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Adequacy of Help Received by Individuals with Severe Mental Disorders After a Major Healthcare Reform in Quebec: Predictors and Changes at 5-Year Follow-Up. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 43:799-812. [DOI: 10.1007/s10488-015-0695-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVES This study aims to assess the rate of six monthly communications between specialised psychiatric services and primary care and to determine factors which predict such communication. METHODS A retrospective review of the clinical records of all patients attending the relevant local psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to identify patient demographic and clinical variables as well as to determine if there has been documentation of communication with primary care in the preceding six months. Letters were sent to the relevant primary care teams regarding progress on their patients in cases where it was identified that no communication had occurred in the preceding six months. RESULTS A total of 145 patients' charts were reviewed. Of these, 53.3% of the patients were females and 46.7% were males. The mean age was 47.9 years (SD = 14). Patients' diagnoses included; depression (41%), bipolar affective disorder (6.7%), schizophrenia/schizoaffective disorder (27.6%), anxiety disorders (6.7%), alcohol dependency syndrome (11%) and other disorders (7%). Overall, only 36% of patients' charts had a record of communication with primary care in the last six months. Only one variable, 'changes made to the patents medication in the last six months' was significantly associated with the likelihood that there had been communication with primary care with an odds ratio of 15 and a p-value of 0.00. CONCLUSION A six monthly review has a potential to improve the level of communication between specialised psychiatric services and primary care.
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Fleury MJ, Grenier G, Bamvita JM, Perreault M, Caron J. Determinants associated with the utilization of primary and specialized mental health services. Psychiatr Q 2012; 83:41-51. [PMID: 21607642 PMCID: PMC5023421 DOI: 10.1007/s11126-011-9181-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The study aims to compare variables associated with the exclusive and joint use of primary and specialized care for mental health reasons by individuals diagnosed with a mental disorder in a Montreal/Canadian catchment area. Data were collected from a random sample (2,443 individuals). Among 406 people, diagnosed with a mental disorder 12 months pre-interview, 212 (52%) reported having used healthcare services. Compared to users of primary care only, people who sought both primary and specialized care presented more mental disorders and lower quality of life. People using only specialized healthcare received significantly less social support than persons using primary care exclusively and lived in neighborhoods with a high proportion of rental housing. Healthcare service provision should favor social networking and enable social cohesion and integration, particularly in neighborhoods with a high proportion of rental housing. Shared care and enhanced collaboration with other public and community-based resources should be encouraged.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada.
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Atun R, de Jongh TE, Secci FV, Ohiri K, Adeyi O, Car J. Integration of priority population, health and nutrition interventions into health systems: systematic review. BMC Public Health 2011; 11:780. [PMID: 21985434 PMCID: PMC3204262 DOI: 10.1186/1471-2458-11-780] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 10/10/2011] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Objective of the study was to assess the effects of strategies to integrate targeted priority population, health and nutrition interventions into health systems on patient health outcomes and health system effectiveness and thus to compare integrated and non-integrated health programmes. METHODS Systematic review using Cochrane methodology of analysing randomised trials, controlled before-and-after and interrupted time series studies. We defined specific strategies to search PubMed, CENTRAL and the Cochrane Effective Practice and Organisation of Care Group register, considered studies published from January 1998 until September 2008, and tracked references and citations. Two reviewers independently agreed on eligibility, with an additional arbiter as needed, and extracted information on outcomes: primary (improved health, financial protection, and user satisfaction) and secondary (improved population coverage, access to health services, efficiency, and quality) using standardised, pre-piloted forms. Two reviewers in the final stage of selection jointly assessed quality of all selected studies using the GRADE criteria. RESULTS Of 8,274 citations identified 12 studies met inclusion criteria. Four studies compared the benefits of Integrated Management of Childhood Illnesses in Tanzania and Bangladesh, showing improved care management and higher utilisation of health facilities at no additional cost. Eight studies focused on integrated delivery of mental health and substance abuse services in the United Kingdom and United States of America. Integrated service delivery resulted in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients, with no significant difference found overall. Quality of care, patient satisfaction, and treatment engagement were higher in integrated delivery models. CONCLUSIONS Targeted priority population health interventions we identified led to improved health outcomes, quality of care, patient satisfaction and access to care. Limited evidence with inconsistent findings across varied interventions in different settings means no general conclusions can be drawn on the benefits or disadvantages of integrated service delivery.
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Affiliation(s)
- Rifat Atun
- Imperial College Business School, South Kensington Campus, London SW7 2AZ, UK
| | - Thyra E de Jongh
- Imperial College Business School, South Kensington Campus, London SW7 2AZ, UK
| | - Federica V Secci
- Imperial College Business School, South Kensington Campus, London SW7 2AZ, UK
| | - Kelechi Ohiri
- Human Development Network, The World Bank, 1818 H St., NW, Washington DC, 20433, USA
| | - Olusoji Adeyi
- Human Development Network, The World Bank, 1818 H St., NW, Washington DC, 20433, USA
| | - Josip Car
- Department of Primary Care and Social Medicine, Imperial College Faculty of Medicine, London W6 8RP, UK
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Lund C, Kleintjes S, Cooper S, Petersen I, Bhana A, Flisher AJ, the MHaPP Research Programme Consor. Challenges facing South Africa's mental health care system: stakeholders' perceptions of causes and potential solutions. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/17542863.2010.503039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mwape L, Sikwese A, Kapungwe A, Mwanza J, Flisher A, Lund C, Cooper S. Integrating mental health into primary health care in Zambia: a care provider's perspective. Int J Ment Health Syst 2010; 4:21. [PMID: 20653981 PMCID: PMC2919445 DOI: 10.1186/1752-4458-4-21] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 07/25/2010] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services. AIMS The aim of this paper was to explore health providers' views about mental health integration into primary health care. METHODS A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa). RESULTS There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems. RECOMMENDATIONS It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. CONCLUSION Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia.
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Affiliation(s)
- Lonia Mwape
- Department of Mental Health Nursing, Chainama College of Health Sciences, Lusaka, Zambia
- Research Officer, Mental Health and Poverty Project, Department of Psychiatry, Chainama College of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Alice Sikwese
- Department of Mental Health Nursing, Chainama College of Health Sciences, Lusaka, Zambia
| | - Augustus Kapungwe
- Department of Social Development Studies, Demography Division, University of Zambia, Lusaka, Zambia
| | - Jason Mwanza
- Department of Social Development Studies, Demography Division, University of Zambia, Lusaka, Zambia
| | - Alan Flisher
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Crick Lund
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Sara Cooper
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Fleury MJ, Grenier G, Bamvita JM, Caron J. Professional service utilisation among patients with severe mental disorders. BMC Health Serv Res 2010; 10:141. [PMID: 20507597 PMCID: PMC2896947 DOI: 10.1186/1472-6963-10-141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 05/27/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generally, patients with serious mental disorders (SMD) are frequent users of services who generate high care-related costs. Current reforms aim to increase service integration and primary care for improved patient care and health-care efficiency. This article identifies and compares variables associated with the use by patients with SMD of services offered by psychiatrists, case managers, and general practitioners (GPs). It also compares frequent and infrequent service use. METHOD One hundred forty patients with SMD from five regions in Quebec, Canada, were interviewed on their use of services in the previous year. Patients were also required to complete a questionnaire on needs-assessment. In addition, data were collected from clinical records. Descriptive, bivariate, and multivariate analyses were conducted. RESULTS Most patients used services from psychiatrists and case managers, but no more than half consulted GPs. Most patients were followed at least by two professionals, chiefly psychiatrists and case managers. Care access, continuity of care, and total help received were the most important variables associated with the different types of professional consultation. These variables were also associated with frequent use of professional service, as compared with infrequent service use. In all, enabling factors rather than need factors were the core predictors of frequency of service utilisation by patients with SMD. CONCLUSION This study reveals that health care system organisation and professional practice--rather than patient need profiles--are the core predictors of professional consultation by patients with SMD. The homogeneity of our study population, i.e. mainly users with schizophrenia, recently discharged from hospital, may partly account for these results. Our findings also underscored the limited involvement of GPs in this patient population's care. As comorbidity is often associated with serious mental disorders, closer follow-up by GPs is needed. Globally, more effort should be directed at increasing shared-care initiatives, which would enhance coordination among psychiatrists, GPs, and psychosocial teams (including case managers). Finally, there is a need to increase awareness among health care providers, especially GPs, of the level of care required by patients with disabling and serious mental disorders.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Researcher, Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3, Canada.
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Ouadahi Y, Lesage A, Rodrigue J, Fleury MJ. [Can mental health problems be diagnosed by general physicians? Perspectives of family physicians according to administrative standards]. SANTE MENTALE AU QUEBEC 2009; 34:161-72. [PMID: 19475199 DOI: 10.7202/029764ar] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Youcef Ouadahi
- MBA, Agent de planification, programmation et recherche, Agence de la santé et des services sociaux de la Montérégie
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Fortune L, Gracey D, Burke M, Rawson D. The effect of service setting on treatment outcome: A comparison between cognitive behavioural approaches within primary and secondary care. J Ment Health 2009. [DOI: 10.1080/09638230500271162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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NOLAN ELOISE, HEWISON ALISTAIR. Teamwork in primary care mental health: a policy analysis. J Nurs Manag 2008; 16:649-61. [DOI: 10.1111/j.1365-2934.2007.00766.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
There is a constant stream of information emanating from psychiatric research. The challenge for the clinician to keep abreast of the latest research findings is huge. However, even more daunting is the task of making sense of the sometimes conflicting data. In this paper, we provide some examples of evidence that seemed to have been accepted with relatively little critical examination. We discuss how evidence may look plausible on the surface either because contextual factors have not been considered or because they fit into a pre-determined world view. We argue that, in the end, the process of making sense of evidence is not straightforward and that professional biases and social prejudices often influence decisions.
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Affiliation(s)
- Alex Cohen
- Department of Social Medicine, Harvard Medical School, Boston, MA, USA.
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Thompson A, Hunt C, Issakidis C. Why wait? Reasons for delay and prompts to seek help for mental health problems in an Australian clinical sample. Soc Psychiatry Psychiatr Epidemiol 2004; 39:810-7. [PMID: 15669662 DOI: 10.1007/s00127-004-0816-7] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The initial delay to seek treatment accounts for a significant proportion of the unmet need for treatment of common psychiatric conditions. This study aimed to examine the barriers to initial help-seeking and factors that facilitate help-seeking for anxiety and depression. METHODS Help-seeking history was retrospectively self-reported by 233 patients at a specialist anxiety clinic, all of whom had delayed seeking professional treatment for at least one month. Data gathered included age at onset, age at help-seeking, primary reason for the delay, prompt to seek help and first professional contacted. RESULTS The most frequently endorsed reasons for the delay related to lack of knowledge about mental illness or available treatment. Increasing illness severity or disability was the primary prompt to seek help for the majority of respondents. Reason for the delay showed some relationship with length of the delay, but prompt to seek help did not. A general medical practitioner (GP) was the first professional contacted in 71 % of cases. CONCLUSIONS Lack of public 'mental health literacy' contributes to slow problem recognition. Increasing illness severity eventually facilitates problem recognition and prompts help-seeking. Structural barriers to initial help-seeking are relatively unimportant within the Australian health care system. General practitioners play an important role as gate-keepers to appropriate mental health care.
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Affiliation(s)
- Anna Thompson
- School of Psychology, University of Sydney, Sydney (NSW) 2006, Australia
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Betting on a different horse: a qualitative analysis of mental health in health promotion policies. JOURNAL OF PUBLIC MENTAL HEALTH 2004. [DOI: 10.1108/17465729200400015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study is to analyse the position and role of mental health in health promotion policy. Policy documents from Finland, Sweden, Denmark, the Netherlands, England and Portugal indicate that, although mental health is considered a serious issue, it is problematic in policy terms. A range of arguments are put forward, making the case for the importance of mental health within the health promotion agenda, including the classification of mental illness as a public health problem, socio‐economic and individual costs of mental health problems and the view that mental well‐being is a crucial element of overall health. However problems of definition, measurement and a traditional focus on treatment and care continue to make mental health promotion problematic for policy makers.
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