1
|
Bertuccio P, Vigezzi GP, Amerio A, Cavalieri D'oro L, Iacoviello L, Stuckler D, Signorelli C, Zucchi A, Gallus S, Odone A. Health and social home services among community-dwelling older people during COVID-19: Results from the cross-sectional LOST in Lombardia project. Scand J Public Health 2024; 52:262-270. [PMID: 37688313 DOI: 10.1177/14034948231184516] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND Few studies have focused on changes in health and social services access due to the COVID-19 pandemic. We aimed to describe changes in the use of selected health and social home services due to the pandemic and to investigate potential associated factors, including socio-demographic characteristics, number of chronic diseases and mental health indicators, among older Italian individuals. METHODS We analysed data from the LOST in Lombardia cross-sectional study conducted in November 2020 on a large representative sample of 4400 individuals aged ⩾65 years. To identify potential factors associated with the increased use of three selected health and social home services, we estimated odds ratios (OR) and confidence intervals (CI) using multivariable logistic regression models. RESULTS Compared to the year before, 5.0% of older adults increased help from domestic workers (vs. 6.9% reducing) during the pandemic, 4.4% increased help from non-familiar caregivers (vs. 1.3% decreasing) and 4.7% increased medical home visits (vs. 1.0% decreasing). An increase in the use of these services was more frequent among participants with co-morbidities (p for trend <0.001), especially with diabetes (for caregivers: OR=12.2, 95% CI 6.0-24.8), and worse mental health (for caregivers and for those with a GAD-2 score ⩾3 vs. <3: OR=10.6, 95% CI 5.8-19.4). Conversely, people living in more crowded households less frequently increased health and social services use during the pandemic. CONCLUSIONS Our results should inform targeted interventions for the identified vulnerable groups to close the gap in health and social inequities.
Collapse
Affiliation(s)
- Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
- Collegio Ca' della Paglia, Fondazione Ghislieri, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Italy
| | | | - Licia Iacoviello
- Department of Medicine and Surgery, Research Centre in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Italy
| | | | - Alberto Zucchi
- Epidemiology Unit, Bergamo Health Protection Agency, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| |
Collapse
|
2
|
Jones A, Sturrock A, Elliott E, Gussy M, Maidment I, Nelson D, Chew-Graham CA, Aggarwal VR. Community pharmacists' perceptions on managing people with oral health problems-A prioritisation survey. J Oral Rehabil 2024; 51:851-860. [PMID: 38225810 DOI: 10.1111/joor.13657] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/29/2023] [Accepted: 01/05/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Alternative sources of oral health information are likely to be of benefit to the public, particularly where access to dental services is limited. There is evidence that community pharmacists are willing to advocate for oral health, but it is unclear what is needed to develop this role. OBJECTIVES The aims of this study were to obtain the views of community pharmacy staff on the frequency and type of oral health conditions they encounter challenges in management and training/research priorities. METHODS An anonymous online survey targeted pharmacy staff and elicited quantitative data related to the types and frequencies of oral health conditions experienced. Participants were stratified by age, gender, ethnicity, experience and setting. Free text responses allowed participants to detail challenging aspects of patient management, their priorities for service development and future research. Reflexive thematic analysis of free text responses identified key themes. RESULTS Oral/facial pain and swelling were seen weekly by most respondents, and daily by 28.8%. Other commonly presenting conditions were ulcers, dry-mouth, thrush and denture issues. Challenges in managing oral health conditions included: access to NHS dentistry, awareness of referral pathways, examination/diagnosis and understanding 'Red Flags'. CONCLUSION Acute and chronic oral health conditions commonly present to community pharmacists who lack necessary knowledge/training, which may result in missing 'red flag' symptoms for oral cancer or acute facial swellings which can be life threatening. There is a need to support pharmacists, who are willing to act as oral health advocates, in recognition, prevention and onward referral for oral diseases.
Collapse
Affiliation(s)
- Adam Jones
- School of Dentistry, University of Leeds, Leeds, UK
| | - Andrew Sturrock
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Emma Elliott
- School of Dentistry, University of Leeds, Leeds, UK
| | - Mark Gussy
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
| | - Ian Maidment
- Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - David Nelson
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
| | | | | |
Collapse
|
3
|
Zhan S, Ye J. Disrupted ageing in place: Urbanisation and displaced older villagers in Suzhou, China. Australas J Ageing 2024. [PMID: 38497227 DOI: 10.1111/ajag.13299] [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] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/20/2024] [Accepted: 02/09/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE This study examines the impacts of urbanisation-induced displacement on rural older villagers and the issues of rebuilding ageing in place in Suzhou Municipality in China's Jiangsu Province. METHODS The study employed a qualitative research method involving three measures of data collection, including 20 older-adult interviews, 14 key informant interviews (with street and community administrators, managers of service companies, managers of nursing homes and community doctor) and participant observation of older villagers' daily life in urban resettlement communities. RESULTS The displacement and resettlement of villagers for urbanisation had serious negative impacts on older villagers, including financial insecurity, relative deprivation and radical changes to the living environment. The community services were limited and insufficient, but the resettlement of the whole village in the same place enabled the village community to maintain social and cultural continuities, which facilitated older villagers' adaptation to the new urban place. Filial piety, though weakened and transformed, continued to play an important role in regulating old-age support, but descending familism reduced family resources for old-age support. CONCLUSIONS This study highlights the importance of examining the impacts of external social and economic forces, such urbanisation in China, on ageing in place. We draw three conclusions based on empirical research in Suzhou: (1) the resettlement of older villagers in urban areas did not significantly narrow the rural-urban gap in old-age support in Suzhou; (2) urbanisation-induced displacement in China affected older residents differently from gentrification in Western countries, due to different processes of compensation and resettlement as well as China's rural-urban welfare gap; and (3) community services for displaced older villagers are limited, but social and cultural continuities before and after resettlement have helped older villagers adapt to the new urban place.
Collapse
Affiliation(s)
- Shaohua Zhan
- School of Social Sciences, Nanyang Technological University, Singapore
| | - Jihong Ye
- School of Politics and Public Administration, Governance Modernization Research Base of Southern Jiangsu Province, Soochow University, Suzhou, China
| |
Collapse
|
4
|
Farr M, Mamluk L, Jackson J, Redaniel MT, O'Brien M, Morgan R, Costello C, Spencer J, Banks J. Providing men at risk of suicide with emotional support and advice with employment, housing and financial difficulties: a qualitative evaluation of the Hope service. J Ment Health 2024; 33:3-13. [PMID: 35830874 DOI: 10.1080/09638237.2022.2091756] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/10/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Men at risk of suicide often face difficulties with finances, employment, or housing, yet support services are usually psychologically based. This study evaluated the Hope service which provides integrated psychosocial support alongside practical, financial and specialist advice. AIMS To examine how the Hope service supports men at risk of suicide and factors that influence its impact and usefulness. METHODS Twenty-six qualitative interviews with 16 service users, six Hope staff, two specialist money advice workers funded to work for Hope and two NHS referral staff, thematically analysed. RESULTS The Hope service provided an essential service for men at risk of suicide, with complex needs including addiction, job loss, homelessness, debt, relationship-breakdown and bereavement who often would otherwise have fallen through service provision gaps. Working in a person-centred, non-judgemental way elicited trust and specialist advice tackled problems such as housing needs, debt, benefit claims and employment, enabling men to regain a sense of control over their lives. Some men shared histories of abuse, for which specialist counselling was hard to access. CONCLUSIONS Hope provides an effective integrated support package for suicidal men. Funding for services like Hope are important to tackle structural issues such as homelessness and debt, alongside emotional support.
Collapse
Affiliation(s)
- Michelle Farr
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Loubaba Mamluk
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joni Jackson
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Theresa Redaniel
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marina O'Brien
- Second Step, Suicide Prevention and Post-Vention Services, Bristol, UK
| | - Rebecca Morgan
- Second Step, Suicide Prevention and Post-Vention Services, Bristol, UK
| | | | - Jez Spencer
- 6188 Ltd., Suicide Prevention and Intervention Trainer, Bristol, UK
| | - Jonathan Banks
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
5
|
Forthal S, Choi S, Yerneni R, Macinski S, Levey W, Kerwin J, Ahadzi M, Fish D, Anderson BJ, Neighbors C. Impact of supportive housing health homes program on medicaid utilization for persons diagnosed with HIV (PDWH). AIDS Care 2023; 35:1885-1890. [PMID: 36524897 PMCID: PMC10272282 DOI: 10.1080/09540121.2022.2158302] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
ABSTRACTUnstable housing among persons diagnosed with HIV (PDWH) has been consistently linked to poor HIV-related care engagement. We examined the relationship between enrollment in a supportive housing program and health care utilization (use of outpatient services, emergency department (ED) visits, and hospitalizations) for a group of unstably housed, Medicaid and Health Homes (HH)-enrolled PDWH in New York State. We analyzed monthly longitudinal data consisting of linked supportive housing data, HH data, and Medicaid claims from New York State (excluding New York City) between 2012 and 2017 using time series models. Participants who had at least six consecutive months of supportive housing at month t had 20% higher odds of using an outpatient service, 19% lower odds of visiting the ED, and 24% lower odds of being hospitalized compared to those with less than six consecutive months of supportive housing after adjusting for covariates. Supportive housing may promote better medical management by increasing outpatient visits among chronically homeless PDWH.
Collapse
Affiliation(s)
- Sarah Forthal
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
| | - Sugy Choi
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Rajeev Yerneni
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
| | - Sarah Macinski
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Wendy Levey
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Joseph Kerwin
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Martina Ahadzi
- Office of Health Insurance Programs, New York State Department of Health, Albany, New York
| | - Douglas Fish
- Office of Health Insurance Programs, New York State Department of Health, Albany, New York
| | - Bridget J. Anderson
- AIDS Institute, New York State Department of Health, Albany, New York
- New York State Center for Community Health, Department of Health, Albany, New York
| | - Charles Neighbors
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
6
|
Lapierre N, Labrie D, Routhier F, Mortenson WB. Service delivery and programing adaptations for individuals with disabilities by municipalities and non-profit organizations during the COVID pandemic. Home Health Care Serv Q 2023; 42:347-362. [PMID: 36966566 DOI: 10.1080/01621424.2023.2193560] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Municipalities and nonprofit organizations play a major role in administrating services that support individuals with disabilities. The purpose of this study was to explore how these organizations responded to the COVID-19 pandemic in regards to service delivery and programming for people with disabilities. This qualitative interpretative description study used semi-structured individual interviews for data collection. Recordings of the interviews were transcribed. Then the transcripts were analyzed qualitatively for themes following an inductive approach. Twenty-six individuals working for nonprofit organization or municipalities participated in the study. Six themes were identified: doing more with less; adapting rather than creating new services; ongoing consultation with stakeholders; feeling successful at adapting the services; being innovative with fundraising and embracing radical change. Flexibility and iterative user-centered approach appeared to be common coping strategies. Remote services were privileged to adapt service delivery during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Nolwenn Lapierre
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Dylane Labrie
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - François Routhier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Research Centre, Vancouver, BC, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Research Lab, Vancouver, BC, Canada
| |
Collapse
|
7
|
Stigen L, Bjørk E, Lund A. Occupational Therapy Interventions for Persons with Cognitive Impairments Living in the Community. Occup Ther Health Care 2023; 37:476-495. [PMID: 35357265 DOI: 10.1080/07380577.2022.2056777] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
This study describes interventions provided by community occupational therapists for persons with cognitive impairments. Using an online questionnaire, a cross-sectional study was conducted, collecting data from 497 of the 1367 occupational therapists in Norwegian community-based services. The most common interventions provided were environmental modifications (87%), implementation of assistive devices (85%), and training of activities of daily life (ADL) (77%). Two main reasons to carry out these interventions were identified as the initial assessment of clients (89%) and expectations of others. The most preferred interventions were ADL training (77%), cognitive training (63%), and environmental modifications (56%). Chi-squared tests identified a significant difference (p < 0.001) between interventions provided and preferred interventions on all interventions except environmental modifications. The findings provide an insight into interventions provided for persons with cognitive impairments in community services.
Collapse
Affiliation(s)
- Linda Stigen
- Department of Health Sciences, NTNU Norwegian University of Science and Technology, Gjøvik, Norway
- Department of Health and Functioning, Faculty of Health and Social Sciences, University of Applied Sciences, Western, Norway
| | - Evastina Bjørk
- Department of Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Anne Lund
- Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet- Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
8
|
Cervantes PE, Conlon GR, Seag DEM, Feder M, Lang Q, Meril S, Baroni A, Li A, Hoagwood KE, Horwitz SM. Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems. Autism 2023; 27:704-713. [PMID: 35893840 PMCID: PMC9880247 DOI: 10.1177/13623613221112202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
LAY ABSTRACT Autistic children and adolescents experience high rates of co-occurring mental health conditions, including depression and suicidality, which are frequently identified by stakeholders as treatment priorities. Unfortunately, accessing community-based mental health care is often difficult for autistic youth and their families. The first obstacle families confront is finding a provider that offers mental health treatment to autistic youth within the many service systems involved in supporting the autism community. The mental health and developmental disability systems are two of the most commonly accessed, and previous work has shown there is often confusion over which of these systems is responsible for providing mental health care to autistic individuals. In this study, we conducted a telephone survey to determine the availability of outpatient mental health services for autistic youth with depressive symptoms or suicidal thoughts or behaviors in New York City across the state's mental health and developmental disability systems. Results showed that while a greater percentage of clinics in the mental health system compared with in the developmental disability system offered outpatient mental health services to autistic youth (47.1% vs 25.0%), many more did not offer care to autistic youth and there were very few options overall. Therefore, it is important that changes to policy are made to increase the availability of services and that mental health care providers' knowledge and confidence in working with autistic youth are improved.
Collapse
Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Greta R. Conlon
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Dana E. M. Seag
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Michael Feder
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Qortni Lang
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Samantha Meril
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Annie Li
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Kimberly E. Hoagwood
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Sarah M. Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| |
Collapse
|
9
|
Hodgson A, Jones J, Campbell H, Carolan J, Powell J. National quality standards for neuro rehabilitation in a community setting: Do they achieve their purpose? J Eval Clin Pract 2023. [PMID: 36939169 DOI: 10.1111/jep.13819] [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] [Received: 07/16/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 03/21/2023]
Abstract
RATIONALE There is known variation in neuro-rehabilitation service provision, however, the extent of service variation and impact on people who experience an acquired brain injury (ABI) is not articulated in the literature. The aim of this study was to assess and determine the extent to which neuro-rehabilitation services in one part of the United Kingdom (UK) are meeting national quality standards. METHOD A mixed method design, across five community neuro-rehabilitation providers and six districts in South London, comprised of ABI population incidence data, web-based surveys to determine compliance with the National Institute for Health and Care Excellence (NICE) Head Injury Quality Standard, and focus groups to understand the patient perspective of community neuro-rehabilitation service provision. RESULTS The population incidence of ABI amongst districts demonstrated differences between the datasets analyzed, resulting in an inability to determine whether service variation was based on population need. The web-based surveys revealed that five community neuro-rehabilitation providers have variations between the models of care provided, including clinical referral criteria, duration, intensity of therapy interventions, and overall cost per patient, which was correlated with workforce capacity and patient waiting times. Focus group discussion highlighted current key challenges of service restraints, disconnect between services and limited professional support, as well as improvement opportunities pertaining to access, flexible, local and timely health and social care services. CONCLUSION This study indicates that despite the publication of the NICE Head Injury Quality Standard, there is variation in the local provision of community neuro-rehabilitation across six districts in South London. Each district partly meets the recommendations, highlighting variability in the model of care delivered, that impacts consumers/carers accessing quality neuro-rehabilitation services. A disconnect remains between evidence-based quality standards and implementation. No standardized ABI data set is available in the UK, which impacts planning for future clinical service delivery.
Collapse
Affiliation(s)
- Alisa Hodgson
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Jacky Jones
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Heather Campbell
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Jodie Carolan
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - John Powell
- National Institute for Health and Care Excellence, London, UK
| |
Collapse
|
10
|
Yang CWL, Wan ANT, Kwok MCW, Lam TH, Lai AYK. Implementation and evaluation of a model-based risk management process and service enhancement for home-based community care services amidst COVID-19 pandemic in Hong Kong: A mixed-method approach. Front Public Health 2023; 11:1070182. [PMID: 36891327 PMCID: PMC9986770 DOI: 10.3389/fpubh.2023.1070182] [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] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
Background The COVID-19 pandemic has greatly challenged all public social services, particularly home-based community care services (HBCCS). Aberdeen Kai-fong Association (AKA) is a non-government organization (NGO) in Hong Kong that systematically manages the challenges to HBCCS. This paper presents a practical example of the implementation and evaluation of the risk management process for HBCCS. Methods Mixed-method design was used to evaluate the implementation of the risk management process in encountering the challenges from existing and potential problems to maintain and enhance HBCCS in four major areas amidst the pandemic. A cross-sectional questionnaire survey and three qualitative focus group interviews were conducted by AKA from 30 December 2021 to 12 March 2022 to collect staff feedback on the institutional risk management process in four areas. Results 109 HBCCS staff members (69% aged 40 years or above; 80% female) completed the questionnaire survey. For resource arrangement and staff training, over 90% of the participants agreed (including strongly agreed) that they had sufficient and reliable personal protective equipment and clear infection control guideline and effective training. Over 80% agreed they had safe working space and effective manpower allocation. However, only 75% agreed they had received emotional support from the organization. Over 90% agreed that the basic services were maintained for service continuation and enhancement, the service users and their families trusted the organization, and the provided services were adjusted according to users' needs. 88% agreed that the organization had obtained support from the neighborhood. For communication among stakeholders, over 80% agreed they had open discussions with the senior management team, and the senior management team was willing to listen. Twenty-six staff members joined the three focus group interviews. The qualitative findings corroborated the quantitative results. Staff appreciated the organisation's work to enhance staff safety and continue advancing services during this difficult period. Regular in-service training, updated information and guidelines to staff, and proactive phone calls to service users, especially the elderly, were suggested to enhance the quality of services. Conclusions The paper could help NGOs and others encountering management challenges in community social services in diverse settings amidst the pandemic and beyond.
Collapse
Affiliation(s)
- Caroline W L Yang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Alice N T Wan
- Aberdeen Kai-fong Welfare Association Social Service, Hong Kong, Hong Kong SAR, China
| | - Mable C W Kwok
- Aberdeen Kai-fong Welfare Association Social Service, Hong Kong, Hong Kong SAR, China
| | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Agnes Y K Lai
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| |
Collapse
|
11
|
Robinson L, Trevors Babici L, Tedesco A, Spaner D, Morey T, Dosani N. Assessing the impact of a health navigator on improving access to care and addressing the social needs of palliative care patients experiencing homelessness: A service evaluation. Palliat Med 2022; 37:646-651. [PMID: 36576315 PMCID: PMC10074742 DOI: 10.1177/02692163221146812] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND Health navigators are healthcare professionals who specialize in care coordination, case management, navigating transitions, and reducing barriers to care. There is limited literature on the impact of health navigators on community-based palliative care for people experiencing homelessness. AIM We devised key performance indicators in nine categories with the aim to quantify the impact of a health navigator on the delivery of palliative care to patients experiencing homelessness. DESIGN Data were collected prospectively for all patient encounters involving a health navigator from July 2020 to 2021 and reviewed to determine the distribution of the health navigator's role and the ways in which patient care was impacted. SETTING AND PARTICIPANTS This study was conducted in Toronto, Ontario with the Palliative Education and Care for the Homeless (PEACH) Program. At any one time, the PEACH health navigator served a total of 50 patients. RESULTS We identified five key areas of the health navigator role including (1) facilitating access (2) coordinating care (3) addressing social determinants of health (4) advocating for patients, and (5) counselling patients and loved ones. The health navigator role was split evenly between activities pertaining to palliative care for structurally vulnerable populations and community-based palliative care for the general population. To achieve high impact outcomes, a considerable investment of time and energy was required of the health navigator, speaking to the importance of adequate and sustainable funding. CONCLUSIONS These findings underscore the potential for health navigators to add value to community-based palliative care teams, especially those caring for structurally vulnerable populations.
Collapse
Affiliation(s)
- Lilian Robinson
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Leeann Trevors Babici
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada.,Second Mile Club, Kensington Health, Toronto, ON, Canada
| | - Alissa Tedesco
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Donna Spaner
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Trevor Morey
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Naheed Dosani
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| |
Collapse
|
12
|
Breidenbach A, Heinz H, Jimenez EY. Factors Associated With Self-Reported Family Enrollment in Community Services After Referral by First Born Home Visitors. Acad Pediatr 2022:S1876-2859(22)00433-8. [PMID: 36122831 DOI: 10.1016/j.acap.2022.09.008] [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] [Received: 04/18/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To examine factors associated with family enrollment in community services after receiving a referral from First Born home visiting staff in New Mexico. METHODS Analyses of program administrative data from August 2010 to January 2020 for 1049 families with 5397 referrals were conducted in Stata 15.1 using mixed effects logistic regression; missing data were imputed. We examined the likelihood of a referral outcome being coded as "client enrolled in services" based on family self-report as a function of program, referral type and initiator, and staff and referral recipient characteristics. RESULTS About one fourth of referrals resulted in enrollment in services, with the highest enrollment rate for early intervention (39%) and lower enrollment rates for behavioral health (18%) and domestic violence (14%) services. Reported enrollment in the referred-to service was significantly higher for older caseholders versus teens (odds ratio [OR]: 1.69, 95% confidence interval [CI] 1.07-2.67) and for children (OR: 1.33, 95% CI 1.06-1.67) and pregnant mothers (OR: 1.45, 95% CI 1.04-2.01) versus non-pregnant mothers and significantly lower for referrals initiated by home visitors (in discussion with family - OR: 0.62, 95% CI 0.49-0.79; based on screening results - OR: 0.52, 95% CI 0.37-0.72) versus family initiated referrals, for fathers versus non-pregnant mothers (OR: 0.49, 95% CI 0.32-0.75) and for Asian, Black, and multi-racial/ethnic group caseholders versus white caseholders (OR: 0.53, 95% CI 0.30-0.97). CONCLUSIONS Quality improvement efforts and home visitor training on making sensitive referrals, anti-racism, and motivational interviewing could potentially improve family engagement with community services via the First Born home visiting model.
Collapse
Affiliation(s)
- Andrew Breidenbach
- Cradle to Career Policy Institute, University of New Mexico (A Breidenbach, H Heinz, and EY Jimenez), Albuquerque, NM
| | - Hailey Heinz
- Cradle to Career Policy Institute, University of New Mexico (A Breidenbach, H Heinz, and EY Jimenez), Albuquerque, NM.
| | - Elizabeth Yakes Jimenez
- Cradle to Career Policy Institute, University of New Mexico (A Breidenbach, H Heinz, and EY Jimenez), Albuquerque, NM; Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center (EY Jimenez), Albuquerque, NM
| |
Collapse
|
13
|
Chambers JE, Roscoe JN, Berrick JD, Lery B, Thompson D. Safely Increasing Connection to Community-Based Services: A Study of Multidisciplinary Team Decision Making for Child Welfare Referrals. Child Maltreat 2022; 27:434-443. [PMID: 33550845 DOI: 10.1177/1077559521992127] [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] [Indexed: 06/12/2023]
Abstract
Initial child welfare screening decisions, traditionally made by an individual worker, determine if a family will receive further intervention by child protective services. A multi-disciplinary team (MDT) decision-making approach for child welfare referrals aims to provide a more thorough assessment of needs and strengths and to connect families to appropriate community-based providers. This study examined 159 child welfare referrals handled by MDTs compared to 331 referrals handled via the traditional screening approach. The study used a pseudo randomization procedure to assign referrals to the study conditions: Referrals logged on 2.5 days of the week were assigned to the treatment group; all others were assigned to the comparison group. Referrals handled by an MDT were more than four times as likely as those not handled by an MDT to be referred to community-based organizations (OR = 4.32, p < .001). There were no statistically significant differences in families' engagement with community-based organizations or child welfare outcomes. MDTs are a promising step in the initial process of connecting families to services, although they did not affect this study's longer-term outcomes.
Collapse
Affiliation(s)
- Jaclyn E Chambers
- Department of Social Welfare, 1438University of California, Berkeley, CA, USA
| | - Joseph N Roscoe
- Department of Social Welfare, 1438University of California, Berkeley, CA, USA
| | - Jill Duerr Berrick
- Department of Social Welfare, 1438University of California, Berkeley, CA, USA
| | - Bridgette Lery
- San Francisco Human Services Agency, San Francisco, CA, USA
| | - Doug Thompson
- San Francisco Human Services Agency, San Francisco, CA, USA
| |
Collapse
|
14
|
Jones LM, Mitchell KJ. Predictors of Multidisciplinary Team Sustainability in Work With Child Sex Trafficking Cases. Violence Vict 2022; 37:222-243. [PMID: 35264454 DOI: 10.1891/vv-d-19-00073] [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] [Indexed: 06/14/2023]
Abstract
A coordinated response by a trained multidisciplinary team (MDT) can help support child sex trafficking (CST) victims, but little is known about factors that influence the development and sustainability of MDTs in this work. An online survey was conducted with 171 professionals who attended a Multidisciplinary Team Child Sex Trafficking (MDT-CST) training to identify factors related to team growth. Increased MDT success was related to: (1) the presence of a CST-specific advocacy organization in the community; (2) other community agencies active in supporting CST victims (e.g., SANE nurses, faith-based organizations, and runaway shelters); (3) a greater breadth of professional representation on the MDT; and (4) agency leadership support for the CST action plan. Most of the MDTs sustained and increased their coordination with other community agencies over time, but the study identified that growth is improved when administrators support team efforts and there are resources and supports for CST victims elsewhere in the community.
Collapse
Affiliation(s)
- Lisa M Jones
- Crimes Against Children Research Center, University of New Hampshire
| | | |
Collapse
|
15
|
Krutter S, Schaffler‐Schaden D, Eßl‐Maurer R, Seymer A, Osterbrink J, Flamm M. Home care nursing for persons with dementia from a family caregivers' point of view: Predictors of utilisation in a rural setting in Austria. Health Soc Care Community 2022; 30:389-399. [PMID: 33963625 PMCID: PMC9290922 DOI: 10.1111/hsc.13412] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 03/18/2021] [Accepted: 04/04/2021] [Indexed: 06/12/2023]
Abstract
The service utilisation of persons with dementia (PwD) and their caregivers is subject to lively debate. The reasons for non-utilisation are manifold and heterogeneous. Conceptual models and explanatory frameworks may help identify predictors of the usage of health services. Literature examining the utilisation of home care services for PwD is scarce. This study explored predictors of home care nursing utilisation of PwD and their informal caregivers in a rural setting, according to the Andersen Behavioural Model of Health Care Use. A mixed-methods study was conducted in a rural area of Austria. In using non-random multistage sampling, anonymous questionnaires were distributed to collect data on family caregivers of PwD. Data were analysed using sequential binary logistic regression to characterise home care service users. To reflect the complexity of the Andersen model, a regression tree model was used. In total, 107 family caregivers completed the survey. Predisposing factors for home care nursing utilisation were higher age of the caregiver, female gender of PwD and kinship of the PwD and caregiver. Disruptive behaviour and independence in activities of daily living of PwD were associated with need factors for service use. According to the Andersen model, the predisposing and need factors contributed most to the explanation of home care nursing utilisation. The enabling factors employment, education and income tend to predict service use. Our findings indicate that higher age of the family caregiver and female gender of PwD are the main predictors for utilisation of home care nursing in a rural setting. To improve utilisation, the advantages of professional care services should be promoted, and the awareness about the variety of services available should be increased. To ensure a better understanding of the barriers to accessing home care, PwD should more often be included in healthcare service research.
Collapse
Affiliation(s)
- Simon Krutter
- Institute for Nursing Science and PracticeParacelsus Medical UniversitySalzburgAustria
| | - Dagmar Schaffler‐Schaden
- Institute of General Practice, Family Medicine and Preventive MedicineParacelsus Medical UniversitySalzburgAustria
| | - Roland Eßl‐Maurer
- Institute for Nursing Science and PracticeParacelsus Medical UniversitySalzburgAustria
| | | | - Juergen Osterbrink
- Institute for Nursing Science and PracticeParacelsus Medical UniversitySalzburgAustria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive MedicineParacelsus Medical UniversitySalzburgAustria
| |
Collapse
|
16
|
Torres Sanchez A, Park AL, Chu W, Letamendi A, Stanick C, Regan J, Perez G, Manners D, Oh G, Chorpita BF. Supporting the mental health needs of underserved communities: A qualitative study of barriers to accessing community resources. J Community Psychol 2022; 50:541-552. [PMID: 34096626 DOI: 10.1002/jcop.22633] [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: 09/23/2020] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 06/12/2023]
Abstract
This study examined the accessibility of community resources (e.g., welfare programs and afterschool programs) for underserved youth and families with mental health needs. Mental health professionals (n = 52) from a large community mental health and welfare agency serving predominantly low-income, Latinx families completed a semistructured interview that asked about the accessibility of community resources. Participant responses were coded using an inductive thematic analysis. Results showed that 71% of participants endorsed availability barriers (e.g., limited local programs), 37% endorsed logistical barriers (e.g., waitlists), 27% endorsed attitudinal barriers (e.g., stigmatized beliefs about help-seeking), and 23% endorsed knowledge barriers (e.g., lacking awareness about local programs). Professionals' perceived availability barriers were mostly consistent with the actual availability of community resources. Findings highlight the compounding challenges that underserved communities face and point to opportunities for promoting enhanced well-being and functioning for youth and families with mental health needs.
Collapse
Affiliation(s)
| | - Alayna L Park
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Wendy Chu
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Andrea Letamendi
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Cameo Stanick
- Hathaway-Sycamores Child and Family Services, Pasadena, California, USA
| | - Jennifer Regan
- Los Angeles County Department of Mental Health, Los Angeles, California, USA
| | - Gina Perez
- Hathaway-Sycamores Child and Family Services, Pasadena, California, USA
| | - Debbie Manners
- Hathaway-Sycamores Child and Family Services, Pasadena, California, USA
| | - Glory Oh
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
17
|
Ryan L. Accessing community dementia care services in Ireland: Emotional barriers for caregivers. Health Soc Care Community 2021; 29:1980-1989. [PMID: 33682982 DOI: 10.1111/hsc.13342] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/06/2021] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
Despite the benefits of utilising community-based care services (CBS) for people with dementia and their caregiver being well established, people with dementia and caregivers use fewer services in comparison to other people in need of care. While societal, cultural and logistical factors effecting caregiver use of CBS are frequently studied, research of internal emotional barriers, mental limitations created by one's own self that prevents open communication of thoughts and feelings, and their effect on CBS use is limited. This paper explores internal emotional barriers on caregivers' use of CBS within the Irish Healthcare System. Professional Healthcare Providers were also interviewed as a preliminary indicator of their awareness of these internal emotional barriers and their impact on caregivers' use of CBS. Using interpretive description methodology, interviews with 20 caregivers and fourteen dementia professional healthcare providers were transcribed and a thematic analysis methodology applied to illuminate themes/patterns within participants' subjective perceptions of caregivers emotional barriers to using CBS. Four themes emerge: reluctance to question general practitioner (GP) authority; embarrassment during level of care requirement reviews; sense of obligation to provide all care; and fear of stigma. Caregivers interviewed were reluctant to communicate concerns with professional healthcare providers (PHPs), thereby reducing the PHP's awareness of these barriers and delaying/preventing use of CBS. As key gatekeepers within the care pathway, GPs should address the uneven power dynamic with the caregiver through user-centred models of care, which actively encourage open dialogue, and receive training to identify the indicative behaviours of internal emotional barriers and empower the caregiver to communicate their feelings/concerns directly.
Collapse
|
18
|
Ayres L, Pelkowitz L, Simon P, Thompson SC. Necessity as the Catalyst of Change: Exploring Client and Provider Perspectives of Accelerated Implementation of Telehealth by a Regional Australian Community Service Organisation during COVID-19 Restrictions. Int J Environ Res Public Health 2021; 18:ijerph182111433. [PMID: 34769949 PMCID: PMC8583583 DOI: 10.3390/ijerph182111433] [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] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/17/2022]
Abstract
Community services have played a significant role in supporting the psychosocial health and well-being of vulnerable populations during the SARS-CoV-2 (COVID-19) pandemic. To meet increased community needs, organisations were required to rapidly modify service provision, often using remote delivery systems. This in-depth study, undertaken early in the pandemic, explored staff and clients’ experiences of adapting to using telehealth to provide and access services in one regional social services agency. Semi-structured interviews from 15 staff and 11 clients from a regional not-for-profit agency in Western Australia were recorded and transcribed. Inductive coding, and thematic analysis identified eight subthemes, with experiences and perceptions of telehealth varying substantially among staff and client groups. Distinct benefits and challenges were associated with telehealth. Participants highlighted tensions and complexities and commented on the place of telehealth in the community service sector. Clients expressed the importance of relationships and communication. This study provides in-depth insights into the contextualised experiences of staff and clients during a time at which change was both enabled and necessary. The findings highlight the need for tailored service delivery; choice; client collaboration; ongoing staff training relating to telehealth; and guidelines specific to telehealth in the community service sector.
Collapse
Affiliation(s)
- Leah Ayres
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia; (L.P.); (S.C.T.)
- Correspondence:
| | - Lindi Pelkowitz
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia; (L.P.); (S.C.T.)
| | - Perlin Simon
- Centacare Family Services, Geraldton, WA 6530, Australia;
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia; (L.P.); (S.C.T.)
| |
Collapse
|
19
|
Alshahrani AM, Alsheikh MY. Community Pharmacists' Perceptions, Barriers, and Willingness for Offering Sexual and Reproductive Health Services. Int J Environ Res Public Health 2021; 18:10735. [PMID: 34682503 DOI: 10.3390/ijerph182010735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022]
Abstract
The role of community pharmacists is crucial for promoting health and providing consultation related to sexual and reproductive health. This study measured the perception of community pharmacists in the Kingdom of Saudi Arabia (KSA) towards the provision of counselling services on sex education and reproductive health, including barriers to and proficiency in the delivery of services. A cross-sectional survey was developed and distributed electronically to pharmacists, and responses were analyzed using SPSS version 26. Graphical representations for various opinions on perception, proficiency and barriers were created. More than 80% of pharmacists placed a high value on counselling patients on sex and reproductive health, about 90% counselled their patients very often (74.6%) or often (22.2%), and 3.2% of pharmacists did not counsel patients. Most respondents believed counselling was very important (65.3%) or important (15.1%), with only 19.6% of respondents indicating it was not important. Barriers to offering services included fear from responsibility and liability (M = 4.8), lack of information about patient health (M = 4.7), gender differences (M = 4.7), and lack of social acceptability (M = 4.6). Community pharmacists in KSA possessed positive attitudes, professional education, and willingness to provide counselling to patients on sex education and reproductive health. Apart from the existing barriers that require augmented community pharmacists’ soft skills, clear policies and authorization for offering this type of service are also needed.
Collapse
|
20
|
Lunt C, Dowrick C, Lloyd-Williams M. What is the impact of day care on older people with long-term conditions: A systematic review. Health Soc Care Community 2021; 29:1201-1221. [PMID: 33332714 DOI: 10.1111/hsc.13245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
There is a lack of robust evidence regarding outcomes for day care use among older people living with long-term conditions (LTCs). Day care is provided by independent, private and voluntary and charitable sectors. This systematic review aims to establish current evidence of outcomes for older people with LTCs attending day care services and outcomes on carers, across all service models. Narrative synthesis of quantitative and qualitative data was undertaken. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was carried out across eight electronic databases and reference lists of key journals between 2004 and October 2020 were searched. Searches returned 1,202 unique titles. Forty-five articles from 16 countries met the criteria on review of title, abstract and full article. There is limited evidence suggesting improved levels of perceived psychological health, quality of life, perceived general health, physical health and functioning for older people attending day care who have LTCs. The respite function of day care resulted in positive outcomes for carers. Studies evaluating outcomes for participants or carers were limited in quantity and quality. There is limited information regarding outcomes for day care attendance for older people with multiple LTCs from existing literature. Further research focusing on LTCs and day care attendance would benefit this field.
Collapse
Affiliation(s)
- Catherine Lunt
- Academic Palliative and Supportive Care Studies Group (APSCSG), Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Christopher Dowrick
- Academic Palliative and Supportive Care Studies Group (APSCSG), Institute of Psychology Health and Society Block B Waterhouse Building, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), University of Liverpool / Honorary Consultant Liverpool CCG (Liverpool Health Partners), Liverpool, UK
| |
Collapse
|
21
|
Fixsen A, Barrett S, Shimonovich M. Weathering the storm: A qualitative study of social prescribing in urban and rural Scotland during the COVID-19 pandemic. SAGE Open Med 2021; 9:20503121211029187. [PMID: 34262766 PMCID: PMC8252447 DOI: 10.1177/20503121211029187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: The non-clinical approach known as social prescribing aims to tackle multi-morbidity, reduce general practitioner (GP) workload and promote wellbeing by directing patients to community services. Usual in-person modes of delivery of social prescribing have been virtually impossible under social distancing rules. This study qualitatively examined and compared the responses of three social prescribing schemes in Scotland to the COVID-19 pandemic. Methods: We interviewed a theoretical sample of 23 stakeholders in urban and rural social prescribing schemes at the start of COVID-19 pandemic. Follow-up interviews with a representative sample were conducted around 10 months later. Interviewees included social prescribing coordinators (SPCs) GPs, managers, researchers and representatives of third sector organizations. Interview transcripts were analysed in stages and an inductive approach to coding was supported by NVivo. Results: Findings revealed a complex social prescribing landscape in Scotland with schemes funded, structured and delivering services in diverse ways. Across all schemes, working effectively during the pandemic and shifting to online delivery had been challenging and demanding; however, their priorities in response to the pandemic had differed. With GP time and services stretched to limits, GP practice-attached ‘Link Workers’ had taken on counselling and advocacy roles, sometimes for serious mental health cases. Community-based SPCs had mostly assumed a health education role, and those on the Western Isles of Scotland a digital support role. In both rural or urban areas, combatting loneliness and isolation – especially given social distancing – remained a pivotal aspect of the SPC role. Conclusion: This study highlights significant challenges and shifts in focus in social prescribing in response to the pandemic. The use of multiple digital technologies has assumed a central role in social prescribing, and this situation seems likely to remain. With statutory and non-statutory services stretched to their limits, there is a danger of SPCs assuming new tasks without adequate training or support.
Collapse
Affiliation(s)
- Alison Fixsen
- College of Liberal Arts and Sciences, University of Westminster, London, UK
| | - Simon Barrett
- Newcastle University, Population Health Sciences Institute, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Michal Shimonovich
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| |
Collapse
|
22
|
Ito T, Hirata-Mogi S, Watanabe T, Sugiyama T, Jin X, Kobayashi S, Tamiya N. Change of Use in Community Services among Disabled Older Adults during COVID-19 in Japan. Int J Environ Res Public Health 2021; 18:ijerph18031148. [PMID: 33525441 PMCID: PMC7908432 DOI: 10.3390/ijerph18031148] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/23/2021] [Accepted: 01/24/2021] [Indexed: 01/10/2023]
Abstract
During the COVID-19 pandemic, social interactions were restricted, including community services for disabled older adults. This study aimed to describe the change of use in community services related to long-term care insurance (LTCI) during the pandemic in Japan. A retrospective descriptive study was conducted using data collected via a cloud-based management support platform for older adult care provider “Kaipoke”, by a private-sector company “SMS Co., Ltd.”, in which care-managers of LTCI manage their office work. Data collection occurred from July 2019 to June 2020. Study subjects were LTCI service users aged 65 years and above. Subjects were living at home. We examined changes in the number of users of LTCI services before and after the COVID-19 pandemic began, using an interrupted time-series analysis. Results indicated that the use of outpatient services was reduced; however, home-visit services were maintained. The decrease in use was significant in the seven prefectures where the infection initially spread. There are concerns that older adults or surrounding caregivers can be affected by such changes in LTC service use. It is therefore necessary to implement sustainable measures from a long-term perspective and investigate their influence as part of future studies.
Collapse
Affiliation(s)
- Tomoko Ito
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan; (T.I.); (X.J.); (N.T.)
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan; (S.H.-M.); (T.W.)
| | - Sachiko Hirata-Mogi
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan; (S.H.-M.); (T.W.)
- Analytics & Innovation Department, Research & Development Group, SMS Co., Ltd., Tokyo 105-0011, Japan;
| | - Taeko Watanabe
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan; (S.H.-M.); (T.W.)
| | - Takehiro Sugiyama
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan; (T.I.); (X.J.); (N.T.)
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan; (S.H.-M.); (T.W.)
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
- Correspondence:
| | - Xueying Jin
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan; (T.I.); (X.J.); (N.T.)
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan; (S.H.-M.); (T.W.)
| | - Shu Kobayashi
- Analytics & Innovation Department, Research & Development Group, SMS Co., Ltd., Tokyo 105-0011, Japan;
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan; (T.I.); (X.J.); (N.T.)
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan; (S.H.-M.); (T.W.)
| |
Collapse
|
23
|
Thomas T, Baker J, Massey D, D’Appio D, Aggar C. Stepped-Wedge Cluster Randomised Trial of Social Prescribing of Forest Therapy for Quality of Life and Biopsychosocial Wellbeing in Community-Living Australian Adults with Mental Illness: Protocol. Int J Environ Res Public Health 2020; 17:ijerph17239076. [PMID: 33561041 PMCID: PMC7730720 DOI: 10.3390/ijerph17239076] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022]
Abstract
Social Prescribing (SP) involves linking individuals with mental illness to local health and welfare services to improve quality of life (QoL) and biopsychosocial wellbeing. SP programs address psychosocial wellbeing by linking individuals to group activities. Forest Therapy (FT) is a group nature walk with prescribed activities that promote mindfulness, relaxation, and shared experience. Improvements in psychological and physical wellbeing have been demonstrated in FT, but psychosocial impacts have not been widely investigated. This study will implement an SP FT intervention and assess the impacts on QoL and biopsychosocial wellbeing. Participants will include 140 community-living adults with mental illness at Sydney/Gold Coast, Australia. A stepped-wedge cluster randomised design will be used; each participant will complete a 10-week control period followed by a 10-week FT intervention. Weekly 90-min FT sessions will be conducted in groups of 6–10 in local nature reserves. Validated tools will measure self-report QoL and biopsychosocial wellbeing pre- and post-control and intervention periods, and 5-week follow-up. Blood pressure and heart rate will be measured pre- and post-FT sessions. Hypothesised outcomes include improvements in QoL and biopsychosocial wellbeing. This study is the first to assess SP FT, and may provide evidence for a novel, scalable mental illness intervention.
Collapse
Affiliation(s)
- Tamsin Thomas
- School of Health and Human Sciences, Southern Cross University, Southern Cross Drive, Bilinga, QLD 4225, Australia; (D.M.); (C.A.)
- Correspondence: ; Tel.: +61-7-5589-3316
| | - James Baker
- Primary and Community Care Services, 7/1 Central Ave, Thornleigh, NSW 2120, Australia; (J.B.); (D.D.)
| | - Debbie Massey
- School of Health and Human Sciences, Southern Cross University, Southern Cross Drive, Bilinga, QLD 4225, Australia; (D.M.); (C.A.)
| | - Daniel D’Appio
- Primary and Community Care Services, 7/1 Central Ave, Thornleigh, NSW 2120, Australia; (J.B.); (D.D.)
| | - Christina Aggar
- School of Health and Human Sciences, Southern Cross University, Southern Cross Drive, Bilinga, QLD 4225, Australia; (D.M.); (C.A.)
- Northern NSW Local Health District, Crawford House, Hunter Street, Lismore, NSW 2480, Australia
| |
Collapse
|
24
|
Broome EE, Coleston-Shields DM, Dening T, Moniz-Cook E, Poland F, Stanyon M, Orrell M. AQUEDUCT Intervention for Crisis Team Quality and Effectiveness in Dementia: Protocol for a Feasibility Study. JMIR Res Protoc 2020; 9:e18971. [PMID: 33048059 PMCID: PMC7592065 DOI: 10.2196/18971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Specialist community teams often support people with dementia who experience crisis. These teams may vary in composition and models of practice, which presents challenges when evaluating their effectiveness. A best practice model for dementia crisis services could be used by teams to improve the quality and effectiveness of the care they deliver. OBJECTIVE The aim of this study is to examine the feasibility of conducting a large-scale randomized controlled trial comparing the AQUEDUCT (Achieving Quality and Effectiveness in Dementia Using Crisis Teams) Resource Kit intervention to treatment as usual. METHODS This is a multisite feasibility study in preparation for a future randomized controlled trial. Up to 54 people with dementia (and their carers) and 40 practitioners will be recruited from 4 geographically widespread teams managing crisis in dementia. Quantitative outcomes will be recorded at baseline and at discharge. This study will also involve a nested health economic substudy and qualitative research to examine participant experiences of the intervention and acceptability of research procedures. RESULTS Ethical approval for this study was granted in July 2019. Participant recruitment began in September 2019, and as of September 2020, all data collection has been completed. Results of this study will establish the acceptability of the intervention, recruitment rates, and will assess the feasibility and appropriateness of the outcome measures in preparation for a large-scale randomized controlled trial. CONCLUSIONS There is a need to evaluate the effectiveness of crisis intervention teams for older people with dementia. This is the first study to test the feasibility of an evidence-based best practice model for teams managing crisis in dementia. The results of this study will assist in the planning and delivery of a large-scale randomized controlled trial. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18971.
Collapse
Affiliation(s)
- Emma Elizabeth Broome
- National Institute for Health Research Nottingham Biomedical Research Centre, Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Donna Maria Coleston-Shields
- Division of Psychiatry & Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Tom Dening
- Division of Psychiatry & Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Miriam Stanyon
- Division of Psychiatry & Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Martin Orrell
- Division of Psychiatry & Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
25
|
Gauly J, Atherton H, Kimani PK, Ross J. Utilisation of pharmacy-based sexual and reproductive health services: a quantitative retrospective study. Sex Transm Infect 2020; 97:126-133. [PMID: 32817275 PMCID: PMC7892391 DOI: 10.1136/sextrans-2020-054488] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the utilisation of pharmacy-based sexual and reproductive health services (SRHS) in order to optimise delivery and identify barriers to access. METHODS The health provider Umbrella offers six SRHS from over 120 pharmacies in Birmingham (England). In this retrospective study, data collected between August 2015 and August 2018 were used to analyse uptake, user characteristics and attendance patterns according to day of the week. RESULTS A total of 60 498 requests for a pharmacy service were included in the analysis. Emergency contraception (50.4%), condoms (33.1%) and STI self-sampling kits (9.6%) accounted for more than 90% of all requests. A lower uptake of services was observed for the contraceptive injection (0.6%), oral contraception (5.4%) and chlamydia treatment (1.0%). Services were most likely to be requested by those self-identifying as female (85.6%), and those aged 16-24 years (53.8%). Based on available ethnicity data (n=54 668), most requests for a service were made by White/White British individuals (43.4%) and Asian/Asian British people (23.1%). The largest number of services were delivered on Mondays (20.9%) and the lowest on Sundays (5.0%). A high proportion of requests for services on Saturdays (57.0%), Sundays (67.6%) and Mondays (54.4%) were made by females presenting for emergency contraception. CONCLUSION The evaluation of healthcare utilisation is important to help refine and optimise the delivery of services. However, information relating to pharmacy-based SRHS is scarce and often limited to a single type of service provision. Overall, a wide range of pharmacy-based services were accessed by a diverse range of people, suggesting that pharmacies are a suitable provider of many SRHS. However, the routinely collected data analysed in the study had several limitations restricting the analysis. Sexual health providers should ensure they collect data which are as comprehensive as is possible in order to help understand the utilisation of services.
Collapse
Affiliation(s)
- Julia Gauly
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter K Kimani
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jonathan Ross
- Whittall Street Clinic, University Hospital Birmingham, Birmingham, UK
| |
Collapse
|
26
|
Morrisby C, Ciccarelli M, Joosten A. Mind the gap: Comparing perspectives of service providers to the needs of people with dementia living in the community. Dementia (London) 2020; 20:1425-1441. [PMID: 32755229 DOI: 10.1177/1471301220947837] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Research with West Australian people with dementia and their carers living in the community identified that they have a diverse range of needs. However, little is known about the needs of people with dementia and their carers from the perspectives of service providers who provide formal support. This study aimed to investigate the needs of people with dementia and their carers living in the community from the perspectives of service providers, and compare this to service recipients. METHOD This interpretive descriptive study used focus groups to collect qualitative data from service providers (N = 10). Data were analysed using a hybrid inductive-deductive approach to compare the needs identified by service providers to those identified by people with dementia and their carers. RESULTS Three major themes were identified: (i) services and supports required by people with dementia and their carers should be flexible, tailored, and equitable; (ii) building capacity to support carers and people with dementia; and (iii) systems designed to care were fragmented and difficult to navigate. Service providers prioritise needs that are limited to their current capacity to provide in contrast to the holistic needs of people with dementia and their carers. CONCLUSION There was poor alignment between the perceived needs of people with dementia and their carers and the needs prioritised by service providers in the West Australian community. This gap may reduce the ability of services to effectively support people with dementia to remain living in the community.
Collapse
|
27
|
Wylie K, Davidson B, Marshall J, Bampoe JO, Amponsah C, McAllister L. Community service providers' roles in supporting communication disability rehabilitation in Majority World contexts: An example from Ghana. Int J Speech Lang Pathol 2020; 22:414-424. [PMID: 31438722 DOI: 10.1080/17549507.2019.1651395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: In Majority World countries, where speech-language pathology services are extremely limited, people with communication disabilities (PWCD) may seek help from a range of service providers. This qualitative research aimed to explore the nature of community services offered to people with communication disabilities who seek help in Accra, Ghana.Method: Semi-structured interviews were conducted with nine individuals from three professions: pastors (3), doctors (3), and herbalists (3) exploring services that they may offer to PWCD seeking help. Interviews were analysed using Thematic Network Analysis.Result: Six global themes described beliefs about communication disability, types of intervention, explanations provided to people with communication disabilities, promoting communication, processes for selecting treatments, and links between service providers. Interventions encompassed physical, spiritual, psychosocial and environmental approaches, with the notion of plural beliefs interwoven through a number of themes.Conclusion: In Ghana, and other Majority World contexts, service providers in sectors not commonly associated with communication disability rehabilitation may have important roles to play in supporting people with communication disabilities. Understanding the contributions of other service providers may assist the growing profession of speech-language pathology to collaborate across sectors, to develop specific, culturally responsive approaches to service development.
Collapse
Affiliation(s)
- Karen Wylie
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Bronwyn Davidson
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Australia
| | - Julie Marshall
- Health Professions Department, Manchester Metropolitan University, Manchester, UK
| | - Josephine Ohenewa Bampoe
- Department of Audiology, Speech and Language Therapy, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana, and
| | - Clement Amponsah
- Department of Audiology, Speech and Language Therapy, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana, and
| | - Lindy McAllister
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| |
Collapse
|
28
|
Hildebrandt UC, Graham JC, Grant TM. Predictors and moderators of improved social-emotional functioning in mothers with substance use disorders and their young children enrolled in a relationship-based case management program. Infant Ment Health J 2020; 41:677-696. [PMID: 32578238 DOI: 10.1002/imhj.21872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/08/2022]
Abstract
Mothers with substance use disorders (SUDs) typically have trauma histories and psychosocial difficulties that lead to poor social-emotional functioning and disrupted mother-child relationships. This 12-month study explored associations of family adverse circumstances and services (case management, therapeutic, and community-based) received by 57-mothers with SUDs and their infants (less than 24-months-old) with changes in social-emotional functioning. All mothers were enrolled in a relationship-based case management program (Parent-Child Assistance Program [PCAP]) that emphasized connecting mothers to appropriate community services. A subset of mothers was additionally provided a trauma-focused psychotherapeutic intervention (infant-parent psychotherapy [IPP]). Dyads in both treatment groups improved in overall social-emotional functioning as assessed by the Functional Emotional Assessment Scale (FEAS). A combined-sample regression analysis revealed that improved FEAS scores were significantly predicted by the number of community services received but not by PCAP case management hours (IPP was not included in this analysis). More adverse circumstances were associated with less improvement in social-emotional functioning in the children; but among the mothers trauma level did not predict FEAS scores. We also found a moderating effect of trauma: Dyads with relatively more adversity showed a significantly greater association of community services received with improvement in FEAS scores than did those with relatively less adversity.
Collapse
Affiliation(s)
| | - J Christopher Graham
- Alcohol and Drug Abuse Institute, University of Washington Health Sciences Administration, Seattle, Washington
| | - Therese M Grant
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
29
|
Sluggett JK, Ooi CE, Gibson S, Angley MT, Corlis M, Hogan ME, Caporale T, Hughes GA, Van Emden J, Bell JS. Simplifying Medication Regimens for People Receiving Community-Based Home Care Services: Outcomes of a Non-Randomized Pilot and Feasibility Study. Clin Interv Aging 2020; 15:797-809. [PMID: 32581521 PMCID: PMC7276197 DOI: 10.2147/cia.s248377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/01/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose Being able to manage a complex medication regimen is key to older people continuing to live at home. This study determined the feasibility of a multi-component intervention to simplify medication regimens for people receiving community-based home care services. Patients and Methods Research nurses recruited people receiving community-based home care services to participate in this non-randomized pilot and feasibility study (Australian New Zealand Clinical Trials Registry ACTRN12618001130257). Participants received a one-off clinical pharmacist intervention comprising medication reconciliation, assessment of capacity to self-manage medications, and application of a structured 5-step tool to identify medication simplification opportunities. A mixed-methods feasibility assessment with an explanatory design was undertaken to assess recruitment, protocol adherence and stakeholder acceptability. Data from interviews with 12 stakeholders were thematically analyzed. Secondary outcome measures, including medication discrepancies, and changes in number of medication administration times per day, quality of life, medication adherence and health service utilization, were determined over a 4-month follow-up. Results Twenty-five out of the target 50 participants were recruited. Initial recruitment was impacted by apparent uncertain role responsibilities in medication management, with some clients who declined to participate perceiving they would be unlikely to benefit or being reluctant to change regimens. However, with few exceptions, participants who received intervention did so with a high degree of protocol adherence and acceptability. Stakeholders valued the intervention and supported wider implementation. Discrepancies between the baseline medication history from the general medical practitioner and the pharmacist-compiled “best possible medication history” were identified for all participants’ regimens (median of 6 per participant), with one-third resolved at follow-up. Simplification was possible for 14 participants (56%) and implemented for 7 (50%) at follow-up. No significant changes in other secondary outcomes were observed. Conclusion The intervention was delivered as planned, and valued by stakeholders. Recruitment barriers should be addressed before wider implementation.
Collapse
Affiliation(s)
- Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia.,National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Stephanie Gibson
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Manya T Angley
- University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Megan Corlis
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Michelle E Hogan
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Tessa Caporale
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Georgina A Hughes
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Jan Van Emden
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
30
|
Hancock S, Winterton R, Wilding C, Blackberry I. Understanding ageing well in Australian rural and regional settings: Applying an age-friendly lens. Aust J Rural Health 2020; 27:298-303. [PMID: 31429143 DOI: 10.1111/ajr.12497] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/12/2018] [Accepted: 12/08/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study investigates how rural community-dwelling older adults' views on what is important in maintaining health and wellbeing align with the eight age-friendly domains proposed by the World Health Organisation, and which domains are most salient. DESIGN Data were gathered through open-ended response postcards distributed using a whole-of-community approach. SETTING The Rural City of Wangaratta, a rural local government area located in north-east Victoria. PARTICIPANTS 262 postcards were returned by rural older adults, carers and family members. MAIN OUTCOME MEASURE Thematic analysis of open-ended responses to the following question: what is important to you as you grow older (or your loved one), in terms of keeping healthy and well? RESULTS Even though all eight age-friendly domains were identified as important for health and wellbeing, community and health services was the most frequently discussed domain, followed by transportation and access to outdoor spaces and buildings. However, individual-level factors, inclusive of personal activities, attitudes and capacities, were also identified as important to rural older adults. CONCLUSION Findings support the use of the World Health Organization's age-friendly city framework in assessing what is important to rural older adults' health and wellbeing, with the community and health services domain most salient. However, individual-level activities, attitudes and capacities must also be considered.
Collapse
Affiliation(s)
- Shaun Hancock
- John Richards Initiative, College of Science, Health and Engineering, La Trobe University, Wodonga, Victoria, Australia
| | - Rachel Winterton
- John Richards Initiative, College of Science, Health and Engineering, La Trobe University, Wodonga, Victoria, Australia
| | - Clare Wilding
- John Richards Initiative, College of Science, Health and Engineering, La Trobe University, Wodonga, Victoria, Australia
| | - Irene Blackberry
- John Richards Initiative, College of Science, Health and Engineering, La Trobe University, Wodonga, Victoria, Australia
| |
Collapse
|
31
|
Richardson D, Jaricha T, Power M, Lewis DA. Team huddles in sexual health clinics improve communication, clinic capacity and flow, and team relationships and well-being. Sex Transm Infect 2019; 96:312. [PMID: 31801896 DOI: 10.1136/sextrans-2019-054337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/25/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Daniel Richardson
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - Tichaona Jaricha
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - Melissa Power
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia.,Westmead Clinical School, University of Sydney, Parramatta, New South Wales, Australia
| |
Collapse
|
32
|
Sluggett JK, Page AT, Chen EYH, Ilomäki J, Corlis M, Van Emden J, Hogan M, Caporale T, Angley M, Hilmer SN, Ooi CE, Bell JS. Protocol for a non-randomised pilot and feasibility study evaluating a multicomponent intervention to simplify medication regimens for people receiving community-based home care services. BMJ Open 2019; 9:e025345. [PMID: 31326924 PMCID: PMC6661559 DOI: 10.1136/bmjopen-2018-025345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Managing medication regimens is one of the most complex and burdensome tasks performed by older people, and can be prone to errors. People living with dementia may require medication administration assistance from formal and informal caregivers. Simplified medication regimens maintain the same therapeutic intent, but have less complex instructions and administration schedules. This protocol paper outlines a study to determine the feasibility of a multicomponent intervention to simplify medication regimens for people receiving community-based home care services. METHODS AND ANALYSIS This is a non-randomised pilot and feasibility study. Research nurses will recruit 50 people receiving community-based home care services. All participants will receive the intervention from a clinical pharmacist, who will undertake medication reconciliation, assess each participant's capacity to self-manage their medication regimen and apply a structured tool to identify opportunities for medication simplification. The pharmacist will communicate recommendations regarding medication simplification to registered nurses at the community-based home care provider organisation. The primary outcome will be a description of study feasibility (recruitment and retention rates, protocol adherence and stakeholder acceptability). Secondary outcomes include the change in number of medication administration times per day, medication adherence, quality of life, participant satisfaction, medication incidents, falls and healthcare utilisation at 4 months. ETHICS AND DISSEMINATION Ethical approval was obtained from the Monash University Human Research Ethics Committee and the community-based home care provider organisation's ethical review panel. Research findings will be disseminated to consumers and caregivers, health professionals, researchers and healthcare providers through the National Health and Medical Research Council Cognitive Decline Partnership Centre and through conference presentations, lay summaries and peer-reviewed publications. This study will enable an improved understanding of medication management and administration among people receiving community-based home care services. This study will inform the decision to proceed with a randomised controlled trial to assess the effect of this intervention. TRIAL REGISTRATION NUMBER ACTRN12618001130257; Pre-results.
Collapse
Affiliation(s)
- Janet Kathleen Sluggett
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Amy Theresa Page
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Esa Y H Chen
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Megan Corlis
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
- Research and Development, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Jan Van Emden
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
- Research and Development, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Michelle Hogan
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
- Research and Development, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Tessa Caporale
- Research and Development, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Manya Angley
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sarah N Hilmer
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
- Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
33
|
van Weel JM, Renehan E, Ervin KE, Enticott J. Home care service utilisation by people with dementia-A retrospective cohort study of community nursing data in Australia. Health Soc Care Community 2019; 27:665-675. [PMID: 30421836 DOI: 10.1111/hsc.12683] [Citation(s) in RCA: 5] [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: 10/10/2017] [Revised: 09/15/2018] [Accepted: 10/15/2018] [Indexed: 06/09/2023]
Abstract
Progressive aged care reforms are shifting dementia care into the community. These efforts have been shown to prevent transition to residential aged care facilities and hospitals. There is a paucity of studies examining the utilisation of home care services for people living with dementia. This study aims to address the current knowledge gap by providing a comprehensive summary of older adults receiving home care and comparing service use for people with and without dementia. A retrospective secondary data analysis was conducted using routine data prospectively collected from a cohort (n = 2,703 with dementia matched to 9,224 without dementia; total 11,927) using a community home nursing service in metropolitan Melbourne, Australia, in 2014. Descriptive statistics compared individuals with and without dementia on client-level demographics and their episode of home care service use. A comparative analysis on select variables was also performed using a conditional Poisson regression to estimate relative risk (RR). Compared to older adults without dementia, people with dementia were more likely to be born overseas (RR 1.10, 95% CI [1.03-1.19]), require an interpreter (RR 1.41, 95% CI [1.26-1.59]), and live with family (RR 1.09 [1.01-1.16]). When examining an individual's episode of care, people with dementia were more likely to require acute care (RR 1.07, 95% CI [1.01-1.14]) and be discharged from home care with personal care services (RR 1.46, 95% CI [1.24-1.72]). People with dementia were less likely to be referred from a hospital (RR 0.73, 95% CI [0.69-0.77]), achieve their home care goals (RR 0.91, 95% CI [0.87-0.94]), or die while in receipt of home care services (RR 0.82, 95% CI [0.72-0.94]). Our findings suggest that people with dementia have different socio-demographic characteristics and interactions with home care services compared to people without dementia.
Collapse
Affiliation(s)
- Joel M van Weel
- Peninsula Health, Department of Medicine, Frankston, VIC, Australia
| | - Emma Renehan
- Bolton Clarke Research Institute, Melbourne, VIC, Australia
| | - Kaye E Ervin
- Department of Rural Health, The University of Melbourne, Shepparton, VIC, Australia
| | - Joanne Enticott
- Bolton Clarke Research Institute, Melbourne, VIC, Australia
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
34
|
Smith T, Cross J, Poland F, Clay F, Brookes A, Maidment I, Penhale B, Laidlaw K, Fox C. Systematic Review Investigating Multi-disciplinary Team Approaches to Screening and Early Diagnosis of Dementia in Primary Care - What are the Positive and Negative Effects and Who Should Deliver It? Curr Alzheimer Res 2019; 15:5-17. [PMID: 28891442 DOI: 10.2174/1567205014666170908094931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/07/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Primary care services frequently provide the initial contact between people with dementia and health service providers. Early diagnosis and screening programmes have been suggested as a possible strategy to improve the identification of such individuals and treatment and planning health and social care support. OBJECTIVE To determine what early diagnostic and screening programmes have been adopted in primary care practice, to explore who should deliver these and to determine the possible positive and negative effects of an early diagnostic and screening programme for people with dementia in primary care. METHODS A systematic review of the literature was undertaken using published and unpublished research databases. All papers answering our research objectives were included. A narrative analysis of the literature was undertaken, with the CASP tools used appropriately to assess study quality. RESULTS Thirty-three papers were identified of moderate to high quality. The limited therapeutic options for those diagnosed with dementia means that even if such a programme was instigated, the clinical value remains questionable. Furthermore, accuracy of the diagnosis remains difficult to assess due to poor evidence and this raises questions regarding whether people could be over- or under-diagnosed. Given the negative social and psychological consequences of such a diagnosis, this could be devastating for individuals. CONCLUSION Early diagnostic and screening programmes have not been widely adopted into primary care. Until there is rigorous evidence assessing the clinical and cost-effectiveness of such programmes, there remains insufficient evidence to support the adoption of these programmes in practice.
Collapse
Affiliation(s)
- Toby Smith
- School of Health Sciences, University of East Anglia, Norwich. United Kingdom
| | - Jane Cross
- School of Health Sciences, University of East Anglia, Norwich. United Kingdom
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich. United Kingdom
| | - Felix Clay
- Peterborough City Hospital, Peterborough. United Kingdom
| | - Abbey Brookes
- School of Health Sciences, University of East Anglia, Norwich. United Kingdom
| | - Ian Maidment
- School of Life and Health Sciences, ARCHA, Aston University, Birmingham. United Kingdom
| | - Bridget Penhale
- School of Health Sciences, University of East Anglia, Norwich. United Kingdom
| | - Ken Laidlaw
- Norwich Medical School, University of East Anglia, Norwich. United Kingdom
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich. United Kingdom
| |
Collapse
|
35
|
Kaushal P, Hewitt O, Rafi A, Piratla M, Maddock SR, Moye B, Chaplin R, Fountoulaki G. Training and service provision for people with intellectual disability and mental illness: the views of psychiatrists. Int J Dev Disabil 2018; 66:67-74. [PMID: 34141368 PMCID: PMC8115549 DOI: 10.1080/20473869.2018.1484014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/30/2018] [Indexed: 06/12/2023]
Abstract
Objectives: The objectives of this mixed methods study are to 1) investigate the knowledge and skills of mainstream psychiatrists in managing patients with Intellectual Disability (ID) and comorbid mental health disorders, 2) assess their perception of the quality and accessibility of services for this population, and 3) establish the local implementation of the Green Light Toolkit. Method: We surveyed mainstream psychiatrists in the Thames Valley region working in general adult, forensic, and older adult services, to ascertain their opinions about their knowledge and skills in managing patients with ID and comorbid mental disorder, as well as quality and accessibility of services. We compared our findings with previous UK and international research. Results: Respondents mirrored views expressed in earlier studies that inpatient care should be provided in dedicated units for people with ID, rather than general adult inpatient wards. Limited resources, training and competence, and lack of collaborative working were highlighted as key barriers to provision of effective care. Conclusion: Psychiatrists broadly support a specialist service model for people with ID. In the UK, specialist psychiatric services for people with ID have been delivered through inpatient and community services, but there is a current shift towards integrating ID with mainstream service models. Participants expressed concern that mainstream services fail to meet the mental health needs of this patient group, and lead to increased patient vulnerability. The Green Light Toolkit was not well known or used within services. A number of ways of improving collaborative care between services are suggested.
Collapse
Affiliation(s)
| | - Olivia Hewitt
- Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | - Amina Rafi
- Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | | | | | - Barbara Moye
- Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | | | | |
Collapse
|
36
|
Ranson D, Ibrahim J. Geriatric Forensic Medicine - A Specialty that can no Longer Wait to be Realised. J Law Med 2018; 26:39-43. [PMID: 30302971] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The rise in the population and the growth in the proportion of the elderly in our population are changing the structure of many of our communities and placing increasing demands on our social and health care services. "Scandals" regarding conditions and standards of care in residential aged care facilities have raised concerns about the regulation, assessment and auditing of these community services for the elderly. At the same time longer working lives change the age factors related to employment opportunities and the cadre of older employees presents a different range of human resource issues and occupational health and safety problems for employers. While there is evidence that an older workforce can bring a wider experience and understanding of critical issues to many work disciplines, ageing practitioners may pose professional regulatory issues for the community when considerations of cognitive and technical/physical ability arise. It is in these settings that the need for a forensic focus on gerontology and medical geriatrics arises.
Collapse
Affiliation(s)
- David Ranson
- Deputy Director, Victorian Institute of Forensic Medicine
| | - Joseph Ibrahim
- Professor, Department of Forensic Medicine, Monash University
| |
Collapse
|
37
|
Arja SB, Arja SB, Chunchu VA, Datla NSV, Bottu A. Students' perceptions on community-based education at Avalon University School of Medicine during the first two years of the program. MedEdPublish (2016) 2018; 7:190. [PMID: 38074603 PMCID: PMC10701824 DOI: 10.15694/mep.2018.0000190.2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Objectives The socio-cultural learning theory can be divided into a social and cultural process. Learner's learning occurs within the context rather than anticipating and preparing for the future context. It may happen in the workplace through apprenticeship, experiential learning, or community-based learning. Community-based education and community services have always been part of the students' volunteer services at Avalon University School of Medicine. The importance of community-based education has led to its recent integration into the curriculum. The objective of this study is to observe the community services in the field and to record the perceptions of students regarding community-based education at Avalon University School of Medicine. Methods This is a qualitative study. The research was conducted in the form of an observational study and framework analysis was done. The community-based education and community services were observed and recorded along with individual interviews. Students from different semesters were selected randomly for the interviews. The interviews were audio-recorded and transcribed. Results All interviewed students (100%) reported that they are involved in community services. 53.8% of students were not able to recognize the health issues of Curacao. 84.6% of students recognized and acknowledged the local health issues after reminding them of the activities conducted in the community services. 84.6% of students believed community services enhanced their clinical skills and increased their confidence in communication skills. Conclusion Community-based education enhances the competency of future physicians in clinical and communication skills.
Collapse
|
38
|
Bellido-Zanin G, Vázquez-Morejón AJ, Martín-Rodríguez A, Pérez-San-Gregorio MÁ. Predictors in use of mental health resources: The role of behaviour problems in patients with severe mental illness. Int J Soc Psychiatry 2017; 63:532-538. [PMID: 28670933 DOI: 10.1177/0020764017716697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND In recent years, more variables are being included in the use of mental health resource prediction models. Some studies have shown that how well the patient can function is important for this prediction. However, the relevance of a variable as important as behaviour problems has scarcely been explored. AIM This study attempted to evaluate the effect of behaviour problems in patients with severe mental illness on the use of mental health resources. METHOD A total of 185 patients at a Community Mental Health Unit were evaluated using the Behaviour Problem Inventory. Later, a bivariate logistic regression was done to identify what behaviour problems could be specific predictors of use of mental health resources. RESULTS The results showed that the general index of behaviour problems predicts both use of hospitalization resources and outpatient attention. Underactivity/social withdrawal is the best predictor of all the different areas. CONCLUSION These results confirm the role of behaviour problems as predictors of the use of mental health resources in individuals with a severe mental illness.
Collapse
Affiliation(s)
| | | | - Agustín Martín-Rodríguez
- 2 Department of Personality, Assessment, and Psychological Treatment, Faculty of Psychology, University of Seville, Seville, Spain
| | - Maria Ángeles Pérez-San-Gregorio
- 2 Department of Personality, Assessment, and Psychological Treatment, Faculty of Psychology, University of Seville, Seville, Spain
| |
Collapse
|
39
|
Ong JJ, Peng M, Zhu S, Lo YRJ, Fairley CK, Kidd MR, Roland M, Jiang S, Wong WCW. Opportunities and barriers to STI testing in community health centres in China: a nationwide survey. Sex Transm Infect 2017; 93:566-571. [PMID: 28844043 DOI: 10.1136/sextrans-2017-053196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/28/2017] [Accepted: 07/27/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND China has strengthened its primary care workforce and implemented a wide network of community health centres (CHCs). However, STI testing and management are not currently included in the 'Essential Package of Primary Health Care in China'. Legislation change to encourage STI service delivery would be important, but it is also critical to determine if there are also provider-related opportunities and barriers for implementing effective STI programmes through CHCs if future legislation were to change. METHODS A national representative survey was conducted between September and December 2015 in a stratified random sample of 180 CHCs based in 20 cities in China. Primary care practitioners (PCPs) provided information on current experiences of STI testing as well as the barriers and facilitators for STI testing in CHCs. Multivariate logistic regression was conducted to determine factors associated with PCPs performing STI testing. RESULTS 3580 out of 4146 (86%) invited PCPs from 158 CHCs completed the survey. The majority (85%, 95% CI 84% to 87%) of doctors stated that STI testing was an important part of healthcare. However, less than a third (29%, 95% CI 27% to 31%) would perform an STI test if the patients asked. Barriers for performing STI testing included lack of training, concerns about reimbursement, concerns about damage to clinics' reputations and the stigma against key populations. Respondents who reported that they would perform an STI test were likely to be younger, received a bachelor degree or higher, received specific training in STIs, believed that STI test was an important part of healthcare or had resources to perform STI testing. CONCLUSIONS There is potential for improving STI management in China through upskilling the primary care workforce in CHCs. Specific training in STIs is needed, and other structural, logistical and attitudinal barriers are needed to be addressed.
Collapse
Affiliation(s)
- Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Minghui Peng
- General Practice Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Shanzhu Zhu
- General Practice Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ying-Ru J Lo
- Division of Communicable Diseases, World Health Organization, Regional Office for the Western Pacific, Manila, The Philippines
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Michael R Kidd
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Martin Roland
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
| | - Sunfang Jiang
- General Practice Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - William C W Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
40
|
Abstract
The National Health Service (NHS) in the UK is evolving to meet the needs of society, but success depends on effective leadership. The World Health Organization identified intersectoral and multidisciplinary working as key to improving the quality and sustainability of the service, highlighting the need for a new leadership style. This article describes how collaborative leadership was used to successfully implement a virtual ward in the primary care setting in south-east Powys, Wales. The author describes the leadership style and addresses strategies used to manage the change process. The journey demonstrates how collaborative leadership and working collectively enabled a new service to be developed, and established a mutual respect for different professionals' roles.
Collapse
|
41
|
Abstract
OBJECTIVES The purpose of this study was to explore oral health experiences from the perspective of older adults' living in community dwellings. The two objectives of this study were to identify facilitators and barriers to oral health care, and to determine how utilization of oral health services compares to utilization of other healthcare services. METHODOLOGY An interpretive descriptive methodology was employed with a purposive sample of 12 adults, aged 70 years or older. The inclusion criterion was English-speaking seniors residing in community dwellings. Community dwellings were defined as any housing outside of long-term care or other supportive living facilities. Semi-structured interviews were 30-80 min, audio-recorded and transcribed verbatim. Three researchers participated in the comparative analysis process to develop codes, generate categories, interpret patterns and construct themes. RESULTS Three central themes surfacing from the data were as follows: life course influences on oral health, transparency in delivery of oral health services and interrelationships between oral health and overall health. CONCLUSIONS Older adults in this study emphasized the value of establishing collaborative and trusting relationships between oral health practitioners and older adults. Oral health practitioners should be clear and transparent when communicating information about oral health costs and be cognizant of different circumstances from childhood to older adulthood that inhibit or promote routine utilization of oral health services. Including oral health services as part of interdisciplinary care teams could help promote understandings of the reciprocal relationship between oral health and general health and improve oral health status for older adults.
Collapse
Affiliation(s)
- K K Khabra
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - S M Compton
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - L P Keenan
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
42
|
Abstract
BACKGROUND Substance misuse is an increasing problem in urban and rural India. The utility of community-based interventions and preventive strategies are increasingly emphasized in this context. The drug de-addiction and treatment center, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, has been running a drug de-addiction and treatment clinic at Kharar Civil Hospital, Kharar, District Mohali, Punjab, since 1998. As part of an effort to enhance this community outreach program, community-based drug awareness and treatment camps have been organized since March 2004 in villages in and around Tehsil Kharar of Mohali. AIM To study the impact of the drug awareness and treatment camps on the attendance of patients at the community outreach drug de-addiction and treatment clinic at Kharar Civil Hospital. METHODS Sociodemographic and clinical variables, including treatment outcome-related variables, of patients attending the clinic at Kharar Civil Hospital, before and after the camps were compared. DISCUSSION AND CONCLUSION The study showed a positive impact on drug awareness and treatment camps held in the community on outpatient attendance at a community outreach clinic, with attendance increasing more than 1.8 times.
Collapse
Affiliation(s)
- Om Prakash Giri
- Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Bharadwaj
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Misra
- Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Paramanand Kulhara
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
43
|
Herfjord JK, Heggestad T, Ersland H, Ranhoff AH. Intermediate care in nursing home after hospital admission: a randomized controlled trial with one year follow-up. BMC Res Notes 2014; 7:889. [PMID: 25487353 PMCID: PMC4295396 DOI: 10.1186/1756-0500-7-889] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 03/03/2014] [Accepted: 11/28/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Intermediate care is intended to reduce hospital admissions and facilitate early discharge. In Norway, a model was developed with transfer to intermediate care shortly after hospital admission. Efficacy and safety of this model have not been studied previously.In a parallel-group randomized controlled trial, patients over 70 years living at home before admission were eligible if clinically stable, without need for surgical treatment and deemed suited for intermediate care by attending physician. Intervention group patients were transferred to a nursing home unit with increased staff and multidisciplinary assessment, for a maximum stay of three weeks. Patients in the control group received usual care in hospital. Blinding to group assignment was not possible.The primary outcome was number of days living at home in a follow-up period of 365 days. Secondary outcomes were mortality, hospital admissions, need for residential care and home care services. Data were obtained from patient records and registers. RESULTS 376 patients were included, 74% female and mean age 84 years. There was no significant differences between intervention (n=190) and control group (n=186) for number of days living at home (253.7 vs 256.5, p=0.80) or days in hospital (10.4 vs 10.5, p=0.748). Intervention group patients spent less time in nursing home (40.6 days vs. 55.0, p=0.046), and more patients lived independently without home health care services (31.6% vs 19.9%, p=0.007). For orthopaedic patients (n=128), mortality was higher in the intervention group; 15 intervention patients and 7 controls died (25.1% vs 10.3%, p=0.049). There was no significant difference in one-year mortality for medical patients (n=150) or the total study population. CONCLUSIONS This model of rapid transfer to intermediate care did not significantly influence number of days living at home during one year follow-up, but reduced demand for nursing home care and need for home health care services. In post-hoc analysis mortality was increased for orthopedic patients. TRIAL REGISTRATION The trial was registered 26. July 2013 at Current Controlled Trials and assigned with registration number ISRCTN21608185.
Collapse
Affiliation(s)
- Jo Kåre Herfjord
- />County Governor of Hordaland, Postboks 73105020, Bergen, Norway
| | - Torhild Heggestad
- />Haukeland University Hospital, Jonas Lies vei 63, 5021 Bergen, Norway
| | - Håkon Ersland
- />Haukeland University Hospital, Jonas Lies vei 63, 5021 Bergen, Norway
| | - Anette Hylen Ranhoff
- />Department of Clinical Science, University of Bergen and Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Hospital, Ulriksdal 8, 5009 Bergen, Norway
| |
Collapse
|
44
|
Brondani MA, Pattanaporn K, Aleksejuniene J. How can dental public health competencies be addressed at the undergraduate level? J Public Health Dent 2014; 75:49-57. [PMID: 25234583 DOI: 10.1111/jphd.12070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To discuss the extent to which an undergraduate dental module addresses dental public health competencies via its different learning pedagogies and to explore the relevance of students' written reflections on these dental public health competencies. METHODS This article uses a literature review to situate the extent to which dental public health competencies are addressed by the University of British Columbia undergraduate dental module entitled "Professionalism and Community Services" (PACS). It also uses students' written individual self-reflections (between 100 and 500 words) on community service learning activities to critically illustrate how dental public health competencies support their learning. RESULTS The PACS dental module is delivered to undergraduate students in all 4 years, more than 190 in total, and addresses six dental public health competencies, including oral health promotion, ethics, and evidence-based practice. The multifaceted pedagogical approach employed to discuss aspects of dentistry related to dental public health includes guest lectures, community activities, small group activities, self-reflection, and reports. CONCLUSIONS Given the falling number of dental public health professionals in North America, the discussed undergraduate pedagogy aims to sensitize future dentists to a career focused on dental public health. Through reflections, students pondered ideas related to dental public health; they also engaged in developing meaningful activities in various underserved communities. Further studies are needed to evaluate the influence of this community-based curriculum upon students' practice choice.
Collapse
Affiliation(s)
- Mario A Brondani
- Faculty of Dentistry, Department of Oral Health Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | |
Collapse
|
45
|
Abstract
The primary aim of this paper is to illustrate the strategic and ecological nature of implementation. The
ultimate aim of implementation is not dissemination but sustainability beyond the implementation effort. A
case study is utilized to illustrate these broad and long-term perspectives of sustainable implementation
based on qualitative analyses of a 10-year implementation effort. The purveyors aimed to develop selective
community prevention services for children in families burdened by parental psychiatric or addictive problems.
Services were gradually disseminated to 23 sites serving 40 municipalities by 2013. Up to 2013, only one site
terminated services after initial implementation. Although many sites suspended services for shorter periods,
services are still offered at 22 sites. This case analysis is based on project reports, user evaluations,
practitioner interviews, and service statistics. The paper focuses on the analyses and strategies utilized to
cope with quality decay and setbacks as well as progress and success in disseminating and sustaining the
services and their quality. Low-cost multilevel strategies to implement services at the community level were
organized by a prevention unit in child psychiatry, supervised by a university department (purveyors). The
purveyors were also involved in national and international collaboration and development. Multilevel
strategies included manualized intervention, in-practice training methods, organizational responsibility,
media strategies, service evaluation, staff motivation maintenance, quality assurance, and proposals for new
law regulations. These case history aspects will be discussed in relation to the implementation literature,
focusing on possible applicability across settings.
Collapse
Affiliation(s)
- Tormod Rimehaug
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway ; Child and Psychiatry Department, Nord-Trondelag Health Trust, Levanger, Norway
| |
Collapse
|
46
|
Vanderboom CE, Holland DE, Lohse CM, Targonski PV, Madigan EA. Enhancing patient-centered care: pilot study results of a community care team intervention. West J Nurs Res 2013; 36:47-65. [PMID: 23735711 DOI: 10.1177/0193945913490841] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 11/15/2022]
Abstract
Health care reform focuses on primary care and development of Health Care Homes to improve patient-centered chronic illness care. This pilot study evaluated a community care team intervention that linked chronically ill older patients, support persons, and nurse care coordinators from a Health Care Home with community resources using an adaptation of the Wraparound process. A pragmatic clinical trial design was used. Patient-centered chronic illness care; physical, mental, and social health; service use; and study feasibility were evaluated. Differences between groups were compared using two-sample t, Wilcoxon rank sum, chi-square, or Fisher's exact tests. At 3 months, the intervention group reported higher patient-centered chronic illness care (mean total Patient Assessment of Chronic Illness Care change scores were 0.39 for the intervention group and -0.11 for the control group, p = .03). Results indicate that the integrated community care team intervention is a promising strategy to support patient-centered chronic illness care.
Collapse
|
47
|
Abstract
For over a decade, organizations have attempted to include the measurement and reporting of health outcome data in contractual agreements between funders and health service providers, but few have succeeded. This research explores the utility of collecting health outcomes data that could be included in funding contracts for an Australian Community Care Organisation (CCO). An action-research methodology was used to trial the implementation of outcome measurement in six diverse projects within the CCO using a taxonomy of interventions based on the International Classification of Function. The findings from the six projects are presented as vignettes to illustrate the issues around the routine collection of health outcomes in each case. Data collection and analyses were structured around Donabedian's structure-process-outcome triad. Health outcomes are commonly defined as a change in health status that is attributable to an intervention. This definition assumes that a change in health status can be defined and measured objectively; the intervention can be defined; the change in health status is attributable to the intervention; and that the health outcomes data are accessible. This study found flaws with all of these assumptions that seriously undermine the ability of community-based organizations to introduce routine health outcome measurement. Challenges were identified across all stages of the Donabedian triad, including poor adherence to minimum dataset requirements; difficulties standardizing processes or defining interventions; low rates of use of outcome tools; lack of value of the tools to the service provider; difficulties defining or identifying the end point of an intervention; technical and ethical barriers to accessing data; a lack of standardized processes; and time lags for the collection of data. In no case was the use of outcome measures sustained by any of the teams, although some quality-assurance measures were introduced as a result of the project.
Collapse
Affiliation(s)
- Susan A Nancarrow
- School of Health and Human Sciences, Southern Cross University, East Lismore, NSW, Australia
| |
Collapse
|
48
|
Tucker H, Burgis M. Integrating Care in Norfolk (ICN)—A case study on a two-year programme to improve integrated working between primary care, community health services and social care in six localities. Int J Integr Care 2012. [PMCID: PMC3617786] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The ICN programme was designed to test ways of integrating health and social care services in six localities with a population of nearly 300,000 residents with the objective of improving patient and staff satisfaction, and reducing demands on secondary care. The ICN programme is one of 16 national integrated care pilots in England. Data were sourced from questionnaires, focus groups, interviews, and recorded service activity. A core group of practitioners in each locality focused on redesigning services according to their local circumstances in order to improve care for adults and older people with complex care needs. Local arrangements included developing multidisciplinary teams based in GP practices, with coordinators operating in a local hub. 845 patients received ICN interventions. The study showed high levels of satisfaction from patients and staff, with surveyed staff being unanimous that this way of working should continue. A study of 12 of the 32 GP practices that engaged early in the programme showed a 31% reduction in unplanned admissions to hospital between the first and second year of the pilot. Issues included the time required for building trust and communication, the importance of building a platform for integrating care locally and extending to a whole-system approach.
Collapse
Affiliation(s)
- Helen Tucker
- Project Consultant “Integrating Care in Norfolk”, Norfolk County Council and NHS Norfolk; Researcher University of Warwick, UK
| | - Mark Burgis
- Senior Project Manager “Integrating Care in Norfolk”, Norfolk County Council and NHS Norfolk—currently Chief Executive Officer Mid Norfolk Consortium, UK
| |
Collapse
|
49
|
Stirling C, Leggett S, Lloyd B, Scott J, Blizzard L, Quinn S, Robinson A. Decision aids for respite service choices by carers of people with dementia: development and pilot RCT. BMC Med Inform Decis Mak 2012; 12:21. [PMID: 22429384 PMCID: PMC3315425 DOI: 10.1186/1472-6947-12-21] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [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: 08/23/2011] [Accepted: 03/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to make decisions about treatment options. However, they are rarely utilised to help those with chronic or age related conditions to make decisions about care services. Decision aids should also be useful for carers of people with decreased decisional capacity. These carers' choices must balance health outcomes for themselves and for salient others with relational and value-based concerns, while relying on information from health professionals. This paper reports on a study that both developed and pilot tested a decision aid aimed at assisting carers to make evaluative judgements of community services, particularly respite care. METHODS A mixed method sequential study, involving qualitative development and a pilot randomised controlled trial, was conducted in Tasmania, Australia. We undertook 13 semi-structured interviews and three focus groups to inform the development of the decision aid. For the randomised control trial we randomly assigned 31 carers of people with dementia to either receive the service decision aid at the start or end of the study. The primary outcome was measured by comparing the difference in carer burden between the two groups three months after the intervention group received the decision aid. Pilot data was collected from carers using interviewer-administered questionnaires at the commencement of the project, two weeks and 12 weeks later. RESULTS The qualitative data strongly suggest that the intervention provides carers with needed decision support. Most carers felt that the decision aid was useful. The trial data demonstrated that, using the mean change between baseline and three month follow-up, the intervention group had less increase in burden, a decrease in decisional conflict and increased knowledge compared to control group participants. CONCLUSIONS While these results must be interpreted with caution due to the small sample size, all intervention results trend in a direction that is beneficial for carers and their decisional ability. Mixed method data suggest the decision aid provides decisional support that carers do not otherwise receive. Decision aids may prove useful in a community health services context. TRIAL REGISTRATION NUMBER ISRCTN: ISRCTN32163031.
Collapse
Affiliation(s)
- Christine Stirling
- Wicking Dementia Research and Education Centre, Menzies Research Institute, University of Tasmania, Private Bag 121, Hobart, TAS, Australia 7000
- School of Nursing and Midwifery, University of Tasmania, 24 Campbell St, Tasmania, Australia
| | - Susan Leggett
- Wicking Dementia Research and Education Centre, Menzies Research Institute, University of Tasmania, Private Bag 121, Hobart, TAS, Australia 7000
| | - Barbara Lloyd
- Wicking Dementia Research and Education Centre, Menzies Research Institute, University of Tasmania, Private Bag 121, Hobart, TAS, Australia 7000
| | - Jenn Scott
- School of Psychology, University of Tasmania, Sandy Bay Campus, Tasmania, Australia
| | - Leigh Blizzard
- Menzies Research Institute, University of Tasmania, 17 Liverpool St, Hobart, Australia
| | - Stephen Quinn
- Flinders Clinical Effectiveness, Flinders University, Adelaide, Australia
| | - Andrew Robinson
- Wicking Dementia Research and Education Centre, Menzies Research Institute, University of Tasmania, Private Bag 121, Hobart, TAS, Australia 7000
- School of Nursing and Midwifery, University of Tasmania, 24 Campbell St, Tasmania, Australia
| |
Collapse
|
50
|
Brookman-Frazee LI, Taylor R, Garland AF. Characterizing community-based mental health services for children with autism spectrum disorders and disruptive behavior problems. J Autism Dev Disord 2010; 40:1188-201. [PMID: 20204690 PMCID: PMC2943583 DOI: 10.1007/s10803-010-0976-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
This study describes the characteristics of children with autism spectrum disorders (ASD) with disruptive behavior problems served in community-based mental health clinics, characterizes psychotherapy process and outcome, and examines differences between children with ASD and a non-ASD comparison group. Results indicate that children with ASD served in this setting are high functioning and diagnostically complex. Certain research-based behavioral and cognitive behavioral psychotherapeutic strategies were observed frequently, while parent training strategies and active teaching strategies were observed less frequently. The intensity or thoroughness with which strategies were pursued was relatively low. Outcome analyses indicate improvement in child symptoms and family functioning. Treatment delivery and outcome were similar for children with and without ASD. These findings represent the first detailed observational data characterizing community-based mental health services for children with ASD.
Collapse
Affiliation(s)
- Lauren I Brookman-Frazee
- Child and Adolescent Services Research Center, Rady Children's Hospital, 3020 Children's Way MC 5033, San Diego, CA 92123,
| | | | | |
Collapse
|