1
|
Bauer A, Cartagena-Farias J, Christiansen H, Goodyear M, Schamschula M, Zechmeister-Koss I, Paul J. Acceptability, engagement and exploratory outcomes and costs of a co-designed intervention to support children of parents with a mental illness: Mixed-methods evaluation and descriptive analysis. Int J Ment Health Nurs 2024. [PMID: 38500242 DOI: 10.1111/inm.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
Children whose parents have a mental illness are much more likely to experience mental health problems and other adverse long-term impacts. Child-centred psychosocial interventions can be effective, but not much is known about how to design and implement them in different settings. A pre-post, mixed methods, single-arm evaluation of a co-designed social support intervention with parents and children (4-18 years) measured parents' mental health (PHQ-9), perceived social support (ENRICHD), parental self-efficacy (PSAM) and children's mental health (SDQ), quality of life (Kidscreen-27), and child service use (CAMHSRI-EU) at baseline and 6 months. Qualitative data were gathered at 6 months to explore parents' and children's experience with the intervention. Twenty-nine parents and 21 children completed baseline and follow-up questionnaires; 22 parents and 17 children participated in interviews. Parents' depression (MD -1.36, SD 8.08), perceived social support (MD 1, SD 5.91), and children's mental health potentially improved, and children's service use and costs potentially reduced (€224.6 vs. €122.2, MD 112.4). Parental self-efficacy was potentially reduced (MD -0.11, SD 3.33). The sample was too small to perform statistical analysis. Favourable themes emerged describing the high satisfaction with the intervention, parents' improved understanding of the impact of their mental health problems on children, and improvements in parent-child relationships. This study contributes to an emerging evidence base for co-designed child-centred interventions to prevent the transgenerational transmission of poor mental health.
Collapse
Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps University Marburg, Marburg, Germany
| | - Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, Victoria, Australia
| | - Mona Schamschula
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Wien, Austria
| | | | - Jean Paul
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
2
|
Zechmeister-Koss I, Strohmaier C, Hölzle L, Bauer A, Goodyear M, Christiansen H, Paul JL. Economic Evaluation of Family-Focused Programs When Parents Have a Mental Health Problem: Methodological Considerations. Value Health 2023; 26:704-711. [PMID: 36503037 DOI: 10.1016/j.jval.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/18/2022] [Accepted: 11/27/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES The nature of adverse effects of parental mental health problems and of the interventions to address them may require specific designs of economic evaluation studies. Nevertheless, methodological guidance is lacking. We aim to understand the broad spectrum of adverse effects from parental mental health problems in children and the economic consequences on an individual and societal level to navigate the design of economic evaluations in this field. METHODS We conducted a systematic literature search of empirical studies on children's adverse effects from parental mental illness. We clustered types of impact, identified individual and public cost consequences, and illustrated the results in an impact inventory. RESULTS We found a wide variety of short- and long-term (mental) health impacts, impacts on social functioning and socioeconomic implications for the children individually, and adverse effects on the societal level. Consequently, public costs can occur in various public sectors (eg, healthcare, education), and individuals may have to pay costs privately. CONCLUSIONS Existing evaluations in this field mostly follow standard methodological approaches (eg, cost-utility analysis using quality-adjusted life-years) and apply a short-time horizon. Our findings suggest applying a long-term time horizon (at least up to early adulthood), considering cost-consequence analysis and alternatives to health-related quality of life and quality-adjusted life-years as outcome measures, and capturing the full range of possible public and private costs.
Collapse
Affiliation(s)
| | | | - Laura Hölzle
- Village Research Group, Medical University Innsbruck, Innsbruck, Austria
| | - Annette Bauer
- London School of Economics, Care Policy and Evaluation Centre (CPEC), London, England, UK
| | - Melinda Goodyear
- Monash University Australia, School of Rural Health, Melbourne, VIC, Australia
| | | | - Jean L Paul
- Village Research Group, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
3
|
Zechmeister-Koss I, Aufhammer S, Bachler H, Bauer A, Bechter P, Buchheim A, Christiansen H, Fischer M, Franz M, Fuchs M, Goodyear M, Gruber N, Hofer A, Hölzle L, Juen E, Papanthimou F, Prokop M, Paul JL. Practices to support co-design processes: A case-study of co-designing a program for children with parents with a mental health problem in the Austrian region of Tyrol. Int J Ment Health Nurs 2023; 32:223-235. [PMID: 36226745 DOI: 10.1111/inm.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 01/14/2023]
Abstract
Forms of collaborative knowledge production, such as community-academic partnerships (CAP), have been increasingly used in health care. However, instructions on how to deliver such processes are lacking. We aim to identify practice ingredients for one element within a CAP, a 6-month co-design process, during which 26 community- and 13 research-partners collaboratively designed an intervention programme for children whose parent have a mental illness. Using 22 published facilitating and hindering factors for CAP as the analytical framework, eight community-partners reflected on the activities which took place during the co-design process. From a qualitative content analysis of the data, we distilled essential practices for each CAP factor. Ten community- and eight research-partners revised the results and co-authored this article. We identified 36 practices across the 22 CAP facilitating or hindering factors. Most practices address more than one factor. Many practices relate to workshop design, facilitation methods, and relationship building. Most practices were identified for facilitating 'trust among partners', 'shared visions, goals and/or missions', 'effective/frequent communication', and 'well-structured meetings'. Fewer practices were observed for 'effective conflict resolution', 'positive community impact' and for avoiding 'excessive funding pressure/control struggles' and 'high burden of activities'. Co-designing a programme for mental healthcare is a challenging process that requires skills in process management and communication. We provide practice steps for delivering co-design activities. However, practitioners may have to adapt them to different cultural contexts. Further research is needed to analyse whether co-writing with community-partners results in a better research output and benefits for participants.
Collapse
Affiliation(s)
| | | | | | - Annette Bauer
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Hanna Christiansen
- Institut für Klinische Kinder- und Jugendpsychologie, Philipps-University, Marburg, Germany
| | - Maria Fischer
- Hilfe für Angehörige Psychisch Erkrankter Menschen in Tirol, Innsbruck, Austria
| | - Marianne Franz
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Fuchs
- Medical University Innsbruck, Innsbruck, Austria.,Abteilung für Kinder- und Jugendpsychiatrie, Tirol Kliniken GmbH, Hall in Tirol, Austria
| | - Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, Victoria, Australia.,Emerging Minds, Hilton, South Australia, Australia
| | - Nadja Gruber
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Laura Hölzle
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Evi Juen
- Kinder- und Jugendhilfe, Landeck, Austria
| | | | - Mathias Prokop
- Univ. Klinik für Psychiatrie, Landeskrankenhaus-Universitätskliniken Innsbruck Tirol Kliniken GmbH, Innsbruck, Austria
| | - Jean Lillian Paul
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
4
|
Reinsperger I, Gassner L, Zechmeister-Koss I. Overview of national strategies for the prevention and management of non-communicable diseases. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Several countries have developed national strategies or policies for preventing and managing non-communicable diseases (NCDs) which are the leading cause of death worldwide. We aim to provide an overview of these strategies from selected countries and their implementation, focusing on chronic respiratory and cardiovascular diseases, diabetes and depression.
Methods
Using a comprehensive structured hand search, strategies from 8 countries (Germany, Switzerland, Netherlands, Finland, Ireland, United Kingdom, Canada, Australia) were identified and information on the main characteristics and implementation process of the strategies was extracted.
Results
A total of 18 strategies were included. Most of the strategies formulate rather broad overarching aims or visions (e.g., “stay healthy” or “living healthier lives”) as well as more specific targets that differ across strategies, e.g. focusing on improving quality of life and health literacy, reducing health inequalities or strengthening integrated care. The level of detail of information on implementation, monitoring and evaluation processes as well as financing is very heterogeneous. All strategies provide information on activities to achieve their aims, e.g. in the areas of health promotion/primary prevention, self-management, screening, integrated care, measures for specific risk groups or activities outside the health sector. Only a few strategies mention specific, already implemented (and evaluated) interventions, such as prevention or disease management programmes.
Conclusions
The included NCD strategies differ considerably in terms of level of detail, structure and implementation. We focused on interventions within the health sector and on adults as a target group. However, for the prevention and management of NCDs, it is important to start in early childhood and to adequately address the social determinants of health with a ‘Health in All Policies’ approach.
Key messages
Collapse
Affiliation(s)
| | - L Gassner
- Austrian Institute for HTA , Vienna, Austria
| | | |
Collapse
|
5
|
Reinsperger I, Zechmeister-Koss I. Regulation and financing of prenatal screening and diagnostic tests for fetal anomalies in Europe. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pregnant women frequently use prenatal screening and diagnostic tests to detect fetal structural and chromosomal anomalies; however, the regulation and financing of these examinations differ substantially across countries. In this paper we focus on the provision, financing and setting of the following tests in selected European countries: First Trimester Screening (FTS)/Combined Test (CT), Non-invasive Prenatal Test (NIPT), second-trimester ultrasound screening for fetal anomalies, amniocentesis/chorionic villus sampling.
Methods
We chose 6 European countries that differ in various criteria (e.g., health/insurance system, geographical location) to illustrate the range of possible regulations and forms of funding: Germany, Switzerland, Netherlands, United Kingdom, Norway, Italy. We conducted a comprehensive hand search and consulted experts from the 6 countries using a questionnaire.
Results
The results are based on 11 completed expert questionnaires and 22 published sources. The heterogeneity of the provision, regulation and financing of the tests concerns in particular the choice of the first-line screening test for fetal trisomies (FTS/CT, NIPT or the identification of risk factors), the implementation of the NIPT, the reimbursement of the tests, the uptake of the examinations, but also the professional groups responsible for antenatal care (midwives, gynaecologists). There are some similarities between countries, e.g., concerning the provision and financing of invasive tests and of the ultrasound screening for fetal anomalies in the second trimester.
Conclusions
The results highlight the significant heterogeneity between European countries regarding prenatal screening and diagnostic testing for fetal anomalies. Due to the many ethical aspects of the topic, a broad societal discourse with the relevant interest groups and stakeholders seems to be necessary. Decision-makers should pay particular attention to high-quality and non-directive counselling.
Key messages
Collapse
|
6
|
Zechmeister-Koss I, Goodyear M, Grössmann N, Wolf S. Integrating home treatment into the Austrian child and adolescent mental health care system: an implementation science perspective. Neuropsychiatr 2022; 36:28-39. [PMID: 34699039 DOI: 10.1007/s40211-021-00404-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In Austria, similar to other countries, health care planners have considered implementing home treatment (HT) programs for children and adolescents with mental health problems. However, introducing any new service innovation into the complex environment of the child and adolescent mental health care system requires context and implementation issues to be taken into account in advance. METHODS We identified implementation themes from international HT models and developed a questionnaire with open-ended implementation-related questions for Austrian professionals. We analysed the qualitative results alongside the domains in the Context and Implementation of Complex Interventions (CICI) framework to detect key implementation challenges for HT in Austria. RESULTS We found six implementation themes in international HT models, which formed the basis for development of the questionnaire. Within the qualitative data from ten Austrian professionals who responded to the questionnaire, we identified implementation challenges in all eight context and all four implementation domains of the CICI framework. CONCLUSIONS Key implementation challenges detected highlight the need to address the fit of HT within existing sociocultural norms and limited available human resources. Regional context-specific solutions need to be found on how to embed this new element best into the existing provider and financing structures. This calls for monitoring and evaluation alongside implementation to support decision-making.
Collapse
Affiliation(s)
- Ingrid Zechmeister-Koss
- Austrian Institute for Health Technology Assessment GmbH (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria.
| | | | - Nicole Grössmann
- Austrian Institute for Health Technology Assessment GmbH (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
| | - Sarah Wolf
- Austrian Institute for Health Technology Assessment GmbH (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
| |
Collapse
|
7
|
Gassner L, Zechmeister-Koss I, Reinsperger I. National Strategies for Preventing and Managing Non-communicable Diseases in Selected Countries. Front Public Health 2022; 10:838051. [PMID: 35223747 PMCID: PMC8867176 DOI: 10.3389/fpubh.2022.838051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Non-communicable diseases (NCDs) are the leading cause of death worldwide and are responsible for a high burden of disease. Many countries have developed national strategies for the management and prevention of NCDs to improve the care of chronically ill people or prevent NCDs. This article aims to provide an overview of national NCD strategies from selected countries and their implementation. The focus was on cardiovascular and chronic respiratory diseases, diabetes type II, and depression. A comprehensive, structured hand search was conducted in various databases and websites for national strategies on the 4 NCDs. According to pre-defined criteria, 18 strategies from 8 countries (Germany, Switzerland, Netherlands, Finland, Ireland, United Kingdom, Canada, Australia) were selected. The included NCD strategies differ considerably in terms of level of detail, structure and implementation. All strategies include information on planned activities, but only a few provide detailed information on these interventions, including their evaluation. A structured approach from the macro to the micro level seems crucial for a comprehensive, coordinated overall policy. Strategies should be evaluated regularly using appropriate methods to measure target achievement. For the prevention and management of NCDs, it is important to start in early childhood and to adequately consider the social determinants of health with a “Health in All Policies” approach.
Collapse
Affiliation(s)
- Lucia Gassner
- Austrian Institute for Health Technology Assessment GmbH, Vienna, Austria
- Department of Sport Science, University of Vienna, Vienna, Austria
- *Correspondence: Lucia Gassner
| | | | - Inanna Reinsperger
- Austrian Institute for Health Technology Assessment GmbH, Vienna, Austria
| |
Collapse
|
8
|
Goodyear M, Zechmeister-Koss I, Bauer A, Christiansen H, Glatz-Grugger M, Paul JL. Development of an Evidence-Informed and Codesigned Model of Support for Children of Parents With a Mental Illness- "It Takes a Village" Approach. Front Psychiatry 2022; 12:806884. [PMID: 35173638 PMCID: PMC8841827 DOI: 10.3389/fpsyt.2021.806884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Providing support to parents and their children to help address the cycle of intergenerational impacts of mental illness and reduce the negative consequences for children is a key focus of selective prevention approaches in public mental health. However, a key issue for children of parents with a mental illness is the lack of access to early intervention and prevention support when needed. They are not easily identifiable (until presenting with significant mental health issues of their own) and not easily accessing the necessary support that address the complex interplay of parental mental illness within families. There are significant barriers to the early identification of these children, particularly for mental health care. Furthermore, there is a lack of collaborative care that might enhance identification as well as offer services and support for these families. The "It takes a Village" project seeks to improve mental health outcomes for children through the co-development, implementation and evaluation of an approach to collaborative practice concerned with the identification of families where a parent has a mental illness, and establishing a service model to promote child-focused support networks in Austria. Here we describe the development of service delivery approach for the "It takes a Village" project that aims to improve identification and support of these children within enhancements of the existing service systems and informal supports. The paper describes the use of codesign and other implementation strategies, applied to a research setting, with the aim of impacting the sustainability of workforce reform to achieve lasting social impact. Results highlight the steps involved in translating evidence-based components, local practice wisdom and lived experience into the "It takes a Village" practice model for Tyrol, Austria. We highlight through this paper how regional context-specific solutions are essential in the redesign of care models that meet the complex needs of children of parents with a mental illness. Service system and policy formation with local and experienced stakeholders are also vital to ensure the solutions are implementation-ready, particularly when introducing new practice models that rely on organizational change and new ways of practice with vulnerable families. This also creates a solid foundation for the evaluation of the "It take a Village" approach for children of parents with a mental illness in Austria.
Collapse
Affiliation(s)
- Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, VIC, Australia
- Emerging Minds, National Workforce Centre for Child Mental Health, Hilton, SA, Australia
| | | | - Annette Bauer
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Hanna Christiansen
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Martina Glatz-Grugger
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria
| | - Jean Lillian Paul
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
9
|
Wolf S, Grössmann N, Zechmeister-Koss I. Effectiveness and safety analysis of home-treatment models in child and adolescent psychiatric care. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Austrian child and adolescent psychiatric care landscape is characterised by substantial deficits on the intramural and extramural level. To overcome these supply shortfalls alternative outreach approaches, such as home-treatment (HT) can be introduced, which shall facilitate the reduction of hospitalisations. Thus, we aimed to systematically characterise international HT models considering their efficacy and safety in the area of child and adolescent psychiatry.
Methods
A systematic literature search in six databases, as well as an extended hand search, was conducted. Taking into account the predefined inclusion criteria, six HT studies were eligible for the qualitative synthesis; comprising two randomised controlled trials (RCTs), two non-randomised controlled trials (NRCTs) and two observational studies.
Results
The following four effectiveness measures were investigated: change in symptoms, hospitalisation, treatment satisfaction and need for further treatment. A benefit of HT models compared to stationary care could be identified considering patient symptoms, espeicially psychopathological symptoms; however, solely in the longer-term treatment. Studies have also shown that HT is associated with fewer days of hospitalisation, but with a higher need for further treatments. Inconclusive evidence was identified considering treatment satisfaction. Safety endpoints were not evaluated by any included study.
Conclusions
The results are limited by a moderate to high risk of bias due to several factors (e.g. small sample sizes, various assessment instruments). However, the evidence indicates that in long-term, HT can lead to an improvement in psychopathological symptoms and supports the transition from inpatient to outpatient care. Therefore, HT may be considered as an alternative or supplement to the stationary child and adolescent psychiatric care. However, further evidence is needed considering safety outcomes.
Key messages
In the long-term, home-treatment can lead to a bigger improvement in psychopathological symptoms for the children and adolescent compared to stationary care. Further evidence is needed especially regarding possible adverse events of home-treatment in the field of child and adolescent psychiatry.
Collapse
|
10
|
Zechmeister-Koss I, Grössmann N, Wolf S. [Effectiveness and Safety of Home Treatment in Child and Adolescent Mental Health Care: A Systematic Literature Review]. Psychiatr Prax 2021; 49:11-21. [PMID: 34416782 DOI: 10.1055/a-1517-6171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In child and adolescent psychiatry, home treatment is becoming increasingly important due to limited inpatient care capacities and changing treatment philosophies. This paper examines its effectiveness and safety. METHODS We did a systematic literature search and summarized the home treatment model characteristics as well as the evidence on its benefits and harms narratively. RESULTS In the six identified studies, improvements in symptoms were found in both, home and institutionalized treatment. In the long-term, home treatment seems to be slightly superior and involves fewer hospital days. However, a best-practice model cannot be derived from the data available. CONCLUSION Home treatment can be considered as an alternative to inpatient treatment, but requires coordination with other mental health care elements and further evaluation.
Collapse
Affiliation(s)
| | - Nicole Grössmann
- Austrian Institute for Health Technology Assessment GmbH (AIHTA)
| | - Sarah Wolf
- Austrian Institute for Health Technology Assessment GmbH (AIHTA)
| |
Collapse
|
11
|
Bauer A, Best S, Malley J, Christiansen H, Goodyear M, Zechmeister-Koss I, Paul J. Towards a Program Theory for Family-Focused Practice in Adult Mental Health Care Settings: An International Interview Study With Program Leaders. Front Psychiatry 2021; 12:741225. [PMID: 34744833 PMCID: PMC8568767 DOI: 10.3389/fpsyt.2021.741225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives: In several high-income countries, family-focused practice programs have been introduced in adult mental health care settings to identify and support children whose parents live with mental health problems. Whilst their common goal is to reduce the impact of parental mental illness on children, the mechanisms by which they improve outcomes in different systems and settings are less well known. This kind of knowledge can importantly contribute to ensuring that practice programs achieve pre-defined impacts. Methods: The aim of this study was to develop knowledge about relationships between contextual factors, mechanisms and impact that could inform a program theory for developing, implementing, and evaluating family-focused practice. Principles of a realist evaluation approach and complex system thinking were used to conceptualize the design of semi-structured in-depth interviews with individuals who led the implementation of programs. Seventeen individuals from eight countries participated in the study. Results: Interviewees provided rich accounts of the components that programs should include, contextual factors in which they operated, as well as the behavior changes in practitioners that programs needed to achieve. Together with information from the literature, we developed an initial program theory, which illustrates the interconnectedness between changes that need to co-occur in practitioners, parents, and children, many of which related to a more open communication about parental mental health problems. Stigma, risk-focused and fragmented health systems, and a lack of management commitment were the root causes explaining, for example, why conversations about parents' mental illness did not take place, or not in a way that they could help children. Enabling practitioners to focus on parents' strengths was assumed to trigger changes in knowledge, emotions and behaviors in parents that would subsequently benefit children, by reducing feelings of guilt and improving self-esteem. Conclusion: To our knowledge, this is the first research, which synthesizes knowledge about how family-focused practice programs works in a way that it can inform the design, implementation, and evaluation of programs. Stakeholder, who fund, design, implement or evaluate programs should start co-developing and using program theories like the one presented in this paper to strengthen the design and delivery of family-focused practice.
Collapse
Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NWS, Australia
| | - Juliette Malley
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Hanna Christiansen
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps University, Marburg, Germany
| | - Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, VIC, Australia
| | | | - Jean Paul
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
12
|
Mayer S, Fischer C, Zechmeister-Koss I, Ostermann H, Simon J. Are Unit Costs the Same? A Case Study Comparing Different Valuation Methods for Unit Cost Calculation of General Practitioner Consultations. Value Health 2020; 23:1142-1148. [PMID: 32940231 DOI: 10.1016/j.jval.2020.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To inform allocation decisions in any healthcare system, robust cost data are indispensable. Nevertheless, recommendations on the most appropriate valuation approaches vary or are nonexistent, and no internationally accepted gold standard exists. This costing analysis exercise aims to assess the impact and implications of different calculation methods and sources based on the unit cost of general practitioner (GP) consultations in Austria. METHODS Six costing methods for unit cost calculation were explored, following 3 Austrian methodological approaches (AT-1, AT-2, AT-3) and 3 approaches applied in 3 other European countries (Germany, The Netherlands, United Kingdom). Drawing on Austrian data, mean unit costs per GP consultation were calculated in euros for 2015. RESULTS Mean unit costs ranged from €15.6 to €42.6 based on the German top-down costing approach (DE) and the Austrian Physicians' Chamber's price recommendations (AT-3), respectively. The mean unit cost was estimated at €18.9 based on Austrian economic evaluations (AT-1) and €17.9 based on health insurance payment tariffs (AT-2). The Dutch top-down (NL) and the UK bottom-up approaches (UK) yielded higher estimates (NL: €25.3, UK: €29.8). Overall variation reached 173%. CONCLUSIONS Our study is the first to systematically investigate the impact of differing calculation methods on unit cost estimates. It shows large variations with potential impact on the conclusions in an economic evaluation. Although different methodological choices may be justified by the adopted study perspective, different costing approaches introduce variation in cross-study/cross-country cost estimates, leading to decreased confidence in data quality in economic evaluations.
Collapse
Affiliation(s)
- Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | | | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
13
|
Zechmeister-Koss I, Tüchler H, Goodyear M, Lund IO, Paul JL. Reaching families where a parent has a mental disorder: Using big data to plan early interventions. Neuropsychiatr 2020; 34:39-47. [PMID: 31741296 DOI: 10.1007/s40211-019-00323-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Children who grow up with a parent who has a mental health problem (25%) are at increased risk of developing (health) problems themselves. One approach to reach those children for early intervention supports is through their parents seeking treatment within the adult mental healthcare system. We aimed to gain information on the users of adult mental health services in Tyrol, Austria in order to understand more about the identification of these families to provide support. METHODS We descriptively analysed administrative claims data from the Tyrolean health insurance. Uptake of mental health services (hospital inpatient and day-care services, rehabilitation, outpatient psychiatrist and psychotherapy services), prescription medication and sick leave in persons aged 19-64 in 2017 were analysed. RESULTS The vast majority (82%) of an overall number of 49,494 patients were prescribed medication for their mental health issues. Half of them only received medication as their form of treatment. A quarter had contacted an outpatient psychiatrist and 13% received psychotherapy. Five percent were treated in psychiatric inpatient or day-care. The median length of hospital stay was 15 days. More women than men used mental health benefits. CONCLUSIONS Most parents may be reached via the general practitioner (via drug prescriptions) and low numbers were found accessing services in a psychiatric hospital. The latter may, however, have higher needs for support given their greater acuity of illness. How to get into contact with their children requires thoughtful and sensitive preparation, given the stigmatisation of accessing support for mental health issues. Administrative data are a useful source for planning such early intervention strategies.
Collapse
Affiliation(s)
- Ingrid Zechmeister-Koss
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria.
| | - Heinz Tüchler
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria
| | - Melinda Goodyear
- School of Rural Health, Monash University Melbourne, Wellington, 3800, Clayton, Victoria, Australia
| | - Ingunn Olea Lund
- The Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213, Oslo, Norway
| | - Jean Lillian Paul
- Tirol Kliniken GmbH, Mental Health Research Group Programme, The Village, Ludwig Boltzmann Gesellschaft, MedUni Innsbruck, Schöpfstraße 23a, 6020, Innsbruck, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| |
Collapse
|
14
|
Zechmeister-Koss I, Goodyear M, Tüchler H, Paul JL. Supporting children who have a parent with a mental illness in Tyrol: a situational analysis for informing co-development and implementation of practice changes. BMC Health Serv Res 2020; 20:326. [PMID: 32306960 PMCID: PMC7168853 DOI: 10.1186/s12913-020-05184-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A research project, which aims to improve the situation of children of parents with a mental illness (COPMI) is currently underway in the Austrian region of Tyrol. The project aims to strengthen formal and informal support structures around the child, through enhancing their village of collaborative support. Understanding the current situation in the region is vital for implementing practice change. This paper aims to gain knowledge regarding the Tyrolean societal and service provision context. METHODS We collected qualitative (17 interviews among stakeholder and people with lived experience) and quantitative data (e.g. health insurance data) regarding overall societal characteristics, epidemiology of mental illness, currently existing services, uptake of services, and current practices and challenges of identifying and supporting COPMIs. We analysed data along eight external context dimensions: 1) professional influences, 2) political support, 3) social climate, 4) local infrastructure, 5) policy and legal climate, 6) relational climate, 7) target population, and 8) funding and economic climate. RESULTS We identified that there is awareness of potential challenges related to COPMIs at both a professional and planning level. Additionally, there is a lack of installed support processes and standards to meet these children's needs across Tyrol. A variety of services are available both for unwell parents, as well as for families and individual family members. Yet, only one small service addresses COPMIs directly. Services fall into different sectors (education, health, social affairs) and are funded from different sources, making coordination difficult. Access varies from universal to rather restricted (i.e. through referral). The potential number of parents which could be reached in order to identify their children via adult mental health, differs considerably by setting. Societal structures indicate that the informal and voluntary sector may be a realistic source for supporting COPMIs. CONCLUSIONS The societal structures and the current services provide a rich resource for improving identification and support of COPMIs, however considerable coordination and behaviour change efforts will be required due to the fragmentation of the system and professional cultures. The insights into the context of supporting COPMIs have been of high value for developing and implementing practice changes in the local organizations.
Collapse
Affiliation(s)
- Ingrid Zechmeister-Koss
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria
| | - Melinda Goodyear
- School of Rural Health, Monash University Melbourne, Wellington Rd, Clayton, Victoria, 3800, Australia
| | - Heinz Tüchler
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria
| | - Jean Lillian Paul
- Mental Health Research Group Programme, The Village, Ludwig Boltzmann Gesellschaft, c/o MedUni Innsbruck, Tirol Kliniken GmbH, Schöpfstraße 23a, 6020, Innsbruck, Austria.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| |
Collapse
|
15
|
Abstract
BACKGROUND Given limited resources compared to the demand for them, spending resources efficiently is important. Key methods applied for supporting efficient resource allocation are health economic evaluations. METHODS Based on secondary literature, we analyze international challenges for using two types of economic evaluations-cost-effectiveness analysis and cost-utility analysis-in reimbursement decisions and reflect on them for the Austrian case. RESULTS The main challenges with the application of economic evaluations are related to the methods, the decision-making culture, and the respective system. The challenges also apply to the Austrian Bismarck system, where almost no formal requirements for using economic evaluations exist, except on a case-by-case basis. Resource allocation in Austria hence occurs, for the most part, implicitly. CONCLUSION One way forward towards more explicit efficiency considerations may be to consider more descriptive study types and foster capacity building, standardization of methods and presentation of results, and a mandatory detailed guideline.
Collapse
Affiliation(s)
- Ingrid Zechmeister-Koss
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria.
| | - Michal Stanak
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria
- Department of Philosophy, University of Vienna, Vienna, Austria
| | - Sarah Wolf
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria
| |
Collapse
|
16
|
Affiliation(s)
- Claudia Wild
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria.
| | | |
Collapse
|
17
|
Christiansen H, Bauer A, Fatima B, Goodyear M, Lund IO, Zechmeister-Koss I, Paul JL. Improving Identification and Child-Focused Collaborative Care for Children of Parents With a Mental Illness in Tyrol, Austria. Front Psychiatry 2019; 10:233. [PMID: 31057440 PMCID: PMC6478760 DOI: 10.3389/fpsyt.2019.00233] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/28/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Children of parents with a mental illness (COPMI) are more likely to experience negative long-term adversities. However, interventions to support their needs early can significantly enhance adjustment and reduce negative outcomes. Approximately one in four children currently lives with a parent with mental illness worldwide. The lifelong impact for individuals, governments, and broader society is likely to be substantial. There are significant workforce barriers to the early identification of COPMI and addressing their needs, particularly within the adult mental health care system. The current study aims to reduce such barriers and to improve identification of COPMI in the current health care systems. Objectives: The project "The Village" is a multidisciplinary health and social care policy intervention and seeks to improve child development and well-being outcomes for children of parents with a diagnosed mental illness. This will be achieved through the co-development, implementation, and evaluation of a practice approach to the early identification and collaborative care for COPMI, through establishing child-focused support networks. This will be done with open innovation science (OIS) approaches engaging the public in Tyrol, a geographical region of Austria, throughout 4 years. As part of the co-development process, we will work with stakeholders to co-develop the practice approaches based on evidence-based approaches and determine the most appropriate study design to evaluate those, as well as the implementation processes we will undertake. Methods: The project is underpinned by theories from different disciplines (i.e., public health, psychology, sociology, linguistics, economic sciences) as well as drawing on different approaches (i.e., co-development, implementation science, symbolic interactionism, and realist evaluation). It is based on the seven content work packages (WPs): 1) management, 2) focusing on children and methods to understand their "voice," 3) scoping, 4) co-development, 5) implementation, 6) evaluating the practice approaches, and 7) knowledge dissemination. "Scoping" will involve exploring the existing evidence, practice, and current state of identification and collaborative care in Tyrol, Austria. "Co-development" involves the co-design of practice approaches to identify and support children in partnership with key stakeholders and service providers working in Tyrol. The "implementation" of practice approaches will be based on the results of the co-development phase and will involve working with organizations to develop support strategies that draw on known organizational drivers from the field of implementation science to support the rollout of the practice approaches. In "Evaluation" we will follow principles of a realist approach; this includes developing program theories and logic models for the practice approaches. Those will set out the outcomes hypothesized to achieve and the processes that are expected to lead to those changes. This will refer to changes in children, parents, and practitioners. We expect that the main focus will be on measuring child quality of life and mental health outcomes, and outcomes that are on the path to those (such as social support needs, resilience, mental health literacy, stigma, and help-seeking behavior) as well as costs. The "child voice" WP focuses on children's perceptions and needs as the importance of "assent" and support of children to develop their own "voice" in health care is increasingly recognized within child health research. The "dissemination" step focuses on reaching a broad public audience of different stakeholders, researchers, and families involved. Discussion: The research project aims to directly improve identification and support of vulnerable children across selected regions in Tyrol, Austria, and by doing so, improve the health and well-being of future generations, through breaking the cycle of intergenerational transfer of adverse childhood experiences.
Collapse
Affiliation(s)
- Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Annette Bauer
- Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science, London, United Kingdom
| | - Batool Fatima
- Human Development Programme, Aga Khan University, Karachi, Pakistan
| | - Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, VIC, Australia
| | | | | | - Jean Lillian Paul
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
18
|
Zechmeister-Koss I, Winkler R, Fritz C, Thun-Hohenstein L, Tuechler H. Services Use of Children and Adolescents before Admission to Psychiatric Inpatient Care. J Ment Health Policy Econ 2016; 19:103-113. [PMID: 27453457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Although 20% of children and adolescents in Europe suffer from overt mental health problems, their illness-related service utilisation is often unknown. If at all, existing research has only addressed the health care sector while services requirements in mental health care go far beyond the health care system, including the social, the educational and the criminal justice system. AIMS OF STUDY This paper aims at describing the service contact patterns of children and adolescents within and outside the health care sector before they are admitted to a child and adolescent mental health hospital. Additionally, we evaluate the private out-of-pocket payments that occur for primary carers. METHOD A cohort of consecutive admissions to a child and adolescent hospital in Austria was prospectively analysed. We collected data on service use and out-of-pocket expenses before hospital admission from primary carers through face-to-face interviews using an adapted version of the European Child and Adolescent Mental Health Service Receipt Inventory (EU-CAMHSRI). Clinical data came from validated questionnaires (CBCL, YSR) and from the anamnestic documentation. RESULT Ninety percent from a cohort of 441 patients had some contact with services or took medication before they were admitted to hospital. Most often, services in the health care outpatient setting were used. Outside of the health care system, support in school, as well as counselling services, were used most frequently, whereas the persons hardly sought support in living or employment. Roughly 32,400 per 100 patients was spent privately, yet these out-of pocket expenses were very unevenly distributed. Service use and out-of-pocket spending increased with social status and were gender-specific. The more severe external behaviour symptoms were, the more non-health care services were used. DISCUSSION Mentally ill children and adolescents use a broad range of services across sectors before admission to hospital. Service use is associated with specific symptoms of the disease, yet not with the diagnosis. For some carers, this is linked to considerable financial burden because many of those services are only partly publicly funded or are not part of the health sector. A limitation of the study is the uncertainty of self-reports. Furthermore, we do not know whether the services used were needs-based and effective, and what the utilisation patterns of non-hospitalised children and adolescents are. IMPLICATIONS FOR HEALTH POLICIES Mental health policy for children and adolescents in Austria needs to focus on how to organise a needs-oriented and coordinated services mix across different sectors that is equally accessible regardless of the patients' socio-economic background. IMPLICATIONS FOR FUTURE RESEARCH To support planning, further research on the factors that predict service use and on the cost-effectiveness of services is required.
Collapse
Affiliation(s)
- Ingrid Zechmeister-Koss
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090 Vienna, Austria,
| | | | | | | | | |
Collapse
|
19
|
Piso B, Zechmeister-Koss I, Wild C. [Opinion on Schwarz E., Maier M. Publication output in the field of Public Health and its appreciation at political level in Austria, Wien Med Wochenschr (2014) 164:123-130]. Wien Med Wochenschr 2014; 164:536-7. [PMID: 25404357 DOI: 10.1007/s10354-014-0324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Brigitte Piso
- Ludwig Boltzmann Institut für Health Technology Assessment, Garnisongasse 7/20, 1090, Wien, Österreich,
| | | | | |
Collapse
|
20
|
Kisser A, Zechmeister-Koss I. A systematic review of p16/Ki-67 immuno-testing for triage of low grade cervical cytology. BJOG 2014; 122:64-70. [DOI: 10.1111/1471-0528.13076] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2014] [Indexed: 12/14/2022]
Affiliation(s)
- A Kisser
- Ludwig Boltzmann Institute for Health Technology Assessment; Vienna Austria
| | - I Zechmeister-Koss
- Ludwig Boltzmann Institute for Health Technology Assessment; Vienna Austria
| |
Collapse
|
21
|
|
22
|
Piso B, Zechmeister-Koss I, Winkler R. Antenatal interventions to reduce preterm birth: an overview of Cochrane Systematic Reviews. BMC Res Notes 2014; 7:265. [PMID: 24758148 PMCID: PMC4021758 DOI: 10.1186/1756-0500-7-265] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 04/04/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Several factors are associated with an increased risk of preterm birth (PTB); therefore, various interventions might have the potential to influence it. Due to the large number of interventions that address PTB, the objective of this overview is to summarise evidence from Cochrane reviews regarding the effects and safety of these different interventions. METHODS We conducted a systematic literature search in the Cochrane Database of Systematic Reviews. Included reviews should be based on randomised controlled trials comparing antenatal non-pharmacological and pharmacological interventions that directly or indirectly address PTB with placebo/no treatment or routine care in pregnant women at less than 37 completed weeks of gestation without signs of threatened preterm labour. We considered PTB at less than 37 completed weeks of gestation as the primary outcome. RESULTS We included 56 Cochrane systematic reviews. Three interventions increased PTB risk significantly. Twelve interventions led to a statistically significant lower incidence of PTBs. However, this reduction was mostly observed in defined at-risk subgroups of pregnant women. The remaining antenatal interventions failed to prove a significant effect on PTB < 37 weeks, but some of them at least showed a positive effect in secondary outcomes (e.g., reduction in early PTBs). As an unintended result of this review, we identified 28 additional Cochrane reviews which intended to report on PTB < 37 weeks, but were not able to find any RCTs reporting appropriate data. CONCLUSIONS The possible effects of a diverse range of interventions on PTB have been evaluated in Cochrane systematic reviews. Few interventions have been demonstrated to be effective and a small number have been found to be harmful. For around half of the interventions evaluated, the Cochrane review concluded that there was insufficient evidence to provide sound recommendations for clinical practice. No RCT evidence is available for a number of potentially relevant interventions.
Collapse
Affiliation(s)
- Brigitte Piso
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090 Wien, Austria
| | - Ingrid Zechmeister-Koss
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090 Wien, Austria
| | - Roman Winkler
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090 Wien, Austria
| |
Collapse
|
23
|
Zechmeister-Koss I, Huić M, Fischer S. The Duodenal–Jejunal Bypass Liner for the Treatment of Type 2 Diabetes Mellitus and/or Obesity: a Systematic Review. Obes Surg 2013; 24:310-23. [DOI: 10.1007/s11695-013-1137-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
24
|
Zechmeister-Koss I, Schnell-Inderst P, Zauner G. Appropriate evidence sources for populating decision analytic models within health technology assessment (HTA): a systematic review of HTA manuals and health economic guidelines. Med Decis Making 2013; 34:288-99. [PMID: 24135150 DOI: 10.1177/0272989x13509406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND An increasing number of evidence sources are relevant for populating decision analytic models. What is needed is detailed methodological advice on which type of data is to be used for what type of model parameter. PURPOSE We aim to identify standards in health technology assessment manuals and economic (modeling) guidelines on appropriate evidence sources and on the role different types of data play within a model. METHODS Documents were identified via a call among members of the International Network of Agencies for Health Technology Assessment and by hand search. We included documents from Europe, the United States, Canada, Australia, and New Zealand as well as transnational guidelines written in English or German. We systematically summarized in a narrative manner information on appropriate evidence sources for model parameters, their advantages and limitations, data identification methods, and data quality issues. RESULTS A large variety of evidence sources for populating models are mentioned in the 28 documents included. They comprise research- and non-research-based sources. Valid and less appropriate sources are identified for informing different types of model parameters, such as clinical effect size, natural history of disease, resource use, unit costs, and health state utility values. Guidelines do not provide structured and detailed advice on this issue. LIMITATIONS The article does not include information from guidelines in languages other than English or German, and the information is not tailored to specific modeling techniques. CONCLUSIONS The usability of guidelines and manuals for modeling could be improved by addressing the issue of evidence sources in a more structured and comprehensive format.
Collapse
Affiliation(s)
- Ingrid Zechmeister-Koss
- Department of Health Economics, Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria (IZ-K)
| | - Petra Schnell-Inderst
- Department of Public Health and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria (PS-I)
| | | |
Collapse
|
25
|
Zechmeister-Koss I, Piso B. Affordability of programmes to prevent spontaneous preterm birth in Austria: a budget impact analysis. Eur J Public Health 2013; 24:145-50. [PMID: 23478210 DOI: 10.1093/eurpub/ckt024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Preterm birth is a rising health problem in Europe generally, and in Austria specifically. Decision makers require objective information on the effects and costs of measures to prevent preterm birth. METHODS We undertook a budget impact analysis from a public payer perspective and for a 1-year and 5-year time horizon for five prevention approaches to reduce preterm birth. These were cervix screening + progesterone application, progesterone injection, smoking cessation, fish oil supplementation and infection screening. We analysed affordability in terms of programme costs and potential cost savings. RESULTS Programme costs range from below €50 000 (cervix screening in high-risk pregnancy) to €500 000 (universal infection screening). The lowest health effects have been shown for smoking cessation programmes (-10 preterm births per year), whereas infection screening demonstrated the largest effect (-230 preterm births per year). In the base-case analysis, all programmes are potentially cost saving (-€500 000 to -€13 million per year). In the sensitivity analyses, preterm birth costs, target group size and (partly) unit costs of programme components have an influence on potential cost savings. However, except for two programmes, the results are robust concerning an overall economic net benefit of the programmes analysed compared with no programme. The study is mainly limited by the quality of some cost data and choice of the reference scenario. CONCLUSION When considering potential cost savings, the five prevention programmes analysed seem affordable, with cervix screening and infection screening likely being the most promising in Austria.
Collapse
|
26
|
Zechmeister-Koss I, Huic M. Vascular endothelial growth factor inhibitors (anti-VEGF) in the management of diabetic macular oedema: a systematic review. Br J Ophthalmol 2011; 96:167-78. [PMID: 22133986 DOI: 10.1136/bjophthalmol-2011-300674] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND RESEARCH QUESTION The authors address the question of whether vascular endothelial growth factor inhibitors (anti-VEGF) lead to better clinical outcomes than current treatments in patients with clinically manifest diabetic macular oedema (DMO), which is the leading cause of vision loss in the working age population in developed countries. METHODS The authors performed a systematic literature search in common databases and compiled the evidence according to the GRADE methodology. The authors analysed clinically relevant improvement of visual acuity, vision-related quality of life and local or systemic adverse events. RESULTS In a proportion of patients (on average 25%), VEGF inhibitors result in better visual acuity (≥15 ETDRS letters or equivalent) than in patients treated with laser photocoagulation or sham injection. The number of injections required for long-term improvement as well as the general long-term efficacy is unknown. The evidence is not sufficient to confirm safety of the products in patients with DMO and does not suggest superiority of a single product. CONCLUSION For some patients with DMO, VEGF inhibitors seem to be more effective as a short-term treatment option than alternative therapies. The evidence is not of sufficient quality to confirm safety. Decisions on financing should take into account the high price difference between the products and ongoing research.
Collapse
Affiliation(s)
- Ingrid Zechmeister-Koss
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090 Wien, Austria.
| | | |
Collapse
|