51
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Malathesh BC, Bairy BK, Kumar CN, Nirisha PL, Gajera GV, Pandey P, Manjunatha N, Ganesh A, Mehrotra K, Bhaskarapillai B, Gunasekaran DM, Arora S, Sinha NK, Math SB. Impact Evaluation of Technology Driven Mental Health Capacity Building in Bihar, India. Psychiatr Q 2021; 92:1855-1866. [PMID: 34510379 DOI: 10.1007/s11126-021-09945-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
Task-shifting is an important means to address the barrier of inadequate specialist human resources for mental health in countries such as India. This paper aims to report the impact of one such task-shifting initiative. Twenty-two non-specialist Medical Officers of Bihar, an eastern Indian state were engaged in a ten-month long hybrid (a 15-days onsite orientation to psychiatry and periodic online mentoring in primary care psychiatry) training program to enable them to identify commonly presenting psychiatric disorders in their respective clinics. 20 online sessions (hub and spoke ECHO model) occurred over the next 10 months. Apart from didactic topics, 75 cases covering severe mental disorders, common mental disorders and substance use disorders were discussed (case presentations by the primary care doctors (PCDs)) and moderated by a specialist psychiatrist and clinical psychologist). 12 successive self-reported monthly reports (comprising of the number and nature of psychiatric cases seen by the trainee PCDs) were analyzed. The mean (SD) number of sessions attended was 9 (8.0) and median was 13 (Range: 0-20). Mean number of cases (per PCD) discussed was 3.4 (3.4) (Median: 4; Range: 0-10). Total 20,909 patients were cared for in the 12 months after initiation of the training program. Increasingly, a greater number of patients were cared for as the training progressed. This pattern was mainly driven by more identifications of severe mental disorders (SMDs), common mental disorders (CMDs), dementias and substance use disorders. Mean (SD) number of patients seen per month before and after training was 1340.33 (86.73) and 1876.44 (236.51) (t = - 3.5, p < 0.05) respectively. A hybrid model of training PCDs is feasible and can be effective in identification of persons with psychiatric disorders in the community. Prospective, well designed studies are essential to demonstrate the effectiveness of this model.
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Affiliation(s)
| | - Bhavya K Bairy
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - P Lakshmi Nirisha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopi V Gajera
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Praveen Pandey
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Aurobind Ganesh
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kanika Mehrotra
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Durai Murukan Gunasekaran
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sanjeev Arora
- Distinguished Professor of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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52
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Perceptions of Patients’ Alcohol Use and Related Problems Among Primary Care Professionals in Rio de Janeiro. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00648-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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O'Dell SM, Fisher HR, Schlieder V, Klinger T, Kininger RL, Cosottile M, Cummings S, DeHart K. Engaging Parents and Health Care Stakeholders to Inform Development of a Behavioral Intervention Technology to Promote Pediatric Behavioral Health: Mixed Methods Study. JMIR Pediatr Parent 2021; 4:e27551. [PMID: 34609324 PMCID: PMC8527378 DOI: 10.2196/27551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/01/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite effective psychosocial interventions, gaps in access to care persist for youth and families in need. Behavioral intervention technologies (BITs) that apply psychosocial intervention strategies using technological features represent a modality for targeted prevention that is promising for the transformation of primary care behavioral health by empowering parents to take charge of the behavioral health care of their children. To realize the potential of BITs for parents, research is needed to understand the status quo of parental self-help and parent-provider collaboration to address behavioral health challenges and unmet parental needs that could be addressed by BITs. OBJECTIVE The aim of this study is to conduct foundational research with parents and health care stakeholders (HCS) to discover current practices and unmet needs related to common behavioral health challenges to inform the design, build, and testing of BITs to address these care gaps within a predominantly rural health system. METHODS We conducted a convergent mixed-parallel study within a large, predominantly rural health system in which the BITs will be developed and implemented. We analyzed data from parent surveys (N=385) on current practices and preferences related to behavioral health topics to be addressed in BITs along with focus group data of 48 HCS in 9 clinics regarding internal and external contextual factors contributing to unmet parental needs and current practices. By comparing and relating the findings, we formed interpretations that will inform subsequent BIT development activities. RESULTS Parents frequently endorsed several behavioral health topics, and several topics were relatively more or less frequently endorsed based on the child's age. The HCS suggested that BITs may connect families with evidence-based guidance sooner and indicated that a web-based platform aligns with how parents already seek behavioral health guidance. Areas of divergence between parents and HCS were related to internalizing problems and cross-cutting issues such as parenting stress, which may be more difficult for health care HCS to detect or address because of the time constraints of routine medical visits. CONCLUSIONS These findings provide a rich understanding of the complexity involved in meeting parents' needs for behavioral health guidance in a primary care setting using BITs. User testing studies for BIT prototypes are needed to successfully design, build, and test effective BITs to empower parents to take charge of promoting the behavioral health of their children.
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Affiliation(s)
- Sean M O'Dell
- Department of Psychiatry and Behavioral Health, Geisinger, Danville, PA, United States
- Department of Population Health Sciences, Geisinger, Danville, PA, United States
| | - Heidi R Fisher
- Autism and Developmental Medicine Institute, Geisinger, Lewisburg, PA, United States
| | - Victoria Schlieder
- Investigator Initiated Research Operations, Geisinger, Danville, PA, United States
| | - Tracey Klinger
- Investigator Initiated Research Operations, Geisinger, Danville, PA, United States
| | - Rachel L Kininger
- Department of Psychiatry and Behavioral Health, Geisinger, Danville, PA, United States
| | - McKenna Cosottile
- Department of Psychiatry and Behavioral Health, Geisinger, Danville, PA, United States
| | - Stacey Cummings
- Department of Pediatrics, Geisinger, Danville, PA, United States
| | - Kathy DeHart
- Department of Pediatrics, Geisinger, Danville, PA, United States
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Kamalapathy P, Kurker KP, Althoff AD, Browne JA, Werner BC. The Impact of Mental Illness on Postoperative Adverse Outcomes After Outpatient Joint Surgery. J Arthroplasty 2021; 36:2734-2741. [PMID: 33896669 DOI: 10.1016/j.arth.2021.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/15/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The effect of pre-existing mental illness on outpatient surgical outcomes is not well characterized. The objective of this study was to evaluate the association between pre-existing mental illness diagnosis and postoperative complications after outpatient total knee (TKA) and total hip arthroplasty (THA) and 2) compare with inpatient total joint arthroplasty (TJA). METHODS The Mariner Claims Database was used to capture patients undergoing outpatient TJA from 2010 to 2017. Patients were grouped into three categories: those with an existing history of anxiety and/or depression, those with severe mental illness, and those without history of mental illness. Additional subgroup analysis compared those with severe mental illness undergoing outpatient vs inpatient TJA. Outcomes were analyzed using multivariable logistic regression (P < .05). RESULTS Patients undergoing outpatient TJA with prior history of anxiety and/or depression or severe mental illness had an increased risk of emergency department (ED) visits (TKA, P < .001; THA, P = .014) within 90 days compared with those without history of mental illness. Severe mental illness was also associated with increased risk of medical complications at 90 days (TKA, P < .001; THA, P = .006). When compared with those undergoing inpatient surgery, patients undergoing outpatient TKA with severe mental illness were at increased risk of periprosthetic infection (P = .005) and ED visit (P = .003) within 90 days of surgery. CONCLUSION Anxiety/depression and severe mental illness are associated with higher rates of ED visits after outpatient TJA. Patients with severe mental illness also experienced more adverse events, whereas those with anxiety and/or depression had similar rates compared with control. A higher rate of adverse outcomes was seen after TKA in patients with severe mental illness when surgery was performed in the outpatient setting vs those that had surgery as an inpatient. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Kristina P Kurker
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Alyssa D Althoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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55
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Fabian KE, Muanido A, Cumbe VFJ, Manaca N, Hicks L, Weiner BJ, Sherr K, Wagenaar BH. Optimizing treatment cascades for mental healthcare in Mozambique: preliminary effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH). Health Policy Plan 2021; 35:1354-1363. [PMID: 33221835 DOI: 10.1093/heapol/czaa114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 11/13/2022] Open
Abstract
Substantial investments are being made to scale-up access to mental healthcare in low- and middle-income countries, but less attention has been paid to quality and performance of nascent public-sector mental healthcare systems. This study tested the initial effectiveness of an implementation strategy to optimize routine outpatient mental healthcare cascade performance in Mozambique [the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH)]. This study employed a pre-post design from September 2018 to August 2019 across four Ministry of Health clinics among 810 patients and 3234 outpatient mental health visits. Effectiveness outcomes evaluated progression through the care cascade, including: (1) initial diagnosis and medication selection; (2) enrolling in follow-up care; (3) returning after initial consultation within 60 days; (4) returning for follow-up visits on time; (5) returning for follow-up visits adherent to medication and (6) achieving function improvement. Clustered generalized linear models evaluated odds of completing cascade steps pre- vs post-intervention. Facilities prioritized improvements focused on the follow-up cascade, with 62.5% (10 of 16) monthly system modifications targeting medication adherence. At baseline, only 4.2% of patient visits achieved function improvement; during the 6 months of SAIA-MH implementation, this improved to 13.1% of patient visits. Multilevel logistic regression found increased odds of returning on time and adherent [aOR = 1.53, 95% CI (1.21, 1.94), P = 0.0004] and returning on time, adherent and with function improvement [aOR = 3.68, 95% CI (2.57, 5.44), P < 0.0001] after SAIA-MH implementation. No significant differences were observed regarding other cascade steps. The SAIA-MH implementation strategy shows promise for rapidly and significantly improving mental healthcare cascade outcomes, including the ultimate goal of patient function improvement. Given poor baseline mental healthcare cascade performance, there is an urgent need for evidence-based implementation strategies to optimize the performance of mental healthcare cascades in low- and middle-income countries.
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Affiliation(s)
- Katrin E Fabian
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Vasco F J Cumbe
- Sofala Provincial Health Directorate, Department of Mental Health, Ministry of Health, Beira, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Mozambique
| | - Nelia Manaca
- Health Alliance International, Beira, Mozambique
| | | | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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Sampaio ML, Bispo Júnior JP. Towards comprehensive mental health care: experiences and challenges of psychosocial care in Brazil. BMC Public Health 2021; 21:1352. [PMID: 34238266 PMCID: PMC8268580 DOI: 10.1186/s12889-021-11397-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Recommendations are in place for mental health (MH) care to be developed into a comprehensive, people-centred perspective and organised primarily through community services. In recent decades, Brazil has promoted psychiatric reform aimed at transforming the hospital-centred model into a psychosocial model of MH. However, current political and economic changes threaten this reform. This article analyses the comprehensive MH care offered by a Psychosocial Care Network (Rede de Atenção Psicossocial – RAPS) in Brazil. Methods The study involved semi-structured in-depth interviews with 33 stakeholders (policymakers, health professionals, and MH service users) and direct observation of MH services members of the RAPS. Data were analysed using framework analysis with the following dimensions: mental health services access, long-term mental health care, comprehensive mental health care, and crisis patient care. Results Results indicated progression towards comprehensive MH care provision. We identified MH care provided primarily by community services, featuring an ‘open door’ policy, development of localised actions and a search for autonomy. Deinstitutionalisation principles and the psychosocial model support a comprehensive view of MH by policy makers, MH professionals, and users. However, difficulties in providing comprehensive care remain, with the main challenges being insufficient services offered and difficulties in user access at all levels of care, fragile integration between services, lack of clear definitions of the responsibilities of each service, discontinuity of care, limitations in family support, and fragility in crisis patient care. Conclusion We highlight the need to increase funding and services of RAPS, qualification of staff professional, family support, and development of strategies for integrating services. Support and expansion of MH care depend on strengthening the Brazilian health system, which is in danger of being dismantled. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11397-1.
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Affiliation(s)
- Mariá Lanzotti Sampaio
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - José Patrício Bispo Júnior
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil.
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57
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Siqueira M, Coube M, Millett C, Rocha R, Hone T. The impacts of health systems financing fragmentation in low- and middle-income countries: a systematic review protocol. Syst Rev 2021; 10:164. [PMID: 34078460 PMCID: PMC8170990 DOI: 10.1186/s13643-021-01714-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/19/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Health systems are often fragmented in low- and middle-income countries (LMICs). This can increase inefficiencies and restrict progress towards universal health coverage. The objective of the systematic review described in this protocol will be to evaluate and synthesize the evidence concerning the impacts of health systems financing fragmentation in LMICs. METHODS Literature searches will be conducted in multiple electronic databases, from their inception onwards, including MEDLINE, EMBASE, LILACS, CINAHL, Scopus, ScienceDirect, Scielo, Cochrane Library, EconLit, and JSTOR. Gray literature will be also targeted through searching OpenSIGLE, Google Scholar, and institutional websites (e.g., HMIC, The World Bank, WHO, PAHO, OECD). The search strings will include keywords related to LMICs, health system financing fragmentation, and health system goals. Experimental, quasi-experimental, and observational studies conducted in LMICs and examining health financing fragmentation across any relevant metric (e.g., the presence of different health funders/insurers, risk pooling mechanisms, eligibility categories, benefits packages, premiums) will be included. Studies will be eligible if they compare financing fragmentation in alternative settings or at least two-time points. The primary outcomes will be health system-related goals such as health outcomes (e.g., mortality, morbidity, patient-reported outcome measures) and indicators of access, services utilization, equity, and financial risk protection. Additional outcomes will include intermediate health system objectives (e.g., indicators of efficiency and quality). Two reviewers will independently screen all citations, abstract data, and full-text articles. Potential conflicts will be resolved through discussion and, when necessary, resolved by a third reviewer. The methodological quality (or risk of bias) of selected studies will be appraised using established checklists. Data extraction categories will include the studies' objective and design, the fragmentation measurement and domains, and health outcomes linked to the fragmentation. A narrative synthesis will be used to describe the results and characteristics of all included studies and to explore relationships and findings both within and between the studies. DISCUSSION Evidence on the impacts of health system fragmentation in LMICs is key for identifying evidence gaps and priority areas for intervention. This knowledge will be valuable to health system policymakers aiming to strengthen health systems in LMICs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020201467.
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Affiliation(s)
- Marina Siqueira
- Institute for Health Policy Studies, IEPS, Itapeva St 286, Conjunto 81-84, Bela Vista, São Paulo, SP, 01332-000, Brazil.
| | - Maíra Coube
- Institute for Health Policy Studies, IEPS, Itapeva St 286, Conjunto 81-84, Bela Vista, São Paulo, SP, 01332-000, Brazil
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
| | - Rudi Rocha
- Institute for Health Policy Studies, IEPS, Itapeva St 286, Conjunto 81-84, Bela Vista, São Paulo, SP, 01332-000, Brazil
| | - Thomas Hone
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
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Petts RA, Gaynor ST. Behavioral Health in Primary Care: Brief Screening and Intervention Strategies for Pediatric Clinicians. Pediatr Clin North Am 2021; 68:583-606. [PMID: 34044987 DOI: 10.1016/j.pcl.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite the high prevalence of behavioral health concerns presenting in pediatric primary care and the growing support for integrating behavioral health services into this setting, a majority of primary care providers do not have access to on-site behavioral health specialists. Fortunately, primary care providers can implement some services typically provided by behavioral health clinicians. This article outlines screening, brief intervention, and referral guidelines for prominent behavioral health problems seen in primary care. The evidence-based approaches have the potential to supplement typical management of behavioral health problems in primary care and provide a foundation for future integrated behavioral health practice.
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Affiliation(s)
- Rachel A Petts
- Department of Psychology, Wichita State University, 1845 Fairmount Street, Wichita, KS 67260, USA.
| | - Scott T Gaynor
- Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008, USA
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Occhipinti JA, Skinner A, Carter S, Heath J, Lawson K, McGill K, McClure R, Hickie IB. Federal and state cooperation necessary but not sufficient for effective regional mental health systems: insights from systems modelling and simulation. Sci Rep 2021; 11:11209. [PMID: 34045644 PMCID: PMC8160145 DOI: 10.1038/s41598-021-90762-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022] Open
Abstract
For more than a decade, suicide rates in Australia have shown no improvement despite significant investment in reforms to support regionally driven initiatives. Further recommended reforms by the Productivity Commission call for Federal and State and Territory Government funding for mental health to be pooled and new Regional Commissioning Authorities established to take responsibility for efficient and effective allocation of ‘taxpayer money.’ This study explores the sufficiency of this recommendation in preventing ongoing policy resistance. A system dynamics model of pathways between psychological distress, the mental health care system, suicidal behaviour and their drivers was developed, tested, and validated for a large, geographically diverse region of New South Wales; the Hunter New England and Central Coast Primary Health Network (PHN). Multi-objective optimisation was used to explore potential discordance in the best-performing programs and initiatives (simulated from 2021 to 2031) across mental health outcomes between the two state-governed Local Health Districts (LHDs) and the federally governed PHN. Impacts on suicide deaths, mental health-related emergency department presentations, and service disengagement were explored. A combination of family psychoeducation, post-attempt aftercare, and safety planning, and social connectedness programs minimises the number of suicides across the PHN and in the Hunter New England LHD (13.5% reduction; 95% interval, 12.3–14.9%), and performs well in the Central Coast LHD (14.8% reduction, 13.5–16.3%), suggesting that aligned strategic decision making between the PHN and LHDs would deliver substantial impacts on suicide. Results also highlighted a marked trade-off between minimising suicide deaths versus minimising service disengagement. This is explained in part by the additional demand placed on services of intensive suicide prevention programs leading to increases in service disengagement as wait times for specialist community based mental health services and dissatisfaction with quality of care increases. Competing priorities between the PHN and LHDs (each seeking to optimise the different outcomes they are responsible for) can undermine the optimal impact of investments for suicide prevention. Systems modelling provides essential regional decision analysis infrastructure to facilitate coordinated federal and state investments for optimal impacts.
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Affiliation(s)
- Jo-An Occhipinti
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia. .,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia. .,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia. .,Translational Health Research Institute, Western Sydney University, Penrith, Australia.
| | - Adam Skinner
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia
| | - Samantha Carter
- Hunter New England & Central Coast Primary Health Network, Newcastle, Australia
| | - Jacinta Heath
- Everymind, Hunter New England Local Health District, Newcastle, Australia
| | - Kenny Lawson
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Katherine McGill
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, Australia.,MH-READ, Hunter New England Local Health District, Newcastle, Australia
| | - Rod McClure
- Faculty of Medicine and Health, University of New England, Armidale, Australia
| | - Ian B Hickie
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia
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Yang BK, Idzik S, Evans P. Patterns of mental health service use among Medicaid-insured youths treated by nurse practitioners and physicians: A retrospective cohort study. Int J Nurs Stud 2021; 120:103956. [PMID: 34091256 DOI: 10.1016/j.ijnurstu.2021.103956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite the growing involvement of nurse practitioners in mental health services for children and adolescents, little is known about the patterns of mental health service use among youths treated by nurse practitioners compared to those by physicians. OBJECTIVES To identify new users of psychotropic medications initiated by nurse practitioners and physicians among Medicaid-insured youths and to assess if receiving psychosocial services prior to or concurrent with medication initiation differs among youths treated by provider and specialty type. DESIGN A retrospective cohort study. SETTINGS We used Medicaid-insurance claims data in one mid-Atlantic state in the US. PARTICIPANTS A total 12,991 Medicaid-insured youths aged 0-20 years who started psychotropic medications prescribed by nurse practitioners or physicians with primary care or psychiatric specialty during 2013-2014. METHODS Providers were grouped into nurse practitioners and physicians and into primary care and psychiatric specialty. Descriptive statistics were performed to compare each class of psychotropic medications initiated and psychiatric diagnoses of enrollees according to provider type within each specialty. Using multinomial logistic regression with psychiatrists as a reference group, we estimated the odds of having a type of prescriber for psychotropic medication initiation for youths who received psychosocial services prior to a new start of the medication and concurrently, compared to that for those who did not, after adjusting for patients' demographic characteristics and diagnosis. RESULTS Youths served by nurse practitioners resided in small and non-metropolitan areas significantly more often than those served by their physician counterparts. There was no major difference in a class of psychotropic medications initiated by nurse practitioners and physicians within each specialty type, except a higher proportion of antidepressants (13.5% versus 10.5%) and a lower proportion of attention deficit hyperactivity disorder medications prescribed (68.8% versus 74.0%) by primary care nurse practitioners compared to their physician counterparts. Youths who received psychosocial services prior to medication initiation were less likely to have primary care physicians (Adjusted odds ratio=0.15, 95% confidence interval=0.82, 1.33) or primary care nurse practitioners (Adjusted odds ratio=0.16, 95% confidence interval=0.12, 0.20) as their initiating prescriber than those who did not. CONCLUSIONS Youths treated by nurse practitioners and physicians with or without psychiatric specialty showed unique patterns of mental health service use. Our findings can be used to build effective collaborations among provider and specialty type for quality of mental health services delivered to targeted populations in need.
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Affiliation(s)
- Bo Kyum Yang
- Department of Health Sciences, Towson University, 8000 York Rd, Towson, MD 21252, USA.
| | - Shannon Idzik
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, 655 W. Lombard St., Baltimore, MD 21201, USA
| | - Paige Evans
- Department of Health Sciences, Towson University, 8000 York Rd, Towson, MD 21252, USA
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Pawloski C, Hilgert J, Senturia K, Davis S, Koday M, Cunha-Cruz J. Medical-Dental Integration in a Rural Community Health Center: A Qualitative Program Evaluation. Health Promot Pract 2021; 23:416-424. [PMID: 33853397 DOI: 10.1177/15248399211002832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A community health center (CHC) implemented a medical-dental integration (MDI) program where children were seen at a pediatric medical clinic or women, infants, and children program location by medical and dental providers in the same visit. Our study aims were to elicit the perspectives and experiences of providers and administrators involved in the MDI program to assess the acceptability, feasibility, and success of a CHC integration strategy in Eastern Washington. METHODS This is a qualitative study where we conducted semistructured interviews over the phone over a period of 2 months with 12 medical and dental providers and clinical administrators who were involved with the MDI program. Questions addressed perspectives on workflow, patient identification and engagement, leadership support, and barriers and facilitators of the initiative. Qualitative data were analyzed, and emergent themes were identified. RESULTS The emergent themes included (a) the MDI program is feasible and acceptable albeit with key considerations regarding the setting, including charting and service integration, progressive leadership and effective communication, and appropriate providers; (b) implementation included structural, systemic, and individual behavior barriers, (c) the program is seen as a benefit to the clinic and patients and a success to date as a way to increase access to quality care. CONCLUSIONS Findings from this study helped identify facilitators, such as cultural relevancy and progressive office systems, as well as barriers, such as reimbursement, associated with integrating medical and dental care in a rural CHC setting, is acceptable by providers, and can inform future studies and implementation strategies for others wishing to integrate these services.
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Affiliation(s)
| | - Juliana Hilgert
- University of Washington, Seattle, WA, USA.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Stephen Davis
- Yakima Valley Farm Workers Clinic, Toppenish, WA, USA
| | - Mark Koday
- Yakima Valley Farm Workers Clinic, Toppenish, WA, USA
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Yitbarek K, Birhanu Z, Tucho GT, Anand S, Agenagnew L, Ahmed G, Getnet M, Tesfaye Y. Barriers and Facilitators for Implementing Mental Health Services into the Ethiopian Health Extension Program: A Qualitative Study. Risk Manag Healthc Policy 2021; 14:1199-1210. [PMID: 33776497 PMCID: PMC7989539 DOI: 10.2147/rmhp.s298190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The Ethiopian Ministry of Health has integrated mental health services into the community health service, but it has not yet been implemented. Therefore, this study aimed to explore the barriers and facilitators of mental health service implementation in the Ethiopian community health program. METHODS A qualitative case study was conducted in the Ethiopian primary health care system in 2019. We have conducted about eight key informant interviews with policymakers, service managers, and service providers. The interviews were tape-recorded, transcribed, translated, and analyzed manually using the World Health Organization building blocks framework. RESULTS The Health Ministry of Ethiopia has recently included mental health services into the health extension package but not yet implemented as part of integrated services. The identified barriers were low political commitment, shortage of resources, non-functional referral system, lack of interest from private health service organizations, attitudinal problems from both the society and service providers, and lack of consistent reporting system of the mental health problems. However, the well-designed primary health care system, trained health extension workers, changing political commitment and attitude of the community could facilitate the mental health service implementation. CONCLUSION A series of activities are expected, especially from the healthcare system managers to implement, follow, and evaluate mental health services implementation at the health extension programs.
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Affiliation(s)
- Kiddus Yitbarek
- Departemnt of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Department of Health Behaviors and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Gudina Terefe Tucho
- Department of Environmental Health and Technology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Susan Anand
- Department of Nursing, Faculty Health Sciences, Jimma University, Jimma, Ethiopia
| | - Liyew Agenagnew
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Gutema Ahmed
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Masrie Getnet
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Yonas Tesfaye
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
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Troup J, Fuhr DC, Woodward A, Sondorp E, Roberts B. Barriers and facilitators for scaling up mental health and psychosocial support interventions in low- and middle-income countries for populations affected by humanitarian crises: a systematic review. Int J Ment Health Syst 2021; 15:5. [PMID: 33413526 PMCID: PMC7792016 DOI: 10.1186/s13033-020-00431-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Humanitarian crises increase the burden of mental disorders due to exposure to traumatic events and ongoing daily stressors. Effective mental health and psychosocial support (MHPSS) interventions exist, but barriers and facilitators for scaling up those interventions are less understood. The study aim was to identify barriers and facilitators for scaling up MHPSS interventions for populations affected by humanitarian crises in low- and middle-income countries. METHODS A systematic review following PRISMA guidelines was conducted. Types of scale up were summarised, and barriers and facilitators analysed using the World Health Organization's Expandnet framework of scaling up. Evidence quality was appraised using the Mixed Methods Appraisal Tool. RESULTS Fourteen eligible studies were identified. Most described horizontal types of scale up, integrating services into primary and community care through staff training, task-sharing, and establishing referral and supervision mechanisms. Barriers were reported in a range of framework elements, but primarily related to those in the health system. The overall quality of studies were limited. CONCLUSION Few MHPSS interventions in humanitarian crises appear to have been scaled up, and scaling up efforts were largely horizontal which challenges long-term sustainability. Greater focus should be on both horizontal and vertical scaling up, which should be accompanied by higher quality research.
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Affiliation(s)
- Jordan Troup
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | - Daniela C Fuhr
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | - Aniek Woodward
- KIT Health, KIT Royal Tropical Institute, Mauritskade 64, Amsterdam, The Netherlands
| | - Egbert Sondorp
- KIT Health, KIT Royal Tropical Institute, Mauritskade 64, Amsterdam, The Netherlands
| | - Bayard Roberts
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK.
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van der Keylen P, Tomandl J, Wollmann K, Möhler R, Sofroniou M, Maun A, Voigt-Radloff S, Frank L. The Online Health Information Needs of Family Physicians: Systematic Review of Qualitative and Quantitative Studies. J Med Internet Res 2020; 22:e18816. [PMID: 33377874 PMCID: PMC7806443 DOI: 10.2196/18816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/20/2020] [Accepted: 11/11/2020] [Indexed: 01/27/2023] Open
Abstract
Background Digitalization and the increasing availability of online information have changed the way in which information is searched for and retrieved by the public and by health professionals. The technical developments in the last two decades have transformed the methods of information retrieval. Although systematic evidence exists on the general information needs of specialists, and in particular, family physicians (FPs), there have been no recent systematic reviews to specifically address the needs of FPs and any barriers that may exist to accessing online health information. Objective This review aims to provide an up-to-date perspective on the needs of FPs in searching, retrieving, and using online information. Methods This systematic review of qualitative and quantitative studies searched a multitude of databases spanning the years 2000 to 2020 (search date January 2020). Studies that analyzed the online information needs of FPs, any barriers to the accessibility of information, and their information-seeking behaviors were included. Two researchers independently scrutinized titles and abstracts, analyzing full-text papers for their eligibility, the studies therein, and the data obtained from them. Results The initial search yielded 4541 studies for initial title and abstract screening. Of the 144 studies that were found to be eligible for full-text screening, 41 were finally included. A total of 20 themes were developed and summarized into 5 main categories: individual needs of FPs before the search; access needs, including factors that would facilitate or hinder information retrieval; quality needs of the information to hand; utilization needs of the information available; and implication needs for everyday practice. Conclusions This review suggests that searching, accessing, and using online information, as well as any pre-existing needs, barriers, or demands, should not be perceived as separate entities but rather be regarded as a sequential process. Apart from accessing information and evaluating its quality, FPs expressed concerns regarding the applicability of this information to their everyday practice and its subsequent relevance to patient care. Future online information resources should cater to the needs of the primary care setting and seek to address the way in which such resources may be adapted to these specific requirements.
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Affiliation(s)
- Piet van der Keylen
- Friedrich-Alexander University Erlangen-Nürnberg, Institute of General Practice, University Hospital Erlangen, Erlangen, Germany
| | - Johanna Tomandl
- Friedrich-Alexander University Erlangen-Nürnberg, Institute of General Practice, University Hospital Erlangen, Erlangen, Germany
| | - Katharina Wollmann
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Cochrane Germany Foundation, Freiburg, Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Heinrich-Heine-University Düsseldorf, Center for Health and Society, Faculty of Medicine, Düsseldorf, Germany
| | - Mario Sofroniou
- Division of General Practice, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andy Maun
- Division of General Practice, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Luca Frank
- Friedrich-Alexander University Erlangen-Nürnberg, Institute of General Practice, University Hospital Erlangen, Erlangen, Germany
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Hasan MZ, Singh S, Arora D, Jain N, Gupta S. Evidence of integrated primary-secondary health care in low-and middle-income countries: protocol for a scoping review. Syst Rev 2020; 9:260. [PMID: 33168062 PMCID: PMC7654598 DOI: 10.1186/s13643-020-01514-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrated care is a people-centered health delivery approach that ensures the comprehensiveness, quality, and continuity of service across the settings and levels of health systems. The World Health Organization (WHO) recommends integration across levels and building-blocks of health systems as a prerequisite of Universal Health Coverage (UHC). While health systems of low- and middle-income countries (LMICs) are often fragmented and led by siloed service delivery structure, several LMICs-including India-have attempted health system integration. Several systematic reviews of evidence on healthcare integration from developed countries exist, but no synthesis from LMICs was reported to date. This review will overview the existing evidence of primary-secondary care integration (PSI) in the context of LMICs, aiming to support policy decisions for the effective integration of health delivery systems in India. METHODS The review will be conducted following the six steps recommend by Arksey and O'Malley. Scientific and grey literature will be systematically selected from PubMed, Embase, Scopus, Web of Science, Global Index Medicus, and electronic repositories (such as WHO, World Bank, Health Policy Plus, and OpenGrey). Using a comprehensive search strategy, literature written in English and published between 2000 and 2020 will be selected, and two independent authors will screen their titles and abstracts. The result will be charted using a data extraction form and reported using tables, figures, and narrative forms. DISCUSSION No ethical approval is necessary for the review. The final report will be developed with the consultation of other stakeholders and disseminated through workshops, conference papers, and peer review articles. The review will serve as a guiding tool to approach, implement, and test the PSI models in India and other LMICs. SCOPING REVIEW REGISTRATION: https://osf.io/kjhzt .
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Affiliation(s)
- Md Zabir Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Shalini Singh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Dinesh Arora
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Nishant Jain
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), New Delhi, India
| | - Shivam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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A Low-Intensity Internet-Based Intervention Focused on the Promotion of Positive Affect for the Treatment of Depression in Spanish Primary Care: Secondary Analysis of a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218094. [PMID: 33153062 PMCID: PMC7662551 DOI: 10.3390/ijerph17218094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/27/2022]
Abstract
Background: A large number of low-intensity Internet-based interventions (IBIs) for the treatment of depression have emerged in Primary Care; most of them focused on decreasing negative emotions. However, recent studies have highlighted the importance of addressing positive affect (PA) as well. This study is a secondary analysis of a randomized control trial. We examine the role of an IBI focused on promoting PA in patients with depression in Primary Care (PC). The specific objectives were to explore the profile of the patients who benefit the most and to analyze the change mechanisms that predict a significantly greater improvement in positive functioning measures. Methods: 56 patients were included. Measures of depression, affect, well-being, health-related quality of life, and health status were administered. Results: Participants who benefited the most were those who had lower incomes and education levels and worse mental health scores and well-being at baseline (7.9%-39.5% of explained variance). Improvements in depression severity and PA were significant predictors of long-term change in well-being, F (3,55) = 17.78, p < 0.001, R2 = 47.8%. Conclusions: This study highlights the importance of implementing IBIs in PC and the relevance of PA as a key target in Major Depressive Disorder treatment.
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A narrative review of economic constructs in commonly used implementation and scale-up theories, frameworks and models. Health Res Policy Syst 2020; 18:115. [PMID: 32998752 PMCID: PMC7528255 DOI: 10.1186/s12961-020-00633-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Translating research evidence into practice is challenging and, to date, there are relatively few public health interventions that have been effectively and cost-effectively implemented and delivered at scale. Theories, models and frameworks (herein termed 'frameworks') have been used in implementation science to describe, guide and explain implementation and scale-up. While economic constructs have been reported as both barriers and facilitators to effective implementation and scale-up of public health interventions, there is currently no published review of how economic constructs are considered within commonly used implementation and scale-up frameworks. This paper aimed to narratively review the economic constructs incorporated in commonly used implementation and scale-up frameworks. METHODS Frameworks for inclusion in the narrative review were identified from the literature and thematic content analysis was undertaken using a recursive deductive approach. Emergent key themes and sub-themes were identified and results were summarised narratively within each theme. RESULTS Twenty-six framework publications were included in our analysis, with wide variation between frameworks in the scope and level of detail of the economic constructs included. Four key themes emerged from the data - 'resources', 'benefit', 'cost' and 'funding'. Only five frameworks incorporated all four identified key themes. Overarching lenses from which to consider key themes included 'stakeholder perspectives', 'stage in the research translation process' and 'context'. 'Resources' were most frequently considered in relation to the sub-themes of 'types of resources' (e.g. labour, time or infrastructure) and 'availability' of resources, and the opportunity for 'economies of scale'. The 'relative advantage of interventions' emerged as an interconnecting sub-theme between 'cost' and 'benefit'. 'Funding' was most often considered in relation to 'funding sources', 'availability', 'sustainability' or 'contextual impact'. The concept of 'opportunity cost' was considered in relatively few frameworks, despite being fundamental to economic theory. CONCLUSIONS Implementation and scale-up frameworks provide a conceptual map to inform the effective and cost-effective implementation of public health interventions delivered at scale. Despite evidence of an emerging focus on the economic considerations of implementation and scale-up within some commonly used frameworks, our findings suggest that there is significant scope for further exploration of the economic constructs related to implementation and scale-up.
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68
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Luitel NP, Jordans MJD, Subba P, Komproe IH. Perception of service users and their caregivers on primary care-based mental health services: a qualitative study in Nepal. BMC FAMILY PRACTICE 2020; 21:202. [PMID: 32988367 PMCID: PMC7523041 DOI: 10.1186/s12875-020-01266-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022]
Abstract
Background Integration of mental health services into primary health care systems has been advocated as a strategy to minimize the tremendous mental health treatment gap, particularly in low- and middle-income countries. Barriers to integration of mental health into primary health care have been widely documented; however, very little is known about the perception of service users and their caregivers on primary care-based mental health services. This study assessed service users’ and caregivers’ perceptions of mental health services provided by trained primary health care workers in Nepal. Methods A qualitative study was conducted among people with depression, psychosis, alcohol use disorder and epilepsy, and their caregivers in Chitwan, a district in southern Nepal. Semi-structured interviews were conducted with 43 service users and 38 caregivers to assess their perceptions about the accessibility of the services, types of services they received, skills and competencies of health care providers, satisfaction and barriers to receiving services. Results Overall, both service users and caregivers were satisfied with the mental health services provided by primary health care providers. They also perceived health workers to be competent and skillful because the services they received were effective in reducing their mental health problems. Both psychological and pharmacological services were made available free of cost, however, they considered psychological services more effective than pharmacological treatment. Major challenges and difficulties accessing services were associated with frequent transfer of trained health workers, non-availability of the same health care provider at follow-ups, frequent stock-out of medicines or non-availability of required medicines, lack of a confidential space for consultation in health facilities, and stigmatizing and negative behavior of some health workers. Conclusion The results demonstrated that both service users and caregivers perceived primary care-based mental health services to be accessible, acceptable and effective. The key recommendations emerging from this study for improving mental health services in primary care include the provision of a separate cadre of psychosocial workers to provide psychological interventions, developing quick and efficient mechanisms for the procurement and supply of psychotropic medicines, establishing a confidential place within health facilities for consultation, and further training of health workers to reduce stigma.
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Affiliation(s)
- N P Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
| | - M J D Jordans
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Faculty of Social and Behavioural Sciences; Department of Anthropology, University of Amsterdam, Armsterdam, the Netherlands
| | - P Subba
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - I H Komproe
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
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Sorsdahl K, Naledi T, Lund C, Levitt NS, Joska JA, Stein DJ, Myers B. Integration of mental health counselling into chronic disease services at the primary health care level: Formative research on dedicated versus designated strategies in the Western Cape, South Africa. J Health Serv Res Policy 2020; 26:172-179. [DOI: 10.1177/1355819620954232] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective To explore health care providers’ views on the acceptability and feasibility of two models for integrating facility-based counsellor delivered mental health counselling into chronic disease care, and how such an approach could be improved in South Africa. Methods Fourteen focus group discussions and 25 in-depth individual interviews were conducted with 109 health care workers and facility managers from 24 primary health clinics in the Western Cape, South Africa. Results Findings suggested that despite recent efforts to integrate mental health counselling into chronic disease services for common mental disorders, there remains limited availability of psychosocial and psychological counselling. Feedback on the two models of integration suggested equipoise and the potential of a hybrid approach where these approaches may be tailored to the specific needs and available resources of each facility. Participants identified constraints within the health system and broader social context that require consideration for integrating mental health counselling into chronic disease care. Conclusion Although study participants unanimously agreed that counselling for common mental disorders should be integrated into chronic disease services, they had differing views on the type of model that should be adopted. There is a need for further testing of the two models and aspects of the health service that may require strengthening to implement any such model.
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Affiliation(s)
- Katherine Sorsdahl
- Co-Director, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, South Africa
| | - Tracey Naledi
- Senior Lecturer, Public Health Medicine, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Crick Lund
- Professor of Public Mental Health, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, South Africa
| | - Naomi S Levitt
- Head of HIV and Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - John A Joska
- Head of Department, Department of Psychiatry and Mental Health, University of Cape Town, South Africa & SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - Dan J Stein
- Head of Department, Department of Psychiatry and Mental Health, University of Cape Town, South Africa & SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - Bronwyn Myers
- Deputy Director, Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council & Department of Psychiatry & Mental Health, University of Cape Town, South Africa
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O Donnell R, Ayton D, Pizzirani B, Savaglio M, Fast D, Vicary D, Skouteris H. Program description and implementation findings of MyCare: enhancing community mental health care in Tasmania, Australia. Aust J Prim Health 2020; 26:374-382. [PMID: 32961106 DOI: 10.1071/py20046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022]
Abstract
Since 2014, Tasmania has experienced unprecedented rates of hospitalisations related to mental health issues. To address reliance on such acute-based care, government funding was invested to enhance community-based care, which, in turn, led to the development of MyCare. This paper represents the initial phase of a larger body of work (i.e. an effectiveness-controlled trial of MyCare) that describes the MyCare program and the successful implementation strategy underpinning the program. The implementation of MyCare was evaluated with 41 key stakeholders (staff, clients and senior executives) using semistructured interviews and focus groups, informed by the Consolidated Framework for Implementation Research (CFIR). According to stakeholders, three CFIR constructs that were directly addressed by the program, namely Tension for Change, Evidence Strength and Quality, and Available Resources for Implementation, facilitated the successful implementation of MyCare. In contrast, a feature of the program that impeded implementation was Patient Needs and Resources, which restricted program access to those with the most severe mental health issues. The reporting of implementation strategies underpinning mental health programs is rare. This study describes the implementation strategy underpinning a community-based mental health program that was successful in facilitating program uptake. We encourage other researchers to not only report on implementation findings, which may help avoid replication failure, but also to apply these innovative implementation processes (i.e. address the tension for change and ensure the program is evidence informed and that sufficient resources are available for implementation) within mental health programs to aid successful uptake.
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Affiliation(s)
- Renee O Donnell
- Monash Centre of Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Vic. 3168, Australia; and Corresponding authors. ;
| | - Darshini Ayton
- Monash Centre of Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Vic. 3168, Australia
| | - Bengianni Pizzirani
- Monash Centre of Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Vic. 3168, Australia
| | - Melissa Savaglio
- Monash Centre of Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Vic. 3168, Australia
| | - Debra Fast
- Baptcare, Level 1/1193 Toorak Road, Camberwell, Vic. 3124, Australia
| | - Dave Vicary
- Baptcare, Level 1/1193 Toorak Road, Camberwell, Vic. 3124, Australia
| | - Helen Skouteris
- Monash Centre of Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Vic. 3168, Australia; and Corresponding authors. ;
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Hentges RF, Graham SA, Fearon P, Tough S, Madigan S. The chronicity and timing of prenatal and antenatal maternal depression and anxiety on child outcomes at age 5. Depress Anxiety 2020; 37:576-586. [PMID: 32419282 DOI: 10.1002/da.23039] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Maternal depression and anxiety have been associated with deleterious child outcomes. It is, however, unclear how the chronicity and timing of maternal mental health problems predict child development outcomes. The aim of the current study was to assess the effect of both chronicity and timing of maternal anxiety and depression in pregnancy, infancy, and the toddler period on children's internalizing and externalizing symptoms, as well as social and communication skills at age 5. METHOD Participants were 1,992 mother-child pairs drawn from a large prospective pregnancy cohort. Mothers reported on anxiety and depression symptoms with clinical screening tools at six time points between <25 weeks gestation and 3 years postpartum. Child outcomes were assessed at age 5. RESULTS Effect sizes were small for brief incidents of depression/anxiety and increased for intermittent and chronic problems (i.e., three or more timepoints) compared with mothers who had never experienced clinical-level anxiety or depression. Maternal anxiety/depression during pregnancy, infancy, and toddlerhood predicted all child outcomes, even after controlling for depression/anxiety during the other timepoints. However, maternal anxiety and depression during toddlerhood had a stronger association with child internalizing/externalizing symptoms and communication skills than either prenatal or postpartum depression/anxiety. CONCLUSIONS Increasing number of exposures to clinical-level anxiety and depression is related to poorer child outcomes. Neither prenatal nor postpartum periods emerged as "sensitive" periods. Rather, maternal depression and anxiety during toddlerhood was more strongly associated with child outcomes at age 5. Results highlight the need for continued support for maternal mental health across early childhood.
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Affiliation(s)
- Rochelle F Hentges
- Department of Psychology, University of Calgary, Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Susan A Graham
- Department of Psychology, University of Calgary, Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Pasco Fearon
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK.,Developmental Neuroscience Unit, Anna Freud National Centre for Children and Families, London, UK
| | - Suzanne Tough
- Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Canada
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Arundell LL, Greenwood H, Baldwin H, Kotas E, Smith S, Trojanowska K, Cooper C. Advancing mental health equality: a mapping review of interventions, economic evaluations and barriers and facilitators. Syst Rev 2020; 9:115. [PMID: 32456670 PMCID: PMC7251669 DOI: 10.1186/s13643-020-01333-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/16/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This work aimed to identify studies of interventions seeking to address mental health inequalities, studies assessing the economic impact of such interventions and factors which act as barriers and those that can facilitate interventions to address inequalities in mental health care. METHODS A systematic mapping method was chosen. Studies were included if they: (1) focused on a population with: (a) mental health disorders, (b) protected or other characteristics putting them at risk of experiencing mental health inequalities; (2) addressed an intervention focused on addressing mental health inequalities; and (3) met criteria for one or more of three research questions: (i) primary research studies (any study design) or systematic reviews reporting effectiveness findings for an intervention or interventions, (ii) studies reporting economic evaluation findings, (iii) primary research studies (any study design) or systematic reviews identifying or describing, potential barriers or facilitators to interventions. A bibliographic search of MEDLINE, HMIC, ASSIA, Social Policy & Practice, Sociological Abstracts, Social Services Abstracts and PsycINFO spanned January 2008 to December 2018. Study selection was performed according to inclusion criteria. Data were extracted and tabulated to map studies and summarise published research on mental health inequalities. A visual representation of the mapping review (a mapping diagram) is included. RESULTS Overall, 128 studies met inclusion criteria: 115 primary studies and 13 systematic reviews. Of those, 94 looked at interventions, 6 at cost-effectiveness and 36 at barriers and facilitators. An existing taxonomy of disparities interventions was used and modified to categorise interventions by type and strategy. Most of the identified interventions focused on addressing socioeconomic factors, race disparities and age-related issues. The most frequently used intervention strategy was providing psychological support. Barriers and associated facilitators were categorised into groups including (not limited to) access to care, communication issues and financial constraints. CONCLUSIONS The mapping review was useful in assessing the spread of literature and identifying highly researched areas versus prominent gaps. The findings are useful for clinicians, commissioners and service providers seeking to understand strategies to support the advancement of mental health equality for different populations and could be used to inform further research and support local decision-making. SYSTEMATIC REVIEW REGISTRATION Not applicable.
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Affiliation(s)
- Laura-Louise Arundell
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB UK
- National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB UK
| | - Helen Greenwood
- National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB UK
| | - Helen Baldwin
- National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB UK
| | - Eleanor Kotas
- York Economics Consortium, University of York, Heslington, York, YO10 5DD UK
| | - Shubulade Smith
- National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Kasia Trojanowska
- National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB UK
| | - Chris Cooper
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB UK
- Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF UK
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Fuhr DC, Acarturk C, Uygun E, McGrath M, Ilkkursun Z, Kaykha S, Sondorp E, Sijbrandij M, Ventevogel P, Cuijpers P, Roberts B. Pathways towards scaling up Problem Management Plus in Turkey: a theory of change workshop. Confl Health 2020; 14:22. [PMID: 32391076 PMCID: PMC7197136 DOI: 10.1186/s13031-020-00278-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background A considerable evidence base has been produced in recent years highlighting the effectiveness of brief scalable psychological interventions for people living in communities exposed to adversity. However, practical guidance on how to scale up these interventions to wider populations does not exist. In this paper we report on the use of Theory of Change (ToC) to plan the scale up of the World Health Organization’s flagship low intensity psychological intervention “Problem Management Plus” (PM+) for Syrian refugees in Turkey. Methods We conducted a one-day ToC workshop in Istanbul. ToC is a participatory planning process used in the development, implementation and evaluation of projects. It is similar to driver diagrams or logic models in that it offers a tool to visually present the components needed to reach a desired long-term outcome or impact. The overall aim of ToC is to understand the change process of a complex intervention and to map out causal pathways through which an intervention or strategy has an effect. Results Twenty-four stakeholders (including governmental officials, mental health providers, officials from international/national non-governmental organisations, conflict and health researchers) participated in the ToC workshop. A ToC map was produced identifying three key elements of scaling up (the resource team; the innovation and the health system; and the user organisation) which are represented in three distinct causal pathways. Context-specific barriers related to the health system and the political environment were identified, and possible strategies for overcoming these challenges were suggested. Conclusion ToC is a valuable methodology to develop an integrated framework for scaling up. The results highlight that the scaling up of PM+ for Syrian refugees in Turkey needs careful planning and investment from different stakeholders at the national level. Our paper provides a theoretical foundation of the scaling up of PM+, and exemplifies for the first time the use of ToC in planning the scaling up of an evidence-based psychological intervention in global mental health.
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Affiliation(s)
- Daniela C Fuhr
- 1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine; Public Health and Policy, 15-17 Tavistock Place, London, UK
| | - Ceren Acarturk
- 2Department of Psychology, Koc University Istanbul, Istanbul, Turkey
| | - Ersin Uygun
- Refugee Mental Health Branch Outpatient Clinic of Bakirkoy Mental Health Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Michael McGrath
- 1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine; Public Health and Policy, 15-17 Tavistock Place, London, UK.,4KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Zeynep Ilkkursun
- 2Department of Psychology, Koc University Istanbul, Istanbul, Turkey
| | - Sadaf Kaykha
- War Trauma Foundation, Amsterdam, The Netherlands
| | - Egbert Sondorp
- 4KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- 6Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter Ventevogel
- 7Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Pim Cuijpers
- 6Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bayard Roberts
- 1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine; Public Health and Policy, 15-17 Tavistock Place, London, UK
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Wakida EK, Obua C, Musisi S, Rukundo GZ, Ssebutinde P, Talib ZM, Akena D, Okello ES. Implementing clinical guidelines to promote integration of mental health services in primary health care: a qualitative study of a systems policy intervention in Uganda. Int J Ment Health Syst 2019; 13:49. [PMID: 31346348 PMCID: PMC6636121 DOI: 10.1186/s13033-019-0304-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/10/2019] [Indexed: 01/09/2023] Open
Abstract
Background Clinical practice guidelines (CPG) are developed based on a synthesis of evidence regarding the best options for the assessment, diagnosis and treatment of diseases and are recognized as essential quality improvement tools. However, despite growing availability of CPG, research evaluating their use for mental disorders in Uganda is lacking. For a successful implementation of CPG to be achieved, a number of considerations need to be put in place. Objective This study aimed to assess the feasibility and acceptability of the educational intervention that we developed towards improvement of the primary health care providers (PHCPs) uptake of the Uganda Clinical Guidelines (UCG) in integrating mental health services into PHC in Mbarara district, southwestern Uganda. Methods This was a descriptive cross-sectional qualitative study with a semi-structured in-depth interview guide. The educational intervention we were assessing had four components: (i) summarized UCG on common mental disorders; (ii) modified Health Management Information System (HMIS) registers to include mental health; (iii) clinician's checklist outlining the steps to be followed; and iv) support supervision/training. Results Six themes emerged from the study while the components of the intervention formed the apriori subthemes. Key results based on the subthemes show: (i) summarized UCG: the participants liked the packaging stating that it eased their work, was time saving and user friendly; (ii) modified register: participants appreciated the modifications made to the register updating the existing record in the Health Management Information System (HMIS) registers to include mental health disorders; (iii) TRAINING and support supervision: the PHCPs attributed the success in using the summarized UCG to the training they received, and they further expressed the need to regularize the training in assessment for mental health and support by the mental health specialists. Conclusion Our study demonstrates that the use of summarized UCG, modified HMIS registers to include mental health, training and support supervision by mental health specialists in implementing the UCG in integrating mental health at PHC settings is feasible and acceptable by the PHCPs in Mbarara district, southwestern Uganda. Given the need for improved mental health care in Uganda, this intervention could be rigorously evaluated for effectiveness, scalability and generalizability.
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Affiliation(s)
- Edith K Wakida
- 1Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Celestino Obua
- 2Department of Pharmacology and Therapeutics and Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Seggane Musisi
- 3Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Godfrey Z Rukundo
- 4Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Peter Ssebutinde
- Mbarara District Local Goverment, Directorate of Health Services, Mbarara, Uganda
| | - Zohray M Talib
- Department of Medical Education, California University of Science and Medicine, San Bernardino, USA.,7Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dickens Akena
- 3Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
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Nilsen P, Bernhardsson S. Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Serv Res 2019; 19:189. [PMID: 30909897 PMCID: PMC6432749 DOI: 10.1186/s12913-019-4015-3] [Citation(s) in RCA: 377] [Impact Index Per Article: 75.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 03/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relevance of context in implementation science is reflected in the numerous theories, frameworks, models and taxonomies that have been proposed to analyse determinants of implementation (in this paper referred to as determinant frameworks). This scoping review aimed to investigate and map how determinant frameworks used in implementation science were developed, what terms are used for contextual determinants for implementation, how the context is conceptualized, and which context dimensions that can be discerned. METHODS A scoping review was conducted. MEDLINE and EMBASE were searched from inception to October 2017, and supplemented with implementation science text books and known published overviews. Publications in English that described a determinant framework (theory, model, taxonomy or checklist), of which context was one determinant, were eligible. Screening and inclusion were done in duplicate. Extracted data were analysed to address the study aims. A qualitative content analysis with an inductive approach was carried out concerning the development and core context dimensions of the frameworks. The review is reported according to the PRISMA guidelines. RESULTS The database searches yielded a total of 1113 publications, of which 67 were considered potentially relevant based on the predetermined eligibility criteria, and retrieved in full text. Seventeen unique determinant frameworks were identified and included. Most were developed based on the literature and/or the developers' implementation experiences. Six of the frameworks explicitly referred to "context", but only four frameworks provided a specific definition of the concept. Instead, context was defined indirectly by description of various categories and sub-categories that together made up the context. Twelve context dimensions were identified, pertaining to different aggregation levels. The most widely addressed context dimensions were organizational support, financial resources, social relations and support, and leadership. CONCLUSIONS The findings suggest variation with regard to how the frameworks were developed and considerable inconsistency in terms used for contextual determinants, how context is conceptualized, and which contextual determinants are accounted for in frameworks used in implementation science. Common context dimensions were identified, which can facilitate research that incorporates a theory of context, i.e. assumptions about how different dimensions may influence each other and affect implementation outcomes. A thoughtful application of the concept and a more consistent terminology would enhance transparency, simplify communication among researchers, and facilitate comparison across studies.
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Affiliation(s)
- Per Nilsen
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, SE-581 83, Linköping, Sweden
| | - Susanne Bernhardsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden.
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Wakida EK, Okello ES, Rukundo GZ, Akena D, Alele PE, Talib ZM, Obua C. Health system constraints in integrating mental health services into primary healthcare in rural Uganda: perspectives of primary care providers. Int J Ment Health Syst 2019; 13:16. [PMID: 30949234 PMCID: PMC6429816 DOI: 10.1186/s13033-019-0272-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background The World Health Organization issued recommendations to guide the process of integrating mental health services into primary healthcare. However, there has been general as well as context specific shortcomings in the implementation of these recommendations. In Uganda, mental health services are intended to be decentralized and integrated into general healthcare, but, the services are still underutilized especially in rural areas. Purpose The purpose of this study was to explore the health systems constraints to the integration of mental health services into PHC in Uganda from the perspective of primary health care providers (PHCPs). Methods This was a cross sectional qualitative study guided by the Supporting the Use of Research Evidence (SURE) framework. We used a semi-structured interview guide to gain insight into the health systems constraints faced by PHCPs in integrating mental health services into PHC. Results Key health systems constraints to integrating mental health services into PHC identified included inadequate practical experience during training, patient flow processes, facilities, human resources, gender related factors and challenges with accessibility of care. Conclusion There is need to strengthen the training of healthcare providers as well as improving the health care system that supports health workers. This would include periodic mental healthcare in-service training for PHCPs; the provision of adequate processes for outreach, and receiving, referring and transferring patients with mental health problems; empowering PHCPs at all levels to manage and treat mental health problems and adequately provide the necessary medical supplies; and increase the distribution of health workers across the health facilities to address the issue of high workload and compromised quality of care provided. Electronic supplementary material The online version of this article (10.1186/s13033-019-0272-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edith K Wakida
- 1Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Elialilia S Okello
- Mwanza Intervention Trials Unit, Tanzania National Institute for Medical, Mwanza Centre, Mwanza, Tanzania
| | - Godfrey Z Rukundo
- 1Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Dickens Akena
- 3Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul E Alele
- 4Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Zohray M Talib
- Department of Medical Education, California University of Science and Medicine, San Bernardino, CA USA.,6Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- 7Department of Pharmacology and Therapeutics and Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
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