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PubMed2000

The measurement of a case manager's workload burden.

OBJECTIVE: The aim of this activity was to develop an appropriate scale to accurately assess the level of clinical load carried by each case manager at the Royal Brisbane Hospital Integrated Mental Health Service. METHOD: A survey of, and consultation with, case managers over a period of 15 months was used to gather data and modify the monitoring tool for future use in the service. RESULTS AND CONCLUSION: Analysis of the data gathered revealed the level of case managers' work load burden and the depth of need required by clients. Professionally the Clinical Load Monitoring scores have been used in the allocation of additional cases for case management and in the supervision by discipline seniors. Service management has used the Clinical Load Monitoring Scale by dividing individual caseloads into low, medium and heavy service users - with low service users being further investigated for discharge from the service. Heavy service users were assessed for entry into more intensive treatment areas.

Burnout, Professional↗

PubMed1998

The meaning of patient satisfaction: an explanation of high reported levels.

The social policy background to the proliferation of patient satisfaction surveys is a desire for increased patient representation and participation. Within this context, it is assumed that satisfaction surveys embody patients' evaluations of services. However, as most surveys report high satisfaction levels, the interpretation of satisfaction as the outcome of an active evaluation has been called into question. The aim of this study is to identify whether and how service users evaluate services. This was made possible through unstructured in-depth interviews with users of mental health services and through more structured discussion around their responses on a patient satisfaction questionnaire (CSQ 18B) whose psychometric properties has been well documented. Twenty-nine people with current or recent contact with mental health services within the British National Health Service were interviewed. The data revealed that service users frequently described their experiences in positive or negative terms. However, the process by which these experiences were transformed into "evaluations" of the service was complex. Consequently, many expressions of "satisfaction" on the CSQ 18B hid a variety of reported negative experiences. An explanation for this lack of correspondence is outlined.

Bias↗

PubMed2005

Happy with your care?

With the recent rise of consumerism within health care, the views of service users are becoming increasingly important. The National Service Framework for Mental Health (DoH 1999) identifies assertive outreach as a strategy to engage people with severe and enduring mental illness, who traditionally lose contact with services. Assessing the views of service users is not a new strategy for service evaluation, but in relation to assertive outreach in the United Kingdom is relatively untested. A postal client satisfaction survey was undertaken as a means of enquiry, in order to ascertain the effectiveness of the Preston Assertive Outreach service from a service user perspective after its first year of operation. The team offers a service based upon the PACT (Program of Assertive Community Treatment) model. An evaluation study of 36 questionnaires produced a return rate of 56% (21 returns). The results showed a fairly high level of client satisfaction with the service provided. Client involvement in treatment was the area of service evaluated least favourably by the service users, with General satisfaction showing the highest level of client satisfaction. From the outcome of the study it appears there are potential benefits in utilizing feedback from service users' to inform future service provision.

Adult↗

PubMed2005

General medical and pharmacy claims expenditures in users of behavioral health services.

OBJECTIVE: To quantify the magnitude of general medical and/or pharmacy claims expenditures for individuals who use behavioral health services and to assess future claims when behavioral service use persists. DESIGN: Retrospective cost trends and 24-month cohort analyses. SETTING: A Midwest health plan. PARTICIPANTS: Over 250,000 health plan enrollees during 2000 and 2001. MEASUREMENTS: Claims expenditures for behavioral health services, general medical services, and prescription medications. MAIN RESULTS: Just over one tenth of enrollees (10.7%) in 2001 had at least 1 behavioral health claim and accounted for 21.4% of total general medical, behavioral health, and pharmacy claims expenditures. Costs for enrollees who used behavioral health services were double that for enrollees who did not use such services. Almost 80% of health care costs were for general medical services and medications, two thirds of which were not psychotropics. Total claims expenditures in enrollees with claims for both substance use and mental disorders in 2000 were 4 times that of those with general medical and/or pharmacy claims only. These expenditures returned to within 15% of nonbehavioral health service user levels in 2001 when clinical need for behavioral health services was no longer required but increased by another 37% between 2000 and 2001 when both chemical dependence and mental health service needs persisted. CONCLUSIONS: The majority of total claims expenditures in patients who utilize behavioral health services are for medical, not behavioral, health benefits. Continued service use is associated with persistently elevated total general medical and pharmacy care costs. These findings call for studies that better delineate: 1) the interaction of general medical, pharmacy, and behavioral health service use and 2) clinical and/or administrative approaches that reverse the high use of general medical resources in behavioral health patients.

Adolescent↗

PubMed1997

The chief scientist reports ... co-ordination of care on discharge from hospital into the community for patients with HIV/AIDS in Lothian.

OBJECTIVE: To document service use by people living with HIV/AIDS discharged from hospital, to identify gaps and overlaps in service provision after discharge, and to evaluate liaison between hospital-based and community-based services. DESIGN: Four week follow-up diary and interview study of service users, and interview/questionnaire study of service providers. SETTING: Services used by people discharged from the wards of two units of two Lothian hospitals. SUBJECTS: All patients with HIV infection admitted to the wards of two units of two Lothian hospitals from October 1992 to February 1993, and their service providers. RESULTS AND CONCLUSION: General practitioners were the most contacted service post discharge, but general practitioners did not appear to play a co-ordination role in service provision. Liaison on discharge was found to be effective in terms of continuity of care in most cases; and from a service user perspective, liaison between hospital and primary care agencies did not appear a major concern. The majority of hospital discharges were organised in a setting with a large number of services, with complex communication patterns and informal procedures of discharge arrangements. This created uncertainty among service providers as to the arrangements which had been made, and fear and anxiety that they fall through. On the other hand, the informality of discharge procedures also ensured flexibility and responsiveness to unexpected events and changes in service users' circumstances and was a vital factor in continuity of care experienced by them. A more important issue for service users was the poor integration of services concerned with social/material support in the system of medical and emotional care.

Adult↗

PubMed2001

Profile of Community Mental Health Service Needs in the Moretele District (North-West Province) in South Africa.

BACKGROUND: The emergence of democracy in South Africa led to a need to transform all public structures, including the health care system. The aim has been to transform these structures in order to bring them in line with the new culture of human rights. Transformation of the whole health care system is motivated by a number of key objectives, which include achieving equity in resource allocation and health service delivery, developing primary health care infrastructure and decentralising services to promote community participation. AIMS OF THE STUDY: In the context of de-institutionalising mental health services in South Africa, this study aimed to investigate community mental health service needs of mental health service users and that of their families in the Moretele district, North-West province, South Africa. METHODS: The study was conducted in three clinics situated in three different communities in the Moretele district. Data collection consisted of : 147 clinical record reviews, 105 interviews with patients followed by a joint interview with a family member, 83 interviews with caregivers and eight interviews with community key informants (traditional healers, a civic leader, a councillor, a retired teacher, and a physician). RESULTS: The majority of service users were males (54%). The mean age was 41 years and 63% had completed primary schooling.Patients were recorded as having only one of two primary diagnoses, namely schizophrenia (57%) or epilepsy (41%). However, a review of prescribed drugs and caregiver interviews showed that there was a presence of mood disorders among service users. The local hospital was service users primary entry point into the mental health care system, followed by traditional healers (30%). Interviews with service users, service providers and caregivers reveal limited knowledge of patient illness. Nevertheless, service users who had epilepsy were more likely to provide details of their illness than those with mental illness. Above half of service users had basic social skills such as bathing, eating, washing and using public transportation independently. Feelings of loneliness and isolation were common among service users in the community; seventy nine percent (79%), for example spent their days entirely in their homes. Only 7% reported contact with friends. Experiences of community discrimination and exploitation of people with mental illness were reported in key informant interviews and by service users themselves. DISCUSSION: The main community mental health service needs identified in this study were: (i) Improved quality of mental health services at clinics. (ii) Better co-ordination of services (clinic, hospital, social work and traditional healers) and removal of barriers to health service utilisation. (iii) Alleviation of the social isolation of mental health service users by building on existing community structures and individuals willing to engage in partnerships with service providers. The authors indentify a need to train primary health care providers in mental health in order to promote the adequate diagnosis and detection of common psychiatric illnesses.They also point out the need for social support interventions to enable people with mental illness to deal with loneliness and isolation and a need for psycho-educational programmes to make patients and caregivers better informed about mental illness.

Journal Article↗

PubMedDate not supplied

Issues in user feedback on health services for elderly people.

This article highlights a number of difficulties experienced when collecting consumer feedback from elderly service users and offers suggestions as to how many of these problems can be overcome. Structured interviews would appear to provide the most reliable form of feedback for this client group. The importance of good communication and the fact that ageist and stereotypical attitudes need to be overcome before effective feedback can occur is emphasized. Finally, more research needs to be carried out on elderly clients' expectations of health care and which factors make the health service a positive or negative experience for them.

Aged↗

PubMed2004

An evaluation of dependency assessment: experiences of staff, patients and carers in a UK hospice.

AIM: To evaluate the experiences of health-care professionals, service users and carers of service users from a UK hospice in relation to dependency assessment. DESIGN: Qualitative evaluation. SAMPLE: Purposive, convenience sample of hospice staff, patients receiving hospice services and carers of patients receiving hospice services. METHODS: Focus group interviews with hospice staff and carers of hospice service users. Individual interviews with patients. RESULTS: Staff felt the tool used produced inaccurate results, in part because of omissions in content. They did not perceive the data produced affected working practice, e.g. staffing levels. Patients described unobtrusive assessment and stated their needs were met. Carers reported feelings of isolation. They also described differing information and support needs from the patients. CONCLUSION: Further research is required to improve the validity of dependency data collection. Further investigation of carer assessment is also justified.

Aged↗

PubMed2005

Homecare service perspective in Tuscany: vision and new user centred services.

"With medical knowledge expanding every day, no physician can keep up without help. By using high-tech medical communication, high-performance computers, high resolution video, and fibre-optic information "superhighways," we have been able to put the entire world of medical science at the fingertips of even the most isolated rural family doctor." [1] This quote by a former Surgeon General encapsulates the promise and potential for healthcare technology. Service organization and stakeholders' commitment are the real crucial issues for actual e-Health services deployment. In such a contest Homecare services start playing such a role of services integration and new care models development.

Biomedical Technology↗

PubMedDate not supplied

The Gospel Oak project 1987-1990: provision and use of community services.

This longitudinal survey of elderly people examines morbidity and service usage. 705 elderly people who lived in their own homes were interviewed as part of the Gospel Oak project in 1987/88, and in 1990, 524 (74.3%) were re-interviewed--90 (12.8%) had died, 51 (7.2%) had moved and 40 (5.7%) refused a follow-up interview. The results indicate that 60% of residents (1987/88 and 1990) had been in contact with community services within the month before the survey. Respondents with depression were mostly in contact with the health service, those with dementia were in contact with social services. Long-term activity-limited people had high contact with both services, although this finding was less likely among newly activity-limited people. Multiple service-users from the first survey were likely to be either dead, or high service-users in 1990. Low service-users tended to continue to be low service-users. New users were generally living alone, aged around 70 years and had been relatively healthy previously. Respondents who stopped using services were generally younger, mostly women, and possibly depressed. People who had never been service-users, were generally younger and healthier. Information on community services performance is inadequate to ensure targeted, efficient services, and this survey gives detailed information to help planning and resource allocation.

Aged↗

PubMed2001

Substance use, need, and demand for substance user treatment services in patients treated for sexually transmitted diseases in michigan.

The association between substance use and communicable diseases, and the need for substance user treatment services for patients treated for communicable diseases, is well documented. This study builds upon this knowledge in that it quantifies the need and demand for substance user treatment services in a large population of patients treated for communicable diseases, specifically, sexually transmitted diseases (STDs), an area in which there is insufficient research published in the literature, but which is essential for policy development. More than 1700 patients treated for STDs in publicly funded clinics in Michigan between 1994-1995 were interviewed about their substance use, consequences of use and demand for substance user treatment services. Results indicated that the rates of substance use and demand for substance user treatment services were significantly higher among persons encountered in the STD clinics compared to the Michigan general adult population; however, a large proportion of STD patients determined to need substance user treatment services according to DSM-III-R criteria for "substance dependence" and "abuse" did not report ever receiving it. These results are followed by a discussion of possible policy implications for planning for substance user treatment services for patients treated for STDs in publicly funded clinics and suggestions for further research.

Adolescent↗

PubMed1993

Cooperatives as a social enterprise in Italy: a place for social integration and rehabilitation.

This article analyses the history and development of an integrated cooperative established in 1981 in northern Italy. Integrated cooperatives, otherwise known as social enterprises, are among the most interesting activities developed in the area of social assistance and rehabilitation in recent years in Italy. In particular, they acquired relevance in the care of mentally disordered people by providing them with job opportunities, which is an important rehabilitative and integrative factor. The aim of social enterprises is two-fold. They have the economic goal of offering remunerative work just as any other commercial enterprise, as well as the social mandate of promoting the physical, social, and mental health of their members. A positive coexistence between market competition and rehabilitation is therefore constantly pursued. This research aimed at analysing the working and social experience of people employed by the cooperative during its 10-year life. The study was limited to those who had a social or health problem when entering the cooperative. The investigation was promoted by cooperative members, who felt the need to document their experience and to undertake initiatives towards evaluating the rehabilitative value of the social enterprise. The results show that cooperative members come from different marginalized areas of social and health distress, of which the two largest are social service users and psychiatric service users. There is a noticeable turn-over rate, which underlines one function of the cooperative as being a transitional working context from which users can gain access to other more rewarding job opportunities in the labour market.

Adult↗

PubMed2006

Developing inclusive partnerships: user-defined outcomes, networking and knowledge--a case study.

Two major developments have been associated with the reorientation of United Kingdom health and social care policy and provision in recent years, placing a new emphasis on: quality and 'outcome' measures; and service user (and public and patient) involvement. These issues have become central to health and social care, representing expressions of the shift in political and ideological interest in public policy. However, these two strands of development have tended to be treated as discrete discourses and have developed separately in policy. Nevertheless, it can hardly be assumed that what policy makers, service planners, providers and purchasers would value and prioritise as good quality would necessarily coincide with what service users would want. Developing effective partnership working needs to go beyond considerations of organisations and professional groupings, and fully involve service users as one of the key stakeholders. This paper describes the findings of three projects undertaken by Shaping Our Lives. These studies confirmed that service-user concepts of outcomes and quality may differ significantly from those currently employed; moreover, service users are able to offer a complex and sophisticated model of what outcome measures might look like if they were centrally involved in their definition and application. Nevertheless, service users currently have little impact in defining and influencing quality outcomes. The projects also highlight the importance of networking and knowledge sharing for service users and user organisations in their ability to influence policy definitions of quality, and a number of the barriers and obstacles which undermine this process. The paper concludes with two proposals which, considered together, offer the basis for taking forward effective and inclusive partnerships and developing measures for quality consistent with the rights and preferences of service users themselves. They are an essential complement to broader efforts and strategies to develop effective partnerships in health and social care.

Health Services Administration↗

PubMed1996

Men with learning disabilities who have sex with men in public places: mapping the needs of services and users in south east London.

This survey investigated the prevalence of men with learning disabilities who have sex with men in public places in three south east London boroughs. The work was administered through contact with providers of services for people with learning disabilities and was commissioned by the local health authority. It represents the first example of needs assessment work on this theme. Service responses to risk assessment and risk management in relation to HIV and the sexual behaviour of male service users were explored. The survey identified 13 services where this was a management or practice issue, and 16 and 18 men for whom this behaviour definitely or possibly applied. This paper reports the findings of the survey and identifies issues relevant to commissioning and providing services for people with learning disabilities.

Adolescent↗

PubMed1999

Determinants of users' satisfaction with primary health care settings and services in Saudi Arabia.

OBJECTIVE: To identify the components of primary health care that cause most concern to service users and to identify socio-demographic and other factors associated with satisfaction among the users of primary health care centres. DESIGN: Interviews conducted by well-trained interviewers with a random sample of heads of households. The questionnaires were composed of questions that measure the extent of satisfaction with settings and services in the primary health care centres using a 5-point rating scale from very satisfied to very dissatisfied. SETTING: The community of Qateef, eastern Saudi Arabia. STUDY PARTICIPANTS: A sample of 802 households representing 838 families was chosen randomly from the housing lists of the primary health care centres in Qateef. There were 40 vacant houses and nine refusals. Thus the number of heads of households actually interviewed was 789. RESULTS: Waiting area structure, confidentiality measures and environmental structure were the areas that caused most concern to service users. The factors that showed the greatest association with satisfaction were the type of the primary health care centre building (purpose-built or rented), literacy status of the household head (literate or illiterate), the extent of the primary health care centre utilization (regular or infrequent). Surprisingly, age showed no association when other characteristics of the respondents were adjusted for, and sex was less important than in other studies. CONCLUSION: How regular the respondent was in using his or her primary health care centre was more predictive in deciding the extent of satisfaction with the various components in the study than the other variables. Socio-demographic factors played minor roles in deciding the extent of satisfaction, although each had a deciding role with one or more, but not all, components.

Adolescent↗

PubMed2003

Reflecting together: developing a new strategy for continuous user involvement in mental health nurse education.

This paper explores the first issues encountered when establishing a method of service user involvement in the preparation of a cohort of mental health nursing students during their branch programme. The method involved the creation of a group of service users and students whose purpose was to jointly reflect upon mental health issues. To do this students are expected to use their experience from practice placements and the service users to use their experiences as recipients of mental health services. This approach is being investigated through research utilizing an evaluative case study with features of action research incorporated into the design. The findings to date, which concern the process of negotiation, pre-study attitudinal survey and the first group process, will be presented. This will offer mental health professionals the opportunity to gain insight into one approach of actively involving service users in programmes of higher education over a sustained period of time. Reflection on practice themes will include: collaborative strategy, evaluative case study, education, mental health nursing, reflection on practice, and service-user involvement.

Education, Nursing↗

PubMed2004

Service providers' perception of affective influences on decision-making about treatments for chronic pain.

PURPOSE: Service providers working with people who have complex health problems like chronic pain are considered at particular risk from the heavy emotional content of these interactions (frustration, guilt, hostility). For the good of service users and in the interests of healthcare workers' own health it is important for them to employ reflective practice acknowledging these issues. Service providers are inculcated to negate the affective domain of their practice despite the growing awareness that wellbeing can no longer be envisioned as a linear (cause and effect) process divorced from socio-cultural influences and attendant values and beliefs. The aim of this report is to examine to what degree service users (SU) and service providers (SP) believe their decisions about treatment importance are influenced by self-image and emotion. DESIGN: These results are extrapolated from a larger study based on a postal questionnaire that went to members of the Pain Society (UK Chapter of IASP) and service users belonging to chronic pain support groups in the North-West of England. The question of interest in this report asked participants to identify their level of agreement with statements about how four themes influence their decision-making about whether a treatment is important. The themes (coherence, purposiveness, self-image and affect) arise from Chapman's model of consciousness and pain. RESULTS: Only 20.5% of service providers rated the influence of self-image (what someone like me would think) as 3 (mostly) or 4 (completely). Service provider rating for the influence of affect (how this treatment makes me feel) were similarly low with only 19.4% of respondents selecting a rating of 3 or 4. In marked contrast, 73.3% of the service users selected self-image and 92.9% selected affect as a strong influence. CONCLUSION: Service providers felt that affect and self-image had little influence on their decision-making. However, there is growing evidence in the literature to suggest that it is not possible, nor preferable, to divorce emotion from the clinical encounter.

Adult↗

PubMed1987

Planning for end user search services in the health sciences library.

End user searching now has the potential for becoming a new reference service in health sciences libraries. No longer viewed simply as a fad, end user searching is contemplated by medical reference librarians for implementation within the information services department. For the most part these services have centered around educational and training sessions. Planning for a more detailed service program is discussed with an outline of issues and concerns. Items that should be discussed in the planning process include costs, searching environment, equipment, telephone, service placement, search system selection, policies, publicity and training. A case report is also presented as an example of implementing a limited end user search service.

Computer User Training↗