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Pokhilenko I, Gutierrez-Colosia MR, Janssen LMM, Evers SMAA, Paulus ATG, Drost RMWA, Campoy-Muñoz P, Simon J, Salvador-Carulla L. Clarifying terminology and definitions in education services for mental health users: A disambiguation study. PLoS One 2024; 19:e0306539. [PMID: 38959274 PMCID: PMC11221696 DOI: 10.1371/journal.pone.0306539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 06/18/2024] [Indexed: 07/05/2024] Open
Abstract
In the wake of the mental health crisis in children and adolescents, the coordination of education and mental health services has become a global priority. However, differing terminologies and classifications across sectors, hinder effective comparison. The classification in education focuses mainly on outputs like qualifications or throughputs like teaching programs. This proof-of-concept study tested the applicability of a standard classification of health services, the Description and Evaluation of Services and DirectoriEs (DESDE), to evaluate education services for mental health users in the context of Spain and The Netherlands. It was conducted alongside the PECUNIA project, that sought to develop methods for the assessment of mental health costs and outcomes in different sectors. The study followed an ontoterminology approach involving: 1) identification of services from a predefined list of 46 resource-use items, 2) disambiguation of identified services with the DESDE, and classifying them as accurate, ambiguous, vague or confuse; and 3) external validation by an expert panel. The analysis was conducted at the level of type of resource, target population and care provision. From the initial list, only ten of the resources could be categorized as services using DESDE, and not activities, interventions or professionals. Only four of them (8,65%) were accurate across all disambiguation categories. Experts were unaware of terminology problems in classification of service provision in the education sector. Classifications and glossaries can clarify service naming, description and costing allowing comparative effectiveness analysis and facilitating cross-sectoral planning. This should be grounded in common methodologies, tools, and units of analysis.
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Affiliation(s)
- Irina Pokhilenko
- Institute of Applied Health Research, Center for Economics of Obesity, Health Economics Unit, University of Birmingham, Birmingham, The United Kingdom
| | | | - Luca M. M. Janssen
- Faculty of Health, Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Silvia M. A. A. Evers
- Faculty of Health, Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Trimbos Institute Centre of Economic Evaluation & Machine Learning, Utrecht, The Netherlands
| | - Agnes T. G. Paulus
- Faculty of Health, Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Ruben M. W. A. Drost
- Faculty of Health, Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | | | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
- Health Care Information Systems (CTS553), University of Cadiz, Cadiz, Spain
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Furst MA, McDonald T, McCalman J, Salinas-Perez J, Fagan R, Lee Hong A, Nona M, Saunders V, Salvador-Carulla L. Evaluating Aboriginal and Torres Strait Islander Social and Emotional Wellbeing services: A collective case study in Far North Queensland. Aust N Z J Psychiatry 2024; 58:506-514. [PMID: 38590033 PMCID: PMC11128140 DOI: 10.1177/00048674241242935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Access to a coordinated range of strengths-based, culturally appropriate community-led primary mental health and Social and Emotional Wellbeing services is critical to the mental health and wellbeing of young Aboriginal and Torres Strait Islander people, and is a policy commitment of the Australian government. However, complex and fragmented service networks and a lack of standardised service data are barriers in identifying what services are available and what care they provide. METHOD A standardised service classification tool was used to assess the availability and characteristics of Social and Emotional Wellbeing services for young Aboriginal and Torres Strait Islander people in two regions in Queensland, Australia. RESULTS We identified a complex pattern of service availability and gaps in service provision. Non-Indigenous non-governmental organisations provided a significant proportion of services, particularly 'upstream' support, while Aboriginal Community Controlled Organisations were more likely to provide 'downstream' crisis type care. Most services provided by the public sector were through Child Safety and Youth Justice departments. CONCLUSIONS Our findings demonstrate the complexity of current networks, and show that non-Indigenous organisations are disproportionately influential in the care received by young Aboriginal and Torres Strait Islander people, despite community goals of self-determination, and government commitment to increasing capacity of Aboriginal Community Controlled Organisations to support their local communities. These findings can be used to support decision making and planning.
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Affiliation(s)
- Mary Anne Furst
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - Tina McDonald
- Jawun Research Centre, Office of Indigenous Engagement, CQUniversity, Cairns, QLD, Australia
| | - Janya McCalman
- Jawun Research Centre, Office of Indigenous Engagement, CQUniversity, Cairns, QLD, Australia
| | - Jose Salinas-Perez
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Bruce, ACT, Australia
- Department of Quantitative Methods, Universidad Loyola Andalucía, Seville, Spain
| | - Ruth Fagan
- Jawun Research Centre, Office of Indigenous Engagement, CQUniversity, Cairns, QLD, Australia
| | - Anita Lee Hong
- Gurriny Yealamucka Health Service Aboriginal Corporation, Yarrabah, QLD, Australia
| | - Merrissa Nona
- Deadly Inspiring Youth Doing Good (DIYDG) Aboriginal and Torres Strait Islander Corporation, Cairns, QLD, Australia
| | - Vicki Saunders
- Jawun Research Centre, Office of Indigenous Engagement, CQUniversity, Cairns, QLD, Australia
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Bruce, ACT, Australia
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW, Australia
- National Centre for Epidemiology and Population Health (NCEPH), College of Health & Medicine, Australian National University, Canberra, ACT, Australia
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Tabatabaei-Jafari H, Furst MA, Bagheri N, D’Cunha NM, Bail K, Sachdev PS, Salvador-Carulla L. The Integrated Atlas of Dementia Care in the Australian Capital Territory: A Collective Case Study of Local Service Provision. Health Serv Insights 2024; 17:11786329241232254. [PMID: 38348356 PMCID: PMC10860480 DOI: 10.1177/11786329241232254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
Background This study evaluates the dementia care system in a local area and aimed to include all specialised services designed to provide health and social services to people with dementia or age-related cognitive impairment, as well as general services with a high or very high proportion of clients with dementia. Methods The study used an internationally standardised service classification instrument called Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) to identify and describe all services providing care to people with dementia in the Australian Capital Territory (ACT). Results A total of 47 service providers were eligible for inclusion. Basic information about the services was collected from their websites, and further information was obtained through interviews with the service providers. Of the 107 services offered by the 47 eligible providers, 27% (n = 29) were specialised services and 73% (n = 78) were general services. Most of the services were residential or outpatient, with a target population mostly of people aged 65 or older, and 50 years or older in the case of Aboriginal and Torres Strait Islander Australians. There were government supports available for most types of care through various programmes. Conclusions Dementia care in the ACT relies heavily on general services. More widespread use of standardised methods of service classification in dementia will facilitate comparison with other local areas, allow for monitoring of changes over time, permit comparison with services provided for other health conditions and support evidence-informed local planning.
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Mary Anne Furst
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Nasser Bagheri
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Nathan M. D’Cunha
- School of Rehabilitation and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Kasia Bail
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Berger M, Mayer S, Simon J. A novel set of Austrian reference unit costs for comprehensive societal perspectives consistent with latest European costing methods for economic evaluations. Wien Klin Wochenschr 2024; 136:1-12. [PMID: 36564501 PMCID: PMC9786525 DOI: 10.1007/s00508-022-02128-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
Decision making in public health often happens against the background of scarce resources. The systematic use of economic evaluations can be a main enabler in the alignment of public health goals with budgetary constraints. However, the lack of standardized methodology in terms of costing method and perspective are a critical barrier to the implementation of economic evaluations and the international comparability of results. We present a novel set of 22 reference unit costs (RUCs) optimized for cross-sectoral economic evaluations in Austria suitable for international comparability calculated using the standardized PECUNIA RUC Template. The common framework for costing and reporting, as well as the easy availability of the RUCs will reduce the burden on researchers and policy makers in future economic evaluations. The higher quality, accuracy, transparency and availability of economic evidence for policy design will help to improve the efficiency of public health-relevant healthcare decisions and make it easier for policy makers to bring funding arrangements and decision making across multiple sectors in line with Health-in-All-Policies goals.
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Affiliation(s)
- Michael Berger
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
- Department of Psychiatry, University of Oxford, Warneford Hospital, OX3 7JX, Oxford, UK.
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Hinck P, Gutierrez-Colosía M, Duval C, König HH, Simon J, Fischer C, Mayer S, Salvador-Carulla L, Brodszky V, Roijen LHV, Evers S, Park AL, Hollingworth W, Konnopka A. The identification of economically relevant health and social care services for mental disorders in the PECUNIA project. BMC Health Serv Res 2023; 23:1045. [PMID: 37775752 PMCID: PMC10542258 DOI: 10.1186/s12913-023-09944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/21/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Health economic research is still facing significant problems regarding the standardization and international comparability of health care services. As a result, comparative effectiveness studies and cost-effectiveness analyses are often not comparable. This study is part of the PECUNIA project, which aimed to improve the comparability of economic evaluations by developing instruments for the internationally standardized measurement and valuation of health care services for mental disorders. The aim of this study was to identify internationally relevant services in the health and social care sectors relevant for health economic studies for mental disorders. METHODS A systematic literature review on cost-of-illness studies and economic evaluations was conducted to identify relevant services, complemented by an additional grey literature search and a search of resource use measurement (RUM) questionnaires. A preliminary long-list of identified services was explored and reduced to a short-list by multiple consolidation rounds within the international research team and an external international expert survey in six European countries. RESULTS After duplicate removal, the systematic search yielded 15,218 hits. From these 295 potential services could be identified. The grey literature search led to 368 and the RUM search to 36 additional potential services. The consolidation process resulted in a preliminary list of 186 health and social care services which underwent an external expert survey. A final consolidation step led to a basic list of 56 services grouped into residential care, daycare, outpatient care, information for care, accessibility to care, and self-help and voluntary care. CONCLUSIONS The initial literature searches led to an extensive number of potential service items for health and social care. Many of these items turned out to be procedures, interventions or providing professionals rather than services and were removed from further analysis. The resulting list was used as a basis for typological coding, the development of RUM questionnaires and corresponding unit costs for international mental health economic studies in the PECUNIA project.
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Affiliation(s)
- Paul Hinck
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Germany
| | - Mencia Gutierrez-Colosía
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
- Scientific Association PSICOST, Seville, Spain
| | - Christine Duval
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Germany
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna (MUW), Vienna, Austria
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna (MUW), Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna (MUW), Vienna, Austria
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
- Menzies Centre for Health Policy. School of Population Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest (CUB), Budapest, Hungary
| | - Leona Hakkaart-van Roijen
- Institute for Medical Technology Assessment, Erasmus University Rotterdam (EUR), Burgemeester Oudlaan 50, PO Box 1738, 3000, Rotterdam, DR, Netherlands
- Health Technology Assessment, Erasmus School of Health Policy and Management, Erasmus University Rotterdam (EUR), Burgemeester Oudlaan 50, PO Box 1738, 3000, Rotterdam, DR, Netherlands
| | - Silvia Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University (UM), Maastricht, the Netherlands
- Trimbos, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, The Netherlands
| | - A-La Park
- Care Policy and Evaluation Centre (CPEC), Department of Health Policy, London School of Economics and Political Science (LSE), London, UK
| | - William Hollingworth
- Health Economics Bristol, Department of Population Health Sciences, Bristol Medical School (UnivBris), Bristol, UK
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Germany.
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Tabatabaei-Jafari H, Bagheri N, Lueck C, Furst MA, Salinas-Perez JA, Salvador-Carulla L. Standardized Systematic Description of Provision of Care for Multiple Sclerosis at a Local Level: A Demonstration Study. Int J MS Care 2023; 25:124-130. [PMID: 37250197 PMCID: PMC10211356 DOI: 10.7224/1537-2073.2022-014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND This study evaluates and describes the pattern of services provided for people living with multiple sclerosis (MS) in a local area as a starting point for a more global assessment. METHODS A health care ecosystem approach has been followed using an internationally standardized service classification instrument-the Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC)-to identify and describe all services providing care to people with MS in the Australian Capital Territory, Australia. Available services were classified according to the target population into those specifically dedicated to people living with MS and those providing general neurologic services, both public and private, and across both social and health sectors. RESULTS A limited range of services was available. There were no local facilities providing or coordinating multidisciplinary integrated care specific to people with MS. Subspecialty services specific to MS were limited in number (6 of the 28 services), and use of specialist services provided in neighboring states was frequently reported. Overall, very few services were provided outside the core health sector (4%). CONCLUSIONS The provision of care to people living with MS in the Australian Capital Territory is fragmented and relies heavily on generic neurology services in the public and private sectors. More widespread use of the DESDE-LTC as a standardized method of service classification in MS will facilitate comparison with other local areas, allow monitoring of changes over time, and permit comparison with services provided for other health conditions (eg, dementia, mental disorders).
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Nasser Bagheri
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Christian Lueck
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Department of Neurology, Canberra Hospital, Canberra, ACT, Australia (CL)
- Australian National University Medical School, Canberra, ACT, Australia (CL)
| | - Mary Anne Furst
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Jose A. Salinas-Perez
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Department of Quantitative Methods, Loyola University Andalucia, Seville, Spain (JAS-P)
| | - Luis Salvador-Carulla
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia (LS-C)
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Pokhilenko I, Janssen LMM, Paulus ATG, Drost RMWA, Hollingworth W, Thorn JC, Noble S, Simon J, Fischer C, Mayer S, Salvador-Carulla L, Konnopka A, Hakkaart van Roijen L, Brodszky V, Park AL, Evers SMAA. Development of an Instrument for the Assessment of Health-Related Multi-sectoral Resource Use in Europe: The PECUNIA RUM. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:155-166. [PMID: 36622541 PMCID: PMC9931843 DOI: 10.1007/s40258-022-00780-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Measuring objective resource-use quantities is important for generating valid cost estimates in economic evaluations. In the absence of acknowledged guidelines, measurement methods are often chosen based on practicality rather than methodological evidence. Furthermore, few resource-use measurement (RUM) instruments focus on the measurement of resource use in multiple societal sectors and their development process is rarely described. Thorn and colleagues proposed a stepwise approach to the development of RUM instruments, which has been used for developing cost questionnaires for specific trials. However, it remains unclear how this approach can be translated into practice and whether it is applicable to the development of generic self-reported RUM instruments and instruments measuring resource use in multiple sectors. This study provides a detailed description of the practical application of this stepwise approach to the development of a multi-sectoral RUM instrument developed within the ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) project. METHODS For the development of the PECUNIA RUM, the methodological approach was based on best practice guidelines. The process included six steps, including the definition of the instrument attributes, identification of cost-driving elements in each sector, review of methodological literature and development of a harmonized cross-sectorial approach, development of questionnaire modules and their subsequent harmonization. RESULTS The selected development approach was, overall, applicable to the development of the PECUNIA RUM. However, due to the complexity of the development of a multi-sectoral RUM instrument, additional steps such as establishing a uniform methodological basis, harmonization of questionnaire modules and involvement of a broader range of stakeholders (healthcare professionals, sector-specific experts, health economists) were needed. CONCLUSION This is the first study that transparently describes the development process of a generic multi-sectoral RUM instrument in health economics and provides insights into the methodological aspects and overall validity of its development process.
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Affiliation(s)
- Irina Pokhilenko
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Luca M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Aggie T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - William Hollingworth
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Noble
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
- School of Public Health, Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg, Hamburg, Germany
| | - Leona Hakkaart van Roijen
- Erasmus School of Health Policy and Management, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| | - Valentin Brodszky
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - A-La Park
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Trimbos Institute National Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Salinas-Perez JA, Gutierrez-Colosia MR, Garcia-Alonso CR, Furst MA, Tabatabaei-Jafari H, Kalseth J, Perkins D, Rosen A, Rock D, Salvador-Carulla L. Patterns of mental healthcare provision in rural areas: A demonstration study in Australia and Europe. Front Psychiatry 2023; 14:993197. [PMID: 36815193 PMCID: PMC9939444 DOI: 10.3389/fpsyt.2023.993197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Mental healthcare systems are primarily designed to urban populations. However, the specific characteristics of rural areas require specific strategies, resource allocation, and indicators which fit their local conditions. This planning process requires comparison with other rural areas. This demonstration study aimed to describe and compare specialized rural adult mental health services in Australia, Norway, and Spain; and to demonstrate the readiness of the healthcare ecosystem approach and the DESDE-LTC mapping tool (Description and Evaluation of Services and Directories of Long Term Care) for comparing rural care between countries and across areas. METHODS The study described and classified the services using the DESDE-LTC. The analyses included context analysis, care availability, placement capacity, balance of care, and diversity of care. Additionally, readiness (Technology Readiness Levels - TRL) and impact analyses (Adoption Impact Ladder - AIL) were also assessed by two independent raters. RESULTS The findings demonstrated the usability of the healthcare ecosystem approach and the DESDE-LTC to map and identify differences and similarities in the pattern of care of highly divergent rural areas. Day care had a greater weight in the European pattern of care, while it was replaced by social outpatient care in Australian areas. In contrast, care coordination was more common in Australia, pointing to a more fragmented system that requires navigation services. The share between hospital and community residential care showed no differences between the two regions, but there were differences between catchment areas. The healthcare ecosystem approach showed a TRL 8 (the tool has been demonstrated in a real-world environment and it is ready for release and general use) and an AIL of 5 (the target public agencies provided resources for its completion). Two experts evaluated the readiness of the use of DESDE-LTC in their respective regional studies. All of them were classified using the TRL. DISCUSSION In conclusion, this study strongly supports gathering data on the provision of care in rural areas using standardized methods to inform rural service planning. It provides information on context and service availability, capacity and balance of care that may improve, directly or through subsequent analyses, the management and planning of services in rural areas.
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Affiliation(s)
- Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | - Carlos R Garcia-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Mary Anne Furst
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | | | - David Perkins
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,Centre for Rural and Remote Mental Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alan Rosen
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Daniel Rock
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,WA Primary Health Alliance, Subiaco, WA, Australia.,Discipline of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Luis Salvador-Carulla
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,National Centre for Epidemiology and Population Health (NCEPH), Faculty of Health and Medicine, Australian National University, Canberra, Australia
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Magnitude of terminological bias in international health services research: a disambiguation analysis in mental health. Epidemiol Psychiatr Sci 2022; 31:e59. [PMID: 35993182 PMCID: PMC9428902 DOI: 10.1017/s2045796022000403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
AIMS Health services research (HSR) is affected by a widespread problem related to service terminology including non-commensurability (using different units of analysis for comparisons) and terminological unclarity due to ambiguity and vagueness of terms. The aim of this study was to identify the magnitude of the terminological bias in health and social services research and health economics by applying an international classification system. METHODS This study, that was part of the PECUNIA project, followed an ontoterminology approach (disambiguation of technical and scientific terms using a taxonomy and a glossary of terms). A listing of 56 types of health and social services relevant for mental health was compiled from a systematic review of the literature and feedback provided by 29 experts in six European countries. The disambiguation of terms was performed using an ontology-based classification of services (Description and Evaluation of Services and DirectoriEs - DESDE), and its glossary of terms. The analysis focused on the commensurability and the clarity of definitions according to the reference classification system. Interrater reliability was analysed using κ. RESULTS The disambiguation revealed that only 13 terms (23%) of the 56 services selected were accurate. Six terms (11%) were confusing as they did not correspond to services as defined in the reference classification system (non-commensurability bias), 27 (48%) did not include a clear definition of the target population for which the service was intended, and the definition of types of services was unclear in 59% of the terms: 15 were ambiguous and 11 vague. The κ analyses were significant for agreements in unit of analysis and assignment of DESDE codes and very high in definition of target population. CONCLUSIONS Service terminology is a source of systematic bias in health service research, and certainly in mental healthcare. The magnitude of the problem is substantial. This finding has major implications for the international comparability of resource use in health economics, quality and equality research. The approach presented in this paper contributes to minimise differentiation between services by taking into account key features such as target population, care setting, main activities and type and number of professionals among others. This approach also contributes to support financial incentives for effective health promotion and disease prevention. A detailed analysis of services in terms of cost measurement for economic evaluations reveals the necessity and usefulness of defining services using a coding system and taxonomical criteria rather than by 'text-based descriptions'.
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Furst MA, Salinas-Perez JA, Gutiérrez-Colosia MR, Salvador-Carulla L. A new bottom-up method for the standard analysis and comparison of workforce capacity in mental healthcare planning: Demonstration study in the Australian Capital Territory. PLoS One 2021; 16:e0255350. [PMID: 34314451 PMCID: PMC8315559 DOI: 10.1371/journal.pone.0255350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022] Open
Abstract
The aims of this study are to evaluate and describe mental health workforce and capacity, and to describe the relationship between workforce capacity and patterns of care in local areas. We conducted a comparative demonstration study of the applicability of an internationally validated standardised service classification instrument—the Description and Evaluation of Services and Directories—DESDE-LTC) using the emerging mental health ecosystems research (MHESR) approach. Using DESDE-LTC as the framework, and drawing from international occupation classifications, the workforce was classified according to characteristics including the type of care provided and professional background. Our reference area was the Australian Capital Territory, which we compared with two other urban districts in Australia (Sydney and South East Sydney) and three benchmark international health districts (Helsinki-Uusima (Finland), Verona (Italy) and Gipuzkoa (Spain)). We also compared our data with national level data where available. The Australian and Finnish regions had a larger and more highly skilled workforce than the southern European regions. The pattern of workforce availability and profile varied, even within the same country, at the local level. We found significant differences between regional rates of identified rates of psychiatrists and psychologists, and national averages. Using a standardised classification instrument at the local level, and our occupational groupings, we were able to assess the available workforce and provide information relevant to planners about the actual capacity of the system. Data obtained at local level is critical to providing planners with reliable data to inform their decision making.
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Affiliation(s)
- Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
- * E-mail:
| | | | | | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
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Vagueness and Ambiguity in Communication of Case Management: A Content Analysis in the Australian National Disability Insurance Scheme. Int J Integr Care 2021; 21:17. [PMID: 33776606 PMCID: PMC7977023 DOI: 10.5334/ijic.5590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Case management (CM) is an integrated care strategy, characterised by a set of actions to support person-centred planning, coordination of health and social services. Decades of CM, organisational psychology and occupational research highlight how vagueness and ambiguity in role communication can create role conflict and job stress, negatively impacts staff turnover, intra-organisational collaboration, job performance, and that poor communication of CM impedes policy, quality analysis service development and practice. We conducted a detailed top-down hierarchical, quality analysis of communication about CM roles and responsibilities in a Scheme for people with disability in Australia. The study used content analysis methods and the main actions as defined in a validated CM taxonomy (Appendix 1). We systematically searched and analysed 53 Scheme policy and practice documents of CM from 2013-2019. The results showed poor role communication with vagueness, ambiguity, gaps in the description of CM roles and responsibilities. Poor role communication has contributed to negative experiences and outcomes of CM actions of planning and coordination, as reported by CM users in many Scheme-related parliamentary inquiries, research, formal complaints, and decision appeals. The results reinforce the importance of an ontological approach in communication of CM roles and actions and provides learnings for integrated care roles across countries and contexts.
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Tabatabaei-Jafari H, Salinas-Perez JA, Furst MA, Bagheri N, Mendoza J, Burke D, McGeorge P, Salvador-Carulla L. Patterns of Service Provision in Older People's Mental Health Care in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8516. [PMID: 33212966 PMCID: PMC7698522 DOI: 10.3390/ijerph17228516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022]
Abstract
Australia has a population of around 4 million people aged 65 years and over, many of whom are at risk of developing cognitive decline, mental illness, and/or psychological problems associated with physical illnesses. The aim of this study was to describe the pattern of specialised mental healthcare provision (availability, placement capacity, balance of care and diversity) for this age group in urban and rural health districts in Australia. The Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) tool was used in nine urban and two rural health districts of the thirty-one Primary Health Networks across Australia. For the most part service provision was limited to hospital and outpatient care across all study areas. The latter was mainly restricted to health-related outpatient care, and there was a relative lack of social outpatient care. While both acute and non-acute hospital care were available in urban areas, in rural areas hospital care was limited to acute care. Limited access to comprehensive mental health care, and the uniformity in provision across areas in spite of differences in demographic, socioeconomic and health characteristics raises issues of equity in regard to psychogeriatric care in this country. Comparing patterns of mental health service provision across the age span using the same classification method allows for a better understanding of care provision and gap analysis for evidence-informed policy.
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - Jose A. Salinas-Perez
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
- Department of Quantitative Methods, Universidad Loyola Andalucía, 41704 Dos Hermanas, Sevilla, Spain
| | - Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - Nasser Bagheri
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - John Mendoza
- Mental Health & Prison Health, Central Adelaide Local Health Network, Adelaide, SA 5000, Australia;
- Brain and Mind Centre, University of Sydney, Sydney, NSW 2050, Australia
| | - David Burke
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW 2010, Australia; (D.B.); (P.M.)
| | - Peter McGeorge
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW 2010, Australia; (D.B.); (P.M.)
- School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia
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