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Case management programs for people with complex needs: Towards better engagement of community pharmacies and community-based organisations. PLoS One 2021; 16:e0260928. [PMID: 34879101 PMCID: PMC8654230 DOI: 10.1371/journal.pone.0260928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction The objectives of this study were 1) to describe how case management programs engaged community pharmacies and community-based organisations in a perspective of integrated care for people with complex needs, and 2) to identify enablers, barriers and potential strategies for this engagement. Methods Using a descriptive qualitative design, individual interviews and focus groups with patients, healthcare providers and managers were analysed according to a mixed thematic analysis based on a deductive (Rainbow Model of Integrated Care) and an inductive approach. Results and discussion Participants highlighted the individualized service plan as a significant tool to foster a shared person-focused vision of care, information exchanges and concerted efforts. Openness to collaboration was also considered as an enabler for community stakeholders’ engagement. The lack of recognition of community-based organisations by certain providers and the time required to participate in individualized service plans were outlined as barriers to professional integration. Limited opportunities for community stakeholders to be involved in decision-making within case management programs were reported as another constraint to their engagement. Cultural differences between organisations regarding the focus of the intervention (psychosocial vs healthcare needs) and differences in bureaucratic structures and funding mechanisms may negatively affect community stakeholders’ engagement. Formal consultation mechanisms and improvement of communication channels between healthcare providers and community stakeholders were suggested as ways to overcome these barriers. Conclusion Efforts to improve care integration in case management programs should be directed toward the recognition of community stakeholders as co-producers of care and co-builders of social policies across the entire care continuum for people with complex needs.
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Simpson VL, Hass ZJ, Panchal J, McGowan B. Understanding the Development, Evaluation, and Sustainability of Community Health Networks Using Social Network Analysis: A Scoping Review. Am J Health Promot 2021; 36:318-327. [PMID: 34865522 DOI: 10.1177/08901171211045984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Identify the scope of the literature which reports use of social network analysis to inform, support, or evaluate health promotion-focused community network/partnership development. DATA SOURCE A comprehensive search (not date-limited) of PubMed, CINAHL, Web of Science Core Collection, PsycInfo, and the Cochrane Library Database for Systematic Reviews. INCLUSION AND EXCLUSION CRITERIA Criteria for inclusion included published in the English language and used social network analysis to inform, support, or evaluate development of community networks/partnerships aiding health promotion efforts. Studies were excluded if they did not use social network analysis or were not focused upon health promotion. DATA EXTRACTION Three of the four authors extracted data using a summary chart to document information regarding study aims, target issue/population, methods, and key outcomes of the social network analysis. DATA SYNTHESIS The extracted data were qualitatively analyzed by 3 authors to categorize key social network analysis outcomes into categories. RESULTS Ninety-seven studies representing 9 geographical regions were included, with the majority (69) published after 2010. Key outcomes included the effectiveness of social network analysis to identify network characteristics, track network change over time, compare similar networks across locations, and correlate network attributes with outcomes. CONCLUSION Findings support the utility of social network analysis to inform, support, and evaluate development of sustainable health promotion-focused networks/partnerships.
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Affiliation(s)
| | - Zachary Joseph Hass
- Regenstrief Center for Healthcare Engineering Core Faculty, Schools of Nursing and Industrial Engineering, 311308Purdue University, West Lafayette, IN, USA
| | - Jitesh Panchal
- School of Mechanical Engineering, 311308Purdue University, West Lafayette, IN, USA
| | - Bethany McGowan
- Libraries and School of Information Studies, 311308Purdue University, West Lafayette, IN, USA
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Voisard B, Whitley R, Latimer E, Looper K, Laliberté V. Insights from homeless men about PRISM, an innovative shelter-based mental health service. PLoS One 2021; 16:e0250341. [PMID: 33886653 PMCID: PMC8062052 DOI: 10.1371/journal.pone.0250341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
PRISM (Projet Réaffiliation Itinérance Santé Mentale-mental health and homelessness reaffiliation project), is a new shelter-based mental health service in Montreal, Canada. It offers short-term residential services in a shelter with the aim of housing and connecting the person to the appropriate services in the community. This qualitative research project was designed to gain a rich understanding of service-user experience within this program, and to apply these impressions to a broader reflection concerning how to best serve the needs of homeless people living with severe mental illness. We conducted in-depth interviews with 20 clients from the all-male PRISM-Welcome Hall Mission at program intake and departure between May 2018 and March 2019. We used methods stemming from grounded theory to analyze themes emerging from the interviews. Analysis revealed three core aspects endorsed by PRISM clients as helpful to their recovery: first, the community-based and flexible PRISM structure allows for continuity in daily routine through the preservation and expansion of the client's existing informal resource network; second, the secure environment is conducive to improving one's physical and mental health; and third, the multimodal mental health and social service approach used at PRISM is appreciated and stands in contrast to what most have experienced during other inpatient experiences. This led us to reflect more broadly on the benefits of a shelter-based intervention, as a catalyst to the achievement of longer-term goals such as housing, as well as flexible care adapted to the specific needs of these individuals. Even though this study took place in a specific program in Quebec, it sheds light more broadly on how to best meet the needs of individuals with mental illness living in homeless situations and contributes to the growing literature on men's mental health.
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Affiliation(s)
- Brigitte Voisard
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Rob Whitley
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Eric Latimer
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Karl Looper
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Vincent Laliberté
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Gentil L, Grenier G, Bamvita JM, Fleury MJ. Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:22-33. [PMID: 31452296 DOI: 10.1111/hsc.12834] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/02/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
User satisfaction is a crucial quality indicator in health service provision. Few studies have measured user satisfaction among homeless and formerly homeless individuals, despite the high prevalence of mental health disorders (MHD) in this population. The purpose of this study was to assess overall satisfaction among 455 homeless and formerly homeless individuals who were receiving health and community services, and to identify factors associated with user satisfaction. Data collection occurred between January and September 2017. Study participants were 18 years old or over, with experience of homelessness in the current or recent past. They completed a questionnaire eliciting socio-demographic information, and data on residential history, service use and satisfaction and health profiles. Multivariate linear analysis was performed on overall satisfaction with health and community services in the previous 12 months. Independent variables were organised as predisposing, enabling and needs factors based on the Gelberg-Andersen Behavioral Model. The mean satisfaction score was 4.11 (minimum: 1; maximum: 5). Variables associated with greater user satisfaction included: older age, residence in permanent housing, common MHD (e.g., depression, anxiety), having a family physician, having a case manager, strong social network, good quality of life and, marginally, male sex and having substance use disorders (SUD). By contrast, frequent users of public ambulatory health services were the most dissatisfied. User satisfaction was more strongly associated with enabling factors. Strategies for improving satisfaction include: promoting more tailored primary care programmes (including family physician) adapted to the needs of this population, better integrating primary care with specialised services including SUD integrated treatment and enhancing continuity of care through the reinforcement of case management services. Further efforts aimed at increasing access to permanent housing with supports, and eliciting more active involvement by relatives and friends may also improve user satisfaction with services, and reduce unnecessary service use.
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Affiliation(s)
- Lia Gentil
- Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Institut Uiniversitaire sur le Dépendances, Montreal, QC, Canada
- Recherche et intervention sur les substances psychoactives Québec, Trois Rivières, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute, Montréal, QC, Canada
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Gabet M, Grenier G, Cao Z, Fleury MJ. Predictors of Emergency Department Use among Individuals with Current or Previous Experience of Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4965. [PMID: 31817747 PMCID: PMC6950268 DOI: 10.3390/ijerph16244965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/15/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022]
Abstract
This study assessed the contributions of predisposing, enabling, and needs factors in predicting emergency department (ED) use among 270 individuals with current or previous experience of homelessness. Participants were recruited from three different types of housing (shelter, temporary housing and permanent housing) in Montreal, Quebec (Canada). They were interviewed at baseline (T0), and again 12 months after recruitment (T1). Longitudinal data analyses were conducted on associations between a set of baseline predictors (T0) with the dependent variable (ED users vs. non-users) from T1. Predictors were identified according to the Gelberg-Andersen Behavioral Model. Findings revealed two needs factors associated with ED use: having a substance use disorder (SUD) and low perceived physical health. Two enabling factors, use of ambulatory specialized services and stigma, were also related to ED use. No predisposing factors were retained in the model, and ED use was not associated with type of housing. Improvements are needed in SUD and physical health management in order to reduce ED use, as well as interventions aimed at stigma prevention for this vulnerable population.
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Affiliation(s)
- Morgane Gabet
- Département de Gestion, Évaluation et Politiques de Santé, École de santé publique, Université de Montréal, 7101 av. du Parc, Montréal, QC H3X1X9, Canada;
- Research Center, Douglas MH University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada; (G.G.); (Z.C.)
| | - Guy Grenier
- Research Center, Douglas MH University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada; (G.G.); (Z.C.)
| | - Zhirong Cao
- Research Center, Douglas MH University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada; (G.G.); (Z.C.)
| | - Marie-Josée Fleury
- Research Center, Douglas MH University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada; (G.G.); (Z.C.)
- Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada
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Farinas L. Tisser des liens pour aider des sans-abri : des relations de première ligne en action. SANTE MENTALE AU QUEBEC 2018. [DOI: 10.7202/1048894ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Les intervenants de première ligne participent parfois à des relations interorganisationnelles pendant leurs tâches quotidiennes dans l’aide aux sans-abri. Ces praticiens publics et communautaires agissent pour créer, maintenir et interrompre ces liens dans des conditions particulières. Le cas du rôle de liaison de l’Équipe Itinérance permet d’illustrer comment ils procèdent pour tisser leurs relations à Montréal. En adoptant une approche interactionniste et en misant sur leurs perspectives, cet article explore et documente le travail relationnel nécessaire à leur accomplissement. Cela peut éclairer la complexité de leur capacité de coordination et d’organisation qui peut permettre de composer avec celle de l’itinérance.
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Affiliation(s)
- Luc Farinas
- Chercheur postdoctoral de l’équipe Regards du Centre de recherche et de partage des savoirs InterActions du CIUSSS du Nord-de-l’Île-de-Montréal et à l’École de travail social de l’Université de Montréal
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van Rensburg AJ, Rau A, Fourie P, Bracke P. Power and Integrated Health Care: Shifting from Governance to Governmentality. Int J Integr Care 2016; 16:17. [PMID: 28435425 PMCID: PMC5350653 DOI: 10.5334/ijic.2480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/24/2016] [Indexed: 11/20/2022] Open
Abstract
Integrated care occurs within micro, meso and macro levels of governance structures, which are shaped by complex power dynamics. Yet theoretically-led notions of power, and scrutiny of its meanings and its functioning, are neglected in the literature on integrated care. We explore an alternative approach. Following a discussion on governance, two streams of theorising power are presented: mainstream and second-stream. Mainstream concepts are based on the notion of power-as-capacity, of one agent having the capacity to influence another-so the overall idea is 'power over?'. Studies on integrated care typically employ mainstream ideas, which yield rather limited analyses. Second-stream concepts focus on strategies and relations of power-how it is channelled, negotiated and (re)produced. These notions align well with the contemporary shift away from the idea that power is centralised, towards more fluid ideas of power as dispersed and (re)negotiated throughout a range of societal structures, networks and actors. Accompanying this shift, the notion of governance is slowly being eclipsed by that of governmentality. We propose governmentality as a valuable perspective for analysing and understanding power in integrated care. Our contribution aims to address the need for more finely tuned theoretical frameworks that can be used to guide empirical work.
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Affiliation(s)
- André Janse van Rensburg
- Department of Political Science, Stellenbosch University, ZA
- Department of Sociology, Ghent University, BE
- Centre for Health Systems Research & Development, University of the Free State, ZA
| | - Asta Rau
- Centre for Health Systems Research & Development, University of the Free State, ZA
| | - Pieter Fourie
- Department of Political Science, Stellenbosch University, ZA
| | - Piet Bracke
- Department of Sociology, Ghent University, BE
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van Rensburg AJ, Fourie P. Health policy and integrated mental health care in the SADC region: strategic clarification using the Rainbow Model. Int J Ment Health Syst 2016; 10:49. [PMID: 27453722 PMCID: PMC4957874 DOI: 10.1186/s13033-016-0081-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/14/2016] [Indexed: 11/17/2022] Open
Abstract
Background Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care in selected SADC countries, specifically how integrated care is outlined in state-driven policies. Methods Health policies from five SADC countries were analysed using the Rainbow Model as framework. Electronic copies of policy documents were transferred into NVivo 10, which aided in the framework analysis on the different types of integrated mental health care promoted in the countries assessed. Results Several Rainbow Model components were emphasised. Clinical integration strategies (coordination of person-focused care) such as centrality of client needs, case management and continuity were central considerations, while others such as patient education and client satisfaction were largely lacking. Professional integration (inter-professional partnerships) was mentioned in terms of agreements on interdisciplinary collaboration and performance management, while organisational integration (inter-organisational relationships) emerged under the guise of inter-organisational governance, population needs and interest management. Among others, available resources, population management and stakeholder management fed into system integration strategies (horizontally and vertically integrated systems), while functional integration strategies (financial, management and information system functions) included human resource, information and resource management. Normative integration (a common frame of reference) included collective attitude, sense of urgency, and linking cultures, though aspects such as conflict management, quality features of the informal collaboration, and trust were largely lacking. Conclusions Most countries stressed the importance of integrating mental health on primary healthcare level, though an absence of supporting strategies could prove to bar implementation. Inter-service collaboration emerged as a significant goal, though a lack of (especially) normative integration dimensions could prove to be a key omission. Despite the usefulness of the Rainbow Model, it failed to adequately frame regional governance aspects of integration, as the SADC Secretariat could play an important role in coordinating and supporting the development and strengthening of better mental health systems. Electronic supplementary material The online version of this article (doi:10.1186/s13033-016-0081-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- André Janse van Rensburg
- Health and Demographic Research Unit, Department of Sociology, Ghent University, Korte Meer 5, 9000 Ghent, Belgium ; Department of Political Science, Stellenbosch University, Corner Merriman and Ryneveld Street, Stellenbosch, 7602 South Africa ; Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300 South Africa
| | - Pieter Fourie
- Department of Political Science, Stellenbosch University, Corner Merriman and Ryneveld Street, Stellenbosch, 7602 South Africa
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