Needs assessment: from theory to practice

The validation of the Needs Examination, Evaluation, and Dissemination assessment framework within the European Union: a modified Delphi study

The NEED (Needs Examination, Evaluation, and Dissemination) assessment framework was designed to identify and measure unmet health-related needs of patients and society across various health conditions, aiding the development of needs-driven healthcare policy and innovation. The framework consists of 25 needs criteria and 46 associated indicators that assess whether these needs are met or not. This study aims to validate the framework at the European Union (EU) level using a modified Delphi approach. We selected national and European institutes for the Delphi process based on their roles in public health, health technology assessment (HTA), medicine authorization, pricing and reimbursement (P&R), and patient advocacy. Using a modified Delphi approach, experts provided feedback on the framework's structure (dimensions and domains), health-related needs criteria, and indicators. Two Delphi rounds were conducted via online questionnaires. A panel of 26 experts participated in both rounds of the study. The majority of the participants reported expertise in HTA (50%) and P&R (15%), followed by patient advocacy (15%) and public health (8%). Seventeen EU Member States were represented, with a higher representation of experts from Belgium (12%) and Germany (12%). The NEED framework based on expert consensus consists of 4 dimensions, 3 domains, 24 criteria, and 43 indicators. The modified Delphi technique proved effective for validating the NEED framework at the EU level. This marks a critical first step toward consensus on defining and identifying unmet health-related needs, paving the way for a more needs-driven healthcare policy and innovation landscape.

Segmenting the Population and Estimating Transition Probabilities Using Data on Health and Health-Related Social Service Needs from the US Health and Retirement Study

BackgroundSimulation modeling is a promising tool to help policy makers and providers make evidence-based decisions when evaluating integrated care programs. The functionality of such models, however, depends on 2 prerequisites: 1) the analytical segmentation of populations to capture both health and health-related social service (HASS) needs and 2) the precise estimation of transition probabilities among the various states of need.MethodsWe took a validated instrument for segmenting the population by HASS needs and adapted it to the Health and Retirement Study, a nationally representative survey dataset from the US population older than 50 y. We then estimated the transition probabilities across all 10 need states and death using multistate modeling. A need state was defined as a combination of any of the 5 ordinal global impression segments and a complicating factor status.ResultsKaplan-Meier survival curves, log-rank tests, and c-indices were used to assess predictive validity in relation to mortality. The Markov traces, using the estimated transition probability to replicate 2 closed cohorts, resembled the proportion of individuals per health state across subsequent waves well enough to indicate adequate fit of the estimated transition probabilities.ConclusionsThis article provides a population segmentation approach that incorporates HASS needs for the US population and 1-y transition probabilities across HASS need states and death. This is the first application of HASS segmentation that can estimate transitions between all 10 HASS need states, facilitating novel analysis of policy decisions related to integrated care.ImplicationsOur results will be used as input for a simulation model that performs scenario analysis on the long-term effects of various integrated care policies on population health.HighlightsWe took a validated tool for segmenting the population according to health and health-related social service (HASS) needs and adapted it to the Health and Retirement Study, a nationally representative survey dataset from the US population over the age of 50 y.We estimated the 1-y transition probabilities across all 10 HASS segments and death.This is the first application of a version of this HASS segmentation tool that includes HASSs in the various need states when estimating transition probabilities.Our results will be used as input for a simulation model that performs scenario analysis on the long-term effects of various integrated care policies on population health.

Needs assessment and Acceptability of a Community First Aid Responder programme to increase Out-of-hospital capacity in Kinshasa, Democratic Republic of Congo: A qualitative study

Objective

Despite efforts in recent years to expand the availability of prehospital care in low- and middle-income countries, its availability remains limited in many regions. The World Health Organization advocates the development of layperson first responder programmes as a supportive step in building functioning prehospital systems. This study aimed to identify the need for, and acceptability of, a community first responder programme to increase out-of-hospital capacity in Kinshasa, Democratic Republic of Congo.

Methods

We conducted five focus group discussions using purposive sampling. We included health system planners, emergency care providers, community health volunteers, and community members in both urban and peri‑urban areas. Interviews were recorded and transcribed verbatim, validated, and subjected to inductive content analysis to identify themes and sub-themes.

Results

Several areas of the emergency care system were identified for improvement, starting with the initial response to emergencies in the community. Barriers included planning and governance issues; inadequate resources such as trained staff; cost; transportation issues; and reliance on alternative forms of care. There was a dominant view that sustainably addressing these barriers and building on identified facilitators requires a multi-pronged approach involving government, healthcare, and community members. Perspectives about the acceptability and sustainability of a community first responder programme were largely positive, and numerous actionable recommendations were provided.

Conclusion

A community first responder programme was deemed a useful and acceptable intervention to help increase out-of-hospital emergency care capacity in Kinshasa. Key potential facilitators and barriers to its implementation and sustainability were identified.

Development and validation of a brief assessment of normative health and health-related social needs using the Simple Segmentation Tool

OBJECTIVES

Population segmentation provides a promising solution to address patients' complex needs to provide "whole person" care. The primary objective of this study is to create an expert-based algorithm based on combinations of medical and social characteristics derived from the Simple Segmentation Tool (SST), that are indicative of high value health and health-related social service (HASS) needs for an elderly population. The secondary objective was to examine the association between failing to meet the HASS needs 3-months post hospital discharge suggested by the algorithm and adverse outcomes over the ensuing year.

DESIGN & SETTING

Based on a parsimonious set of 10 patient characteristics identified in the SST, a representative expert panel was engaged using the Modified Appropriateness Methodology (MAM). A prospective study was then performed on patients admitted to the Singapore General Hospital, using HASS needs identified at discharge and met needs at 3 months post-discharge follow-up of services received, to assess whether unmet needs were associated with higher adverse outcomes in the year following discharge. The primary outcome of interest was time to all-cause mortality over 12-months post-discharge and was assessed with Cox regression analysis.

RESULTS

The MAM exercise resulted in 12 normatively defined high value services, using a combination of patients' medical and social characteristics based on the SST, as well as a list of means of providing those service needs. The all-cause mortality hazard ratio of having at least one unmet need versus having all needs met for individuals deemed to be chronically symptomatic at discharge was 1.949, (95% CI: 0.99 - 3.84, and p = 0.05), while for those who were either healthy or only had asymptomatic chronic conditions the all-cause mortality ratio of having at least one unmet need versus having all needs met was 0.28 (95% CI = 0.06-1.27 and p-value = 0.10). The hazard ratio for ED visits and hospital readmission were above one but did not reach level of 95% confidence level.

CONCLUSION

The SST methodology provides a practical way to assess HASS needs that are predictive of mortality when needs are not met. It could serve as a screening tool to identify individuals who are likely to benefit from detailed care planning and follow-up.

Seeking help for menstrual pain during adolescence: A mixed-methods retrospective survey of treatment experiences and preferences

BACKGROUND

Menstrual pain can significantly impact adolescents' well-being and functioning. Despite the prevalence of adolescent menstrual pain, information about adolescents' experiences seeking treatment is limited.

OBJECTIVES

We examined retrospective reports of help-seeking in adolescence among menstruators to better understand perceptions and experiences of interacting with the healthcare system due to menstrual pain.

DESIGN

This study used an embedded mixed-methods design in which the qualitative and quantitative data were collected concurrently.

METHODS

Young adults aged 18-25 who experienced menstrual pain in adolescence completed an online, mixed-methods survey of help-seeking experiences. Responses were analyzed using descriptive statistics and reflexive thematic analysis.

RESULTS

Across participants (N = 590, Mage = 21.78 years), 41% sought treatment for menstrual pain in adolescence and of these 43% found the treatments they were offered ineffective. Three themes were generated related to why treatment was perceived as unsuitable: "Side effects and risks of pharmacological treatment," "treatment not tailored to the individual," and "treatment seen as a band-aid solution." Participants perceived the treatment options as limited and likely not addressing the underlying cause of their pain. Four themes were generated related to perceived improvements to treatment seeking. Participants recommended that healthcare providers: "Go beyond contraceptives," "share and demonstrate expertise," "investigate menstrual pain," and "listen and do not dismiss." Participants reported that having more information, feeling validated, and understanding treatment recommendations would improve their experience.

CONCLUSION

Participants perceived that their menstrual pain-related treatment needs were unmet in adolescence, despite being offered treatments that align with treatment guidelines for adolescent menstrual pain. Findings suggest that improving explanations about treatment provided to youth, along with improving communication and menstrual education, may lead to more optimal help-seeking experiences among adolescents.

Scaling-Out Digitally Enabled Integrated Care in Europe Through Good Practices Transfer: The JADECARE Study

Introduction

The absence of a coordinated approach to health and social care compromises the ability of health systems to provide universal, equitable, high-quality, and financially sustainable care. Transferring evidence-based practices focused on digitally-enabled integrated care to new contexts can overcome this challenge if implementation is satisfactory. This paper presents the scaling-out methodology that JADECARE has designed to spread effective innovative practices across Europe.

Methodology

The scaling-out methodology pretends to guide the Next Adopters in the transfer and adoption of practices, whereas increasing their implementation capacity and providing an evaluation framework to assess impact and success.

Discussion

JADECARE scaling-out effort is based on guiding principles found in the literature such as the balance between fidelity to the original practice and the degree of adaptation required to fit the new context, the need for capacity building in implementation to bridge the gap between research and routine practice and the focus on explaining why, for whom and in what circumstances an intervention works.

Conclusion

The JADECARE scaling-out methodology is theory-driven and pragmatic and aims to facilitate the transfer of complex interventions across different contexts.

Transition of care from post-acute services for the older adults in Quebec: a pilot impact evaluation

BACKGROUND

Early discharge of frail older adults from post-acute care service may result in individuals' reduced functional ability to carry out activities of daily living, and social, emotional, and psychological distress. To address these shortcomings, the Montreal West Island Integrated University Health and Social Services Centre in Quebec, Canada piloted a post-acute home physiotherapy program (PAHP) to facilitate the transition of older adults from the hospital to their home. This study aimed to evaluate: (1) the implementation fidelity of the PAHP program; (2) its impact on the functional independence, physical and mental health outcomes and quality of life of older adults who underwent this program (3) its potential adverse events, and (4) to identify the physical, psychological, and mental health care needs of older adults following their discharge at home.

METHODS

A quasi-experimental uncontrolled design with repeated measures was conducted between April 1st, 2021 and December 31st, 2021. Implementation fidelity was assessed using three process indicators: delay between referral to and receipt of the PAHP program, frequency of PAHP interventions per week and program duration in weeks. A battery of functional outcome measures, including the Functional Independence Measure (FIM) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scale, as well as fall incidence, emergency visits, and hospitalizations were used to assess program impact and adverse events. The Patient's Global Impression of Change (PGICS) was used to determine changes in participants' perceptions of their level of improvement/deterioration. In addition, the Camberwell Assessment of Need for the Elderly (CANE) questionnaire was administered to determine the met and unmet needs of older adults.

RESULTS

Twenty-four individuals (aged 60.8 to 94 years) participated in the PAHP program. Implementation fidelity was low in regards with delay between referral and receipt of the program, intensity of interventions, and total program duration. Repeated measures ANOVA revealed significant improvement in FIM scores between admission and discharge from the PAHP program and between admission and the 3-month follow-up. Participants also reported meaningful improvements in PGICS scores. However, no significant differences were observed on the physical or mental health T-scores of the PROMIS Global-10 scale, in adverse events related to the PAHP program, or in the overall unmet needs.

CONCLUSION

Findings from an initial sample undergoing a PAHP program suggest that despite a low implementation fidelity of the program, functional independence outcomes and patients' global impression of change have improved. Results will help develop a stakeholder-driven action plan to improve this program. A future study with a larger sample size is currently being planned to evaluate the overall impact of this program.

CLINICAL TRIAL REGISTRATION

Retrospectively registered NCT05915156 (22/06/2023).

Factors influencing emotional support of older adults living in the community: a scoping review protocol

BACKGROUND

Emotional support is key to improve older adults' subjective health, and psychological, social and emotional well-being. However, many older adults living in the community lack emotional support, increasing the risk for loneliness, depression, anxiety, potentially avoidable healthcare use and costs, and premature death. Multiple intersecting factors may influence emotional support of older adults in the community, but these are poorly understood. Studies have focused on specific populations (e.g., older adults with depression, cancer). Although relevant, these studies may not capture modifiable factors for the wider and more diverse population of older adults living in the community. Our scoping review will address these important gaps. We will identify and synthesize the evidence on factors that influence emotional support of older adults in the community.

METHODS

We will use the Johanna Briggs Institute updated methodological guidance for the conduct of scoping reviews to guide our review process. We will search MEDLINE, EMBASE, APA Psycinfo, CINAHL, Dissertations and Theses Global, and Scopus from inception. We will include studies published in English, examining factors influencing emotional support of older adults residing in community, without restrictions on the study design or year of publication. We will also include gray literature (dissertations and reports). Two independent reviewers will conduct title, abstract, and full-text screening, as well as risk of bias assessment, using validated quality appraisal tools based on study designs. Discrepancies will be resolved by consensus. The primary reviewer will extract the data from all studies, and the second reviewer will check the extractions of all the studies. We will use descriptive statistics and narrative synthesis for analysis. Family/friend caregivers and older adults involved as an advisory group will help with explaining the findings in terms of whether associations observed reflect their experiences and reality. We will analyze the discussion and generate themes, and summarize in a narrative form.

DISCUSSION

This scoping review may identify factors that could be modified or mitigated to improve emotional support provision for older adults residing in community. The knowledge will inform the development of tailored interventions directed to older adults and their caregivers.

SYSTEMATIC REVIEW REGISTRATION

https://doi.org/10.17605/OSF.IO/4TAEB (associated project link: osf.io/6y48t).

Development and validation of the MAnchester Needs Tool for Injured Children (MANTIC)

OBJECTIVE

To develop a measure of the needs injured children and their families' needs throughout recovery; The MAnchester Needs Tool for Injured Children (MANTIC).

DESIGN

Tool development, psychometric testing.

SETTING

Five children's major trauma centres in England.

PARTICIPANTS

Children aged 2 to 16 years with any type of moderate/severe injury(ies) treated in a major trauma centre within 12 months of injury, plus their parents.

METHODS

Stage 1a (Item generation): Interviews with injured children and their parents to generate draft items. Stage 1b (Co-production): Feedback about item clarity, relevance and appropriate response options was provided by parents and the patient and public involvement group. Stage 2 (Psychometric development): Completion of the prototype MANTIC by injured children and their parents with restructuring (as necessary) to establish construct validity. Concurrent validity was assessed by correlation with quality of life (EQ-5D-Y). MANTICs were repeated 2 weeks later to assess test-retest reliability.

RESULTS

Stages 1a,b: Interviews (13 injured children, 19 parents) generated 64 items with semantic differential four-point response scale (strongly disagree, disagree, agree, strongly agree). Stage 2: One hundred and forty-four participants completed MANTIC questionnaires (mean age 9.8 years, SD 3.8; 68.1% male). Item responses were strong requiring only minor changes to establish construct validity. Concurrent validity with quality of life was moderate (r = 0.55, P < 0.01) as was test-retest reliability (ICC = 0.46 and 0.59, P < 0.001). Uni-dimensionality was strong (Cronbach's α > 0.7).

CONCLUSION

The MANTIC is a feasible, acceptable, valid self-report measure of the needs of injured children and their families, freely available for clinical or research purposes.

Health Needs Assessment: Comparison of Applications of All-in-One AI Platform during the COVID-19 Pandemic between Mainland China and Hong Kong

Objectives: The COVID-19 pandemic has been a public health hazard since 2020. Preventive measures taken in mainland China and Hong Kong to control the spread of COVID-19, including quarantine, could potentially affect people's physical and mental health. Methods: We used a snowball sampling method to investigate the experience of people in mainland China and Hong Kong using AI chatbots during the COVID-19 pandemic to obtain information on mental health related to COVID-19, the current situation, and the multi-dimensional experience of using AI chatbots. The people who participated in the survey were residents aged 18-75 in the 2 areas. Results: The effective response rate of the questionnaire was 98%. Concerning demographics, 91.1% of the target group were 18-55 years old. The most important sources of information for the respondents were WeChat and Web pages. There was no difference between Hong Kong and mainland China in terms of access to COVID-19-related mental health information (??2=0.59, p=.444), and no difference shown in access to information by gender (??2=0.01, p=.942). There was no difference in age group (??2=2.97, p=.594) and was not related to whether respondents were in the provincial capital city area (??2=0.62, p=.429). Age groups “<18 years old” and “56-65 years old” were related to giving a higher (4 or 5) score to AI text questions answering chatbot (p=.030), and there is a positive relationship between the satisfactory of AI text question answering chatbot and that of AI voice question answering chatbot (R2=0.8074, p=.038). Conclusion: There is no significant difference in the use of all-in-one AI platforms in mainland China and Hong Kong, and both have large market potential in the field of AI services for mental health. This platform is suitable for people of all ages in both regions. The results of this study provide forward-looking guidance for our team to develop robots based on an all-in-one AI platform.

A Causal View of the Role and Potential Limitations of Capitation in Promoting Whole Health System Performance

For several decades, health systems in developed countries have faced rapidly rising healthcare costs without concomitant improvements in health outcomes. Fee for service (FFS) reimbursement mechanisms (RMs), where health systems are paid based on volume, contribute to this trend. In Singapore, the public health service is trying to curb rising healthcare costs by transitioning from a volume-based RM to a capitated payment for a population within a geographical catchment area. To provide insight into the implications of this transition, we developed a causal loop diagram (CLD) to represent a causal hypothesis of the complex relationship between RM and health system performance. The CLD was developed with input from government policymakers, healthcare institution administrators, and healthcare providers. This work highlights that the causal relationships between government, provider organizations, and physicians involve numerous feedback loops that drive the mix of health services. The CLD clarifies that a FFS RM incentivizes high margin services irrespective of their health benefits. While capitation has the potential to mitigate this reinforcing phenomenon, it is not sufficient to promote service value. This suggests the need to establish robust mechanisms to govern common pool resources while minimizing adverse secondary effects.

A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses

BACKGROUND

Community health needs and assets assessment is a means of identifying and describing community health needs and resources, serving as a mechanism to gain the necessary information to make informed choices about community health. The current review of the literature was performed in order to shed more light on concepts, rationale, tools and uses of community health needs and assets assessment.

METHODS

We conducted a scoping review of the literature published in English using PubMed, Embase, Scopus, Web of Science, PDQ evidence, NIH database, Cochrane library, CDC library, Trip, and Global Health Library databases until March 2021.

RESULTS

A total of 169 articles including both empirical papers and theoretical and conceptual work were ultimately retained for analysis. Relevant concepts were examined guided by a conceptual framework. The empirical papers were dominantly conducted in the  United States. Qualitative, quantitative and mixed-method approaches were used to collect data on community health needs and assets, with an increasing trend of using mixed-method approaches. Almost half of the included empirical studies used participatory approaches to incorporate community inputs into the process.

CONCLUSION

Our findings highlight the need for having holistic approaches to assess community's health needs focusing on physical, mental and social wellbeing, along with considering the broader systems factors and structural challenges to individual and population health. Furthermore, the findings emphasize assessing community health assets as an integral component of the process, beginning foremost with community capabilities and knowledge. There has been a trend toward using mixed-methods approaches to conduct the assessment in recent years that led to the inclusion of the voices of all community members, particularly vulnerable and disadvantaged groups. A notable gap in the existing literature is the lack of long-term or longitudinal-assessment of the community health needs assessment impacts.

The Needs of Orthopaedic Patients in Discharge Planning

Introduction

Patients' transition from hospital to home could be challenging for patients and caregivers. This is of utmost importance for patients requiring special or long-term care such as post-orthopaedic surgery. Effective discharge planning is required to ensure that patients are prepared to and get continuous care after returning home to prevent complications. Patients' need assessment is essential to develop effective discharge planning to meet the patient's needs.

Materials and methods

This mixed-method study aimed to determine the patient's needs to develop a discharge planning for total knee replacement surgery. The needs for 96 total knee replacement patients were assessed using the Needs Evaluation Questionnaire (NEQ). The in-depth interview primary focus was to explore the lived experience of the post-total knee replacement patients receiving care in the hospital.

Results

A total of 96 participants (100%) completed the NEQ questionnaire. Most of the needs concerned by the participants were expressed by at least 70% of them except the financial need (59.4%). The semi-structured interview found two elements which were a support group and patients' needs in terms of emotional, physical and spiritual preparation in developing effective discharge planning.

Conclusion

This study clarified that the patient needs assessment in the patient care plan.

Proposing a Practical, Simplified Framework for Implementing Integrated Diabetes Data and Technology Solutions

Diabetes is a uniquely quantifiable disease, and as technology and data have proliferated over the past two decades, so have the tools to manage diabetes. Patients and providers have at their disposal devices, applications, and data platforms that generate immense amounts of data, provide critical insights into a patient’s disease, and allow for personalization of treatment plans. However, the proliferation of options also comes with new burdens for providers: selecting the right tool, getting buy-in from leadership, defining the business case, implementation, and maintenance of the new technology. The complexity of these steps can be overwhelming and sometimes lead to inaction, depriving providers and patients of the advantages of technology-assisted diabetes care. Conceptually, the adoption of digital health solutions can be thought of as occurring in five interconnected phases: Needs Assessment, Solution Identification, Integration, Implementation, and Evaluation. There are a number of existing frameworks to help guide much of this process, but relatively little attention has been focused on integration. Integration is a critical phase for a number of contractual, compliance, financial, and technical processes. Missing a step or doing them out of order can lead to significant delays and potentially wasted resources. To address this gap, we have developed a practical, simplified framework for integrating diabetes data and technology solutions that can guide clinicians and clinical leaders on the critical steps in adopting and implementing a new technology.

A Comprehensive Evaluation of Health-Related Life Quality Assessment Through Head and Neck, Prostate, Breast, Lung, and Skin Cancer in Adults

Health assessment data assists the well-being and patient care teams' process in drawing up a care and assistance plan and comprehending the requirements of the patient. Comprehensive and precise data about the Quality of Life of cancer patients play a significant part in the development and organization of cancer patient care. Quality of Life has been used to mean a variety of various things, such as health situation, physical function, symptoms, psychosocial modification, well-being, enjoyment of life, and happiness. Chronic diseases such as cancer are among the disorders that severely affect people's health and consequently their Quality of Life. Cancer patients experience a range of symptoms, including pain and various physical and mental conditions that negatively affect their Quality of Life. In this article, we examined cancer and the impact that this disease can have on the Quality of Life of cancer patients. The cancers examined in this article include head and neck, prostate, breast, lung, and skin cancers. We also discussed health assessment and the importance and purpose of studying patients' Quality of Life, especially cancer patients. The various signs and symptoms of the disease that affect the Quality of Life of patients were also reviewed.

Needs of patients with early psychosis: A comparison of patient's and mental health care provider's perception

BACKGROUND

Needs define the capacity of a patient to benefit from health care services and a systematic assessment of needs allows planning and delivery of effective treatment to suit patients. This study aimed to understand the (a) needs felt by patients and those perceived by the care providers (CPs), (b) agreement between patients and CPs in the identified needs and (c) factors associated with unmet needs.

METHODS

Participants (N = 215) were recruited through convenience sampling from the Early Psychosis Intervention Programme (EPIP). Data was captured from patients and CPs using the Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS).

RESULTS

Patients and CPs identified an average of 4.06 and 3.84 needs, respectively. The highest number of unmet needs were identified for the social (50% of patients and CPs) and health domains (31.13% of patients' vs. 28.30% of CPs). Company, intimate relationships, psychotic symptoms, money, sexual expression and psychological distress, information and benefits were the unmet needs identified by patients, whereas company, intimate relationships, physical health, and daytime activities were identified by CPs. The concordance between patients and CPs was low with majority of the items scoring slight to fair agreement (Cohen's kappa = 0-0.4). Older age, depression, severe anxiety and having Obsessive-Compulsive Disorder (OCD) were positively associated with unmet needs in patients.

CONCLUSION

While there was an overall consensus on the total needs and met needs between patients and CPs, the level of agreement between the two groups on various items were low. Different perceptions regarding unmet needs were noted between the groups. A holistic approach that takes into account different facets of the needs of patients together with strategic planning to address unmet needs might improve treatment outcomes and satisfaction.

Validation and application of a needs-based segmentation tool for cross-country comparisons

OBJECTIVE

To compare countries' health care needs by segmenting populations into a set of needs-based health states.

DATA SOURCES

We used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data.

STUDY DESIGN

We developed the Cross-Country Simple Segmentation Tool (CCSST), a validated clinician-administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self-reported physician diagnosis of chronic disease, and performance-based tests conducted during the survey interview, individuals were assigned to 1-5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross-sectionally to assess cross-country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death.

DATA COLLECTION/EXTRACTION METHODS

We segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories.

PRINCIPAL FINDINGS

The CCSST is a valid tool for segmenting populations into needs-based states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country-specific areas for analysis of ecological and cultural risk factors.

CONCLUSIONS

The CCSST is an innovative tool for aggregate cross-country comparisons of both health needs and transitions between them. A cross-country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high-need, high-cost patients.

The Use of Medical and Non-Medical Services by Older Inpatients from Emergency vs. Chronic Departments, during the SARS-CoV-2 Pandemic in Poland

The COVID-19 pandemic has forced numerous changes in medical care. The monitoring of current needs and problems among the elderly in health care facilities seems to be essential. This study aims to assess the difference in terms of the use of medical and non-medical services before planned or emergency hospitalisation by the older population during the strict lockdown period due to the SARS-CoV-2 pandemic in Poland. The study used the FIMA (Fragebogen zur Inanspruchnahme medizinischer und nicht-medizinischer Versorgungsleistungen im Alter) questionnaire. Patients admitted on a planned basis (n = 61) were on average 4 years younger, self-administered the questionnaire more frequently and used the services of different types of therapists. Patients admitted on an emergency basis (n = 60) were more likely to visit general practitioners and other specialists and used the carer’s allowance benefits. In the case of the elderly, emergency hospitalisation during the pandemic is more frequently preceded by seeking outpatient care in specialists in various fields, covered by insurance. The chronically ill use the services of various therapists while awaiting hospitalisation, usually not covered by health insurance. For both groups, the age > 73 years is critical for the use of assisting means and completing the self-administered questionnaire, which can be used in planning the health care in these patients.

The experiences of socially vulnerable groups in England during the COVID-19 pandemic: A rapid health needs assessment

Objectives

This rapid health needs assessment was undertaken to urgently identify the needs of socially vulnerable groups arising during the first wave of cases of the COVID-19 pandemic in England. The objective was to develop recommendations for policy makers and stakeholders to mitigate adverse impacts on socially vulnerable groups throughout the COVID-19 response and recovery period.

Study design

Rapid health needs assessment.

Methods

The needs assessment employed qualitative methods to systematically collect data about the knowledge and views of key informants through semi-structured interviews and focus groups. Participants were either topic experts providing services to socially vulnerable groups who routinely face barriers to healthcare access or experts by experience. Participants included people experiencing homelessness, sex workers, people from Gypsy, Roma and Traveller communities and people facing challenges due to their immigration status. Data was collected over a week period in April/May 2020 and followed by thematic analysis to examine interview transcripts.

Results

Forty-two participants were included in the study, half of whom were experts by experience. Challenges with accessing and following COVID-19 information and government guidance were described as affecting all groups, due to exclusion from digital technology, translated resources, tailored support and adequate housing. Altered delivery of healthcare services, such as the closure of outreach and drop-in services, remote consultations, and online patient registration, were noted by interviewees as worsening existing barriers to accessing healthcare. Being charged for NHS care remained a key fear for migrants. All groups’ access to income, education and social support were reported as being impacted by service closures and job losses, putting them at higher risk of destitution. Isolation, loneliness and deteriorating mental health were frequently reported.

Conclusions

This assessment has highlighted the disproportionate impact of the COVID-19 pandemic on socially vulnerable groups and demonstrated a plethora of unmet needs. As the effects of COVID-19 continue, it is imperative that the needs of these groups are urgently and explicitly addressed and prioritised. This is essential to promote engagement with test and trace services, enable isolation adherence, and achieve high vaccine uptake in socially vulnerable populations.

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COVID-19 has exacerbated health inequalities experienced by socially vulnerable groups.

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Participatory qualitative methods were used to collect data about lived experience.

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Digital exclusion, language and accommodation created barriers to following guidance.

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GP registration, NHS charging, fear and digital exclusion are barriers to healthcare.

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COVID-19 resulted in financial hardship and destitution for many vulnerable groups.

Improving interprofessional handover on labor and delivery: A needs assessment study

Handover is the transfer of important clinical information between health providers. The current report describes a needs assessment of interprofessional labor and delivery handover at an urban hospital in Canada. The goal of this study was to explore the perceptions of the current handover meeting and opportunities for improvement. Using a constructivist paradigm, we conducted 28 semi-structured inter- views with handover participants. We used a recruitment grid to ensure we included the voices of participants representing each profession involved in interprofessional handover meetings. An inductive process was used to code the interview transcripts and theme the data. Major themes identified were: (1) Interprofessional handover contributes positively to team situational awareness, interprofessional relationships, and team communication; (2) Handover could be better if it had a more defined process; (3) Interprofessional handover can lead to feelings of intimidation; and (4) Interprofessional handovers on the labor and delivery unit in our setting need increased inclusivity of midwives. From these themes, continued development of interprofessional handover meetings on labor and delivery should be aimed at a formal definition of the scope and process for these meetings reducing feelings of intimidation, increased integration of Midwifery providers, and continued improvement of relationships between different professions and practitioners on labor and delivery.

El Sistema de Salud Colombiano y el reconocimiento de la enfermedad de Alzheimer

La enfermedad de Alzheimer (EA) es la más común de las demencias; es un problema de salud pública en el Mundo, pero en Colombia no hace parte de las prioridades del Estado. El presente ensayo aborda cómo el sistema de salud colombiano reconoce, identifica y provee servicios a los pacientes con EA, desde una óptica de la Justicia Social. En primera medida se evalúa la información generada por la academia, su correlato con la normativa vigente y su articulación. Se explora la lógica utilitarista del sistema de salud colombiano y el incentivo a la maximización de ganancias de los aseguradores y cómo esto ha llevado a los pacientes a exigir la restitución de derechos a través de la acción de tutela. Se explora el sistema de codificación y diagnostico usado para la generación de información y como esta es imprecisa en los canales de información consolidada. Por otra parte, se valora como el rol de la familia se hace parte fundamental del proceso, y cómo esta termina siendo víctima del mismo.  Finalmente, se plantea reflexiones de cómo pueden abordarse las dificultades identificadas desde una perspectiva de la Justicia Social.

Population Segmentation Based on Healthcare Needs: Validation of a Brief Clinician-Administered Tool

BACKGROUND

As populations age with increasingly complex chronic conditions, segmenting populations into clinically meaningful categories of healthcare and related service needs can provide healthcare planners with crucial information to optimally meet needs. However, while conventional approaches typically involve electronic medical records (EMRs), such records do not always capture information reliably or accurately.

OBJECTIVE

We describe the inter-rater reliability and predictive validity of a clinician-administered tool, the Simple Segmentation Tool (SST) for categorizing older individuals into one of six Global Impression (GI) segments and eight complicating factors (CFs) indicative of healthcare and related social needs.

DESIGN

Observational study ( ClinicalTrials.gov , number NCT02663037).

PARTICIPANTS

Patients aged 55 years and above.

MAIN MEASURES

Emergency department (ED) subjects (between May and June 2016) had baseline SST assessment by two physicians and a nurse concurrently seeing the same individual. General medical (GM) ward subjects (February 2017) had a SST assessment by their principal physician. Adverse events (ED visits, hospitalizations, and mortality over 90 days from baseline) were determined by a blinded reviewer. Inter-rater reliability was measured using Cohen's kappa. Predictive validity was evaluated using Cox hazard ratios based on time to first adverse event.

KEY RESULTS

Cohen's kappa between physician-physician, service physician-nurse, and physician-nurse pairs for GI were 0.60, 0.71, and 0.68, respectively. Cox analyses demonstrated significant predictive validity of GI and CFs for adverse outcomes.

CONCLUSIONS

With modest training, clinicians can complete a brief instrument to segment their patient into clinically meaningful categories of healthcare and related service needs. This approach can complement and overcome current limitations of EMR-based instruments, particularly with respect to whole-patient care.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02663037.

Psychometric Properties of the Polish Version of the 36-Item WHODAS 2.0 in Patients with Low Back Pain

The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is considered by the World Health Organization (WHO) to be a useful tool for assessing the functioning and disability of the general population as well as the effectiveness of the applied interventions. Until this study, no data regarding the validity of the 36-item WHODAS 2.0 in chronic low back pain (LBP) in Poland have been explored. This study was conducted on 92 patients suffering from chronic LBP admitted to the rehabilitation ward. The Polish version of the 36-item WHODAS 2.0, the Sf-36 Health Survey (SF-36), the Oswestry Disability Index (ODI), the Hospital Anxiety and Depression Scale (HADS) and the Visual Analogue Scale (VAS) questionnaires were applied to assess patients. The scale score reliability of the entire tool for the study population was very high. The Cronbach's alpha test result for the entire scale was 0.92. For the overall result of the WHODAS 2.0, the Intraclass Correlation Coefficient (ICC1,2) was 0.928, which confirmed that the scale was consistent over time. The total result and the vast majority of domains of the 36-item WHODAS 2.0 correlated negatively with domains of the SF-36 questionnaire; thus, a higher WHODAS 2.0 score was associated with a lower score on the SF-36 questionnaire. We found that the minimal clinically important difference (MCID) for the total WHODAS 2.0 score in patients after rehabilitation for LBP was 4.87. Overall, the results indicated that the Polish version of the 36-item WHODAS is suitable for assessing health and disability status in patients with LBP.

Toward a new definition of rehabilitation for research purposes: a comparative analysis of current definitions

There is a need for a common, shared definition of rehabilitation to conduct systematic reviews and identify relevant systematic reviews for knowledge translation purposes, which is an important task of Cochrane Rehabilitation. The present paper aimed to introduce and compare existing health-related definitions of rehabilitation and to propose core aspects that should characterize a new and workable definition of rehabilitation that is able to serve both as the basis for internal communication and identity work and for external communication. We have conducted a PubMed literature search on current definitions that have been published since the launch of WHO's ICF in 2001. Definitions were analyzed by framing questions to which the definitions provide answers. Nine definitions were included in the analysis. Rehabilitation has been defined as a process, as a set or bundle of interventions, and as a health strategy. The main beneficiaries were mainly related to the presence of disability, however, no specific means or interventions in rehabilitation could be identified. The definitions provided varying answers to the questions "by whom…," "where…," and "when…" and additionally identified certain conditions for rehabilitation. The present analysis can serve as a valuable source of information for developing a Cochrane Rehabilitation definition of rehabilitation.

Health needs assessment in a regional community pharmacy using the PRECEDE-PROCEED model

BACKGROUND

Community pharmacies have capacity to provide a variety of professional pharmacy services. However, planning models are underutilised when guiding pharmacists in assessing local health and social needs for providing tailored services to meet community needs and priorities.

OBJECTIVE

The objective of this was to utilize the PRECEDE-PROCEED model to perform a health needs assessment to identify health concerns in a regional Australian community for guiding professional pharmacy service development.

METHODS

A health needs assessment using the PRECEDE-PROCEED model was conducted in November 2019 using a convergent mixed-methods design through: (1) convenience sampling of pharmacy customers with a survey, (2) purposive sampling of a sole community pharmacist with a semi-structured interview, and (3) collection of regional health and social data from online databases.

RESULTS

The community survey response rate was 44.8%. Of 113 participants, the majority were female (71.7%) and town dwellers (89.4%), representing 6.4% of the town's population. Mental illness was cited by 35.3% of community survey participants to be impacting local health and wellbeing, with depression/anxiety the most prevalent self-reported condition (44.2%), predominantly affecting women (72%). The community pharmacist and regional secondary data provided additional support for the prioritization of mental illness. Depression/anxiety was associated with delays/avoidance of prescription medicine due to cost (p = .002), poor self-rated health (p = .012), worsening health over the past year (p < .001), seeking advice from a pharmacist about health or medicines (p = .03), and receipt of emergency care in the past year (p = .001). The lack of a local general practitioner, social isolation, and environmental issues also impacted health and wellbeing.

CONCLUSIONS

The PRECEDE-PROCEED model identified mental health as the greatest health priority in the community, using multiple data sources and participatory methods. Using this model provides insight into the development of tailored community pharmacy interventions that address health priorities such as mental health needs in a community.

A Framework for Equity Access to Primary Dental Care

Abstract The objective of this study was to demonstrate face validity with a novel resource allocation framework designed to maximize equity into dental booking systems. The study was carried out in 2014. Eleven experts in primary dental care practice in Southern Brazil participated, using a three-round consensus group technique. First, the experts reached consensus on the items to be included in a 5-level diagnostic scale. They identified 21 clinical conditions and categorized them according to the oral health intervention required. Then, they described workload and activity standards for dental staff to carry out health promotion, oral disease prevention, dental treatment, dental rehabilitation, and urgent dental care. Finally, they agreed upon a set of wait times for primary dental care, establishing maximum waits from 2 to 365 days, according to the diagnostic classification. The framework demonstrated potential ability to promote more equitable access to primary dental services, since equal diagnostic classifications share the same waiting times for the dental care they require.

Adult palliative care 2004-2030 population study: estimates and projections in Malaysia

Objectives

To estimate past trends and future projection of adult palliative care needs in Malaysia.

Methods

This is a population-based secondary data analysis using the national mortality registry from 2004 to 2014. Past trend estimation was conducted using Murtagh’s minimum and maximum methods and Gómez-Batiste’s method. The estimated palliative care needs were stratified by age groups, gender and administrative states in Malaysia. With this, the projection of palliative care needs up to 2030 was conducted under the assumption that annual change remains constant.

Results

The palliative care needs in Malaysia followed an apparent upward trend over the years regardless of the estimation methods. Murtagh’s minimum estimation method showed that palliative care needs grew 40% from 71 675 cases in 2004 to 100 034 cases in 2014. The proportion of palliative care needs in relation to deaths hovered at 71% in the observed years. In 2030, Malaysia should anticipate the population needs to be at least 239 713 cases (240% growth from 2014), with the highest needs among age group ≥80-year-old in both genders. Sarawak, Perak, Johor, Selangor and Kedah will become the top five Malaysian states with the highest number of needs in 2030.

Conclusion

The need for palliative care in Malaysia will continue to rise and surpass its service provision. This trend demands a stepped-up provision from the national health system with advanced integration of palliative care services to narrow the gap between needs and supply.

The use of future scenario thinking for child public health in a local authority

BACKGROUND

Socioeconomic, cultural, technological, environment and ecological changes are rapidly transforming how children and young people (CYP) grow up, yet their impacts on CYP are difficult to predict. The traditional ways that Public Health practitioners work may not capture such complex and dynamic change. To address this, Lambeth Council used future scenario thinking.

METHODS

A literature review looked at political, socioeconomic and other 'transitions' in the borough. Interviews, focus groups and workshops were held with CYP, parents, carers, local statutory and non-statutory stakeholders about the future for Lambeth CYP in the decade ahead. Themes were analysed to identify which had the potential for the biggest impact or the most uncertainty.

RESULTS

The main transitions were described, 100 stakeholders interviewed, and five 'drivers' of the future were identified: protracted austerity, technological explosion, demographic shift, 'democratic shake-up' and planetary health. From all these data, four future scenarios were developed: 'communities care for themselves', 'collaborating to care for all', 'nobody cares' and 'who cares?'

CONCLUSIONS

New insights were gained about promoting more responsibility for, and active participation of CYP. This led to Lambeth's CYP Plan and the 'Made in Lambeth' campaign aiming to enlist the community and business in creating a child-friendly borough.

Socioeconomic and citizenship inequalities in hospitalisation of the adult population in Italy

BACKGROUND

Higher levels of hospital admissions among people with lower socioeconomic level, including immigrants, have been observed in developed countries. In Europe, immigrants present a more frequent use of emergency services compared to the native population. The aim of our study was to evaluate the socioeconomic and citizenship differences in the hospitalisation of the adult population in Italy.

METHODS

The study was conducted using the database created by the record linkage between the National Health Interview Survey (2005) with the National Hospital Discharge Database (2005-2014). 79,341 individuals aged 18-64 years were included. The outcomes were acute hospital admissions, urgent admissions and length of stay (1-7 days, > = 8 days). Education level, occupational status, self-perceived economic resources and migratory status were considered as socioeconomic determinants. A multivariate proportional hazards model for recurrent events was used to estimate the risk of total hospital admissions. Logistic models were used to estimate the risk of urgent hospitalisation as well as of length of stay.

RESULTS

Low education level, the lack of employment and negative self-perceived economic resources were conditions associated with the risk of hospitalisation, a longer hospital stay and greater recourse to urgent hospitalisation. Foreigners had a lower risk of hospitalisation (HR = 0.75; 95% CI:0.68-0.83) but a higher risk of urgent hospitalisation (OR = 1.36; 95% CI:1.18-1.55) and more frequent hospitalisations with a length of stay of at least eight days (OR = 1.19; 95% CI:1.02-1.40).

CONCLUSIONS

To improve equity in access, effective primary, secondary and tertiary prevention strategies must be strengthened, as should access to appropriate levels of care.

Population segmentation based on healthcare needs: a systematic review

BACKGROUND

Healthcare needs-based population segmentation is a promising approach for enabling the development and evaluation of integrated healthcare service models that meet healthcare needs. However, healthcare policymakers interested in understanding adult population healthcare needs may not be aware of suitable population segmentation tools available for use in the literature and barring better-known alternatives, may reinvent the wheel by creating and validating their own tools rather than adapting available tools in the literature. Therefore, we undertook a systematic review to identify all available tools which operationalize healthcare need-based population segmentation, to help inform policymakers developing population-level health service programmes.

METHODS

Using search terms reflecting concepts of population, healthcare need and segmentation, we systematically reviewed and included articles containing healthcare need-based adult population segmentation tools in PubMed, CINAHL and Web of Science databases. We included tools comprising mutually exclusive segments with prognostic value for clinically relevant outcomes. An updated secondary search on the PubMed database was also conducted as the last search was conducted 2 years ago. All identified tools were characterized in terms of segment formulation, segmentation base, whether they received peer-reviewed validation, requirement for comprehensive electronic medical records, proprietary status and number of segments.

RESULTS

A total of 16 unique tools were identified from systematically reviewing 9970 articles. Peer-reviewed validation studies were found for 9 of these tools.

DISCUSSION AND CONCLUSIONS

The underlying segmentation basis of most identified tools was found to be conceptually comparable to each other which suggests a broad recognition of archetypical patient overall healthcare need profiles. While many tools operate based on administrative record data, it is noted that healthcare systems without comprehensive electronic medical records would benefit from tools which segment populations through primary data collection. Future work could therefore include development and validation of such primary data collection-based tools. While this study is limited by exclusion of non-English literature, the identified and characterized tools will nonetheless facilitate efforts by policymakers to improve patient-centred care through development and evaluation of services tailored for specific populations segmented by these tools.

Assessing the need for a mental health services reform in Moldova: a situation analysis

BACKGROUND

This study describes the Moldovan mental health system and reform needs before and during the initial phase of the MENSANA project (2014-2022) over the period 2007-2017.

METHODS

A situation analysis was performed on: (1) the comparative need based on a country comparison using publicly available mental health system data; (2) the normative need based on a document review comparing the Moldovan mental health services structure with the norms of the WHO on the ideal mix of services, and a content analysis of interview and survey data from professionals (n = 93); (3) the felt need based on a content analysis of survey data from service users and carers (n = 52).

RESULTS

The main finding from the comparative analysis is that mental health care remains largely institutionalized with little alternative care options in the community. Moldova has large mental hospitals and a high number of psychiatric beds per 100.000 population (59.8) in comparison with the South-eastern European Health Network and EU15 average in 2014 (47.63 and 36.61). The country also shows an inversion of the ideal mix of services. This points to the potential need for a mental health system reform which was confirmed by the perspectives of the professionals, service users and carers. The majority of respondents favour a mental services reform (82.8% of the professionals and 92.3% of the care recipients) and express numerous issues and reform needs with the most frequently mentioned being the need to: (1) reintegrate service users in society, community and family; (2) deinstitutionalise and implement CBMHS; (3) improve the accessibility and quality of services, and; and 4) address health workforce issues.

CONCLUSION

All three types of need explored in the situation analysis (e.g. comparative, normative and felt) point towards the necessity to reform the mental health system in Moldova. However, it is emphasized that this will only materialize when underlying socio-economic challenges that both constrain the implementation of community-based mental health services and foster the dependence of people with a mental illness on inpatient services are addressed.

Long-term unmet needs after stroke: systematic review of evidence from survey studies

OBJECTIVES

To synthesise evidence on longer term unmet needs perceived by stroke survivors, and psychometric properties of the tools used to evaluate unmet care needs after stroke.

DESIGN

Systematic review.

SETTING

Community or patients' home.

PARTICIPANTS

Stroke survivors.

METHODS

We searched PubMed, PsycINFO, CINAHL, EMBASE from inception to 31 March 2018 to identify survey studies that evaluated unmet needs perceived by stroke survivors after hospital discharge. Reported unmet needs were categorised under three domains: body functioning, activity/participation and environmental factors. Ranges of prevalence rates of unmet needs reported in studies were presented.

RESULTS

We included 19 eligible studies, with considerable heterogeneity in patients, survey methods and results. Psychometric properties of two stroke-specific tools were formally evaluated, indicating their moderate reliability and content/concurrent validity. The median number of reported unmet needs per stroke survivor was from two to five, and the proportion of stroke survivors with at least one unmet needs was on average 73.8% (range 19.8%- 91.7%). Unmet needs perceived by stroke survivors included 55 records of unmet body functioning needs, 47 records of unmet activities/participatory needs and 101 records of unmet environmental needs. Common unmet service needs were unmet information needs (3.1%- 65.0%), transport (5.4%-53.0%), home help/personal care (4.7%-39.3%) and therapy (2.0%-35.7%).

CONCLUSIONS

The prevalence of unmet long-term needs is high among stroke survivors, and there is considerable heterogeneity in type and frequency of specific unmet needs. More research is required to link regular assessment of long-term unmet needs of stroke survivors with the provision of cost-effective patient-centred health and social care services.

Comprehensive geriatric assessment for frail older people in acute hospitals: the HoW-CGA mixed-methods study

Background

The aim of this study was to provide high-quality evidence on delivering hospital-wide Comprehensive Geriatric Assessment (CGA).

Objective(s)

(1) To define CGA, its processes, outcomes and costs in the published literature, (2) to identify the processes, outcomes and costs of CGA in existing hospital settings in the UK, (3) to identify the characteristics of the recipients and beneficiaries of CGA in existing hospital settings in the UK and (4) to develop tools that will assist in the implementation of hospital-wide CGA.

Design

Mixed-methods study combining a mapping review, national survey, large data analysis and qualitative methods.

Participants

People aged ≥ 65 years in acute hospital settings.

Data sources

Literature review – Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE and EMBASE. Survey – acute hospital trusts. Large data analyses – (1) people aged ≥ 75 years in 2008 living in Leicester, Nottingham or Southampton (development cohort,n = 22,139); (2) older people admitted for short stay (Nottingham/Leicester,n = 825) to a geriatric ward (Southampton,n = 246) or based in the community (Newcastle,n = 754); (3) people aged ≥ 75 years admitted to acute hospitals in England in 2014–15 (validation study,n = 1,013,590). Toolkit development – multidisciplinary national stakeholder group (co-production); field-testing with cancer/surgical teams in Newcastle/Leicester.

Results

Literature search – common outcomes included clinical, operational and destinational, but not patient-reported, outcome measures. Survey – highly variable provision of multidisciplinary assessment and care across hospitals. Quantitative analyses – in the development cohort, older people with frailty diagnoses formed a distinct group and had higher non-elective hospital use than older people without a frailty diagnosis. Patients with the highest 20% of hospital frailty risk scores had increased odds of 30-day mortality [odds ratio (OR) 1.7], long length of stay (OR 6.0) and 30-day re-admission (OR 1.5). The score had moderate agreement with the Fried and Rockwood scales. Pilot toolkit evaluation – participants across sites were still at the beginning of their work to identify patients and plan change. In particular, competing definitions of the role of geriatricians were evident.

Limitations

The survey was limited by an incomplete response rate but it still provides the largest description of acute hospital care for older people to date. The risk stratification tool is not contemporaneous, although it remains a powerful predictor of patient harms. The toolkit evaluation is still rather nascent and could have meaningfully continued for another year or more.

Conclusions

CGA remains the gold standard approach to improving a range of outcomes for older people in acute hospitals. Older people at risk can be identified using routine hospital data. Toolkits aimed at enhancing the delivery of CGA by non-specialists can be useful but require prolonged geriatrician support and implementation phases. Future work could involve comparing the hospital-based frailty index with the electronic Frailty Index and further testing of the clinical toolkits in specialist services.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Need analysis for a new high acuity medical psychiatry unit: which patients are considered for admission?

BACKGROUND

The study aims were: to estimate the proportion of patients with an indication for admission to a new high acuity Medical Psychiatric Unit (MPU), to explore the reasons for MPU-admission according to different health disciplines, and to check for differences in patient characteristics. The results of this study are to be utilized in the proposed establishment of a high-acuity MPU in a University Medical Center. Such a unit currently does not exist at Erasmus MC.

METHODS

Hospital in-patients were included if they received psychiatric consultation from the Psychiatric Consultative Service (PCS). As part of the study protocol, psychiatrists, other medical specialists, and nurses determined the need for admission to the proposed MPU. Patient groups were compared with respect to diagnoses, socio-demographic characteristics and patient routing.

RESULTS

One hundred and fifty-one patients were included, 43% had an indication for MPU-admission, for the other patients PCS involvement was sufficient. There was agreement on suicide attempts as a reason for MPU-admission. For psychiatrists, the need for further diagnostic evaluation was a common reason for MPU admission, while other medical specialists more often emphasized the need for safety measures. Patients with an unplanned hospital admission had a higher chance of MPU eligibility (OR = 2.72, 95% CI 1.10-6.70). The main psychiatric diagnoses of MPU-eligible patients were organic disorders (including delirium), mood disorders, and disorders related to substance abuse. The most common diagnoses found were similar to those in previous research on MPU populations.

CONCLUSION

Different medical disciplines have different views on the advantages of MPUs, while all see the need for such facilities. The proposed MPU should be able to accommodate patients directly from the Emergency Unit, and the MPU should provide specialized diagnostic care in an extra safe environment.

Can we understand population healthcare needs using electronic medical records?

INTRODUCTION

The identification of population-level healthcare needs using hospital electronic medical records (EMRs) is a promising approach for the evaluation and development of tailored healthcare services. Population segmentation based on healthcare needs may be possible using information on health and social service needs from EMRs. However, it is currently unknown if EMRs from restructured hospitals in Singapore provide information of sufficient quality for this purpose. We compared the inter-rater reliability between a population segment that was assigned prospectively and one that was assigned retrospectively based on EMR review.

METHODS

200 non-critical patients aged ≥ 55 years were prospectively evaluated by clinicians for their healthcare needs in the emergency department at Singapore General Hospital, Singapore. Trained clinician raters with no prior knowledge of these patients subsequently accessed the EMR up to the prospective rating date. A similar healthcare needs evaluation was conducted using the EMR. The inter-rater reliability between the two rating sets was evaluated using Cohen's Kappa and the incidence of missing information was tabulated.

RESULTS

The inter-rater reliability for the medical 'global impression' rating was 0.37 for doctors and 0.35 for nurses. The inter-rater reliability for the same variable, retrospectively rated by two doctors, was 0.75. Variables with a higher incidence of missing EMR information such as 'social support in case of need' and 'patient activation' had poorer inter-rater reliability.

CONCLUSION

Pre-existing EMR systems may not capture sufficient information for reliable determination of healthcare needs. Thus, we should consider integrating policy-relevant healthcare need variables into EMRs.

What influenced provision of non-communicable disease healthcare in the Syrian conflict, from policy to implementation? A qualitative study

BACKGROUND

There has been increasing focus on tackling the growing burden of non-communicable diseases (NCD) in crisis settings. The complex and protracted crisis in Syria is unfolding against a background of increasing NCD burden. This study investigated factors influencing implementation of NCD healthcare in Syria.

METHODS

This is a qualitative study, whereby semi-structured interviews were conducted with fourteen humanitarian health staff working on NCD healthcare in Syria.

RESULTS

Challenges to NCD care implementation were reflected at several stages, from planning services through to healthcare delivery. There was a lack of information on unmet population need; little consensus among humanitarian actors regarding an appropriate health service package; and no clear approach for prioritising public health interventions. The main challenges to service delivery identified by participants were conflict-related insecurity and disruption to infrastructure, hampering continuity of chronic illness care. Collaboration was a key factor which influenced implementation at all stages.

CONCLUSIONS

The historical context, the conflict situation, and the characteristics of health actors and their relationships, all impacted provision of NCD care. These factors influenced each other, so that the social views and values (of individuals and organisations), as well as politics and relationships, interacted with the physical environment and security situation. Infrastructure damage has implications for wider healthcare across Syria, and NCD care requires an innovative approach to improve continuity of care. There is a need for a transparent approach to resource allocation, which may be generalisable to the wider humanitarian health sector.

Needs Assessment for a Targeted Health Promotion Campaign

ABSTRACTSince the first human A/H7N9 infection in Hong Kong, there has been an ongoing threat of human-to-human transmission, potentially causing a pandemic. Because there is no vaccine for A/H7N9, the individual preventive measures become all the more important for reducing transmission. However, due to the ongoing threat of numerous avian influenza viruses, the public may suffer from pandemic-media-fatigue. This study was done to assess the need for a targeted A/H7N9 health promotion campaign. Steven and Gillam's framework using epidemiological, comparative, and corporate approaches was used to assess the need for a targeted A/H7N9 health promotion campaign.Local surveillance data showed that Hong Kong faces a double burden of increasing seasonal influenza activity and threat of an avian influenza pandemic. Experts warned of potential severity and difficulties in A/H7N9 control. In contrast, surveys showed that the Hong Kong public were suffering from pandemic-media-fatigue, lacked anxiety, had misconceptions, and were not vigilant in preventive practices. This was more evident in certain demographics. Content analysis showed that health promotion materials were not targeted or tailored in countries with human A/H7N9 cases. Targeted health promotion campaigns and framing the issue to increase public and media awareness are crucial in preventing the current pandemic-media-fatigue. (Disaster Med Public Health Preparedness. 2019;13:596-604).

"Taking away the chaos": a health needs assessment for people who inject drugs in public places in Glasgow, Scotland

BACKGROUND

Public injecting of recreational drugs has been documented in a number of cities worldwide and was a key risk factor in a HIV outbreak in Glasgow, Scotland during 2015. We investigated the characteristics and health needs of people involved in this practice and explored stakeholder attitudes to new harm reduction interventions.

METHODS

We used a tripartite health needs assessment framework, comprising epidemiological, comparative, and corporate approaches. We undertook an analysis of local and national secondary data sources on drug use; a series of rapid literature reviews; and an engagement exercise with people currently injecting in public places, people in recovery from injecting drug use, and staff from relevant health and social services.

RESULTS

Between 400 and 500 individuals are estimated to regularly inject in public places in Glasgow city centre: most experience a combination of profound social vulnerabilities. Priority health needs comprise addictions care; prevention and treatment of blood-borne viruses; other injecting-related infections and injuries; and overdose and drug-related death. Among people with lived experience and staff from relevant health and social care services, there was widespread - though not unanimous - support for the introduction of safer injecting facilities and heroin-assisted treatment services.

CONCLUSIONS

The environment and context in which drug consumption occurs is a key determinant of harm, and is inextricably linked to upstream social factors. Public injecting therefore requires a multifaceted response. Though evidence-based interventions exist, their implementation internationally is variable: understanding the attitudes of key stakeholders provides important insights into local facilitators and barriers. Following this study, Glasgow plans to establish the world's first co-located safer injecting facility and heroin-assisted treatment service.

A public health needs assessment for domestic indoor overheating

OBJECTIVES

Indoor overheating is a potentially fatal health hazard that was identified as an issue requiring urgent action in the 2017 UK Climate Change Risk Assessment. We aimed to make research on this issue more accessible to local public health teams to encourage its inclusion in local strategic needs assessments.

STUDY DESIGN

Epidemiological health needs assessment.

METHODS

We adapted established health needs assessment methods, focussing on the epidemiological component, drawing evidence from a non-systematic literature review that was complemented by discussion with experts.

RESULTS

Indoor overheating arises from an interaction between occupants' susceptibility to heat, their behaviour and the building's location and its characteristics. Many of these factors are interrelated and, at a national level, are expected to vary over time with demographic and climate change. Understanding these factors, ways to mitigate them and a long-term view are all essential for managing overheating risk.

CONCLUSIONS

There is a need for services to be provided at the local level that consider the home environment and its impact on health in all seasons. A population-level approach to risk management across a local area is also useful to inform collaborative efforts to reduce future incidence of overheating and better understand how it varies with socio-economic deprivation.

Building hospital capacity planning mechanisms in Poland: The impact of 2016/2017 regulatory changes

Capacity planning is a crucial component of modern health care governance. The aim of this paper is to analyze the requirements that need to be met to build effective hospital capacity planning mechanisms in Poland. In this context, the recent regulatory changes strongly influencing hospital sector functioning, including introduction of health care needs maps, capital investment assessment, and hospital network regulations, are analyzed. Some possible ways forward, based on review of international experiences in hospital capacity planning, are discussed. Applied methods include literature review and analysis of statistical data as well as desk analysis of key national regulations related to hospital sector. Results indicate that at the system level, the process of capacity planning involves 4 elements: capital investment in facilities, equipment, and technology; service delivery; allocation of staff; and financial resources. For hospital capacity planning to be effective, the strategic decision at the macrolevel must be complemented by appropriate management of individual hospitals. The major challenge of building hospital capacity planning mechanism in Poland is imbedding it into the overall health system strategy. Because of the lack of such a strategy, the practical implementation of the ad hoc changes, which have been introduced, shows some inconsistencies. The regulations implemented between 2016 and 2017 provided a basis for hospital capacity planning, yet still need evaluation and adjustments. Also, including a mechanism for human resources planning is of crucial importance. The regulations should provide incentives for reducing oversized hospital infrastructure with simultaneous development of the long-term and coordinated care models.

Digital Health Interventions for Adults With Type 2 Diabetes: Qualitative Study of Patient Perspectives on Diabetes Self-Management Education and Support

BACKGROUND

The prevalence of type 2 diabetes is increasing globally, and health services in many countries are struggling with the morbidity, mortality, and costs associated with the complications of this long-term condition. Diabetes self-management education (DSME) and behavioral support can reduce the risks of developing diabetes-related complications and improve glycemic control. However, their uptake is low. Digital health interventions (DHI) can provide sustained support and may overcome challenges associated with attending diabetes self-management sessions. They have the potential for delivery at multiple locations at convenient times, anonymity, and presentation of content in attractive and tailored formats. This study investigates the needs and wants of patients with type 2 diabetes to inform the development of digital self-management education and support.

OBJECTIVE

The objective of this study was to explore patient perspectives on unmet needs for self-management and support and the role of DHI in adults living with type 2 diabetes.

METHODS

This study used a qualitative approach based on data generated from 4 focus groups with 20 patients.

RESULTS

The data generated by the focus groups illustrated the significant burden that the diagnosis of diabetes places on many patients and the negative impacts on their emotional well-being, work, social life, and physical health. Although patients' experiences of the health care services varied, there was agreement that even the best services were unable to meet all users' needs to support the emotional regulation, psychological adjustment, and behavioral changes needed for successful self-management.

CONCLUSIONS

By focusing on medical management and information provision, existing health care services and education programs may not be adequately meeting all the needs of patients with type 2 diabetes. DHIs have the potential to improve access to DSME and behavioral support and extend the range of content offered by health services to fit with a wider range of patient needs. Features that could help DHIs address some of the unmet needs described by participants in this study included placing an emphasis on emotional and role management, being available at all times, having up-to-date evidence-based guidance for patients, and providing access to peer-generated and professional advice.

How many people will need palliative care in 2040? Past trends, future projections and implications for services

BACKGROUND

Current estimates suggest that approximately 75% of people approaching the end-of-life may benefit from palliative care. The growing numbers of older people and increasing prevalence of chronic illness in many countries mean that more people may benefit from palliative care in the future, but this has not been quantified. The present study aims to estimate future population palliative care need in two high-income countries.

METHODS

We used mortality statistics for England and Wales from 2006 to 2014. Building on previous diagnosis-based approaches, we calculated age- and sex-specific proportions of deaths from defined chronic progressive illnesses to estimate the prevalence of palliative care need in the population. We calculated annual change over the 9-year period. Using explicit assumptions about change in disease prevalence over time, and official mortality forecasts, we modelled palliative care need up to 2040. We also undertook separate projections for dementia, cancer and organ failure.

RESULTS

By 2040, annual deaths in England and Wales are projected to rise by 25.4% (from 501,424 in 2014 to 628,659). If age- and sex-specific proportions with palliative care needs remain the same as in 2014, the number of people requiring palliative care will grow by 25.0% (from 375,398 to 469,305 people/year). However, if the upward trend observed from 2006 to 2014 continues, the increase will be of 42.4% (161,842 more people/year, total 537,240). In addition, disease-specific projections show that dementia (increase from 59,199 to 219,409 deaths/year by 2040) and cancer (increase from 143,638 to 208,636 deaths by 2040) will be the main drivers of increased need.

CONCLUSIONS

If recent mortality trends continue, 160,000 more people in England and Wales will need palliative care by 2040. Healthcare systems must now start to adapt to the age-related growth in deaths from chronic illness, by focusing on integration and boosting of palliative care across health and social care disciplines. Countries with similar demographic and disease changes will likely experience comparable rises in need.

The Development of a Telemedicine Planning Framework Based on Needs Assessment

Providing equitable access to healthcare services in rural and remote communities is an ongoing challenge that faces most governments. By increasing access to specialty expertise, telemedicine may be a potential solution to this problem. Regardless of its potential, many telemedicine initiatives do not progress beyond the research phase, and are not implemented into mainstream practice. One reason may be that some telemedicine services are developed without the appropriate planning to ascertain community needs and clinical requirements. The aim of this paper is to report the development of a planning framework for telemedicine services based on needs assessment. The presented framework is based on the key processes in needs assessment, Penchansky and Thomas's dimensions of access, and Bradshaw's types of need. This proposed planning framework consists of two phases. Phase one comprises data collection and needs assessment, and includes assessment of availability and expressed needs; accessibility; perception and affordability. Phase two involves prioritising the demand for health services, balanced against the known limitations of supply, and the implementation of an appropriate telemedicine service that reflects and meets the needs of the community. Using a structured framework for the planning of telemedicine services, based on need assessment, may help with the identification and prioritisation of community health needs.

Unmet healthcare needs and health status: Panel evidence from Korea

AIMS

Even though basic healthcare services have been considered human rights, studies on optimal level of healthcare utilization have produced mixed results. A growing body of literatures has been using unmet healthcare needs, a subjective survey measure, to find inequity in healthcare. But no studies so far have tried to reveal the association of unmet needs with health outcomes so it was hard to get the public's attention. To answer it, this study tries to reveal the associations between unmet healthcare needs and health outcomes.

METHODS

A 4-year Korean panel dataset of 7,717 persons (31,668 person-years) were analyzed. Unmet healthcare needs were asked (if yes, its reason was also surveyed) if the respondent ever felt healthcare services were needed but could not receive it in the past 12 months. A health-related quality of life instrument (EQ-5D) and self-rated health were used as dependent variables. To avoid simultaneity, 1-year lagged outcome variables were used. And to control for unobserved individual heterogeneity, fixed effects estimation was also run based on Grossman's human capital model.

FINDINGS

Since 2009, more than 14.5% of the study population had reported unmet healthcare needs. When 1-year lagged health outcome variables were regressed on unmet needs, compared to the means, unmet needs were found to associate with 1% decline in EQ-5D and 4.5% decline in self-rated health. Unmet needs due to mild symptoms were not related with outcomes in fixed effects estimation among the elderly.

CONCLUSIONS

Even though causal inference were not found, the association between unmet needs and health outcomes were established. Recognizing demand side determinants of healthcare was a strength of this study.

The assessment of met and unmet care needs in the oldest old with and without depression using the Camberwell Assessment of Need for the Elderly (CANE): Results of the AgeMooDe study

BACKGROUND

Depression belongs to the most common mental disorders in late life and will lead to a significant increase of treatment and health care needs in the future. The Camberwell Assessment of Need for the Elderly (CANE) evaluates met and unmet care needs in older individuals. Reports on needs of the elderly with depression are currently lacking. The aim of the present study was to identify met and unmet needs in older primary care patients with and without depression using the German-language version of the CANE. Furthermore, the association between unmet needs and depression ought to be explored.

METHODS

As part of the study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)", a sample of 1179 primary care patients aged 75 years and older was assessed. Descriptive and inferential statistics as well as logistic regression analyses were conducted.

RESULTS

This study, for the first time in Germany, provides data on the distribution of met and unmet needs in depressive and non-depressive older primary care patients. As a main result, unmet needs were significantly associated with depression; other risk factors identified were gender, institutionalization, care by relatives and impaired functional status.

LIMITATIONS

The conclusions about directions and causality of associations between the variables are limited due to the cross-sectional design.

CONCLUSIONS

The study results provide an important contribution to generate a solid base for an effective and good-quality health and social care as well as to an appropriate allocation of health care resources in the elderly population.

Correlation Between the Type of Acute Coronary Syndrome With the Needs of Hospitalized Patients

Introduction:

Acute Coronary Syndromes (ACS) comprise life-threatening health problems that demand emergency care and immediate intervention. As patients are abruptly transitioning from healthy state into suffering, they consequently experience several needs, mainly attributed to the type of the syndrome including the therapeutic regimen.

Objectives:

To access the correlation between the type of acute coronary syndrome (ACS) with the needs of hospitalized patients.

Methods:

A sample of 454 hospitalized patients with ACS, recruited from 4 hospitals in Greece, was enrolled in the study. Data were collected by the completion of questionnaire which apart from socio-demographic and clinical characteristics, it also included the questionnaire “Needs of hospitalized patients with coronary artery disease” which is consisted 6 subscales: a) need for support and guidance, b) need for information from the medical-nursing staff, c) need for being in contact with other patient groups and ensuring communication with relatives, d) need for individualized treatment and for the patient’s personal participation to his/her treatment e) need to meet the emotional and physical needs f) need to trust the medical-nursing staff. Statistical methods used were Kolmogorov-Smirnov test, chi2 test of independence, Kruskal wallis-test and multiple regression.

Results:

The type of ACS was statistically significant correlated with the place of residence (p=0.002), management of disease (p<0.001) and prior experience of hospitalization (p=0.003). All six needs were statistically significantly correlated with the type of ACS, (p<0.001 for the need for support and guidance, p<0.001 for the need to be informed from the medical and nursing staff, p<0.001 for the need for being in contact with other patient groups, and ensuring communication with relatives, p<0.001 for the need for individualized treatment and for the patient’s personal participation to his/her treatment, p<0.001 for the need to meet the emotional needs and physical needs and p=0.010 for the need to trust the medical and nursing staff). More specifically, patients with angina considered all six needs to be less significant than patients with unstable angina and myocardial infarction. These results were confirmed by the multiple linear regression after controlling for potential confounders.

Conclusions:

Needs of hospitalized patients should be assessed in daily clinical practice according to the type of the syndrome.

Indicators and measurement tools for health system integration: a knowledge synthesis protocol

BACKGROUND

Health system integration is a key component of health system reform with the goal of improving outcomes for patients, providers, and the health system. Although health systems continue to strive for better integration, current delivery of health services continues to be fragmented. A key gap in the literature is the lack of information on what successful integration looks like and how to measure achievement towards an integrated system. This multi-site study protocol builds on a prior knowledge synthesis completed by two of the primary investigators which identified 10 key principles that collectively support health system integration. The aim is to answer two research questions: What are appropriate indicators for each of the 10 key integration principles developed in our previous knowledge synthesis and what measurement tools are used to measure these indicators? To enhance generalizability of the findings, a partnership between Canada and Brazil was created as health system integration is a priority in both countries and they share similar contexts.

METHODS/DESIGN

This knowledge synthesis will follow an iterative scoping review process with emerging information from knowledge-user engagement leading to the refinement of research questions and study selection. This paper describes the methods for each phase of the study. Research questions were developed with stakeholder input. Indicator identification and prioritization will utilize a modified Delphi method and patient/user focus groups. Based on priority indicators, a search of the literature will be completed and studies screened for inclusion. Quality appraisal of relevant studies will be completed prior to data extraction. Results will be used to develop recommendations and key messages to be presented through integrated and end-of-grant knowledge translation strategies with researchers and knowledge-users from the three jurisdictions.

DISCUSSION

This project will directly benefit policy and decision-makers by providing an easy accessible set of indicators and tools to measure health system integration across different contexts and cultures. Being able to evaluate the success of integration strategies and initiatives will lead to better health system design and improved health outcomes for patients.

The need for kidney transplantation in low- and middle-income countries in 2012: an epidemiological perspective

Epidemiological and demographic transitions are shifting the burden of modifiable risk factors for chronic and end-stage kidney disease to low- and middle-income countries (LMIC). This shifting burden of disease--combined with economic transitions and health system reforms--has led to the rapid growth of dialysis populations in LMIC including Malaysia, Tunisia, Turkey, Chile, Mexico, and Uruguay. Yet, compared to 1.5 million on dialysis in LMIC, only approximately 33,000 kidney transplants were performed in 2012. Reasons include health system factors (personnel, infrastructure, system coordination, and financing) and cultural factors (public and professional attitudes and the legal environment). The size of the dialysis populations, however, is generally a poor indicator of the potential need for kidney transplantation in LMIC. Population needs for kidney transplantation should instead be assessed based on the epidemiology of the actual underlying burden of disease (both treated and untreated), and the costs and benefits of treatment as well as prevention strategies relative to existing service provision. Here, we review current data on the global burden of end-stage kidney disease and the distribution of major risk factors, and compare this to access to kidney transplantation in 2012.