Evaluating a primary care psychology service in Ireland: a survey of stakeholders and psychologists

Enhancing primary care psychology services with assistant psychologists in Ireland: An evaluation of output, throughput and stakeholder satisfaction

Primary care mental health services need to expand to assist the increased number of people reporting mild to moderate mental health difficulties. In Ireland, the primary care mental health service has been recently enhanced through the employment of Assistant Psychologists (AP) in primary care psychology. This paper provides an early and brief evaluation of the impact of the AP-enhanced model through a tripartite approach to evaluation which utilises measures of throughput, output and stakeholder satisfaction. We use data from two sources; Health service key performance indicators, and a routinely gathered minimal dataset of client measures. Results indicate that the numbers of clients seen in the period rose by 16%, that AP-delivered treatments are beneficial for clients with mild to moderate mental health difficulties, and more than 80% of clients reported being 'totally satisfied' with the care received. The data provide early evidence that the AP model is beneficial in meeting clients' needs across a range of presentations within the service admission criteria, and that the AP-enhanced model may offer a satisfactory solution to primary care needs. However, further data collection is required, and additional stakeholder input is necessary for a complete evaluation of the assistant psychologist model in primary care.

Depression interventions for individuals with coronary artery disease - Cost-effectiveness calculations from an Irish perspective

BACKGROUND

A substantial proportion of individuals with coronary artery disease experience moderate or severe acute depression that requires treatment. We assessed the cost-effectiveness of four interventions for depression in individuals with coronary artery disease.

METHODS

We assessed effectiveness of pharmacotherapy, psychotherapy, collaborative care and exercise as remission rate after 8 and 26 weeks using estimates from a recent network meta-analysis. The cost assessment included standard doses of antidepressants, contact frequency, and staff time per contact. Unit costs were calculated as health services' purchase price for pharmaceuticals and mid-point staff salaries obtained from the Irish Health Service Executive and validated by clinical staff. Incremental cost-effectiveness ratios were calculated as the incremental costs over incremental remissions compared to usual care. High- and low-cost scenarios and sensitivity analysis were performed with changed contact frequencies, and assuming individual vs. group psychotherapy or exercise.

RESULTS

After 8 weeks, the estimated incremental cost-effectiveness ratio was lowest for group exercise (€526 per remission), followed by pharmacotherapy (€589), individual psychotherapy (€3117) and collaborative care (€4964). After 26 weeks, pharmacotherapy was more cost-effective (€591) than collaborative care (€7203) and individual psychotherapy (€9387); no 26-week assessment for exercise was possible. Sensitivity analysis showed that group psychotherapy could be most cost-effective after 8 weeks (€519) and cost-effective after 26 weeks (€1565); however no group psychotherapy trials were available investigating its effectiveness.

DISCUSSION

Large variation in incremental cost-effectiveness ratios was seen. With the current assumptions, the most cost-effective depression intervention for individuals with coronary artery disease after 8 weeks was group exercise.

Primary and secondary care approach to paediatric mental health conditions: a novel model of care

The enforced isolation caused by the COVID-19 pandemic has led to an increase in mental health issues and severity of presentations to emergency departments in Ireland. Long waiting lists for both Psychology and Psychiatry are further impacting on children's mental well-being. We proposed the creation of a 'Happiness Toolkit' that can be given to children on presentation to their primary or secondary care provider with a mental health issue. The toolkit is comprised of six evidence-based techniques that are proven to boost self-esteem, develop resilience and promote positive mental health. A leaflet detailing the practices along with a physical 'box' that the children must make were created. This resource may therefore provide immediate support to those children that may endure long waiting periods, sometimes greater than a year and a half, for referral to tertiary services. Our toolkit allows children and their families to engage in positive mental health practices that may prevent regression during this waiting period and lead to improved mental health or cessation of symptoms.

Assessing Health Resources Equipped with Hemodynamic Rooms in the Portuguese-Spanish Borderland: Cross-Border Cooperation Strategies as a Possible Solution

Portugal and Spain share one of the greatest European borderland areas. This fact has direct impacts on a large territory and consequently on the communities’ living in it. Still, even if the border areas represent an essential fraction of the territory, planning policies have not resulted in specific cooperation programs that could enable sharing general leisure and recreation assets and infrastructures and collaboration in critical domains—i.e., the case of the health sector. The present study aims to assess the territorial accessibility to the hemodynamic rooms by the potential population of the Spanish-Portuguese transition areas that may suffer an acute myocardial infarction. Contextually, this study employed a spatial interaction model based on the three-step floating catchment area method (method-3SFCA). By applying these methods, it was possible to develop a map of accessibility to health infrastructures equipped with hemodynamics rooms on both sides of the border that may answer the Spanish-Portuguese border populations’ needs. Besides, while granting valuable information for decision-makers regarding the need to develop new infrastructures to guarantee that even considering cross border cooperation, everyone gets access to a hemodynamics room within the critical intervention period.

Trends in patients' overall satisfaction with healthcare delivery in Accra, Ghana

Background

Patient satisfaction represents a key marker for the quality of healthcare delivery and is critical for smooth functioning of the healthcare system.

Aim

The aim of this study was to determine the levels of patient satisfaction with the quality of care they receive, and thus identify the key factors that influence patients’ overall satisfaction with healthcare.

Setting

The study was conducted across seven healthcare facilities in Greater Accra region.

Methods

The study employed a cross-sectional design to obtain data from 417 respondents between 01 November 2017 and 31 January 2018. Patient satisfaction within the context and setting of this study refers to the extent to which patients are happy with the healthcare services they receive. Statistical analysis was performed using Statistical Package for the social Sciences (SPSS) version 23.

Results

Female patients constituted 66.7% of the respondents, while 33.3% were male patients. Most of the participants had health insurance coverage (95.2%). Overall, 69.5% of the patients were satisfied with the level of care, 29.3% were somewhat satisfied and 1.2% were not satisfied. Female patients (86.0%) were more satisfied with the level of care they received compared to male patients (61.9%). Majority of the female patients (87.8%) indicated that they were treated with courtesy and respect. However, more than a half (51.8%) of male patients indicated they were not treated with courtesy and respect. Patient satisfaction negatively correlated with social status and age of the patients.

Conclusion

Measurement of patients’ satisfaction is important for healthcare delivery. It was clear from this study that there is still a gap in improving and managing patients’ satisfaction and expectation. All stakeholders must get involved to ensure timely and satisfactory healthcare delivery to all patients.