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Diaz-Milanes D, Almeda N, Rodero-Cosano ML, Salinas-Perez JA, Garcia-Alonso CR. Assessment of care provision integration in a community-based mental health system: balanced care model implementation in Andalusia (Spain). BMC Public Health 2024; 24:2671. [PMID: 39350100 PMCID: PMC11440898 DOI: 10.1186/s12889-024-20169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 09/24/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Andalusia is the second largest region in Spain, and it has developed a comprehensive mental health (MH) plan that encourages the consolidation of the balanced care model. However, its geographical and socioeconomic disparity is a great challenge for a community-based MH system. Both the assessment of the implementation of the MH plan and the development of new tools to support decision-making can be considered critical. OBJECTIVES The present study aims (i) to assess how the integration of different types of MH care may influence system performance and (ii) to check the performance evolution of the integration process geographically regarding the small MH areas of Andalusia. METHODS The performance of the Andalusian MH system was assessed by combining Monte Carlo simulation, fuzzy inference and data envelopment analysis. The relative technical efficiency was the main performance indicator. RESULTS A correct integration of appropriate types of MH care, according to population needs, increases the performance of the Andalusian MH system both from global and regional perspectives. The spatial representation (based on small MH areas) of the results highlights how the performance depends on specific geographical characteristics. By analyzing the identified spatial clusters, defined by different management patterns depending on user and socioeconomic characteristics, benchmark areas and areas for improvement can be studied to design evidence-informed policies and interventions. CONCLUSIONS A global analysis of MH system performance was carried out, including both the successive integration of different types of care and its spatial evolution. Although an appropriate integration of different types of MH care has a positive effect on the Andalusian MH system, this process has different profiles depending on specific geographically based user and socioeconomic characteristics. The balanced care model can be considered the paradigm for assessing the performance of a large and populated territory such as Andalusia, which has a community-based MH system. This methodological approach (performance assessment and spatial analysis) may be used as a guide for developing future evidence-informed policies and managerial interventions.
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Affiliation(s)
- Diego Diaz-Milanes
- Department of Quantitative Methods, Universidad Loyola Andalucia, Seville, Spain.
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.
| | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucia, Seville, Spain
| | | | - Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucia, Seville, Spain
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Carlos R Garcia-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucia, Seville, Spain
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
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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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Hrzic R, Cade MV, Wong BLH, McCreesh N, Simon J, Czabanowska K. A competency framework on simulation modelling-supported decision-making for Master of Public Health graduates. J Public Health (Oxf) 2024; 46:127-135. [PMID: 38061776 PMCID: PMC10901273 DOI: 10.1093/pubmed/fdad248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Simulation models are increasingly important for supporting decision-making in public health. However, due to lack of training, many public health professionals remain unfamiliar with constructing simulation models and using their outputs for decision-making. This study contributes to filling this gap by developing a competency framework on simulation model-supported decision-making targeting Master of Public Health education. METHODS The study combined a literature review, a two-stage online Delphi survey and an online consensus workshop. A draft competency framework was developed based on 28 peer-reviewed publications. A two-stage online Delphi survey involving 15 experts was conducted to refine the framework. Finally, an online consensus workshop, including six experts, evaluated the competency framework and discussed its implementation. RESULTS The competency framework identified 20 competencies related to stakeholder engagement, problem definition, evidence identification, participatory system mapping, model creation and calibration and the interpretation and dissemination of model results. The expert evaluation recommended differentiating professional profiles and levels of expertise and synergizing with existing course contents to support its implementation. CONCLUSIONS The competency framework developed in this study is instrumental to including simulation model-supported decision-making in public health training. Future research is required to differentiate expertise levels and develop implementation strategies.
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Affiliation(s)
- Rok Hrzic
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Maastricht University, Maastricht, 6200 MD, Netherlands
| | - Maria Vitoria Cade
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Maastricht University, Maastricht, 6200 MD, Netherlands
| | - Brian Li Han Wong
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Maastricht University, Maastricht, 6200 MD, Netherlands
| | - Nicky McCreesh
- Department of Infectious Disease Epidemiology and Dynamics, Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, 1090, Austria
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Maastricht University, Maastricht, 6200 MD, Netherlands
- Department of Health Policy Management, Institute of Public Health, Jagiellonian University, Krakow, 31-066, Poland
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Diaz-Milanes D, Almeda N, Gutierrez-Colosia MR, Garcia-Alonso CR, Sadeniemi M, Salvador-Carulla L. Impact of the workforce allocation on the technical performance of mental health services: the collective case of Helsinki-Uusimaa (Finland). Health Res Policy Syst 2023; 21:108. [PMID: 37872626 PMCID: PMC10594770 DOI: 10.1186/s12961-023-01061-y] [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: 06/22/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Long-term mental health (MH) policies in Finland aimed at investing in community care and promoting reforms have led to a reduction in the number of psychiatric hospital beds. However, most resources are still allocated to hospital and community residential services due to various social, economic and political factors. Despite previous research focussing on the number and cost of these services, no study has evaluated the emerging patterns of use, their technical performance and the relationship with the workforce structure. OBJECTIVE The purpose of this study was to observe the patterns of use and their technical performance (efficiency) of the main types of care of MH services in the Helsinki-Uusimaa region (Finland), and to analyse the potential relationship between technical performance and the corresponding workforce structure. METHODS The sample included acute hospital residential care, non-hospital residential care and outpatient care services. The analysis was conducted using regression analysis, Monte Carlo simulation, fuzzy inference and data envelopment analysis. RESULTS The analysis showed a statistically significant linear relationship between the number of service users and the length of stay, number of beds in non-hospital residential care and number of contacts in outpatient care services. The three service types displayed a similar pattern of technical performance, with high relative technical efficiency on average and a low probability of being efficient. The most efficient acute hospital and outpatient care services integrated multidisciplinary teams, while psychiatrists and nurses characterized non-hospital residential care. CONCLUSIONS The results indicated that the number of resources and utilization variables were linearly related to the number of users and that the relative technical efficiency of the services was similar across all types. This suggests homogenous MH management with small variations based on workforce allocation. Therefore, the distribution of workforce capacity should be considered in the development of effective policies and interventions in the southern Finnish MH system.
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Affiliation(s)
- Diego Diaz-Milanes
- Department of Quantitative Methods, Universidad Loyola Andalucía, Avenida de las Universidades, S/N, Dos Hermanas, Seville, 41704, Cordova, Spain.
- Institute of Health Research, University of Canberra, Canberra, Australia.
| | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
| | | | - Carlos R Garcia-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, Avenida de las Universidades, S/N, Dos Hermanas, Seville, 41704, Cordova, Spain
- Institute of Health Research, University of Canberra, Canberra, Australia
| | | | - Luis Salvador-Carulla
- Institute of Health Research, University of Canberra, Canberra, Australia
- Health Information Systems Group (SICA-CTS-553), University of Cadiz, Cadiz, Spain
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Bedane HK, Lien L, Holsen M, Bale M, Osvoll KI, Thoresen C, Holman PA. Geographic variation in the utilisation of specialist healthcare for patients with severe mental illness in Norway: a population-based registry study. RESEARCH IN HEALTH SERVICES & REGIONS 2023; 2:9. [PMID: 39177876 PMCID: PMC11281748 DOI: 10.1007/s43999-023-00025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 06/12/2023] [Indexed: 08/24/2024]
Abstract
PURPOSE The aim of this study is to measure geographic variations in mental healthcare service utilisation among patients with severe mental illness in Norway. METHOD We analysed data from the Norwegian patient registry for 2014-2018 for patients with severe mental illness. The outcomes measured in this study were: outpatient contact, admission, bed days and total contact rates. Total contacts were calculated as the sum of observed outpatient contacts plus four times the hospital bed days for each hospital catchment area based on the Norwegian health director's report on clinical activity and patient treatment cost. Geographic variations were measured using extreme quotient (EQ), coefficient of variation (CV) and systematic component of variation (SCV). Maps, figures, and tables were used to visualise geographic variation. RESULTS The geographic variations saw a six-fold increase in the outpatient contact rate and a three-fold increase in the admission rate between the areas with lowest rate and areas with the highest rate. However, there was low geographic variation in calculated total contact rates (Eqs. 5 - 95 =1.77). The low-level geographic variation in the total calculated contact rate was also confirmed with an SCV of less than three. CONCLUSION The levels of geographic variations in the utilisation of outpatient and inpatient mental healthcare services among patients with severe mental illness are high. However, the geographic variation in total services provided by hospital catchment areas calculating the two service modalities together using their treatment cost ratio, is low. This may reflect the relatively equal performance of hospital catchment areas in terms of resource utilisation regardless which service modality they prioritise. Factors contributing to high geographic variation in individual service modalities need further investigation.
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Affiliation(s)
- Haji Kedir Bedane
- Research and Innovation Department, Forde Health Trust, Forde, Norway.
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Health and Social Science, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Maria Holsen
- Research and Innovation Department, Forde Health Trust, Forde, Norway
| | - Marte Bale
- Research and Innovation Department, Forde Health Trust, Forde, Norway
| | - Knut Ivar Osvoll
- Research and Innovation Department, Forde Health Trust, Forde, Norway
| | | | - Per Arne Holman
- Department of Patient Safety and Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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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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Salinas-Perez JA, Ghuloum S, Gutierrez-Colosia MR, Bagheri N, Salvador-Carulla L. Analysis of the mental health service provision in Qatar: Progressing in community mental health in a Middle East country. Front Psychiatry 2022; 13:1095788. [PMID: 36590608 PMCID: PMC9800284 DOI: 10.3389/fpsyt.2022.1095788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background Qatari health planning in the last decade aimed to make the transition from the traditional hospital-based psychiatric care to a community-based care, building an integrated and comprehensive mental health system. The objective of this study was to explore the mental health service provision in Qatar in 2018 and 2022. This time span coincided with two mental health plans (2013-2018 and 2019-2022) and one health plan (2018-2022). Methods This study followed a healthcare ecosystem approach, including context analysis and the standard description and classification of mental health services. Service provision was studied applying DESDE-LTC system (Description and Evaluation of Services and DirectoriEs-Long Term Care), an internationally validated methodology to assess and describe mental health services. Service data were analyzed along with sociodemographic indicators from public statistics to know the care context. Results The availability of specialized mental health services increased for adults, although it remained the same for other age groups. The diversity of care and the weight of health-related care over social-related care also remained quite similar. It was noteworthy the development of new services for young adults, migrant workers, and female populations. Conclusion This was the first time that this service research methodology has been applied in a Middle East country to study its mental healthcare pattern. The analysis of the mental healthcare pattern in the study time period showed the continued progress toward community-based care in Qatar in the framework of three health plans and despite the unexpected COVID-19 world pandemic.
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Affiliation(s)
- Jose A. Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Dos Hermanas, Seville, Spain
- Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Suhaila Ghuloum
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | | | - Nasser Bagheri
- Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
- Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, NSW, Australia
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