying mental health problems, and physical or sensory disabilities. Further reliability testing with a wider sample of social care users is warranted, as is further exploration of the relationship between the ASCOT-SCT4, ICECAP-A/O and EQ-5D-3 L indices.

Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study.

PubMed

Rai, Minnie; Vigod, Simone N; Hensel, Jennifer M

2016-08-01

With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom. To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns. We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication. Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91% (62/68), and 59% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns including privacy and loss of in-person contact. A high burden of barriers to attending office-based care paired with a high interest in e-communication supports the integration of e-communication within our outpatient services. There may be early adopters to target: those with identified barriers to office-based care and who are active on social media. There is also a need for caution and preservation of existing services for those who choose not to, or cannot, access e-services.

Service users' views of the assessment process in stroke rehabilitation.

PubMed

Tyson, Sarah F; Burton, Louisa-Jane; McGovern, Alison; Sharifi, Sudi

2014-08-01

To investigate the service users' (stroke survivors and care-givers) experiences and views of the rehabilitation assessment process. Qualitative data analysis from three focus groups using a content analysis to identify the major themes. Participants were recruited from stroke support groups and community rehabilitation services in a large UK city. Seventeen community-dwelling stroke survivors who had completed their rehabilitation within the previous year and six care-givers. Five themes emerged: understanding the purpose of the assessment; repetition of assessments; feedback about assessments and progress; format of feedback and barriers to feedback. While all participants reported undergoing assessment, some felt their purpose was not always explained and resented unexplained repetitions of tests. Some participants reported a positive experience, but most wanted more information about their progress and predictions of recovery. They wanted regular, consistent, objective information presented in layman's terms; verbally and in writing. Some carers reported difficulty accessing information particularly as a result of confidentiality policies. While some participants accepted these short-comings, others considered them due to staff's disinterest or ineptitude, which undermined their trust in the team. Stroke service users require clear information about the purpose of assessments and regular, consistent, objective feedback about their progress using layman's language both verbally and in writing. © The Author(s) 2014.

An Open Architecture to Support Social and Health Services in a Smart TV Environment.

PubMed

Costa, Carlos Rivas; Anido-Rifon, Luis E; Fernandez-Iglesias, Manuel J

2017-03-01

To design, implement, and test a solution to provide social and health services for the elderly at home based on smart TV technologies and access to all services. The architecture proposed is based on an open software platform and standard personal computing hardware. This provides great flexibility to develop new applications over the underlying infrastructure or to integrate new devices, for instance to monitor a broad range of vital signs in those cases where home monitoring is required. An actual system as a proof-of-concept was designed, implemented, and deployed. Applications range from social network clients to vital signs monitoring; from interactive TV contests to conventional online care applications such as medication reminders or telemedicine. In both cases, the results have been very positive, confirming the initial perception of the TV as a convenient, easy-to-use technology to provide social and health care. The TV set is a much more familiar computing interface for most senior users, and as a consequence, smart TVs become a most convenient solution for the design and implementation of applications and services targeted to this user group. This proposal has been tested in real setting with 62 senior people at their homes. Users included both individuals with experience using computers and others reluctant to them.

Planning future care services: Analyses of investments in Norwegian municipalities.

PubMed

Hagen, Terje P; Tingvold, Laila

2018-06-01

To analyse whether the Norwegian Central Government's goal of subsidizing 12,000 places in nursing homes or sheltered housing using an earmarked grant was reached and to determine towards which group of users the planned investments were targeted. Data from the investment plans at municipal level were provided by the Norwegian Housing Bank and linked to variables describing the municipalities' financial situation as well as variables describing the local needs for services provided by Statistics Norway. Using regression analyses we estimated the associations between municipal characteristics and planned investments in total and by type of care place. The Norwegian Central Government reached its goal of giving subsidies to 12,000 new or rebuilt places in nursing homes and sheltered housing. A total of 54% of the subsidies (6878 places) were given to places in nursing homes. About 7500 places were available by the end of the planning period and the rest were under construction. About 50% of the places were planned for user groups aged <67 years and 23% of the places for users aged <25 years. One-third of the places were planned for users with intellectual disabilities. Investments in nursing homes were correlated with the share of the population older than 80 years and investments in sheltered houses were correlated with the share of users with intellectual disabilities. Earmarked grants to municipalities can be adequate measures to affect local resource allocation and thereby stimulate investments in future care. With the current institutional setup the municipalities adapt investments to local needs.

Experience with Health Coach-Mediated Physician Referral in an Employed Insured Population

PubMed Central

Rao, Sowmya R.; Rogers, Robert S.; Mailhot, Johanna R.; Galvin, Robert

2010-01-01

BACKGROUND Given increasing interest in helping consumers choose high-performing (higher quality, lower cost) physicians, one approach chosen by several large employers is to provide assistance in the form of a telephonic “health coach” — a registered nurse who assists with identifying appropriate and available providers. OBJECTIVE To evaluate the health coach’s influence on provider choice and the quality of the user experience in the early introduction of this service. DESIGN Cross-sectional survey of 3490 employees and covered dependents of a large national firm that offered health coach services to all employees and covered dependents. The survey began in September 2007 with proportionate stratified sampling of 1750 employees and covered dependents who used the services between October 2007 and February 2008, and 1740 non-users. PARTICIPANTS Insured adults (ages 21–64) employed by a large national firm or covered dependents of employees. MEASUREMENTS Awareness of the service, reason for using service, visits to providers recommended by service, use of health advice provided by service, user satisfaction. MAIN RESULTS The primary reason for using the service was to obtain provider referrals (73%). Fifty-two percent of users sought a specialist referral, 33% a PCP referral and 9% a hospital referral. Eighty-nine percent of users seeking a provider referral were referred in-network; 81% of those referred visited the referred provider. Measures of satisfaction with both the service and the care delivered by recommended providers were over 70%. CONCLUSIONS Customers largely follow the provider recommendation of the health coach. Users express general satisfaction with existing health coach services, but differences in performance between vendors highlight the need for the services to be well implemented. Electronic supplementary material The online version of this article (doi:10.1007/s11606-010-1428-4) contains supplementary material, which is available to authorized users. PMID:20556533

Factors shaping intersectoral action in primary health care services.

PubMed

Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael

2014-12-01

To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.

Infrastructure issues.

PubMed

Hagland, Mark

2010-03-01

CIOs must ensure the creation of a technology foundation underlying the implementation of new applications, in order to guarantee continuous computing and other essential characteristics of IT service for end-users, going forward. Focusing on the needs of end-users will be essential to creating that foundation. End-user expectations are already outstripping technological capabilities, putting pressure on CIOs to carefully balance the offering of highly desired applications with the creation of a strong tech foundation to undergird those apps.

What does quality maternity care mean in a context of medical pluralism? Perspectives of women in Nigeria

PubMed Central

Izugbara, Chimaraoke O; Wekesah, Frederick

2018-01-01

Abstract User priorities regarding quality care in contexts of medical pluralism are poorly documented. Drawing on group and individual interviews with women, we interrogate ideas of quality maternity care in the context of Nigeria’s medical pluralism. We found complex utilization patterns for conventional, complementary and alternative maternity care services as well as ideas of quality maternity care that stress effective coordination and integration of different typologies of maternity health services; socially sensitive and truthful providers; and socioeconomic, physical and parochial forms of safety. Informal providers were the commonly reported source of maternal health services in the study. Maternal health services in the country were also generally viewed as poor quality, characterized by pervasive abuse, quackery and lack of commitment to the needs and sensitivities of women. Convenience, availability and affordability of maternal health services, as well as sociocultural factors were major influences on women’s use of services. Results demonstrate the embeddedness of women’s quality of care notions in the vast socioeconomic inequities that typify Nigeria’s particular form of poorly regulated medical pluralism, raising need for strategies to strengthen the delivery, coordination and supervision of maternal health services in the country. PMID:29036530

Quality of care and the demand for health services in Bamako, Mali: the specific roles of structural, process, and outcome components.

PubMed

Mariko, Mamadou

2003-03-01

The public finance and foreign exchange crisis of the 1980s aggravated the unfavourable economic trends in many developing countries and resulted in budget cuts in the health sector. Policymakers, following the suggestions of World Bank experts, introduced user fees. Economic analysis of the demand for health care in these countries focused on the impact of price and income on health service utilisation. But the lesson to date from experiences in cost recovery is that without visible and fairly immediate improvements in the quality of care, the implementation of user fees will cause service utilisation to drop. For this reason, the role of quality of health care has been recently a subject of investigation in a number of health care demand studies. In spite of using the data from both households and facilities, recent studies are quite limited because they measure quality only by structural attributes (availability of drugs, equipment, number and qualifications of staff, and so on). Structural attributes of quality are necessary but not sufficient conditions for demand. A unique feature of this study is that it also considers the processes followed by practitioners and the outcome of care, to determine simultaneously the respective influence of price and quality on decision making. A nested multinomial logit was used to examine the choice between six alternatives (self-treatment, modern treatment at home, public hospital, public dispensary, for-profit facility and non-profit facility). The estimations are based on data from a statistically representative sample of 1104 patients from 1191 households and the data from a stratified random sample of 42 out of 84 facilities identified. The results indicate that omitting the process quality variables from the demand model produces a bias not only in the estimated coefficient of the "price" variable but also in coefficients of some structural attributes of the quality. The simulations suggest that price has a minor effect on utilisation of health services, and that health authorities can simultaneously double user fees and increase utilisation by emphasising improvement of both the structural and process quality of care in public health facilities.

Equity in health services use and intensity of use in Canada

PubMed Central

Asada, Yukiko; Kephart, George

2007-01-01

Background The Canadian health care system has striven to remove financial or other barriers to access to medically necessary health care services since the establishment of the Canada Health Act 20 years ago. Evidence has been conflicting as to what extent the Canadian health care system has met this goal of equitable access. The objective of this study was to examine whether and where socioeconomic inequities in health care utilization occur in Canada. Methods We used a nationally representative cross-sectional survey, the 2000/01 Canadian Community Health Survey, which provides a large sample size (about 110,000) and permits more comprehensive adjustment for need indicators than previous studies. We separately examined general practitioner, specialist, and hospital services using two-part hurdle models: use versus non-use by logistic regression, and the intensity of use among users by zero-truncated negative binomial regression. Results We found that lower income was associated with less contact with general practitioners, but among those who had contact, lower income and education were associated with greater intensity of use of general practitioners. Both lower income and education were associated with less contact with specialists, but there was no statistically significant relationship between these socioeconomic variables and intensity of specialist use among the users. Neither income nor education was statistically significantly associated with use or intensity of use of hospitals. Conclusion Our study unveiled possible socioeconomic inequities in the use of health care services in Canada. PMID:17349059

Shared decision making in Swedish community mental health services - an evaluation of three self-reporting instruments.

PubMed

Rosenberg, David; Schön, Ulla-Karin; Nyholm, Maria; Grim, Katarina; Svedberg, Petra

2017-04-01

Despite the potential impact of shared decision making on users satisfaction with care and quality in health care decisions, there is a lack of knowledge and skills regarding how to work with shared decision making among health care providers. The aim of this study was to evaluate the psychometric properties of three instruments that measure varied dimensions of shared decision making, based on self-reports by clients, in a Swedish community mental health context. The study sample consisted of 121 clients with experience of community mental health care, and involved in a wide range of decisions regarding both social support and treatment. The questionnaires were examined for face and content validity, internal consistency, test-retest reliability and construct validity. The instruments displayed good face and content validity, satisfactory internal consistency and a moderate to good level of stability in test-retest reliability with fair to moderate construct correlations, in a sample of clients with serious mental illness and experience of community mental health services in Sweden. The questionnaires are considered to be relevant to the decision making process, user-friendly and appropriate in a Swedish community mental health care context. They functioned well in settings where non-medical decisions, regarding social and support services, are the primary focus. The use of instruments that measure various dimensions of the self-reported experience of clients, can be a key factor in developing knowledge of how best to implement shared decision making in mental health services.

HIV Testing, Care, and Treatment Among Women Who Use Drugs From a Global Perspective: Progress and Challenges.

PubMed

Metsch, Lisa; Philbin, Morgan M; Parish, Carrigan; Shiu, Karen; Frimpong, Jemima A; Giang, Le Minh

2015-06-01

The article reviews data on HIV testing, treatment, and care outcomes for women who use drugs in 5 countries across 5 continents. We chose countries in which the HIV epidemic has, either currently or historically, been fueled by injection and non-injection drug use and that have considerable variation in social structural and drug policies: Argentina, Vietnam, Australia, Ukraine, and the United States. There is a dearth of available HIV care continuum outcome data [ie, testing, linkage, retention, antiretroviral therapy (ART) provision, viral suppression] among women drug users, particularly among noninjectors. Although some progress has been made in increasing HIV testing in this population, HIV-positive women drug users in 4 of the 5 countries have not fully benefitted from ART nor are they regularly engaged in HIV care. Issues such as the criminalization of drug users, HIV-specific criminal laws, and the lack of integration between substance use treatment and HIV primary care play a major role. Strategies that effectively address the pervasive factors that prevent women drug users from engaging in HIV care and benefitting from ART and other prevention services are critical. Future success in enhancing the HIV continuum for women drug users should consider structural and contextual level barriers and promote social, economic, and legal policies that overhaul the many years of discrimination and stigmatization faced by women drug users worldwide. Such efforts must emphasis the translation of policies into practice and approaches to implementation that can help HIV-infected women who use drugs engage at all points of the HIV care continuum.

Perceived effects of the economic recession on population mental health, well-being and provision of care by primary care users and professionals: a qualitative study protocol in Portugal.

PubMed

Antunes, Ana; Frasquilho, Diana; Cardoso, Graça; Pereira, Nádia; Silva, Manuela; Caldas-de-Almeida, José Miguel; Ferrão, João

2017-09-03

Economic recession periods can pose accentuated risks to population's mental health and well-being as well as additional threats to health systems. Users and health professionals are key stakeholders in care delivery; however, little attention has been given to their experiences of the crisis. This paper presents a qualitative study protocol to assess users' and health professionals' perceptions about the effects of the post-2008 economic recession on mental health and care delivery in the Lisbon Metropolitan Area, Portugal. The methodology to assess perceived effects of the economic recession by primary care users and professionals on population mental health, well-being and provision of care is presented. Focus groups with users and semistructured interviews with health professionals will be carried out in three primary healthcare units in Lisbon areas especially affected by the crisis. Thematic analysis of full-transcribed interviews will be conducted using an iterative and reflexive approach. The study protocol was approved by the Ethics Committee of NOVA Medical School, NOVA University of Lisbon. The findings will be useful for other researchers and policy-makers to develop and implement the assessment of prevailing experiences of users and health professionals on the effects of the economic recession on mental health and quality of care in primary health context, promoting their involvement and contribution to services responsiveness. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The EU-project United4Health: User-centred design of an information system for a Norwegian telemedicine service.

PubMed

Smaradottir, Berglind; Gerdes, Martin; Martinez, Santiago; Fensli, Rune

2016-10-01

Organizational changes of health care services in Norway brought to light a need for new clinical pathways. This study presents the design and evaluation of an information system for a new telemedicine service for chronic obstructive pulmonary disease patients after hospital discharge. A user-centred design approach was employed composed of a workshop with end-users, two user tests and a field trial. For data collection, qualitative methods such as observations, semi-structured interviews and a questionnaire were used. User workshop's outcome informed the implementation of the system initial prototype, evaluated by end-users in a usability laboratory. Several usability and functionality issues were identified and solved, such as the interface between the initial colour scheme and the triage colours. Iterative refinements were made and a second user evaluation showed that the main issues were solved. The responses to a questionnaire presented a high score of user satisfaction. In the final phase, a field trial showed satisfactory use of the system. This study showed how the target end-users groups were actively involved in identifying the needs, suggestions and preferences. These aspects were addressed in the development of an information system through a user-centred design process. The process efficiently enabled users to give feedback about design and functionality. Continuous refinement of the system was the key to full development and suitability for the telemedicine service. This research was a result of the international cooperation between partners within the project United4Health, a part of the Seventh Framework Programme for Research of the European Union. © The Author(s) 2015.

Caring for Consumers: Empowering the Individual.

ERIC Educational Resources Information Center

Earl, Martha

1998-01-01

Describes how the free-of-charge Consumer Health Information Service (CHIS) of the Preston Medical Library of the University of Tennessee Medical Center (Knoxville) helps answer the community's health care questions. Discusses challenges related to public policy, time factors, and information retrieval; a user satisfaction survey; and the role of…

Practice-driven evaluation of a multi-layered psychosocial care package for children in areas of armed conflict.

PubMed

Jordans, M J D; Komproe, I H; Tol, W A; Susanty, D; Vallipuram, A; Ntamatumba, P; Lasuba, A C; De Jong, J T V M

2011-06-01

Psychosocial and mental health service delivery frameworks for children in low-income countries are scarce. This paper presents a practice-driven evaluation of a multi-layered community-based care package in Burundi, Indonesia, Sri Lanka and Sudan, through a set of indicators; (a) perceived treatment gains; (b) treatment satisfaction; (c) therapist burden; (d) access to care; (e) care package costs. Across four settings (n = 29,292 children), beneficiaries reported high levels of client satisfaction and moderate post-treatment problem reductions. Service providers reported significant levels of distress related to service delivery. Cost analyses demonstrated mean cost per service user to vary from 3.46 to 17.32 depending on country and specification of costs. The results suggest a multi-layered psychosocial care package appears feasible and satisfactory in reaching out to substantial populations of distressed children through different levels of care. Future replication should address therapist burden, cost reductions to increase sustainability and increase evidence for treatment efficacy.

Attitudes to the public release of comparative information on the quality of general practice care: qualitative study.

PubMed

Marshall, Martin N; Hiscock, Julia; Sibbald, Bonnie

2002-11-30

To examine the attitudes of service users, general practitioners, and clinical governance leads based in primary care trusts to the public dissemination of comparative reports on quality of care in general practice, to guide the policy and practice of public disclosure of information in primary care. Qualitative focus group study using mock quality report cards as prompts for discussion. 12 focus groups held in an urban area in north west England and a semirural area in the south of England. 35 service users, 24 general practitioners, and 18 clinical governance leads. There was general support for the principle of publishing comparative information, but all three stakeholder groups expressed concerns about the practical implications. Attitudes were strongly influenced by experience of comparative reports from other sectors-for example, school league tables. Service users distrusted what they saw as the political motivation driving the initiative, expressed a desire to "protect" their practices from political and managerial interference, and were uneasy about practices being encouraged to compete against each other. General practitioners focused on the unfairness of drawing comparisons from current data and the risks of "gaming" the results. Clinical governance leads thought that public disclosure would damage their developmental approach to implementing clinical governance. The initial negative response to the quality reports seemed to diminish on reflection. Despite support for the principle of greater openness, the planned publication of information about quality of care in general practice is likely to face considerable opposition, not only from professional groups but also from the public. A greater understanding of the practical implications of public reporting is required before the potential benefits can be realised.

Where Should People with Dementia Live? Using the Views of Service Users to Inform Models of Care

ERIC Educational Resources Information Center

Forbat, Liz; Wilkinson, Heather

2008-01-01

This paper reports on research that illuminates how people with a learning disability understand dementia and indicates the implications of these understandings for developing appropriate models of care. As this new policy and practice area struggles to provide appropriate and effective models of care for people with a learning disability and…

[Innovation in the organization of health services delivery within the Metropolitan System of Solidarity in Peru].

PubMed

Arroyo, Juan; Pastor-Goyzueta, Ada

2013-06-01

Based on the results achieved to date by the Metropolitan System of Solidarity (SISOL) in Peru, this study undertook to analyze the extent to which SISOL has contributed to innovation in the organization of health services delivery. SISOL performance indicators were analyzed and compared with those of other health services delivery models in Peru, drawing on data from a survey of 4 570 SISOL users conducted in the last quarter of 2011, National Household Surveys from 2003 through 2011, and statistical data from the Peruvian Ministry of Health and Social Security. SISOL rated high in terms of growth of the demand served in Lima, productivity of human resources in office visits, and levels of user satisfaction. These results are attributed to: (a) the presence of specialists at the first level of care; (b) an innovative public-private structure, as opposed to outsourcing; and (c) a system of incentives based on shared risk management. The findings support the need for primary health care renewal, especially in urban areas to reduce the proliferation of unnecessary levels and sublevels of care. They also point to the possibility of developing synergistic public-private partnerships in which both sectors share risks and act in collaboration within a single service system. And finally, they indicate that primary care needs to be articulated into the segmented models.

Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis.

PubMed

Barnard, Sharmani; Free, Caroline; Bakolis, Ioannis; Turner, Katy M E; Looker, Katharine J; Baraitser, Paula

2018-02-07

Online services for self-sampling at home could improve access to STI testing; however, little is known about those using this new modality of care. This study describes the characteristics of users of online services and compares them with users of clinic services. We conducted a cross-sectional analysis of routinely collected data on STI testing activity from online and clinic sexual health services in Lambeth and Southwark between 1January 2016 and 31March 2016. Activity was included for chlamydia, gonorrhoea, HIV and syphilis testing for residents of the boroughs aged 16 years and older. Logistic regression models were used to explore potential associations between type of service use with age group, gender, ethnic group, sexual orientation, positivity and Index of Multiple Deprivation (IMD) quintiles. We used the same methods to explore potential associations between return of complete samples for testing with age group, gender, ethnic group, sexual orientation and IMD quintiles among online users. 6456 STI tests were carried out by residents in the boroughs. Of these, 3582 (55.5%) were performed using clinic services and 2874 (44.5%) using the online service. In multivariate analysis, online users were more likely than clinic users to be aged between 20 and 30 years, female, white British, homosexual or bisexual, test negative for chlamydia or gonorrhoea and live in less deprived areas. Of the individuals that ordered a kit from the online service, 72.5% returned sufficient samples. In multivariate analysis, returners were more likely than non-returners to be aged >20 years and white British. Nearly half (44.5%) of all basic STI testing was done online, although the characteristics of users of clinic and online services differed and positivity rates for those using the online service for testing were lower. Clinics remain an important point of access for some groups. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Perspectives on quality of care for people who experience disability.

PubMed

Fadyl, Joanna K; McPherson, Kathryn M; Kayes, Nicola M

2011-01-01

Quality of care is considered to be of central importance in healthcare, disability services and rehabilitation. People experiencing disability often access a range of health and social care services; for some, these services are integral parts of daily life. Little research has explored perspectives of disabled people regarding what constitutes good quality care. This qualitative study aimed to explore and synthesise these perspectives to build a better picture of what constitutes good-quality care for disabled people in New Zealand. Qualitative focus groups and interviews were conducted with a range of participants including people with physical, sensory and/or intellectual impairment; informal and formal carers; and health and social care professionals. Data analysis used constant comparison methods as described in Strauss and Corbin (1998) to determine the factors of most importance and how they contributed to quality of care in health and social care services from the perspectives of people who use these services. Thirty-one participants took part, representing a range of ages and disabilities. Three main themes identified from data analysis were: (1) technical competence of care service and professionals; (2) a 'human' approach to service provision; and (3) context-appropriate response to needs. Findings offer a service-user perspective on what makes a difference to quality of care for people experiencing disability. They suggest that to provide context-appropriate care which addresses individual needs, the right mix of technical competence and a 'human' approach to care is needed. The mix required for the 'right' balance may depend on the type of service.

The impact of user fees on access to health services in low- and middle-income countries.

PubMed

Lagarde, Mylene; Palmer, Natasha

2011-04-13

Following an international push for financing reforms, many low- and middle-income countries introduced user fees to raise additional revenue for health systems. User fees are charges levied at the point of use and are supposed to help reduce 'frivolous' consumption of health services, increase quality of services available and, as a result, increase utilisation of services. To assess the effectiveness of introducing, removing or changing user fees to improve access to care in low-and middle-income countries We searched 25 international databases, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group's Trials Register, CENTRAL, MEDLINE and EMBASE. We also searched the websites and online resources of international agencies, organisations and universities to find relevant grey literature. We conducted the original searches between November 2005 and April 2006 and the updated search in CENTRAL (DVD-ROM 2011, Issue 1); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (January 25, 2011); MEDLINE, Ovid (1948 to January Week 2 2011); EMBASE, Ovid (1980 to 2011 Week 03) and EconLit, CSA Illumina (1969 - present) on the 26th of January 2011. We included randomised controlled trials, interrupted time-series studies and controlled before-and-after studies that reported an objective measure of at least one of the following outcomes: healthcare utilisation, health expenditures, or health outcomes. We re-analysed studies with longitudinal data. We computed price elasticities of demand for health services in controlled before-and-after studies as a standardised measure. Due to the diversity of contexts and outcome measures, we did not perform meta-analysis. Instead, we undertook a narrative summary of evidence. We included 16 studies out of the 243 identified. Most of the included studies showed methodological weaknesses that hamper the strength and reliability of their findings. When fees were introduced or increased, we found the use of health services decreased significantly in most studies. Two studies found increases in health service use when quality improvements were introduced at the same time as user fees. However, these studies have a high risk of bias. We found no evidence of effects on health outcomes or health expenditure. The review suggests that reducing or removing user fees increases the utilisation of certain healthcare services. However, emerging evidence suggests that such a change may have unintended consequences on utilisation of preventive services and service quality. The review also found that introducing or increasing fees can have a negative impact on health services utilisation, although some evidence suggests that when implemented with quality improvements these interventions could be beneficial. Most of the included studies suffered from important methodological weaknesses. More rigorous research is needed to inform debates on the desirability and effects of user fees.

Health, function and disability in stroke patients in the community

PubMed Central

Carvalho-Pinto, Bárbara P. B.; Faria, Christina D. C. M.

2016-01-01

ABSTRACT Background Stroke patients commonly have impairments associated with reduction in functionality. Among these impairments, the motor impairments are the most prevalent. The functional profile of these patients living in the community who are users of the primary health-care services in Brazil has not yet been established Objective To describe the functional profile of stroke patients who are users of the primary health-care services in Brazil, looking at one health-care unit in the city of Belo Horizonte, Brazil. Method From medical records and home visits, data were collected regarding health status, assistance received following the stroke, personal and environmental contextual factors, function and disability, organized according to the conceptual framework of the International Classification of Functioning, Disability and Health (ICF). Test and instruments commonly applied in the assessment of stroke patients were used. Results Demographic data from all stroke patients who were users of the health-care unit (n=44, age: 69.23±13.12 years and 67±66.52 months since the stroke) participated of this study. Most subjects presented with disabilities, as changes in emotional function, muscle strength, and mobility, risks of falling during functional activities, negative self-perception of quality of life, and perception of the environment factors were perceived as obstacles. The majority of the patients used the health-care unit to renew drug prescriptions, and did not receive any information on stroke from health professionals, even though patients believed it was important for patients to receive information and to provide clarifications. Conclusion Stroke patients who used primary health-care services in Brazil have chronic disabilities and health needs that require continuous health attention from rehabilitation professionals. All of these health needs should be considered by health professionals to provide better management as part of the integral care of stroke patients, as recommended by the clinical practice guidelines for stroke rehabilitation. PMID:27556392

[City Academy: a health promotion service in the healthcare network of the Unified Health System].

PubMed

Costa, Bruna Vieira de Lima; Mendonça, Raquel de Deus; Santos, Luana Caroline Dos; Peixoto, Sérgio Viana; Alves, Marília; Lopes, Aline Cristine Souza

2013-01-01

This is an analysis of the health and nutritional profile of users of the Unified Health System admitted to a City Academy in Belo Horizonte, Minas Gerais during a triennium. It is a cross-sectional study with users> 20 years and socio-demographic characteristics, health habits, food intake and anthropometrics were gathered. Kolmogorov-Smirnov tests, ANOVA, Kruskal-Wallis test, chi-square and Fisher exact test were applied. There was a high prevalence of hypertensive subjects (41.6%), overweight (70.6%) and metabolic risks associated with obesity (67.6%). About 40% of entrants had 1-3 chronic diseases and over 65% used medication daily. There was an imbalance in daily consumption of fruits and vegetables (75.3%), fatty meat (72.4%) and sweetened drinks (54.2%). They had low education and income, and inadequate eating habits and high prevalence of hypertension, overweight and metabolic risks associated with obesity, which suggests users seeking health care services for treatment of diseases. This illustrates the perceived quest for cure, further demonstrating the lack of healthcare initiatives in the population. This reveals the need to review the actions at different levels of health care, to promote greater comprehensiveness of care provided.

Clinical audit TV.

PubMed

2010-09-02

The Clinical Audit Support Centre supports audit projects that improve patient care and enhance service delivery. Its staff work with healthcare and other professionals to deliver practical and user-friendly, quality-improvement materials.

Measuring patient trust in telemedicine services: Development of a survey instrument and its validation for an anticoagulation web-service.

PubMed

Velsen, Lex van; Tabak, Monique; Hermens, Hermie

2017-01-01

For many eServices, end-user trust is a crucial prerequisite for use. For the telemedicine context however, knowledge about the coming about and measurement of end-user trust is scarce. To develop and validate the PAtient Trust Assessment Tool (PATAT): a survey instrument to quantitatively assess patient trust in a telemedicine service. Informed by focus groups, we developed a survey that includes measurement scales for the following factors: trust in the care organization, care professional, treatment, and technology, as well as a scale that assesses a holistic view on trust in the telemedicine service. The survey was completed by 795 patients that use a telemedicine application to manage their anticoagulation treatment. Data were analyzed by means of Partial Least Squares Structural Equation Modeling (PLS-SEM). The measurement model yielded good to excellent quality measures, after the removal of one item. The causal model resulted in high explained variance (R 2 =0.68). Trust in healthcare professionals and the treatment had a small effect on overall trust, while trust in the technology displayed a large effect. Trust in the care organization did not result in a significant effect on overall trust. The PATAT is a valid means to assess patient trust in a telemedicine service and can be used to benchmark such a service or to elicit redesign input. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Barriers and enablers to integrating maternal and child health services to antenatal care in low and middle income countries.

PubMed

de Jongh, T E; Gurol-Urganci, I; Allen, E; Jiayue Zhu, N; Atun, R

2016-03-01

Antenatal care (ANC) represents a delivery platform for a broad range of health services; however, these opportunities are insufficiently utilised. This review explores key barriers and enablers for successful integration of health s"ervices with ANC in different contexts. Data from peer-reviewed and grey literature were organised using the SURE checklist. We identified 46 reports focusing on integration of HIV, tuberculosis, malaria, syphilis or nutrition services with ANC from Asia, Africa and the Pacific. Perspectives of service users and providers, social and political factors, and health system characteristics (such as resource availability and organisational structures) affected ease of integration. Health system factors, context and stakeholders must be considered for integrated antenatal care services. © 2016 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

Perceived effects of the economic recession on population mental health, well-being and provision of care by primary care users and professionals: a qualitative study protocol in Portugal

PubMed Central

Frasquilho, Diana; Cardoso, Graça; Pereira, Nádia; Silva, Manuela; Caldas-de-Almeida, José Miguel; Ferrão, João

2017-01-01

Introduction Economic recession periods can pose accentuated risks to population’s mental health and well-being as well as additional threats to health systems. Users and health professionals are key stakeholders in care delivery; however, little attention has been given to their experiences of the crisis. This paper presents a qualitative study protocol to assess users’ and health professionals’ perceptions about the effects of the post-2008 economic recession on mental health and care delivery in the Lisbon Metropolitan Area, Portugal. Methods and analysis The methodology to assess perceived effects of the economic recession by primary care users and professionals on population mental health, well-being and provision of care is presented. Focus groups with users and semistructured interviews with health professionals will be carried out in three primary healthcare units in Lisbon areas especially affected by the crisis. Thematic analysis of full-transcribed interviews will be conducted using an iterative and reflexive approach. Ethics and dissemination The study protocol was approved by the Ethics Committee of NOVA Medical School, NOVA University of Lisbon. The findings will be useful for other researchers and policy-makers to develop and implement the assessment of prevailing experiences of users and health professionals on the effects of the economic recession on mental health and quality of care in primary health context, promoting their involvement and contribution to services responsiveness. PMID:28871022

Factors affecting success of an integrated community-based telehealth system.

PubMed

Hsieh, Hui-Lung; Tsai, Chung-Hung; Chih, Wen-Hai; Lin, Huei-Hsieh

2015-01-01

The rise of chronic and degenerative diseases in developed countries has become one critical epidemiologic issue. Telehealth can provide one viable way to enhance health care, public health, and health education delivery and support. The study aims to empirically examine and evaluate the success factors of community-based telehealth system adoption. The valid 336 respondents are the residents of a rural community in Taiwan. The structural equation modeling (SEM) was used to assess the proposed model applied to telehealth. The findings showed the research model had good explanatory power and fitness. Also, the findings indicated that system quality exerted the strongest overall effect on intention to use. Furthermore, service quality exerted the strongest overall effect on user satisfaction. The findings also illustrated that the joint effects of three intrinsic qualities (system quality, information quality, and service quality) on use were mediated by user satisfaction and intention to use. The study implies that community-based telehealth service providers should improve three intrinsic qualities to enhance user satisfaction and intention to use, which in turn can lead to increase the usage of the telehealth equipment. The integrated community-based telehealth system may become an innovative and suitable way to deliver better care to the residents of communities.

["I am nuts, but networking": the qualification process for peer support work with mental health users in the psychosocial care network of Rio de Janeiro].

PubMed

Magalhães Dahl, Catarina; de Araújo Carvalho, Maria C; Moscoso Teixeira de Mendonça, Joana; Mitkiewicz de Souza, Flávia; Wainstok Estivil Bustos, Mayra; Fernandes de Cintra Santos, Jacqueline; Marcos Lovisi, Giovani; Tavares Cavalcanti, Maria

2013-01-01

Peer support work has been increasingly incorporated by community services network in the context of mental health care paradigm shift; however, it is a relatively new device in Latin America. In this article, we will describe the qualification process of peer support workers for implementing a psychosocial intervention in the city of Rio de Janeiro. We use the following methodological strategies based on a narrative, participative and dialogical perspective: focus groups, knowledge transmission through a short course; visits to mental health services and field reports. We used a narrative analysis, building the following thematic categories: experience of the recovery process; what helps and what hinders in the recovery process; the role of the family; the role of community mental health services; prejudice among society and family members; the role of peer support work; challenges. From the users' perspective, recovery is tied to ups and downs and family can either help or disturb this process. Prejudice constitutes the main barrier for recovery. To have a social role and participating in training activities facilitate recovery. Users pointed out that it is necessary to have professional support for peer support work.

Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: a comprehensive approach.

PubMed

Birkhead, Guthrie S; Klein, Susan J; Candelas, Alma R; O'Connell, Daniel A; Rothman, Jeffrey R; Feldman, Ira S; Tsui, Dennis S; Cotroneo, Richard A; Flanigan, Colleen A

2007-10-01

New York State is home to an estimated 230,000 individuals chronically infected with hepatitis C virus (HCV) and roughly 171,500 active injection drug users (IDUs). HCV/HIV co-infection is common and models of service delivery that effectively meet IDUs' needs are required. A HCV strategic plan has stressed integration. HCV prevention and care are integrated within health and human service settings, including HIV/AIDS organisations and drug treatment programmes. Other measures that support comprehensive HCV services for IDUs include reimbursement, clinical guidelines, training and HCV prevention education. Community and provider collaborations inform programme and policy development. IDUs access 5 million syringes annually through harm reduction/syringe exchange programmes (SEPs) and a statewide syringe access programme. Declines in HCV prevalence amongst IDUs in New York City coincided with improved syringe availability. New models of care successfully link IDUs at SEPs and in drug treatment to health care. Over 7000 Medicaid recipients with HCV/HIV co-infection had health care encounters related to their HCV in a 12-month period and 10,547 claims for HCV-related medications were paid. The success rate of transitional case management referrals to drug treatment is over 90%. Training and clinical guidelines promote provider knowledge about HCV and contribute to quality HCV care for IDUs. Chart reviews of 2570 patients with HIV in 2004 documented HCV status 97.4% of the time, overall, in various settings. New HCV surveillance systems are operational. Despite this progress, significant challenges remain. A comprehensive, public health approach, using multiple strategies across systems and mobilizing multiple sectors, can enhance IDUs access to HCV prevention and care. A holisitic approach with integrated services, including for HCV-HIV co-infected IDUs is needed. Leadership, collaboration and resources are essential.

Cost-effectiveness of intensive psychiatric community care for high users of inpatient services.

PubMed

Rosenheck, R A; Neale, M S

1998-05-01

This 2-year experimental study evaluated the effectiveness and cost of 10 intensive psychiatric community care (IPCC) programs at Department of Veterans Affairs medical centers in the northeastern United States. High users of inpatient services were randomly assigned to either IPCC or standard Department of Veterans Affairs care at 6 general medical and surgical hospitals (n=271 vs 257) and 4 neuropsychiatric hospitals (n=183 vs 162). Patient interviews every 6 months and national computerized data were used to assess clinical outcomes, health service use, health care costs, and non-health care costs. There was only 1 significant clinical difference between groups across follow-up periods: IPCC patients at general medical and surgical sites had higher community living skills. However, at the final interview, IPCC patients at general medical and surgical sites showed significantly lower symptoms, higher functioning, and greater satisfaction with services. Treatment with IPCC significantly reduced hospital use only at neuropsychiatric sites (320 vs 513 days, P<.001). Total societal costs, including the cost of IPCC, were lower for IPCC at neuropsychiatric sites ($82,454 vs $116,651, P<.001), but greater at general medical and surgical sites ($51,537 vs $46,491, P<.01). When 2 sites that incompletely implemented the model were dropped from the analysis, costs at general medical and surgical sites were $38 lower for IPCC (P=.26). At acute care hospitals, IPCC treatment is associated with greater long-term clinical improvement and, when fully implemented, is cost-neutral. At long-stay hospitals treating older, less-functional patients, it is not associated with clinical or functional improvement but generates substantial cost savings. Intensive psychiatric community care thus has beneficial, but somewhat different, outcome profiles at different types of hospitals.