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Lai TC, McDaniel CC, Zou C, Turner D, Chou C. Associations Between Medicaid Expansion and Mental Health Among U.S. Racial and Ethnic Groups. Psychiatr Serv 2023; 74:1137-1145. [PMID: 37016826 DOI: 10.1176/appi.ps.20220394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE The authors examined associations between Medicaid expansion and self-reported mental health by race-ethnicity, focusing on lagged associations. METHODS This retrospective, cross-sectional study used 2011-2019 data from the Behavioral Risk Factor Surveillance System. The sample included low-income, childless adults ages 25-64 years. Difference-in-differences (DID) analysis was used to estimate associations between Medicaid expansion and self-reported mental health. Lagged associations were examined by separating the postexpansion period into proximal (2014-2016) and distal (2017-2019) periods. RESULTS In the overall sample (N=327,248), Medicaid expansion was associated with a reduction in the mean number of self-reported past-month poor mental health days (DID=-0.12, 95% CI=-0.21 to -0.03), after adjustment for covariates. The expansion was associated with significant reductions in past-month poor mental health days for the following groups: non-Hispanic White (DID=-0.18, 95% CI=-0.29 to -0.07), non-Hispanic Asian (DID=-1.15, 95% CI=-1.37 to -0.93), non-Hispanic other (DID=-0.62, 95% CI=-1.03 to -0.21), and Hispanic (DID=-0.48, 95% CI=-0.73 to -0.23). The non-Hispanic Black group had a significant increase in past-month poor mental health days (DID=0.27, 95% CI=0.06 to 0.49), and no significant change was noted for the American Indian or Alaska Native (AIAN) group. Improvements in mental health observed at the beginning of the policy implementation (proximal period) were not sustained over time for some racial-ethnic minority groups. CONCLUSIONS Although Medicaid expansion improved mental health for the overall sample, some racial-ethnic disparities were detected. The negative and insignificant associations for the non-Hispanic Black and AIAN groups, respectively, highlight the need to better understand why the Medicaid expansion affected racial-ethnic groups differently.
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Affiliation(s)
- Tim C Lai
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, Alabama (all authors); Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan (Chou)
| | - Cassidi C McDaniel
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, Alabama (all authors); Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan (Chou)
| | - Chenyu Zou
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, Alabama (all authors); Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan (Chou)
| | - Dalton Turner
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, Alabama (all authors); Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan (Chou)
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, Alabama (all authors); Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan (Chou)
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Suetani S, Hull J, Zeniou L, Chong L, Stimming A, Nelson C, Panagoda G. A model of care for attention deficit and hyperactivity disorder among adults in the community. Australas Psychiatry 2023; 31:616-618. [PMID: 37358370 DOI: 10.1177/10398562231186237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To describe the process of collaborative, contextualised development and implementation of a model of care for adults with symptoms suggestive of attention deficit and hyperactivity disorder in an Aboriginal community-controlled health service. CONCLUSION The current article describes an attempt to reduce unmet mental health needs through a systemic approach within a well-established Indigenous community-controlled organisation.
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Affiliation(s)
- Shuichi Suetani
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
- Physical health and mental health stream, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Jaimie Hull
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Lakis Zeniou
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Leshay Chong
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Andrea Stimming
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Gaj Panagoda
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
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Suetani S, Sardinha S, Gill N. Improving the mental health of Australians: A renewed call for primary care psychiatry. Australas Psychiatry 2022; 30:637-639. [PMID: 35595564 DOI: 10.1177/10398562221104418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe different ways to improve liaison between psychiatrists and general practitioners in Australia. CONCLUSION Strengthening the links between psychiatry and GPs in primary care is an effective approach to improve the mental health of Australians.
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Affiliation(s)
- Shuichi Suetani
- Institute for Urban Indigenous Health, Windsor, QLD, Australia; Physical health and mental health stream, 90131Queensland Centre for Mental Health Research, Wacol, QLD, Australia; Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia; and School of Medicine and Dentistry, 97562Griffith University, Southport, QLD, Australia
| | - Savio Sardinha
- Metro South Addiction and Mental Health Services, Brisbane, QLD, Australia
| | - Neeraj Gill
- Health Research Institute, University of Canberra, Canberra, ACT, Australia; and Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
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Abstract
Introduction: Interprofessional collaboration (IPC) is increasingly used but diversely implemented in primary care. We aimed to assess the effectiveness of IPC in primary care settings. Methods: An overview (review of systematic reviews) was carried out. We searched nine databases and employed a double selection and data extraction method. Patient-related outcomes were categorized, and results coded as improvement (+), worsening (–), mixed results (?) or no change (0). Results: 34 reviews were included. Six types of IPC were identified: IPC in primary care (large scope) (n = 8), physician-nurse in primary care (n = 1), primary care physician (PCP)-specialty care provider (n = 5), PCP-pharmacist (n = 3), PCP-mental healthcare provider (n = 15), and intersectoral collaboration (n = 2). In general, IPC in primary care was beneficial for patients with variation between types of IPC. Whereas reviews about IPC in primary care (large scope) showed better processes of care and higher patient satisfaction, other types of IPC reported mixed results for clinical outcomes, healthcare use and patient-reported outcomes. Also, reviews focusing on interventions based on pre-existing and well-defined models, such as collaborative care, overall reported more benefits. However, heterogeneity between the included primary studies hindered comparison and often led to the report of mixed results. Finally, professional- and organizational-related outcomes were under-reported, and cost-related outcomes showed some promising results for IPC based on pre-existing models; results were lacking for other types. Conclusions: This overview suggests that interprofessional collaboration can be effective in primary care. Better understanding of the characteristics of IPC processes, their implementation, and the identification of effective elements, merits further attention.
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Saraiva SAL, Zepeda J, Liria AF. Componentes do apoio matricial e cuidados colaborativos em saúde mental: uma revisão narrativa. CIENCIA & SAUDE COLETIVA 2020; 25:553-565. [DOI: 10.1590/1413-81232020252.10092018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/27/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo Cuidados colaborativos entre saúde mental e atenção primária são efetivos em melhorar desfechos de saúde. O apoio matricial tem semelhanças com cuidados colaborativos pouco exploradas na literatura. Este artigo compara os dois modelos e analisa o apoio matricial a partir de evidências sobre cuidados colaborativos. Revisão narrativa. Componentes de cada modelo (atividades e dimensões) foram identificados e comparados. Evidências sobre cuidados colaborativos informaram análise de componentes semelhantes do apoio matricial. Foram identificadas dimensões do apoio matricial – suporte educacional, cuidado especializado, regulação, cogestão – e dos cuidados colaborativos – cuidado multiprofissional, comunicação sistemática, cuidado estruturado, suporte organizacional. A principal semelhança entre os modelos está nas atividades colaborativas diretas em torno de problemas clínicos, relacionadas a efetividade em estudos sobre cuidados colaborativos. Atividades colaborativas diretas são ponto positivo do apoio matricial. Cuidado estruturado e suporte em nível organizacional devem ser encorajados. Futuros estudos devem refinar as categorias propostas e explorar seu uso para desenvolvimento do apoio matricial.
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Dawson S, Muller J, Renigers V, Varona L, Kernot J. Consumer, health professional and employment specialist experiences of an individual placement and support programme. Scand J Occup Ther 2020; 28:433-445. [PMID: 31976792 DOI: 10.1080/11038128.2020.1714719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Individuals with severe mental illness (SMI) are under-represented in the workforce. The Individual Placement and Support (IPS) programme is an evidence-based intervention that co-locates an Employment Specialist in a community mental health team to support individuals with a SMI with their goal of finding work. Previous research predominantly explored IPS programme outcomes rather than stakeholder experiences. AIM To explore programme stakeholder perspectives and experiences during the early stages of IPS programme implementation. METHODS Qualitative descriptive methodology explored consumers (n = 11), health professionals and employment specialist (n = 11) perceptions and experiences of the IPS programme. Semi-structured interviews were conducted and thematically analysed. RESULTS Three main themes emerged: enacting core care philosophies, IPS programme process and catalyst for supportive environments and relationships. The combination of IPS programme relationships, enactment of core care philosophies, and programme process promoted development of supportive environments and relationships for consumers participating in the programme. CONCLUSION Findings suggest IPS processes promoted the enactment of person-centred and recovery-oriented care approaches and positively influenced care planning practices and service culture. SIGNIFICANCE IPS directly tackles the compounding disadvantage resulting from unemployment for people with a SMI. At a service level, IPS can foster positive changes to care practices and service culture.
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Affiliation(s)
- Suzanne Dawson
- Central Adelaide Local Health Network, Mental Health Directorate, Adelaide, Australia
| | - Jessica Muller
- Department of Rural Health, Division of Health Sciences, University of South Australia, Whyalla, Australia
| | - Vic Renigers
- Central Adelaide Local Health Network, Mental Health Directorate, Adelaide, Australia
| | - Lisa Varona
- Central Adelaide Local Health Network, Mental Health Directorate, Adelaide, Australia
| | - Jocelyn Kernot
- Occupational Therapy Program, School of Health Science, University of South Australia, Adelaide, Australia
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Roberts R. Researching for better health for regional and rural Australians? Aust J Rural Health 2019; 27:474-475. [DOI: 10.1111/ajr.12597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Roberts R. Vale Bob Hawke: What impact has Medicare had on rural Australia? Aust J Rural Health 2019; 27:194-195. [DOI: 10.1111/ajr.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Russell Roberts
- Charles Sturt University; Bathurst New South Wales Australia
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Roy M, Dagenais P, Pinsonneault L, Déry V. Better care through an optimized mental health services continuum (Eastern Townships, Québec, Canada): A systematic and multisource literature review. Int J Health Plann Manage 2018; 34:e111-e130. [PMID: 30378709 DOI: 10.1002/hpm.2687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/25/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION In 2014, the health authorities of the Eastern Townships (Québec, Canada) commissioned an evaluation of the mental health admission system for adults (GASMA) to identify the best GASMA organizational or structural elements and optimize the mental health services continuum. METHODS To develop better services, seven indicators (ie, accessibility to services, integration of levels of services, user satisfaction, guidance and management time, evaluation tools, professional composition, and interprofessional collaboration) were examined through four evaluation questions. A three-step systematic and multisource evaluation was realized. A systematic review of the scientific and gray literature was performed. This evaluation also included key informant opinions to contextualize results from this review. RESULTS Results from 91 scientific articles, 40 gray literature documents, and 10 interviews highlighted determinants and barriers associated with the examined indicators. From these results, 24 preliminary recommendations were formulated and discussed in a steering committee. These recommendations were then weighted and validated. This served to formulate three final recommendations. CONCLUSION To optimize the regional mental health services continuum, stakeholders should (1) implement a single-window access for adults with mental health needs, (2) develop alternative services based on users' needs, and (3) test the effectiveness of new methods, initiatives, and tools.
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Affiliation(s)
- Mathieu Roy
- Health Technology and Social Services Assessment Unit, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine & Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Pierre Dagenais
- Health Technology and Social Services Assessment Unit, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Linda Pinsonneault
- Eastern Townships Public Health Department, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Community Health Sciences, Faculty of Medicine & Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Véronique Déry
- Health Technology and Social Services Assessment Unit, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Community Health Sciences, Faculty of Medicine & Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Bordeleau L, Leblanc J. La collaboration interprofessionnelle comme modalité pour résoudre les impasses thérapeutiques en pédopsychiatrie : une revue de littérature. SANTE MENTALE AU QUEBEC 2017. [DOI: 10.7202/1041925ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
L’intervention auprès des enfants et des adolescents en clinique de pédopsychiatrie génère un risque d’impasses thérapeutiques élevé pour les cliniciens. L’alourdissement des difficultés des jeunes qui y sont référés et l’obligation pour les professionnels qui y travaillent de collaborer avec les différents acteurs présents auprès de cette clientèle contribuent à cette situation. Les recherches démontrent toutefois qu’il existe un lien positif entre la collaboration interprofessionnelle et l’efficacité des services en santé, et ce, même si son implantation demeure difficile. D’Amour et coll. ont développé un modèle de structuration de la collaboration interprofessionnelle qui permet d’en comprendre les processus. La revue de littérature qui constitue le sujet du présent article explore comment, en extrayant les indicateurs de ce modèle, il serait possible d’aider les professionnels travaillant en clinique de pédopsychiatrie à dénouer les impasses thérapeutiques qu’ils rencontrent.
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Affiliation(s)
- Lyne Bordeleau
- M. Ps., psychologue clinicienne, Doctorante en psychologie, Université de Sherbrooke
| | - Jeannette Leblanc
- Ph. D., psychologue, Professeur associée, Département de psychologie, Université de Sherbrooke
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Fuller J, Oster C, Muir Cochrane E, Dawson S, Lawn S, Henderson J, O'Kane D, Gerace A, McPhail R, Sparkes D, Fuller M, Reed RL. Testing a model of facilitated reflection on network feedback: a mixed method study on integration of rural mental healthcare services for older people. BMJ Open 2015; 5:e008593. [PMID: 26560057 PMCID: PMC4654302 DOI: 10.1136/bmjopen-2015-008593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To test a management model of facilitated reflection on network feedback as a means to engage services in problem solving the delivery of integrated primary mental healthcare to older people. DESIGN Participatory mixed methods case study evaluating the impact of a network management model using organisational network feedback (through social network analysis, key informant interviews and policy review). INTERVENTION A model of facilitated network reflection using network theory and methods. SETTING A rural community in South Australia. PARTICIPANTS 32 staff from 24 services and 12 senior service managers from mental health, primary care and social care services. RESULTS Health and social care organisations identified that they operated in clustered self-managed networks within sectors, with no overarching purposive older people's mental healthcare network. The model of facilitated reflection revealed service goal and role conflicts. These discussions helped local services to identify as a network, and begin the problem-solving communication and referral links. A Governance Group assisted this process. Barriers to integrated servicing through a network included service funding tied to performance of direct care tasks and the lack of a clear lead network administration organisation. CONCLUSIONS A model of facilitated reflection helped organisations to identify as a network, but revealed sensitivity about organisational roles and goals, which demonstrated that conflict should be expected. Networked servicing needed a neutral network administration organisation with cross-sectoral credibility, a mandate and the resources to monitor the network, to deal with conflict, negotiate commitment among the service managers, and provide opportunities for different sectors to meet and problem solve. This requires consistency and sustained intersectoral policies that include strategies and funding to facilitate and maintain health and social care networks in rural communities.
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Affiliation(s)
- Jeffrey Fuller
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Candice Oster
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Eimear Muir Cochrane
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Suzanne Dawson
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Sharon Lawn
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Julie Henderson
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Deb O'Kane
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Adam Gerace
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Ruth McPhail
- Country Health South Australia Local Health Network Mental Health Services, Adelaide, South Australia, Australia
| | - Deb Sparkes
- Southern Adelaide-Fleurieu-Kangaroo Island Medicare Local, Adelaide, South Australia, Australia
| | - Michelle Fuller
- City of Victor Harbor, Victor Harbour, South Australia, Australia
| | - Richard L Reed
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
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Calderón C, Balagué L, Iruin Á, Retolaza A, Belaunzaran J, Basterrechea J, Mosquera I. [Primary care and mental health care collaboration in patients with depression: Evaluation of a pilot experience]. Aten Primaria 2015; 48:356-65. [PMID: 26522782 PMCID: PMC6877855 DOI: 10.1016/j.aprim.2015.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/23/2015] [Accepted: 06/29/2015] [Indexed: 11/15/2022] Open
Abstract
Objetivo Implementar y evaluar una experiencia colaborativa entre Atención Primaria (AP) y Salud Mental (SM) para mejorar la asistencia a los pacientes con depresión. Diseño Proyecto colaborativo piloto con enfoque de investigación acción participativa (IAP) durante 2013. Emplazamiento : País Vasco. Osakidetza (Servicio Vasco de Salud). Bizkaia y Gipuzkoa. Participantes Doscientos siete profesionales de medicina de familia, enfermería, psiquiatría, enfermería psiquiátrica, psicología y trabajo social de 9 centros de salud y 6 centros de salud mental de Osakidetza. Intervenciones Diseño y desarrollo compartido de 4 ejes de intervención: 1) comunicación y conocimiento entre profesionales de AP y SM; 2) mejora en la codificación diagnóstica y derivación de pacientes; 3) formación compartida mediante sesiones y guías de práctica clínica comunes, y 4) evaluación. Mediciones principales Encuestas a profesionales de centros de intervención y control sobre conocimiento y satisfacción en la relación AP-SM, actividades formativas conjuntas y valoración de la experiencia. Registros de Osakidetza sobre prevalencias, derivaciones y tratamientos. Reuniones de seguimiento. Resultados Mejoría en los centros de intervención respecto a los de control en los 4 ejes de intervención. Identificación de factores a considerar en el desarrollo y la sostenibilidad de la colaboración AP-SM. Conclusiones La experiencia piloto confirma que los proyectos colaborativos promovidos por AP y SM pueden mejorar la asistencia y satisfacción de los profesionales. Son proyectos complejos que requieren intervenciones simultáneas adecuadas a las singularidades de los servicios de salud. La participación pluridisciplinaria y continuada, y el apoyo de la gestión y los sistemas de información, son condiciones necesarias para su implementación.
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Affiliation(s)
- Carlos Calderón
- Centro de Salud de Alza, OSI Donostia, Osakidetza, Donostia-San Sebastián, España; Unidad de Investigación de Atención Primaria-OSIs Gipuzkoa, Osakidetza, Donostia-San Sebastián, España.
| | - Laura Balagué
- Centro de Salud de Iztieta, OSI Donostia, Osakidetza, Errenteria, España; Unidad de Investigación de Atención Primaria-OSIs Gipuzkoa, Osakidetza, Donostia-San Sebastián, España
| | - Álvaro Iruin
- Red de Salud Mental de Gipuzkoa, Osakidetza, Donostia-San Sebastián, España
| | - Ander Retolaza
- Centro de Salud Mental de Basauri, Red de Salud Mental de Bizkaia, Osakidetza, Basauri, España
| | - Jon Belaunzaran
- Centro de Salud Mental de Zarautz, Red de Salud Mental de Gipuzkoa, Osakidetza, Zarautz, España
| | - Javier Basterrechea
- Unidad de Gestión Sanitaria, OSI Donostia, Osakidetza, Donostia-San Sebastián, España
| | - Isabel Mosquera
- Unidad de Investigación de Atención Primaria-OSIs Gipuzkoa, Osakidetza, Donostia-San Sebastián, España
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Dumoulin R, Heylen L. [A dreamed cooperation: Stakeholder query in Flemish Limburg concerning cooperation in the field of mental healthcare for older people]. Tijdschr Gerontol Geriatr 2015; 46:160-167. [PMID: 25925533 DOI: 10.1007/s12439-015-0131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED This study is an extensive stakeholder query on cooperation in the field of mental healthcare for older people. Cooperation is a key theme in the current policy on mental healthcare in Flanders which is an application of the socialisation of care. The consultative platform SPIL recruited representatives of the primary healthcare through local consultative platforms (POP) and other relevant actors. This qualitative study used the appreciative inquiry in focus groups. There were 12 focus groups with a total of 110 participants, asked to dream of an ideal cooperation. Results show a great willingness to work together effectively with a central role for the patient. Participants seek knowledge, expertise and practical support from each other. They request a consult feature to know where to turn to. The main premise to cooperation is knowing each other, for which time and space is needed. A joint patient record is another request. CONCLUSION No great new projects are requested. Focus must go to further elaboration of working together.
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Affiliation(s)
- Robbie Dumoulin
- Vlaams Onderzoeks- en Kenniscentrum Derde Leeftijd (VONK3), Thomas More, Kleinhoefstraat 4, 2440, Geel, Belgium,
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Intersectoral policy for severe and persistent mental illness: review of approaches in a sample of high-income countries. Glob Ment Health (Camb) 2015; 2:e18. [PMID: 28596866 PMCID: PMC5269620 DOI: 10.1017/gmh.2015.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 04/02/2015] [Accepted: 06/20/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND It is increasingly recognised that intersectoral linkages between mental health and other health and support sectors are essential for providing effective care for individuals with severe and persistent mental illness. The extent to which intersectoral collaboration and approaches to achieve it are detailed in mental health policy has not yet been systematically examined. METHODS Thirty-eight mental health policy documents from 22 jurisdictions in Australia, New Zealand, the United Kingdom, Ireland and Canada were identified via a web search. Information was extracted and synthesised on: the extent to which intersectoral collaboration was an objective or guiding principle of policy; the sectors acknowledged as targets for collaboration; and the characteristics of detailed intersectoral collaboration efforts. RESULTS Recurring themes in objectives/guiding principles included a whole of government approach, coordination and integration of services, and increased social and economic participation. All jurisdictions acknowledged the importance of intersectoral collaboration, particularly with employment, education, housing, community, criminal justice, drug and alcohol, physical health, Indigenous, disability, emergency and aged care services. However, the level of detail provided varied widely. Where detailed strategies were described, the most common linkage mechanisms were joint service planning through intersectoral coordinating committees or liaison workers, interagency agreements, staff training and joint service provision. CONCLUSIONS Sectors and mechanisms identified for collaboration were largely consistent across jurisdictions. Little information was provided about strategies for accountability, resourcing, monitoring and evaluation of intersectoral collaboration initiatives, highlighting an area for further improvement. Examples of collaboration detailed in the policies provide a useful resource for other countries.
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Fuller J, Oster C, Dawson S, O'Kane D, Lawn S, Henderson J, Gerace A, Reed R, Nosworthy A, Galley P, McPhail R, Cochrane EM. Improving the network management of integrated primary mental healthcare for older people in a rural Australian region: protocol for a mixed methods case study. BMJ Open 2014; 4:e006304. [PMID: 25227632 PMCID: PMC4166139 DOI: 10.1136/bmjopen-2014-006304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION An integrated approach to the mental healthcare of older people is advocated across health, aged care and social care sectors. It is not clear, however, how the management of integrated servicing should occur, although interorganisational relations theory suggests a reflective network approach using evaluation feedback. This research will test a network management approach to help regional primary healthcare organisations improve mental health service integration. METHODS AND ANALYSIS This mixed methods case study in rural South Australia will test facilitated reflection within a network of health and social care services to determine if this leads to improved integration. Engagement of services will occur through a governance group and a series of three 1-day service stakeholder workshops. Facilitated reflection and evaluation feedback will use information from a review of health sector and local operational policies, a network survey about current service links, gaps and enablers and interviews with older people and their carers about their help seeking journeys. Quantitative and qualitative analysis will describe the policy enablers and explore the current and ideal links between services. The facilitated reflection will be developed to maximise engagement of senior management in the governance group and the service staff at the operational level in the workshops. Benefit will be assessed through indicators of improved service coordination, collective ownership of service problems, strengthened partnerships, agreed local protocols and the use of feedback for accountability. ETHICS, BENEFITS AND DISSEMINATION Ethics approval will deal with the sensitivities of organisational network research where data anonymity is not preserved. The benefit will be the tested utility of a facilitated reflective process for a network of health and social care services to manage linked primary mental healthcare for older people in a rural region. Dissemination will make use of the sectoral networks of the governance group.
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Affiliation(s)
- Jeffrey Fuller
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Candice Oster
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Suzanne Dawson
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Deb O'Kane
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- School of Medicine, Flinders University, Adelaide, Australia
| | - Julie Henderson
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Adam Gerace
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Richard Reed
- School of Medicine, Flinders University, Adelaide, Australia
| | - Ann Nosworthy
- Southern Fleurieu & Kangaroo Island Positive Ageing Taskforce, Victor Harbor, Australia
| | - Philip Galley
- Southern Adelaide-Fleurieu-Kangaroo Island Medicare Local, Bedford Park, Australia
| | - Ruth McPhail
- Country Health South Australia Local Health Network Mental Health Services, Adelaide, Australia
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Fletcher J, King K, Christo J, Machlin A, Bassilios B, Blashki G, Gibbs C, Nicholas A, Pirkis J. An evaluation of an Australian initiative designed to improve interdisciplinary collaboration in primary mental health care. EVALUATION AND PROGRAM PLANNING 2014; 45:29-41. [PMID: 24698982 DOI: 10.1016/j.evalprogplan.2014.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/23/2014] [Accepted: 03/01/2014] [Indexed: 06/03/2023]
Abstract
This paper reports on a multi-component evaluation of Australia's Mental Health Professionals Network (MHPN). MHPN aims to improve consumer outcomes by fostering a collaborative clinical approach to primary mental health care. MHPN has promoted interdisciplinary communication and networking through activity in three inter-related areas: interdisciplinary workshops supported by education and training materials; fostering ongoing, self-sustained interdisciplinary clinical networks; and a website, web portal (MHPN Online) and a toll-free telephone information line. The evaluation showed that MHPN's workshops were highly successful; almost 1200 workshops were attended by 11,930 individuals from a range of mental health professions. Participants from 81% of these workshops have gone on to join ongoing, interdisciplinary networks of local providers, and MHPN is now supporting these networks in a range of innovative ways to encourage them to become self-sustaining and to improve collaborative care practices.
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Affiliation(s)
- Justine Fletcher
- Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Victoria 3010, Australia.
| | - Kylie King
- Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Victoria 3010, Australia.
| | - Jo Christo
- Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Victoria 3010, Australia.
| | - Anna Machlin
- Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Victoria 3010, Australia.
| | - Bridget Bassilios
- Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Victoria 3010, Australia.
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, Victoria 3010, Australia.
| | - Chris Gibbs
- Mental Health Professionals Network, PO Box 203, Flinders Lane, Victoria 8009, Australia.
| | - Angela Nicholas
- Mental Health Professionals Network, PO Box 203, Flinders Lane, Victoria 8009, Australia.
| | - Jane Pirkis
- Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Victoria 3010, Australia.
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Morgan MAJ, Coates MJ, Dunbar JA, Reddy P, Schlicht K, Fuller J. The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial. BMJ Open 2013; 3:bmjopen-2012-002171. [PMID: 23355671 PMCID: PMC3563126 DOI: 10.1136/bmjopen-2012-002171] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the effectiveness of collaborative care in reducing depression in primary care patients with diabetes or heart disease using practice nurses as case managers. DESIGN A two-arm open randomised cluster trial with wait-list control for 6 months. The intervention was followed over 12 months. SETTING Eleven Australian general practices, five randomly allocated to the intervention and six to the control. PARTICIPANTS 400 primary care patients (206 intervention, 194 control) with depression and type 2 diabetes, coronary heart disease or both. INTERVENTION The practice nurse acted as a case manager identifying depression, reviewing pathology results, lifestyle risk factors and patient goals and priorities. Usual care continued in the controls. MAIN OUTCOME MEASURE A five-point reduction in depression scores for patients with moderate-to-severe depression. Secondary outcome was improvements in physiological measures. RESULTS Mean depression scores after 6 months of intervention for patients with moderate-to-severe depression decreased by 5.7±1.3 compared with 4.3±1.2 in control, a significant (p=0.012) difference. (The plus-minus is the 95% confidence range.) Intervention practices demonstrated adherence to treatment guidelines and intensification of treatment for depression, where exercise increased by 19%, referrals to exercise programmes by 16%, referrals to mental health workers (MHWs) by 7% and visits to MHWs by 17%. Control-practice exercise did not change, whereas referrals to exercise programmes dropped by 5% and visits to MHWs by 3%. Only referrals to MHW increased by 12%. Intervention improvements were sustained over 12 months, with a significant (p=0.015) decrease in 10-year cardiovascular disease risk from 27.4±3.4% to 24.8±3.8%. A review of patients indicated that the study's safety protocols were followed. CONCLUSIONS TrueBlue participants showed significantly improved depression and treatment intensification, sustained over 12 months of intervention and reduced 10-year cardiovascular disease risk. Collaborative care using practice nurses appears to be an effective primary care intervention. TRIAL REGISTRATION ACTRN12609000333213 (Australia and New Zealand Clinical Trials Registry).
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Affiliation(s)
- Mark A J Morgan
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Michael J Coates
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - James A Dunbar
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Prasuna Reddy
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kate Schlicht
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Jeff Fuller
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
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Schlicht K, Morgan MAJ, Fuller J, Coates MJ, Dunbar JA. Safety and acceptability of practice-nurse-managed care of depression in patients with diabetes or heart disease in the Australian TrueBlue study. BMJ Open 2013; 3:bmjopen-2012-002195. [PMID: 23572196 PMCID: PMC3641462 DOI: 10.1136/bmjopen-2012-002195] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To determine the safety and acceptability of the TrueBlue model of nurse-managed care in the primary healthcare setting. DESIGN A mixed methods study involving clinical record audit, focus groups and nurse interviews as a companion study investigating the processes used in the TrueBlue randomised trial. SETTING Australian general practices involved in the TrueBlue trial. PARTICIPANTS Five practice nurses and five general practitioners (GPs) who had experienced nurse-managed care planning following the TrueBlue model of collaborative care. INTERVENTION The practice nurse acted as case manager, providing screening and protocol-management of depression and diabetes, coronary heart disease or both. PRIMARY OUTCOME MEASURES Proportion of patients provided with stepped care when needed, identification and response to suicide risk and acceptability of the model to practice nurses and GPs. RESULTS Almost half the patients received stepped care when indicated. All patients who indicated suicidal ideations were identified and action taken. Practice nurses and GPs acknowledged the advantages of the TrueBlue care-plan template and protocol-driven care, and the importance of peer support for the nurse in their enhanced role. CONCLUSIONS Practice nurses were able to identify, assess and manage mental-health risk in patients with diabetes or heart disease.
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Affiliation(s)
- K Schlicht
- Department of Rural Health, Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - M A J Morgan
- Department of Rural Health, Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - J Fuller
- School of Nursing and Midwifery, Flinders University, Adelaide, Australia
| | - M J Coates
- Department of Rural Health, Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - J A Dunbar
- Department of Rural Health, Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
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Kelly BJ, Perkins DA, Fuller JD, Parker SM. Shared care in mental illness: A rapid review to inform implementation. Int J Ment Health Syst 2011; 5:31. [PMID: 22104323 PMCID: PMC3235059 DOI: 10.1186/1752-4458-5-31] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 11/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While integrated primary healthcare for the management of depression has been well researched, appropriate models of primary care for people with severe and persistent psychotic disorders are poorly understood. In 2010 the NSW (Australia) Health Department commissioned a review of the evidence on "shared care" models of ambulatory mental health services. This focussed on critical factors in the implementation of these models in clinical practice, with a view to providing policy direction. The review excluded evidence about dementia, substance use and personality disorders. METHODS A rapid review involving a search for systematic reviews on The Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects (DARE). This was followed by a search for papers published since these systematic reviews on Medline and supplemented by limited iterative searching from reference lists. RESULTS Shared care trials report improved mental and physical health outcomes in some clinical settings with improved social function, self management skills, service acceptability and reduced hospitalisation. Other benefits include improved access to specialist care, better engagement with and acceptability of mental health services. Limited economic evaluation shows significant set up costs, reduced patient costs and service savings often realised by other providers. Nevertheless these findings are not evident across all clinical groups. Gains require substantial cross-organisational commitment, carefully designed and consistently delivered interventions, with attention to staff selection, training and supervision. Effective models incorporated linkages across various service levels, clinical monitoring within agreed treatment protocols, improved continuity and comprehensiveness of services. CONCLUSIONS "Shared Care" models of mental health service delivery require attention to multiple levels (from organisational to individual clinicians), and complex service re-design. Re-evaluation of the roles of specialist mental health staff is a critical requirement. As expected, no one model of "shared" care fits diverse clinical groups. On the basis of the available evidence, we recommended a local trial that examined the process of implementation of core principles of shared care within primary care and specialist mental health clinical services.
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Affiliation(s)
- Brian J Kelly
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, Faculty of Health University of Newcastle, University Drive, Callaghan 2308, Australia
| | - David A Perkins
- School of Nursing & Midwifery, Flinders University, Sturt Rd, Bedford Park 5024, Australia
| | - Jeffrey D Fuller
- Centre for Remote Health Research, Broken Hill University Department of Rural Health, University of Sydney, Corrindah Court, Broken Hill 2880, Australia
| | - Sharon M Parker
- Centre for Remote Health Research, Broken Hill University Department of Rural Health, University of Sydney, Corrindah Court, Broken Hill 2880, Australia
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