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Searle K, Blashki G, Kakuma R, Yang H, Lu S, Li B, Xiao Y, Minas H. Adapting the depression component of WHO Mental Health Gap Intervention Guide (mhGAP-IG.v2) for primary care in Shenzhen, China: a DELPHI study. Int J Ment Health Syst 2022; 16:13. [PMID: 35168656 PMCID: PMC8845283 DOI: 10.1186/s13033-022-00523-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Primary care doctors in Shenzhen, China are increasingly expected to identify and prevent depressive disorder; however, they have received limited mental health training and community healthcare centres (CHC) do not provide standardised protocols for the diagnosis and care of depressive disorder. The World Health Organization’s mental health gap intervention guide, version 2 (mhGAP-IG.v2) is a decision support tool for non-specialists for the assessment, management and follow-up of mental, neurological and substance use disorders (including depressive disorder). Given that mhGAP-IG.v2 is a generic tool, it requires adaptation to take account of cultural differences in depression presentation and unique characteristics of China’s emergent mental health system. Methods A two-round, web-based, Delphi survey was conducted. A panel of primary care doctors from Shenzhen, were invited to score their level of agreement with 199 statements (arranged across 10 domains) proposing changes to the content and structure of mhGAP-IG.v2 for use in Shenzhen. Consensus was predefined as 80% panelists providing a rating of either “somewhat agree/definitely agree”, or “definitely disagree/somewhat disagree” on a five-point scale for agreement. Results 79% of statements received consensus with a mean score of 4.26 (i.e. “somewhat agree”). Agreed adaptations for mhGAP-IG.v2 included:- an assessment approach which considers a broader spectrum of depression symptoms and reflects the life course of disease; incorporating guidance for screening tool usage; clarifying physicians’ roles and including referral pathways for intersectorial care with strong family involvement; aligning drug treatment with national formularies; stronger emphasis of suicide prevention throughout all sections of the guide; contextualizing health education; reflecting a person-centred approach to care. Panelists chose to maintain diagnostic and treatment advice for bipolar patients experiencing a depressive episode as in the current guide. Conclusions An adapted mhGAP-IG.v2 for depression recognises China’s cultural and contextual needs for assessment guidance; unique primary healthcare system organization, priorities and treatment availability; and diverse psychosocial educational needs. An adapted mhGAP-IG.v2 could both inform the future training programs for primary care in Shenzhen and also offer an additional mental health resource for non-specialists in other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00523-0.
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Affiliation(s)
- Kendall Searle
- Global and Cultural Mental Health Unit, Centre for Mental Health, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Ritsuko Kakuma
- London School of Hygiene and Tropical Medicine, London, WC1E 7HTE, England, UK
| | - Hui Yang
- Monash Institute for Health and Clinical Education, School of Primary Health Care, Monash University, Notting Hill, VIC, 3168, Australia
| | - Shurong Lu
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Baoqi Li
- Shenzhen Guangming Hospital of the University of Chinese Academy of Sciences, Bao'an District, Shenzhen, 518107, China
| | - Yingying Xiao
- Shenzhen Guangming Hospital of the University of Chinese Academy of Sciences, Bao'an District, Shenzhen, 518107, China
| | - Harry Minas
- Global and Cultural Mental Health Unit, Centre for Mental Health, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
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van Steijn D, Pons Izquierdo JJ, Garralda Domezain E, Sánchez-Cárdenas MA, Centeno Cortés C. Population's Potential Accessibility to Specialized Palliative Care Services: A Comparative Study in Three European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910345. [PMID: 34639645 PMCID: PMC8507925 DOI: 10.3390/ijerph181910345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative care is a priority for health systems worldwide, yet equity in access remains unknown. To shed light on this issue, this study compares populations' driving time to specialized palliative care services in three countries: Ireland, Spain, and Switzerland. METHODS Network analysis of the population's driving time to services according to geolocated palliative care services using Geographical Information System (GIS). Percentage of the population living within a 30-min driving time, between 30 and 60 minutes, and over 60 min were calculated. RESULTS The percentage of the population living less than thirty minutes away from the nearest palliative care provider varies among Ireland (84%), Spain (79%), and Switzerland (95%). Percentages of the population over an hour away from services were 1.87% in Spain, 0.58% in Ireland, and 0.51% in Switzerland. CONCLUSION Inequities in access to specialized palliative care are noticeable amongst countries, with implications also at the sub-national level.
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Affiliation(s)
- Danny van Steijn
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
- Correspondence:
| | - Juan José Pons Izquierdo
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- School of Humanities and Social Sciences, University of Navarra, 31009 Pamplona, Navarra, Spain
| | - Eduardo Garralda Domezain
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
| | - Miguel Antonio Sánchez-Cárdenas
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
| | - Carlos Centeno Cortés
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
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A Consideration of Benefits for Midwives Employed in Public Health Systems and Private Midwifery Practices. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-19-00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDBenefits add to the total compensation received by midwives for their professional work in global settings. Some benefits are commonly offered as a package by employers as components of employment contracts. Some benefits may be individually negotiated or may be self-funded by midwives who own their own businesses.PURPOSEIdentify benefits associated with midwifery employment.METHODSBenefits data available to certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States were collected in online surveys conducted in 2004, 2007, 2010, and 2014. Benefits types received and benefits cost-sharing for midwives and their families were compared descriptively.RESULTSMore than 90% of respondents employed full-time in 2014 reported that they received at least 1 of 16 types of benefits in their midwifery-related employment. Professional liability insurance, paid vacation (paid holiday), and paid time off for continuing education were the only benefits reported by 75% or more of respondents in each of 4 survey years. Trends over time reported by U.S. CNMs/CMs employed full-time suggest a decrease in employer contributions to benefit costs. Nearly half of all CNM/CM respondents reported not knowing the basis for calculation of their salary and compensation package.CONCLUSIONChanges appear to indicate increasing employee cost-sharing of benefits packages in recent years for U.S. midwives. Similarities and differences identified for midwives in global settings are discussed, although information on benefits in global settings was limited. Midwives in all settings may gain from education about strategies for negotiation of salary and compensation packages.
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Searle K, Blashki G, Kakuma R, Yang H, Zhao Y, Minas H. Current needs for the improved management of depressive disorder in community healthcare centres, Shenzhen, China: a view from primary care medical leaders. Int J Ment Health Syst 2019; 13:47. [PMID: 31297142 PMCID: PMC6598358 DOI: 10.1186/s13033-019-0300-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/11/2019] [Indexed: 01/03/2023] Open
Abstract
Background The prevalence of depressive disorder in Shenzhen is higher than for any other city in China. Despite national health system reform to integrate mental health into primary care, the majority of depression cases continue to go unrecognized and untreated. Qualitative research was conducted with primary care medical leaders to describe the current clinical practice of depressive disorder in community healthcare centres (CHC) in Shenzhen and to explore the participants' perceptions of psychological, organizational and societal barriers and enablers to current practice with a view to identifying current needs for the improved care of depressive disorder in the community. Methods Seventeen semi-structured, audio-recorded interviews (approx. 1 h long) were conducted in Melbourne (n = 7) and Shenzhen (n = 10) with a convenience sample of primary care medical leaders who currently work in community healthcare centres (CHC) in Shenzhen and completed any one of the 3-month long, Melbourne-based, "Monash-Shenzhen Primary Healthcare Leaders Programs" conducted between 2015 and 2017. The interview guide was developed using the Theoretical Domain's Framework (TDF) and a directed content analysis (using Nvivo 11 software) was performed using English translations. Results Despite primary care medical leaders being aware of a mental health treatment gap and the benefits of early depression care for community wellbeing, depressive disorder was not perceived as a treatment priority in CHCs. Instead, hospital specialists were identified as holding primary responsibility for formal diagnosis and treatment initiation with primary care doctors providing early assessment and basic health education. Current needs for improved depression care included: (i) Improved professional development for primary care doctors with better access to diagnostic guidelines and tools, case-sharing and improved connection with mentors to overcome current low levels of treatment confidence. (ii) An improved consulting environment (e.g. allocated mental health resource; longer and private consultations; developed medical referral system; better access to antidepressants) which embraces mental health initiatives (e.g. development of mental health departments in local hospitals; future use of e-mental health; reimbursement for patients; doctors' incentives). (iii) Improved health literacy to overcome substantive mental health stigma in society and specific stigma directed towards the only public psychiatric hospital. Conclusions Whilst a multi-faceted approach is needed to improve depression care in community health centres in Shenzhen, this study highlights how appropriate mental health training is central to developing a robust work-force which can act as key agents in national healthcare reform. The cultural adaption of the depression component of the World Health Organisation's mental health gap intervention guide (mhGAP-IG.v2) could provide primary care doctors with a future training tool to develop their assessment skills and treatment confidence.
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Affiliation(s)
- Kendall Searle
- 1Global and Cultural Mental Health Unit, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3010 Australia
| | - Grant Blashki
- 2Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC 3010 Australia
| | - Ritsuko Kakuma
- 3London School of Hygiene and Tropical Medicine, London, WC1E 7HTE England UK
| | - Hui Yang
- 4Monash Institute for Health & Clinical Education, School of Primary Health Care, Monash University, Notting Hill, VIC 3168 Australia
| | - Yuanlin Zhao
- 5Faculty of Education, Queen's University, Kingston, ON Canada
| | - Harry Minas
- 1Global and Cultural Mental Health Unit, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3010 Australia
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Legal reflections on the evolving role of general practitioners in China's primary care: an assessment of regulatory strategies. Prim Health Care Res Dev 2018; 20:e9. [PMID: 30113010 PMCID: PMC6476398 DOI: 10.1017/s1463423618000555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim To assess the regulation of the Chinese healthcare system in assisting a nationwide implementation of general practitioner (GP) services. Background Along with the perennial problems of unaffordable and inequitable healthcare, a rapidly ageing population and the increasing burden of non-communicable diseases pose challenges to the Chinese healthcare system. Recognising these challenges and to satisfy people’s demands for more and better healthcare, China has initiated a plan, named ‘Healthy China 2030’, based on the findings from a two-year joint study by the World Health Organization (WHO) and the World Bank Group (WBG) in collaboration with Chinese agencies. The Chinese healthcare plan, officially approved in 2016, is an attempt to use the people-centred, integrated care (PCIC) model recommended by the WHO and WBG to shape the Chinese healthcare system. In accordance with PCIC, China began the implementation of gatekeeping primary care by introducing GP services to local communities. Methods A comparative analysis was employed to point out the importance of introducing GP services. A systematic assessment was carried out to evaluate the regulatory sector of the Chinese healthcare system, including a critical review of related legal norms and a theoretical exploration of external impediments (eg, cultural attitudes, government capacity and interest groups). Findings Results demonstrate that the current regulatory sector of the Chinese healthcare system needs to be improved in order to assist the nationwide implementation of GP services and to strengthen its gatekeeping role. Major deficiencies include the problematic relationship between legal norms and health policies, the lack of effective and consistent new legislation, the low rate of social acceptance, and lack of support from agencies. To address those challenges, this paper recommends that preliminary efforts be devoted, in part, to two changes in the legal structure: enacting a specific law, and creating an independent regulatory oversight body.
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