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Fuente-Moreno M, Dima AL, Rubio-Valera M, Baladon L, Chavarria V, Contaldo SF, Peña-Salazar C, Serra-Sutton V, Hermida-González P, de Loño JP, Rey-Abella ME, Aznar-Lou I, Serrano-Blanco A. Evaluation of adherence to antipsychotics: A real-world data study using four different dosing assumptions. Br J Clin Pharmacol 2024; 90:1480-1492. [PMID: 38499460 DOI: 10.1111/bcp.16042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/28/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024] Open
Abstract
AIMS This study aimed to assess the frequency of dosing inconsistencies in prescription data and the effect of four dosing assumption strategies on adherence estimates for antipsychotic treatment. METHODS A retrospective cohort, which linked prescription and dispensing data of adult patients with ≥1 antipsychotic prescription between 2015-2016 and followed up until 2019, in Catalonia (Spain). Four strategies were proposed for selecting the recommended dosing in overlapping prescription periods for the same patient and antipsychotic drug: (i) the minimum dosing prescribed; (ii) the dose corresponding to the latest prescription issued; (iii) the highest dosing prescribed; and (iv) all doses included in the overlapped period. For each strategy, one treatment episode per patient was selected, and the Continuous Medication Availability measure was used to assess adherence. Descriptive statistics were used to describe results by strategy. RESULTS Of the 277 324 prescriptions included, 76% overlapped with other prescriptions (40% with different recommended dosing instructions). The number and characteristics of patients and treatment episodes (18 292, 18 303, 18 339 and 18 536, respectively per strategy) were similar across strategies. Mean adherence was similar between strategies, ranging from 57 to 60%. However, the proportion of patients with adherence ≥90% was lower when selecting all doses (28%) compared with the other strategies (35%). CONCLUSION Despite the high prevalence of overlapping prescriptions, the strategies proposed did not show a major effect on the adherence estimates for antipsychotic treatment. Taking into consideration the particularities of antipsychotic prescription practices, selecting the highest dose in the overlapped period seemed to provide a more accurate adherence estimate.
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Affiliation(s)
- Marina Fuente-Moreno
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Alexandra L Dima
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Rubio-Valera
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luisa Baladon
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Victor Chavarria
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Carlos Peña-Salazar
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Vicky Serra-Sutton
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS); Health Quality and Assessment Agency of Catalonia, Barcelona, Spain
| | | | - Jorge Peláez de Loño
- Unitat de Farmàcia. Regió Sanitària Metropolitana Sud CatSalut, Barcelona, Spain
| | | | - Ignacio Aznar-Lou
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Antoni Serrano-Blanco
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Karolaakso T, Autio R, Suontausta P, Leppänen H, Rissanen P, Näppilä T, Tuomisto MT, Pirkola S. Mental health service diversity and work disability: associations of mental health service system characteristics and mood disorder disability pensioning in Finland. Soc Psychiatry Psychiatr Epidemiol 2024; 59:631-642. [PMID: 37117785 PMCID: PMC10960744 DOI: 10.1007/s00127-023-02481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE Public mental health services (MHS) are crucial in preventing psychiatric disability pensions (DP). We studied the associations between mood disorder DP risk and the characteristics of Finnish municipalities' MHS provision using the ESMS-R mapping tool and Finnish population registers, based on first-time granted mood disorder DPs between 2010 and 2015. METHODS The final data set included 13,783 first-time mood disorder DP recipients and 1088 mental health service units in 104 municipalities. We focused on five different MHS types: all MHS, outpatient care provision, local services without and with gatekeeping, and centralized services. Three factors for each MHS type were studied: service resources, richness, and diversity index. Negative binomial regression models were used in the analysis. RESULTS In all the municipalities, higher service richness and diversity regarding all MHS, outpatient care and local services with gatekeeping were associated with a lower DP risk. In urban municipalities, service richness was mainly associated with lower DP risk, and in semi-urban municipalities service diversity and resources were primarily associated with lower DP risk in outpatient care and local services with gatekeeping. In rural municipalities, DP risk indicated no association with MHS factors. CONCLUSION The organization and structure of MHS play a role in psychiatric disability pensioning. MHS richness and diversity are associated with lower mood disorder DP in specific societal contexts indicating their role as quality indicators for regional MHS. The diversity of service provision should be accounted for in MHS planning to offer services matching population needs.
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Affiliation(s)
- Tino Karolaakso
- Faculty of Social Sciences (Psychology), Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
- Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Reija Autio
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Petra Suontausta
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Helena Leppänen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Päivi Rissanen
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Turkka Näppilä
- Tampere University Library, Tampere University, Tampere, Finland
| | - Martti T Tuomisto
- Faculty of Social Sciences (Psychology), Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
| | - Sami Pirkola
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
- Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland
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Tabatabaei-Jafari H, Furst MA, Bagheri N, D’Cunha NM, Bail K, Sachdev PS, Salvador-Carulla L. The Integrated Atlas of Dementia Care in the Australian Capital Territory: A Collective Case Study of Local Service Provision. Health Serv Insights 2024; 17:11786329241232254. [PMID: 38348356 PMCID: PMC10860480 DOI: 10.1177/11786329241232254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
Background This study evaluates the dementia care system in a local area and aimed to include all specialised services designed to provide health and social services to people with dementia or age-related cognitive impairment, as well as general services with a high or very high proportion of clients with dementia. Methods The study used an internationally standardised service classification instrument called Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) to identify and describe all services providing care to people with dementia in the Australian Capital Territory (ACT). Results A total of 47 service providers were eligible for inclusion. Basic information about the services was collected from their websites, and further information was obtained through interviews with the service providers. Of the 107 services offered by the 47 eligible providers, 27% (n = 29) were specialised services and 73% (n = 78) were general services. Most of the services were residential or outpatient, with a target population mostly of people aged 65 or older, and 50 years or older in the case of Aboriginal and Torres Strait Islander Australians. There were government supports available for most types of care through various programmes. Conclusions Dementia care in the ACT relies heavily on general services. More widespread use of standardised methods of service classification in dementia will facilitate comparison with other local areas, allow for monitoring of changes over time, permit comparison with services provided for other health conditions and support evidence-informed local planning.
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Mary Anne Furst
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Nasser Bagheri
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Nathan M. D’Cunha
- School of Rehabilitation and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Kasia Bail
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Karolaakso T, Autio R, Suontausta P, Leppänen H, Suokas K, Rissanen P, Tuomisto MT, Pirkola S. Patterns of mental health services and mood disorder disability pensions: a standard comparison of Finland's three largest hospital districts. BMC Psychiatry 2023; 23:828. [PMID: 37957646 PMCID: PMC10644417 DOI: 10.1186/s12888-023-05342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Mental disorders are one of the most common and disabling health conditions worldwide. There is however no consensus on the best practice of system level mental health services (MHS) provision, in order to prevent e.g. mood disorder disability pensions (DPs). We analyzed the MHS provision between Finland's three largest hospital districts Helsinki and Uusimaa (HUS), Southwest Finland and Pirkanmaa, with known differences in mood disorder DP risk but presumably equal rates of mood disorder prevalence. METHODS We used public MHS data analyzed with the standardized DEscription and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) mapping tool, focusing on all MHS, outpatient care provision, local services without and with gatekeeping, and centralized services. We also collected demographic data based on the European Socio-Demographic Schedule (ESDS). As a novel approach, the Gini-Simpson Diversity Index (GSDI) was calculated for the districts. RESULTS Evident differences were observed regarding the districts' MHS factors. As the hospital district with lower DP risk, HUS was characterized by the highest level of regional socioeconomic prosperity as well as high service richness and diversity. With a nationally average DP risk, Southwest Finland had the highest number of MHS personnel in full-time equivalents (FTE) per 100 000 inhabitants. Pirkanmaa, with a higher DP risk, had overall the lowest service richness and the lowest FTE of the three districts in all MHS, outpatient care and local services with gatekeeping. CONCLUSIONS Our findings indicate that greater richness and diversity of MHS, especially in outpatient and community-based settings, may serve as indicators of a balanced, high-quality service system that is more effective in preventing mood disorder DP and meeting the different needs of the population. In addition, the need for sufficient resourcing in all MHS and outpatient services is indicated. We suggest using diversity indices to complement the measuring and reporting of regional service variation.
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Affiliation(s)
- Tino Karolaakso
- Faculty of Social Sciences (Psychology), Tampere University, Arvo Ylpön katu 34, Tampere, FI- 33520, Finland.
- Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Reija Autio
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Petra Suontausta
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Helena Leppänen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kimmo Suokas
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Päivi Rissanen
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Martti T Tuomisto
- Faculty of Social Sciences (Psychology), Tampere University, Arvo Ylpön katu 34, Tampere, FI- 33520, Finland
| | - Sami Pirkola
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
- Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland
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Tabatabaei-Jafari H, Bagheri N, Lueck C, Furst MA, Salinas-Perez JA, Salvador-Carulla L. Standardized Systematic Description of Provision of Care for Multiple Sclerosis at a Local Level: A Demonstration Study. Int J MS Care 2023; 25:124-130. [PMID: 37250197 PMCID: PMC10211356 DOI: 10.7224/1537-2073.2022-014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND This study evaluates and describes the pattern of services provided for people living with multiple sclerosis (MS) in a local area as a starting point for a more global assessment. METHODS A health care ecosystem approach has been followed using an internationally standardized service classification instrument-the Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC)-to identify and describe all services providing care to people with MS in the Australian Capital Territory, Australia. Available services were classified according to the target population into those specifically dedicated to people living with MS and those providing general neurologic services, both public and private, and across both social and health sectors. RESULTS A limited range of services was available. There were no local facilities providing or coordinating multidisciplinary integrated care specific to people with MS. Subspecialty services specific to MS were limited in number (6 of the 28 services), and use of specialist services provided in neighboring states was frequently reported. Overall, very few services were provided outside the core health sector (4%). CONCLUSIONS The provision of care to people living with MS in the Australian Capital Territory is fragmented and relies heavily on generic neurology services in the public and private sectors. More widespread use of the DESDE-LTC as a standardized method of service classification in MS will facilitate comparison with other local areas, allow monitoring of changes over time, and permit comparison with services provided for other health conditions (eg, dementia, mental disorders).
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Nasser Bagheri
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Christian Lueck
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Department of Neurology, Canberra Hospital, Canberra, ACT, Australia (CL)
- Australian National University Medical School, Canberra, ACT, Australia (CL)
| | - Mary Anne Furst
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Jose A. Salinas-Perez
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Department of Quantitative Methods, Loyola University Andalucia, Seville, Spain (JAS-P)
| | - Luis Salvador-Carulla
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia (LS-C)
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Brunn M, Kratz T, Padget M, Clément MC, Smyrl M. Why are there so many hospital beds in Germany? Health Serv Manage Res 2023; 36:75-81. [PMID: 35331042 DOI: 10.1177/09514848221080691] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The place of hospitals in health systems is undergoing rapid change worldwide due to the high cost of hospital care and the changing health needs of the population. The Covid-19 pandemic has recently drawn public attention towards hospital capacity and has added new urgency to discussions on the future role of hospitals. In this context, recent experience in Germany provides valuable information for health systems seeking to manage hospital capacity. Despite reform efforts to reduce hospital capacity, Germany has the highest rates of intensive care beds among high-income countries and the highest overall hospital capacity in Europe. The capacity of the German hospital system can be explained in large part by the high number of elderly in-patients. This, in turn, is driven by (1) a fragmented ambulatory care system; (2) physicians admitting and maintaining elderly patients in hospital at a high rate; (3) a hospital market adding incentives to admit patients; and (4) a political commitment to egalitarian access and universal care. Additionally, recent policies to reduce hospital capacity have had limited impact because hospitals have not responded to financial incentives in the expected manner. Countries looking to learn from Germany's hospital capacity must therefore consider systemic features, political commitments, and unintended policy consequences.
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Affiliation(s)
| | - Torsten Kratz
- 14921Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany
| | | | | | - Marc Smyrl
- 214002Montpellier University Faculty of Law and Political Science, Montpellier, France
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Salinas-Perez JA, Gutierrez-Colosia MR, Garcia-Alonso CR, Furst MA, Tabatabaei-Jafari H, Kalseth J, Perkins D, Rosen A, Rock D, Salvador-Carulla L. Patterns of mental healthcare provision in rural areas: A demonstration study in Australia and Europe. Front Psychiatry 2023; 14:993197. [PMID: 36815193 PMCID: PMC9939444 DOI: 10.3389/fpsyt.2023.993197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Mental healthcare systems are primarily designed to urban populations. However, the specific characteristics of rural areas require specific strategies, resource allocation, and indicators which fit their local conditions. This planning process requires comparison with other rural areas. This demonstration study aimed to describe and compare specialized rural adult mental health services in Australia, Norway, and Spain; and to demonstrate the readiness of the healthcare ecosystem approach and the DESDE-LTC mapping tool (Description and Evaluation of Services and Directories of Long Term Care) for comparing rural care between countries and across areas. METHODS The study described and classified the services using the DESDE-LTC. The analyses included context analysis, care availability, placement capacity, balance of care, and diversity of care. Additionally, readiness (Technology Readiness Levels - TRL) and impact analyses (Adoption Impact Ladder - AIL) were also assessed by two independent raters. RESULTS The findings demonstrated the usability of the healthcare ecosystem approach and the DESDE-LTC to map and identify differences and similarities in the pattern of care of highly divergent rural areas. Day care had a greater weight in the European pattern of care, while it was replaced by social outpatient care in Australian areas. In contrast, care coordination was more common in Australia, pointing to a more fragmented system that requires navigation services. The share between hospital and community residential care showed no differences between the two regions, but there were differences between catchment areas. The healthcare ecosystem approach showed a TRL 8 (the tool has been demonstrated in a real-world environment and it is ready for release and general use) and an AIL of 5 (the target public agencies provided resources for its completion). Two experts evaluated the readiness of the use of DESDE-LTC in their respective regional studies. All of them were classified using the TRL. DISCUSSION In conclusion, this study strongly supports gathering data on the provision of care in rural areas using standardized methods to inform rural service planning. It provides information on context and service availability, capacity and balance of care that may improve, directly or through subsequent analyses, the management and planning of services in rural areas.
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Affiliation(s)
- Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | - Carlos R Garcia-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Mary Anne Furst
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | | | - David Perkins
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,Centre for Rural and Remote Mental Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alan Rosen
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Daniel Rock
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,WA Primary Health Alliance, Subiaco, WA, Australia.,Discipline of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Luis Salvador-Carulla
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,National Centre for Epidemiology and Population Health (NCEPH), Faculty of Health and Medicine, Australian National University, Canberra, Australia
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Salvador-Carulla L, Furst MA, Gillespie J, Rosenberg S, Aryani A, Anthes L, Ferdousi S, Salinas-Perez JA. Regional evolution of psychosocial services in Australia before and after the implementation of the National Disability Insurance Scheme. Aust N Z J Psychiatry 2022; 57:875-883. [PMID: 36208005 DOI: 10.1177/00048674221130981] [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: 11/17/2022]
Abstract
OBJECTIVES This paper compares the evolution of the psychosocial sector in two Australian regions pre and post introduction of the National Disability Insurance Scheme - a major reform to the financing, planning and provision of disability services in Australia, intended to create greater competition and efficiency in the market, and more choice for service users. METHODS We used a standardised service classification instrument based on a health ecosystems approach to assess service availability and diversity of psychosocial services provided by non-government organisations in two Primary Health Network regions. RESULTS We identified very different evolutionary pathways in the two regions. Service availability increased in Western Sydney but decreased in the Australian Capital Territory. The diversity of services available did not increase in either Primary Health Network 4 years after the reform. Many services were experiencing ongoing funding uncertainty. CONCLUSION Assumptions of increased efficiency through organisational scaling up, and a greater diversity in range of service availability were not borne out. IMPLICATIONS This study shows the urgent need for evaluation of the effects of the NDIS on the provision of psychosocial care in Australia. Four years after the implementation of the NDIS at vast expense key objectives not been met for consumers or for the system as a whole, and an environment of uncertainty has been created for providers. It demonstrates the importance of standardised service mapping to monitor the effects of major reforms on mental health care as well as the need for a focus at the local level.
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Affiliation(s)
- Luis Salvador-Carulla
- Health Research Institute, University of Canberra, Bruce, ACT, Australia.,Menzies Centre for Health Policy and Economics and Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Mary Anne Furst
- Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - James Gillespie
- Menzies Centre for Health Policy and Economics and Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | | | - Amir Aryani
- Centre for Transformative Innovation Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | | | - Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Dos Hermanas, Spain.,Psicost Research Association, Jerez de la Frontera, Spain
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Salinas-Perez JA, Ghuloum S, Gutierrez-Colosia MR, Bagheri N, Salvador-Carulla L. Analysis of the mental health service provision in Qatar: Progressing in community mental health in a Middle East country. Front Psychiatry 2022; 13:1095788. [PMID: 36590608 PMCID: PMC9800284 DOI: 10.3389/fpsyt.2022.1095788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Qatari health planning in the last decade aimed to make the transition from the traditional hospital-based psychiatric care to a community-based care, building an integrated and comprehensive mental health system. The objective of this study was to explore the mental health service provision in Qatar in 2018 and 2022. This time span coincided with two mental health plans (2013-2018 and 2019-2022) and one health plan (2018-2022). METHODS This study followed a healthcare ecosystem approach, including context analysis and the standard description and classification of mental health services. Service provision was studied applying DESDE-LTC system (Description and Evaluation of Services and DirectoriEs-Long Term Care), an internationally validated methodology to assess and describe mental health services. Service data were analyzed along with sociodemographic indicators from public statistics to know the care context. RESULTS The availability of specialized mental health services increased for adults, although it remained the same for other age groups. The diversity of care and the weight of health-related care over social-related care also remained quite similar. It was noteworthy the development of new services for young adults, migrant workers, and female populations. CONCLUSION This was the first time that this service research methodology has been applied in a Middle East country to study its mental healthcare pattern. The analysis of the mental healthcare pattern in the study time period showed the continued progress toward community-based care in Qatar in the framework of three health plans and despite the unexpected COVID-19 world pandemic.
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Affiliation(s)
- Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Dos Hermanas, Seville, Spain.,Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Suhaila Ghuloum
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | | | - Nasser Bagheri
- Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia.,Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Romero-Lopez-Alberca C, Alonso-Trujillo F, Almenara-Abellan JL, Salinas-Perez JA, Gutierrez-Colosia MR, Gonzalez-Caballero JL, Pinzon Pulido S, Salvador-Carulla L. A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study. J Med Internet Res 2021; 23:e24930. [PMID: 33720035 PMCID: PMC8074989 DOI: 10.2196/24930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/19/2020] [Accepted: 12/17/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND DESDE-LTC (Description and Evaluation of Services and DirectoriEs for Long-Term Care) is an international classification system that allows standardized coding and comparisons between different territories and care sectors, such as health and social care, in defined geographic areas. We adapted DESDE-LTC into a computer tool (DESDE-AND) for compiling a directory of care services in Andalucia, Spain. OBJECTIVE The aim of this study was to evaluate the maturity of DESDE-AND. A secondary objective of this study is to show the practicality of a new combined set of standard evaluation tools for measuring the maturity of health technology products. METHODS A system for semiautomated coding of service provision has been co-designed. A panel of 23 domain experts and a group of 68 end users participated in its maturity assessment that included its technology readiness level (TRL), usability, validity, adoption (Adoption Impact Ladder [AIL]), and overall degree of maturity [implementation maturity model [IMM]). We piloted the prototype in an urban environment (Seville, Spain). RESULTS The prototype was demonstrated in an operational environment (TRL 7). Sixty-eight different care services were coded, generating fact sheets for each service and its geolocation map. The observed agreement was 90%, with moderate reliability. The tool was partially adopted by the regional government of Andalucia (Spain), reaching a level 5 in adoption (AIL) and a level 4 in maturity (IMM) and is ready for full implementation. CONCLUSIONS DESDE-AND is a usable and manageable system for coding and compiling service directories and it can be used as a core module of decision support systems to guide planning in complex cross-sectoral areas such as combined social and health care.
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Affiliation(s)
- Cristina Romero-Lopez-Alberca
- Department of Psychology, Universidad de Cádiz, Cádiz, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Federico Alonso-Trujillo
- Agencia de Servicios Sociales y Dependencia de Andalucía, Junta de Andalucía, Sevilla, Spain
- Health Information Systems Group (SICA-CTS-553), Universidad de Cádiz, Cádiz, Spain
| | - Jose Luis Almenara-Abellan
- Health Information Systems Group (SICA-CTS-553), Universidad de Cádiz, Cádiz, Spain
- Hospital Universitario Reina Sofía, Servicio Andaluz de Salud, Córdoba, Spain
| | - Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | | | | | - Sandra Pinzon Pulido
- Escuela Andaluza de Salud Pública, Gobierno Regional de la Junta de Andalucía, Granada, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
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Tabatabaei-Jafari H, Salinas-Perez JA, Furst MA, Bagheri N, Mendoza J, Burke D, McGeorge P, Salvador-Carulla L. Patterns of Service Provision in Older People's Mental Health Care in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8516. [PMID: 33212966 PMCID: PMC7698522 DOI: 10.3390/ijerph17228516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022]
Abstract
Australia has a population of around 4 million people aged 65 years and over, many of whom are at risk of developing cognitive decline, mental illness, and/or psychological problems associated with physical illnesses. The aim of this study was to describe the pattern of specialised mental healthcare provision (availability, placement capacity, balance of care and diversity) for this age group in urban and rural health districts in Australia. The Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) tool was used in nine urban and two rural health districts of the thirty-one Primary Health Networks across Australia. For the most part service provision was limited to hospital and outpatient care across all study areas. The latter was mainly restricted to health-related outpatient care, and there was a relative lack of social outpatient care. While both acute and non-acute hospital care were available in urban areas, in rural areas hospital care was limited to acute care. Limited access to comprehensive mental health care, and the uniformity in provision across areas in spite of differences in demographic, socioeconomic and health characteristics raises issues of equity in regard to psychogeriatric care in this country. Comparing patterns of mental health service provision across the age span using the same classification method allows for a better understanding of care provision and gap analysis for evidence-informed policy.
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - Jose A. Salinas-Perez
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
- Department of Quantitative Methods, Universidad Loyola Andalucía, 41704 Dos Hermanas, Sevilla, Spain
| | - Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - Nasser Bagheri
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - John Mendoza
- Mental Health & Prison Health, Central Adelaide Local Health Network, Adelaide, SA 5000, Australia;
- Brain and Mind Centre, University of Sydney, Sydney, NSW 2050, Australia
| | - David Burke
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW 2010, Australia; (D.B.); (P.M.)
| | - Peter McGeorge
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW 2010, Australia; (D.B.); (P.M.)
- School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia
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Alonso-Solís A, Ochoa S, Grasa E, Rubinstein K, Caspi A, Farkas K, Unoka Z, Usall J, Huerta-Ramos E, Isohanni M, Seppälä J, Reixach E, Berdún J, Corripio I, Group MRESIST. A Method to Compare the Delivery of Psychiatric Care for People with Treatment-Resistant Schizophrenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207527. [PMID: 33081208 PMCID: PMC7589763 DOI: 10.3390/ijerph17207527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Community services are gaining ground when it comes to attention to patients with psychiatric diseases. Regarding patients with treatment-resistant schizophrenia (TRS), the use of information and communication technology (ICT) could help to shift the focus from hospital-centered attention to community services. This study compares the differences in mental health services provided for patients with TRS in Budapest (Hungary), Tel-Aviv (Israel) and Catalonia (Spain) by means of a method for the quick appraisal of gaps among the three places, for a potential implementation of the same ICT tool in these regions. METHODS An adapted version of the Description and Standardised Evaluation of Services and Directories in Europe for Long Term Care (DESDE-LTC) instrument was made by researchers in Semmelweis University (Budapest, Hungary), Gertner Institute (Tel-Aviv, Israel) and Hospital de la Santa Creu I Sant Pau and Parc Sanitari Sant Joan de Déu (Catalonia, Spain). RESULTS Two types of outpatient care services were available in the three regions. Only one type of day-care facility was common in the whole study area. Two residential care services, one for acute and the other for non-acute patients were available in every region. Finally, two self-care and volunteer-care facilities were available in the three places. CONCLUSION Although the availability of services was different in each region, most of the services provided were sufficiently similar to allow the implementation of the same ICT solution in the three places.
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Affiliation(s)
- Anna Alonso-Solís
- Psychiatry Department, Institutd’ Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa CreuiSant Pau; Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain; (A.A.-S.); (E.G.); (I.C.)
- CIBERSAM, Biomedical Research Networking Centre Consortium on Mental Health, 28029 Madrid, Spain; (S.O.); (E.H.-R.)
| | - Susana Ochoa
- CIBERSAM, Biomedical Research Networking Centre Consortium on Mental Health, 28029 Madrid, Spain; (S.O.); (E.H.-R.)
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi Llobregat, Barcelona, Spain
| | - Eva Grasa
- Psychiatry Department, Institutd’ Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa CreuiSant Pau; Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain; (A.A.-S.); (E.G.); (I.C.)
- CIBERSAM, Biomedical Research Networking Centre Consortium on Mental Health, 28029 Madrid, Spain; (S.O.); (E.H.-R.)
| | - Katya Rubinstein
- The Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Aviv University, 6997801 Tel Aviv, Israel; (K.R.); (A.C.)
| | - Asaf Caspi
- The Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Aviv University, 6997801 Tel Aviv, Israel; (K.R.); (A.C.)
| | - Kinga Farkas
- Department of Psychiatry and Psychotherapy, Semmelweis University, 1083 Budapest, Hungary; (K.F.); (Z.U.)
| | - Zsolt Unoka
- Department of Psychiatry and Psychotherapy, Semmelweis University, 1083 Budapest, Hungary; (K.F.); (Z.U.)
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi Llobregat, Barcelona, Spain
- Correspondence:
| | - Elena Huerta-Ramos
- CIBERSAM, Biomedical Research Networking Centre Consortium on Mental Health, 28029 Madrid, Spain; (S.O.); (E.H.-R.)
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi Llobregat, Barcelona, Spain
| | - Matti Isohanni
- Centre for Life Course Health Research, University of Oulu, 90570 Oulu, Finland; (M.I.); (J.S.)
- Department of Psychiatry, Oulu University Hospital, 90220 Oulu, Finland
| | - Jussi Seppälä
- Centre for Life Course Health Research, University of Oulu, 90570 Oulu, Finland; (M.I.); (J.S.)
- South Carelia Social and Health Care District, Psychiatric and Substance Use Services, 53130 Lappeenranta, Finland
| | - Elisenda Reixach
- TicSalut Health Department, Generalitat de Catalunya 08005 Barcelona, Spain; (E.R.); (J.B.)
| | - Jesús Berdún
- TicSalut Health Department, Generalitat de Catalunya 08005 Barcelona, Spain; (E.R.); (J.B.)
| | - Iluminada Corripio
- Psychiatry Department, Institutd’ Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa CreuiSant Pau; Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain; (A.A.-S.); (E.G.); (I.C.)
- CIBERSAM, Biomedical Research Networking Centre Consortium on Mental Health, 28029 Madrid, Spain; (S.O.); (E.H.-R.)
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Salinas-Perez JA, Gutierrez-Colosia MR, Furst MA, Suontausta P, Bertrand J, Almeda N, Mendoza J, Rock D, Sadeniemi M, Cardoso G, Salvador-Carulla L. Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland): Modèles de soins de santé mentale dans les régions éloignées: Kimberley (Australie), Nunavik (Canada) et Laponie (Finlande). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:721-730. [PMID: 32720514 PMCID: PMC7502882 DOI: 10.1177/0706743720944312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mental health (MH) care in remote areas is frequently scarce and fragmented and difficult to compare objectively with other areas even in the same country. This study aimed to analyze the adult MH service provision in 3 remote areas of Organization for Economic Cooperation and Development countries in the world. METHODS We used an internationally agreed set of systems indicators, terminology, and classification of services (Description and Evaluation of Services and DirectoriEs for Long Term Care). This instrument provided a standard description of MH care provision in the Kimberley region (Australia), Nunavik (Canada), and Lapland (Finland), areas characterized by an extremely low population density and high relative rates of Indigenous peoples. RESULTS All areas showed high rates of deprivation within their national contexts. MH services were mostly provided by the public sector supplemented by nonprofit organizations. This study found a higher provision per inhabitant of community residential care in Nunavik in relation to the other areas; higher provision of community outreach services in the Kimberley; and a lack of day services except in Lapland. Specific cultural-based services for the Indigenous population were identified only in the Kimberley. MH care in Lapland was self-sufficient, and its care pattern was similar to other Finnish areas, while the Kimberley and Nunavik differed from the standard pattern of care in their respective countries and relied partly on services located outside their boundaries for treating severe cases. CONCLUSION We found common challenges in these remote areas but a huge diversity in the patterns of MH care. The implementation of care interventions should be locally tailored considering both the environmental characteristics and the existing pattern of service provision.
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Affiliation(s)
- Jose A. Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mencia R. Gutierrez-Colosia
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
- Asociación Científica Psicost, Dos Hermanas, Sevilla, Spain
| | - Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Petra Suontausta
- Faculty of Social Sciences, Tampere University, Pirkanmaa, Finland
| | | | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
| | - John Mendoza
- ConNetica Consulting, Coolum, Queensland, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Perth, Western Australia, Australia
- Discipline of Psychiatry, The University of Western Australia, Perth, Western Australia, Australia
| | - Minna Sadeniemi
- Unit for Mental Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Center (CHRC), Nova Medical School, Nova University of Lisbon, Portugal
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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14
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Salinas-Pérez JA, Gutiérrez-Colosia MR, Romero López-Alberca C, Poole M, Rodero-Cosano ML, García-Alonso CR, Salvador-Carulla L. [Everything is on the map: Integrated Mental Health Atlases as support tools for service planning. SESPAS Report 2020]. GACETA SANITARIA 2020; 34 Suppl 1:11-19. [PMID: 32933792 DOI: 10.1016/j.gaceta.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This article reviews the usability of the Integrated Atlases of Mental Health as a decision support tool for service planning following a health ecosystem research approach. METHOD This study describes the types of atlases and the procedure for their development. Atlases carried out in Spain are presented and their impact in mental health service planning is assessed. Atlases comprise information on the local characteristics of the health care system, geographical availability of resources collected with the DESDE-LTC instrument and their use. Atlases use geographic information systems and other visualisation tools. Atlases follow a bottom-up collaborative approach involving decision-makers from planning agencies for their development and external validation. RESULTS Since 2005, Integrated Atlases of Mental Health have been developed for nine regions in Spain comprising over 65% of the Spanish inhabitants. The impact on service planning has been unequal for the different regions. Catalonia, Biscay and Gipuzkoa, and Andalusia reach the highest impact. In these areas, health advisors have been actively involved in their co-design and implementation in service planning. CONCLUSIONS Atlases allow detecting care gaps and duplications in care provision; monitoring changes of the system over time, and carrying out national and international comparisons, efficiency modelling and benchmarking. The knowledge provided by atlases could be incorporated to decision support systems in order to support an efficient mental health service planning based on evidence-informed policy.
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Affiliation(s)
- José A Salinas-Pérez
- Asociación Científica Psicost, Sevilla, España; Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España.
| | - Mencía R Gutiérrez-Colosia
- Asociación Científica Psicost, Sevilla, España; Departamento de Psicología, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España
| | - Cristina Romero López-Alberca
- Asociación Científica Psicost, Sevilla, España; Departamento de Psicología, Universidad de Cádiz, San Fernando, Cádiz, España
| | - Miriam Poole
- Asociación Científica Psicost, Sevilla, España; Asociación Nuevo Futuro, Madrid, España
| | - María Luisa Rodero-Cosano
- Asociación Científica Psicost, Sevilla, España; Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España
| | - Carlos R García-Alonso
- Asociación Científica Psicost, Sevilla, España; Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España
| | - Luis Salvador-Carulla
- Asociación Científica Psicost, Sevilla, España; Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia; Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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15
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Furst MA, Bagheri N, Salvador-Carulla L. An ecosystems approach to mental health services research. BJPsych Int 2020; 18:23-25. [PMID: 34287396 PMCID: PMC8274404 DOI: 10.1192/bji.2020.24] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/24/2020] [Accepted: 03/24/2020] [Indexed: 11/23/2022] Open
Abstract
Mental health ecosystems research is an emerging discipline which takes a whole-systems approach to mental healthcare, facilitating analysis of the complex environment and context of mental health systems, and translation of this knowledge into policy and practice. Evidence from the local context is needed in the analysis of complex interventions and of geographic variations in the outcomes of care. Technical tools and support have been developed to gather and interpret evidence from the local context and translate it in a meaningful and relevant manner for planners and policy makers to guide their decision-making.
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Affiliation(s)
- Mary Anne Furst
- Australian National University College of Health and Medicine.
| | - Nasser Bagheri
- Australian National University College of Health and Medicine.
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Küçük A, Özsoy VS, Balkan D. Assessment of technical efficiency of public hospitals in Turkey. Eur J Public Health 2020; 30:230-235. [PMID: 31412115 DOI: 10.1093/eurpub/ckz143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Turkish public hospitals have been subjected to health care reform because of increasing cost pressure, inequities in access to health care, poor quality of care and limited patient responsiveness in the last three decades. This study investigates the impact of recent hospital reforms on the efficiency of public hospitals. METHODS The study provides a comprehensive evaluation of the efficiency of Turkish hospitals by using Data Envelopment Analysis (DEA). The estimation of efficiency of 669 public hospitals of Turkey is performed by an output-oriented model of DEA under the assumption of variable return-to-scale by using data collected from the Ministry of Health (MoH) over the period 2013-17. RESULTS The average efficiency score is equal to 0.83 for all MoH hospitals. Considering the hospital type, the efficiency scores of training and research hospitals are higher than those of the general and branch hospitals. In addition, considering the hospital size, huge-scale hospitals have the highest efficiency score in all years. Moreover, overcrowded regions such as Marmara and South-eastern Anatolia regions had higher efficiency scores than other geographical regions. CONCLUSIONS The results indicate that recent health reforms did not significantly enhance hospital efficiency. Thus, policymakers and managers should take the necessary precautions to increase hospital efficiency.
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Affiliation(s)
- Aziz Küçük
- Directorate General for Public Hospitals, The Ministry of Health of Turkey, Ankara, Turkey
| | | | - Dursun Balkan
- Directorate General for Productivity, The Ministry of Industry and Technology of Turkey, Ankara, Turkey
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Chung Y, Bagheri N, Salinas-Perez JA, Smurthwaite K, Walsh E, Furst M, Rosenberg S, Salvador-Carulla L. Role of visual analytics in supporting mental healthcare systems research and policy: A systematic scoping review. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2020. [DOI: 10.1016/j.ijinfomgt.2019.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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van Spijker BA, Salinas-Perez JA, Mendoza J, Bell T, Bagheri N, Furst MA, Reynolds J, Rock D, Harvey A, Rosen A, Salvador-Carulla L. Service availability and capacity in rural mental health in Australia: Analysing gaps using an Integrated Mental Health Atlas. Aust N Z J Psychiatry 2019; 53:1000-1012. [PMID: 31250654 DOI: 10.1177/0004867419857809] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Access to services and workforce shortages are major challenges in rural areas worldwide. In order to improve access to mental health care, it is imperative to understand what services are available, what their capacity is and where existing funds might be spent to increase availability and accessibility. The aim of this study is to investigate mental health service provision in a selection of rural and remote areas across Australia by analysing service availability, placement capacity and diversity. METHOD This research studies the health regions of Western New South Wales and Country Western Australia and their nine health areas. Service provision was analysed using the DESDE-LTC system for long-term care service description and classification that allows international comparison. Rates per 100,000 inhabitants were calculated to compare the care availability and placement capacity for children and adolescents, adults and older adults. RESULTS The lowest diversity was found in northern Western Australia. Overall, Western New South Wales had a higher availability of non-acute outpatient services for adults, but hardly any acute outpatient services. In Country Western Australia, substantially fewer non-acute outpatient services were found, while acute services were much more common. Acute inpatient care services were more common in Western New South Wales, while sub-acute inpatient services and non-acute day care services were only found in Western New South Wales. CONCLUSION The number and span of services in the two regions showed discrepancies both within and between regions, raising issues on the equity of access to mental health care in Australia. The standard description of the local pattern of rural mental health care and its comparison across jurisdictions is critical for evidence-informed policy planning and resource allocation.
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Affiliation(s)
- Bregje A van Spijker
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Jose A Salinas-Perez
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia.,Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain
| | - John Mendoza
- ConNetica Consulting, Caloundra, QLD, Australia.,Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Tanya Bell
- ConNetica Consulting, Caloundra, QLD, Australia
| | - Nasser Bagheri
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Julia Reynolds
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Daniel Rock
- Discipline of Psychiatry, University of Western Australia Medical School, Perth, WA, Australia.,Western Australian Primary Health Alliance, Perth, WA, Australia
| | - Andrew Harvey
- Western New South Wales Primary Health District, Dubbo, NSW, Australia
| | - Alan Rosen
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Illawarra Institute for Mental Health, University of Wollongong, Wollongong, NSW, Australia.,Far West LHD Mental Health Services, Broken Hill, NSW, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
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Romero-López-Alberca C, Gutiérrez-Colosía MR, Salinas-Pérez JA, Almeda N, Furst M, Johnson S, Salvador-Carulla L. Standardised description of health and social care: A systematic review of use of the ESMS/DESDE (European Service Mapping Schedule/Description and Evaluation of Services and DirectoriEs). Eur Psychiatry 2019; 61:97-110. [PMID: 31426008 DOI: 10.1016/j.eurpsy.2019.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/27/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Evidence-informed planning and interpretation of research results both require standardised description of local care delivery context. Such context analysis descriptions should be comparable across regions and countries to allow benchmarking and organizational learning, and for research findings to be interpreted in context. The European Service Mapping Schedule (ESMS) is a classification of adult mental health services that was later adapted for the assessment of health and social systems research (Description and Evaluation of Services and DirectoriEs - DESDE). The aim of the study was to review the diffusion and use of the ESMS/DESDE system in health and social care and its impact in health policy and decision-making. METHOD We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (1997-2018). RESULTS Out of 155 papers mentioning ESMS/DESDE, 71 have used it for service research and planning. The classification has been translated into eight languages and has been used by seven international research networks. Since 2000, it has originated 11 instruments for health system research with extensive analysis of their metric properties. The ESMS/DESDE coding system has been used in 585 catchment areas in 34 countries for description of services delivery at local, regional and national levels. CONCLUSIONS The ESMS/DESDE system provides a common terminology, a classification of care services, and a set of tools allowing a variety of aims to be addressed in healthcare and health systems research. It facilitates comparisons across and within countries for evidence-informed planning.
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Affiliation(s)
| | | | - José A Salinas-Pérez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Seville, Asociación Científica Psicost, Spain
| | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
| | - Maryanne Furst
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra. Menzies Centre for Health Policy, University of Sydney, Australia
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Price A, Janssens A, Dunn-Morua S, Eke H, Asherson P, Lloyd T, Ford T. Seven steps to mapping health service provision: lessons learned from mapping services for adults with Attention-Deficit/Hyperactivity Disorder (ADHD) in the UK. BMC Health Serv Res 2019; 19:468. [PMID: 31288805 PMCID: PMC6617903 DOI: 10.1186/s12913-019-4287-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 06/20/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND ADHD affects some individuals throughout their lifespan, yet service provision for adults in the United Kingdom (UK) is patchy. Current methods for mapping health service provision are resource intensive, do not map specialist ADHD teams separately from generic mental health services, and often fail to triangulate government data with accounts from service users and clinicians. Without a national audit that maps adult ADHD provision, it is difficult to quantify current gaps in provision and make the case for change. This paper describes the development of a seven step approach to map adult ADHD service provision in the UK. METHODS A mapping method was piloted in 2016 and run definitively in 2018. A seven step method was developed: 1. Defining the target service 2. Identifying key informants 3. Designing the survey 4. Data collection 5. Data analysis 6. Communicating findings 7. Hosting/updating the service map. Patients and members of the public (including clinicians and commissioners) were involved with design, data collection and dissemination of findings. RESULTS Using a broad definition of adult ADHD services resulted in an inclusive list of identified services, and allowed the definition to be narrowed to National Health Service (NHS) funded specialist ADHD services at data analysis, with confidence that few relevant services would be missed. Key informants included patients, carers, a range of health workers, and commissioners. A brief online survey, written using lay terms, appeared acceptable to informants. Emails sent using national organisations' mailing lists were the most effective way to access informants on a large scale. Adaptations to the methodology in 2018 were associated with 64% more responses (2371 vs 1446) collected in 83% less time (5 vs 30 weeks) than the pilot. The 2016 map of adult ADHD services was viewed 13,688 times in 17 weeks, indicating effective communication of findings. CONCLUSION This seven step pragmatic method was effective for collating and communicating national service data about UK adult ADHD service provision. Patient and public involvement and engagement from partner organisations was crucial throughout. Lessons learned may be transferable to mapping service provision for other health conditions and in other locations.
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Affiliation(s)
- Anna Price
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Astrid Janssens
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
- Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, DK-5000 Odense C, Denmark
| | | | - Helen Eke
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Philip Asherson
- Kings College London, Institute of Psychiatry Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- UK Adult ADHD Network, London, UK
| | - Tony Lloyd
- ADHD Foundation, 151 Dale Street, Liverpool, L2 2AH UK
| | - Tamsin Ford
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
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Abstract
AIMS There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. METHODS A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (≥18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. RESULTS The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sør-Trøndelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. CONCLUSIONS There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.
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Furst MA, Gandré C, Romero López-Alberca C, Salvador-Carulla L. Healthcare ecosystems research in mental health: a scoping review of methods to describe the context of local care delivery. BMC Health Serv Res 2019; 19:173. [PMID: 30885186 PMCID: PMC6423877 DOI: 10.1186/s12913-019-4005-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Evidence from the context of local health ecosystems is highly relevant for research and policymaking to understand geographical variations in outcomes of health care delivery. In mental health systems, the analysis of context presents particular challenges related to their complexity and to methodological difficulties. Method guidelines and standard recommendations for conducting context analysis of local mental health care are urgently needed. This scoping study reviews current methods of context analysis in mental health systems to establish the parameters of research activity examining availability and capacity of care at the local level, and to identify any gaps in the literature. METHODS A scoping review based on a systematic search of key databases was conducted for the period 2005-2016. A systems dynamics/complexity approach was adopted, using a modified version of Tansella and Thornicroft's matrix model of mental health care as the conceptual framework for our analysis. RESULTS The lack of a specific terminology in the area meant that from 10,911 titles identified at the initial search, only 46 papers met inclusion criteria. Of these, 21 had serious methodological limitations. Fifteen papers did not use any kind of formal framework, and five of those did not describe their method. Units of analysis varied widely and across different levels of the system. Six instruments to describe service availability and capacity were identified, of which three had been psychometrically validated. A limitation was the exclusion of grey literature from the review. However, the imprecise nature of the terminology, and high number of initial results, makes the inclusion of grey literature not feasible. CONCLUSION We identified that, in spite of its relevance, context studies in mental health services is a very limited research area. Few validated instruments are available. Methodological limitations in many papers mean that the particular challenges of mental health systems research such as system complexity, data availability and terminological variability are generally poorly addressed, presenting a barrier to valid system comparison. The modified Thornicroft and Tansella matrix and related ecological production of care model provide the main model for research within the area of health care ecosystems.
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Affiliation(s)
- Mary Anne Furst
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd Acton ACT, Canberra, 2601 Australia
| | - Coralie Gandré
- URC-Eco Ile-de-France, F-75004 Paris, France
- University Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010 Paris, France
- Inserm, ECEVE, U1123, F-75010 Paris, France
| | | | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd Acton ACT, Canberra, 2601 Australia
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23
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Sadeniemi M, Almeda N, Salinas-Pérez JA, Gutiérrez-Colosía MR, García-Alonso C, Ala-Nikkola T, Joffe G, Pirkola S, Wahlbeck K, Cid J, Salvador-Carulla L. A Comparison of Mental Health Care Systems in Northern and Southern Europe: A Service Mapping Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1133. [PMID: 29857556 PMCID: PMC6024953 DOI: 10.3390/ijerph15061133] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/21/2018] [Accepted: 05/30/2018] [Indexed: 11/16/2022]
Abstract
Mental health services (MHS) have gone through vast changes during the last decades, shifting from hospital to community-based care. Developing the optimal balance and use of resources requires standard comparisons of mental health care systems across countries. This study aimed to compare the structure, personnel resource allocation, and the productivity of the MHS in two benchmark health districts in a Nordic welfare state and a southern European, family-centered country. The study is part of the REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care) project. The study areas were the Helsinki and Uusimaa region in Finland and the Girona region in Spain. The MHS were mapped by using the DESDE-LTC (Description and Evaluation of Services and Directories for Long Term Care) tool. There were 6.7 times more personnel resources in the MHS in Helsinki and Uusimaa than in Girona. The resource allocation was more residential-service-oriented in Helsinki and Uusimaa. The difference in mental health personnel resources is not explained by the respective differences in the need for MHS among the population. It is important to make a standard comparison of the MHS for supporting policymaking and to ensure equal access to care across European countries.
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Affiliation(s)
- Minna Sadeniemi
- Department of Social Services and Health Care, City of Helsinki, Southern Psychiatric Outpatient Clinic, Työpajankatu 14, FI-00099 Helsinki, Finland.
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (THL); Mannerheimintie 168, Helsinki FI-00270, Finland.
| | - Nerea Almeda
- PSICOST Research Association, Department of Psychology, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Jose A Salinas-Pérez
- PSICOST Research Association, Department of Quantitative Methods, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Mencía R Gutiérrez-Colosía
- PSICOST Research Association, Department of Psychology, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Carlos García-Alonso
- PSICOST Research Association, Department of Quantitative Methods, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Taina Ala-Nikkola
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (THL); Mannerheimintie 168, Helsinki FI-00270, Finland.
| | - Grigori Joffe
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
| | - Sami Pirkola
- University of Tampere School of Health Sciences, and Tampere University Hospital, Lääkärinkatu 1, Tampere FI-33014, Finland.
| | - Kristian Wahlbeck
- Unit for Mental Health, National Institute for Health and Welfare (THL); Mannerheimintie 168, Helsinki FI-00270, Finland.
| | - Jordi Cid
- Mental Health & Addiction Research Group, Institut d'Investigacions Biomèdiques de Girona (IdibGI)-Institut d'Assistència Sanitària, 17190 Salt Girona, Spain.
| | - Luis Salvador-Carulla
- VIDEA Lab, Centre for Mental Health Research, Australian National University, 63 Eggleston Rd, Acton ACT 2601, Australia.
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Chung Y, Salvador-Carulla L, Salinas-Pérez JA, Uriarte-Uriarte JJ, Iruin-Sanz A, García-Alonso CR. Use of the self-organising map network (SOMNet) as a decision support system for regional mental health planning. Health Res Policy Syst 2018; 16:35. [PMID: 29695248 PMCID: PMC5922302 DOI: 10.1186/s12961-018-0308-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Decision-making in mental health systems should be supported by the evidence-informed knowledge transfer of data. Since mental health systems are inherently complex, involving interactions between its structures, processes and outcomes, decision support systems (DSS) need to be developed using advanced computational methods and visual tools to allow full system analysis, whilst incorporating domain experts in the analysis process. In this study, we use a DSS model developed for interactive data mining and domain expert collaboration in the analysis of complex mental health systems to improve system knowledge and evidence-informed policy planning. Methods We combine an interactive visual data mining approach, the self-organising map network (SOMNet), with an operational expert knowledge approach, expert-based collaborative analysis (EbCA), to develop a DSS model. The SOMNet was applied to the analysis of healthcare patterns and indicators of three different regional mental health systems in Spain, comprising 106 small catchment areas and providing healthcare for over 9 million inhabitants. Based on the EbCA, the domain experts in the development team guided and evaluated the analytical processes and results. Another group of 13 domain experts in mental health systems planning and research evaluated the model based on the analytical information of the SOMNet approach for processing information and discovering knowledge in a real-world context. Through the evaluation, the domain experts assessed the feasibility and technology readiness level (TRL) of the DSS model. Results The SOMNet, combined with the EbCA, effectively processed evidence-based information when analysing system outliers, explaining global and local patterns, and refining key performance indicators with their analytical interpretations. The evaluation results showed that the DSS model was feasible by the domain experts and reached level 7 of the TRL (system prototype demonstration in operational environment). Conclusions This study supports the benefits of combining health systems engineering (SOMNet) and expert knowledge (EbCA) to analyse the complexity of health systems research. The use of the SOMNet approach contributes to the demonstration of DSS for mental health planning in practice. Electronic supplementary material The online version of this article (10.1186/s12961-018-0308-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Younjin Chung
- Faculty of Engineering & Information Technologies, The University of Sydney, 1 Cleveland Street, Darlington, NSW, 2008, Australia. .,ANU College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia.
| | - Luis Salvador-Carulla
- Faculty of Health Sciences, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.,ANU College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia
| | - José A Salinas-Pérez
- PSICOST Research Association, Universidad Loyola Andalucía, C/Energía Solar, 1 Edificio G, 41014, Sevilla, Spain
| | - Jose J Uriarte-Uriarte
- Bizkaia Mental Health Services, Osakidetza-Basque Health Service, Biocruces Health Research Institute, Calle Maria Diaz de Haro, 58, 48010, Bilbao, Spain
| | - Alvaro Iruin-Sanz
- Gipuzkoa Mental Health Services, Osakidetza - Basque Health Service, Biocruces Health Research Institute, Paseo Doctor Beguiristain, 115, 20014, San Sebastian, Spain
| | - Carlos R García-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, C/Escritor Castilla Aguayo, 4, 14004, Córdoba, Spain
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Serrano-Blanco A, Rubio-Valera M, Aznar-Lou I, Baladón Higuera L, Gibert K, Gracia Canales A, Kaskens L, Ortiz JM, Salvador-Carulla L. In-patient costs of agitation and containment in a mental health catchment area. BMC Psychiatry 2017; 17:212. [PMID: 28583103 PMCID: PMC5460463 DOI: 10.1186/s12888-017-1373-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. METHODS A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability. RESULTS During 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area. CONCLUSIONS Agitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.
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Affiliation(s)
- Antoni Serrano-Blanco
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Rubio-Valera
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Ignacio Aznar-Lou
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luisa Baladón Higuera
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
| | - Karina Gibert
- Statistics and Operations Research Department, Knowledge Engineering and Machine Learning group, Universitat Politècnica de Catalunya-Barcelona Tech, Barcelona, Spain
| | | | | | - José Miguel Ortiz
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Medicine, Biology & Environment, The Australian National University, Canberra, Australia
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Gandré C, Gervaix J, Thillard J, Macé JM, Roelandt JL, Chevreul K. The Development of Psychiatric Services Providing an Alternative to Full-Time Hospitalization Is Associated with Shorter Length of Stay in French Public Psychiatry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E325. [PMID: 28335580 PMCID: PMC5369161 DOI: 10.3390/ijerph14030325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/03/2017] [Accepted: 03/17/2017] [Indexed: 01/14/2023]
Abstract
International recommendations for mental health care have advocated for a reduction in the length of stay (LOS) in full-time hospitalization and the development of alternatives to full-time hospitalizations (AFTH) could facilitate alignment with those recommendations. Our objective was therefore to assess whether the development of AFTH in French psychiatric sectors was associated with a reduction in the LOS in full-time hospitalization. Using data from the French national discharge database of psychiatric care, we computed the LOS of patients admitted for full-time hospitalization. The level of development of AFTH was estimated by the share of human resources allocated to those alternatives in the hospital enrolling the staff of each sector. Multi-level modelling was carried out to adjust the analysis on other factors potentially associated with the LOS (patients', psychiatric sectors' and environmental characteristics). We observed considerable variations in the LOS between sectors. Although the majority of these variations resulted from patients' characteristics, a significant negative association was found between the LOS and the development of AFTH, after adjusting for other factors. Our results provide first evidence of the impact of the development of AFTH on mental health care and will provide a lever for policy makers to further develop these alternatives.
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Affiliation(s)
- Coralie Gandré
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
| | - Jeanne Gervaix
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
| | - Julien Thillard
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
| | - Jean-Marc Macé
- National Conservatory of Arts and Crafts, LIRSA, EA 4603, 75003 Paris, France.
| | - Jean-Luc Roelandt
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- World Health Organization Collaborating Centre for Research and Training in Mental Health, 59000 Lille, France.
| | - Karine Chevreul
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
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Developing a tool for mapping adult mental health care provision in Europe: the REMAST research protocol and its contribution to better integrated care. Int J Integr Care 2015; 15:e042. [PMID: 27118959 PMCID: PMC4843179 DOI: 10.5334/ijic.2417] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/10/2015] [Accepted: 10/12/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Mental health care is a critical area to better understand integrated care and to pilot the different components of the integrated care model. However, there is an urgent need for better tools to compare and understand the context of integrated mental health care in Europe. METHOD The REMAST tool (REFINEMENT MApping Services Tool) combines a series of standardised health service research instruments and geographical information systems (GIS) to develop local atlases of mental health care from the perspective of horizontal and vertical integrated care. It contains five main sections: (a) Population Data; (b) the Verona Socio-economic Status (SES) Index; (c) the Mental Health System Checklist; (d) the Mental Health Services Inventory using the DESDE-LTC instrument; and (e) Geographical Data. EXPECTED RESULTS The REMAST tool facilitates context analysis in mental health by providing the comparative rates of mental health service provision according to the availability of main types of care; care placement capacity; workforce capacity; and geographical accessibility to services in the local areas in eight study areas in Austria, England, Finland, France, Italy, Norway, Romania and Spain. DISCUSSION The outcomes of this project will facilitate cooperative work and knowledge transfer on mental health care to the different agencies involved in mental health planning and provision. This project would improve the information to users and society on the available resources for mental health care and system thinking at the local level by the different stakeholders. The techniques used in this project and the knowledge generated could eventually be transferred to the mapping of other fields of integrated care.
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Rubio-Valera M, Luciano JV, Ortiz JM, Salvador-Carulla L, Gracia A, Serrano-Blanco A. Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence. BMC Psychiatry 2015; 15:35. [PMID: 25881240 PMCID: PMC4356166 DOI: 10.1186/s12888-015-0417-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Agitation and containment are frequent in psychiatric care but little is known about their costs. The aim was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital or emergency service. METHODS Systematic searches of four electronic databases covering the period January 1998-January 2014 were conducted. Manual searches were also performed. Paper selection and data extraction were performed in duplicate. Cost data were converted to euros in 2014. RESULTS Ten studies met inclusion criteria and were included in the analysis (retrospective cohorts, prospective cohorts and cost-of-illness studies). Evaluated in these studies were length of stay, readmission rates and medication. Eight studies assessed the impact of agitation on the length of stay and six showed that it was associated with longer stays. Four studies examined the impact of agitation on readmission and a statistically significant increase in the probability of readmission of agitated patients was observed. Two studies evaluated medication. One study showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. One study estimated the costs of conflict and containment incurred in acute inpatient psychiatric care in the UK. The estimation for the year 2014 of total annual cost per ward for all conflict was €182,616 and €267,069 for containment based on updated costs from 2005. CONCLUSIONS Agitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Evidence is scarce and further research is needed to estimate the burden of agitation and containment from the perspective of hospitals and the healthcare system.
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Affiliation(s)
- Maria Rubio-Valera
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,School of Pharmacy, Universitat de Barcelona, Barcelona, Spain. .,Research & Development Unit, Parc Sanitari Sant Joan de, 22 Déu. C/ Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
| | - Juan V Luciano
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Open University of Catalonia (UOC), Barcelona, Spain.
| | | | - Luis Salvador-Carulla
- Centre for Disability Research and Policy, Faculty of Health Sciences, and Mental Health Policy Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
| | | | - Antoni Serrano-Blanco
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
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Salvador-Carulla L, Fernandez A, Madden R, Lukersmith S, Colagiuri R, Torkfar G, Sturmberg J. Framing of scientific knowledge as a new category of health care research. J Eval Clin Pract 2014; 20:1045-55. [PMID: 25421111 DOI: 10.1111/jep.12286] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 12/25/2022]
Abstract
RATIONALE The new area of health system research requires a revision of the taxonomy of scientific knowledge that may facilitate a better understanding and representation of complex health phenomena in research discovery, corroboration and implementation. METHOD A position paper by an expert group following and iterative approach. RESULTS 'Scientific evidence' should be differentiated from 'elicited knowledge' of experts and users, and this latter typology should be described beyond the traditional qualitative framework. Within this context 'framing of scientific knowledge' (FSK) is defined as a group of studies of prior expert knowledge specifically aimed at generating formal scientific frames. To be distinguished from other unstructured frames, FSK must be explicit, standardized, based on the available evidence, agreed by a group of experts and subdued to the principles of commensurability, transparency for corroboration and transferability that characterize scientific research. A preliminary typology of scientific framing studies is presented. This typology includes, among others, health declarations, position papers, expert-based clinical guides, conceptual maps, classifications, expert-driven health atlases and expert-driven studies of costs and burden of illness. CONCLUSIONS This grouping of expert-based studies constitutes a different kind of scientific knowledge and should be clearly differentiated from 'evidence' gathered from experimental and observational studies in health system research.
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Affiliation(s)
- Luis Salvador-Carulla
- Mental Health Policy Unit, Brain and Mind Research Institute, Centre for Disability Research Policy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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