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Providing continuity of care for people with severe mental illness- a narrative review.

BACKGROUND: Service users and providers have stated that delivering continuity of care to people with severe mental illness should be a service priority. We reviewed literature on continuity of care for people with severe mental illness (SMI) in order to identify factors that promote and impede this process. METHOD: A systematic search of electronic databases, sources of grey literature and contact with experts in the field. Two reviewers independently rated all papers for possible inclusion. Data extracted from papers formed the basis of a narrative review. RESULTS: We identified 435 papers on continuity of care, of which 60 addressed the study aims. Most did not define continuity of care. Available evidence suggests that assertive community treatment, case management, community mental health teams and crisis intervention reduce the likelihood of patients dropping out of contact with services. CONCLUSIONS: Evidence on which to base services that enhance continuity of care for people with SMI is limited because previous research has often failed to define continuity of care or consider the patient's perspective.

Acute Disease↗

Assessing the new public management: the case of the National Health Service.

AIM: This paper reviews the origins, core principles and impact of New Public Management (NPM) in the UK public services, with particular attention paid to the emergence of NPM in the National Health Service (NHS). BACKGROUND: NPM represents a distinct break from traditional forms of public sector administration. Whilst its origins are grounded in economic crisis and New Right ideology, NPM philosophies and practices have since found wider acceptance. ORIGINS OF INFORMATION: Selective review of key journal papers, books and policy documents. KEY ISSUES: NPM is characterized by: managers being 'free to manage'; public sector disaggregation; competition; concern for efficiency; concern for outcomes; concern for quality; individualism rather than collectivism; and identification of the public service user as 'customer', 'consumer' or 'citizen'. CONCLUSIONS: NPM has taken root in the NHS. Future reform of the health service is likely to modify some aspects of NPM, though many of the core themes of NPM in the NHS look likely to remain for the foreseeable future.

Decision Making, Organizational↗

Perceived barriers to mental health service use among individuals with mental disorders in the Canadian general population.

BACKGROUND: Eliminating barriers to care is important for improving health service use. However, the barriers to mental health care have not been well investigated. OBJECTIVES: This study was designed to provide information about the barriers to mental health service use and to identify clinical factors associated with perceived barriers among individuals with depressive-, anxiety-, and substance use-related disorders in the communities. DESIGN: A cross-sectional analysis using data from the Canadian Community Health Survey-Mental Health and Well-being was instituted. SUBJECTS: Participants with depressive-, anxiety-, and substance use-related disorders in the past 12 months, assessed by the World Mental Health-Composite International Diagnostic Interview, were included (n = 4094). RESULTS: In participants with mental disorders, 19.5% reported barriers to mental health service use. The percentage of perceived barriers due to acceptability was higher than those for barriers due to accessibility and availability. Participants with comorbid mental disorders were more likely to have experienced barriers than those with one disorder in both mental health service users and in the nonusers. Role impairment was a significant factor predicting barriers to care, overall and in the service nonusers, in the groups having anxiety disorders only, having any depressive or anxiety disorders, and having any alcohol or drug dependence. CONCLUSIONS: Clinical characteristics play an important role in perceiving barriers to mental health care. Future efforts should pay particular attention to the needs of those with chronic and severe mental health problems and focus on improving the effectiveness of mental health services.

Adolescent↗

Identifying research priorities in nursing and midwifery service delivery and organisation: a scoping study.

This paper reports on a scoping study commissioned by the National Co-ordinating Centre Service Delivery and Organisation (NCCSDO) Research and Development (R&D) to identify priorities for nursing and midwifery research funding in England and Wales. The study comprised three strands (i) nationally held focus groups with service user representatives (32, plus six written submissions) (ii) semi-structured telephone interviews with 64 stakeholders (nursing, midwifery, medical, social care and allied health professionals; research commissioners; policy makers; educators; managers; researchers) and (iii) literature analysis. Five priority areas for research were identified-appropriate, timely and effective interventions; individualised services; continuity of care; staff capacity and quality; user involvement and participation-from which exemplar research questions and issues for strategic commissioning are suggested.

Attitude of Health Personnel↗

Utilization of home health services before and after the Balanced Budget Act of 1997: what were the initial effects?

OBJECTIVE: To estimate the impact of the Balanced Budget Act of 1997 (BBA), which changed the way Medicare reimbursed for home health services, on a range of home health utilization measures, and to examine whether particular subgroups of beneficiaries were differentially impacted in the post-BBA period. DATA SOURCES: Secondary data from the Centers for Medicare and Medicaid Services (CMS) Standard Analytic Files for the 1 percent sample of Medicare beneficiaries for fiscal years 1997 and 1999, linked with information from CMS eligibility, provider, and cost report files as well as the Area Resources File. STUDY DESIGN: Logistic regression was used to estimate the effects of being in the post-BBA period on the incidence of home health service use and ordinary least squares (OLS) regression was used to estimate the effects of being in the post-BBA period on the amount and type of use by home health service users. Interaction terms we reincluded for all the independent variables to assess whether the effect was disproportionate among particular beneficiary subgroups. PRINCIPAL FINDINGS: Results show a 22 percent decrease in the percentage using home health services post-BBA and a 39 percent decrease in the number of visits per user. Stronger reductions, though not very large, were found in the incidence of use for beneficiaries aged 85 and older, those in states with high historical Medicare home health use, and those with Medicaid buy-in. More intensive reductions in the number of services were found for those aged 85 and older, in high historical Medicare use states, nonwhites, females, those using for-profit agencies, and those treated for certain diagnoses. Less intensive reductions were associated with hospital-based agencies. CONCLUSIONS: This research demonstrates that public program expenditures can be sharply curtailed with financial incentives. As reimbursement shifts to a prospective payment system legislated by the BBA, utilization should be closely monitored, especially for vulnerable subgroups.

Aged↗

Maternal satisfaction and awareness regarding pediatric services at a tertiary hospital in Southwestern Saudi Arabia.

OBJECTIVE: Satisfaction of health service user is the most important aim for health provider. We observed and heard many dissatisfactory comments among people utilizing health services in Aseer Central Hospital, Saudi Arabia which led us to conduct this study to verify these comments. METHODS: During a 12-month period (April 2001 - March 2002) we undertook a systematic sample collection on every 7th mother upon discharge through an Arabic speaking nurse. Participants answered questionnaires; and we encoded and analyzed the result using SPSS software package. RESULTS: One hundred ninety-seven mothers completed the study. There were 93 female and 104 male patients. Mothers rated the satisfaction regarding health services at the Pediatric Department as excellent (71.6%), very good (20.3%) and bad (1%). Ninety-seven percent of mothers feel that the treating physician was in close contact with them, and the nature of disease was explained to them by the treating physician in 78.7% of the cases. Other parameters were tested including using the hospital as training facilities for the student as well as cleanliness and food services. All of which received satisfactory rating. CONCLUSION: This study confirms mother's satisfaction regarding health services provided to them which is contrary to the belief of the community. It also supports the fact that using hospital for teaching purposes does not affect the mother's satisfaction.

Child Health Services↗

A limited entitlement for community care: how members use services.

The goal of this paper is to show how members of three Social HMOs use a limited entitlement for community-based long-term care to meet their needs and solve their problems. The paper is based on in-home interviews with 48 aged Medicare beneficiaries who joined Social HMOs and are eligible for the entitlement. Members' experiences with case management (called service coordination), benefits for covered services, and cost-sharing requirements are explored. Members (and their informal caregivers) are found to have complex lives, into which community care fits (or does not fit) in varied ways, depending on preferences, experiences with providers, informal care, financial resources, and other factors. The paper provides insights into what kinds of problems people want to solve and how community care systems can be better designed to empower service users to solve them.

Aged↗

Mental health. Focal points.

A pathways study looking at the process of acute care found the most vulnerable people admitted to hospital appeared to be the least likely to have received effective community care. Community services must be more systematically focused on those most in need. Day hospitals need to function as acute alternatives to inpatient care. Accommodation for newer service users must be considered.

Catchment Area, Health↗

Clinical management. Where medicine meets management. Faith healers.

An inner London mental health trust wanted to improve services for Muslim patients. Staff at the trust attended workshops on the religion and a cross-cultural nurse was appointed. Inpatient service users are feeling increasingly able to discuss their beliefs.

Community Mental Health Services↗

A bereavement care service to address multicultural user needs.

A bereavement care service was set up in a large, acute NHS trust to understand and address the multicultural and multifaith needs of all its users. The service has not only facilitated support and guidance for friends and relatives at a time of great need and vulnerability, it has also made professionals throughout the trust aware of the importance of death with dignity.

Coroners and Medical Examiners↗

Adult day service use and reductions in caregiving hours: effects on stress and psychological well-being for dementia caregivers.

BACKGROUND: The objective of this study was to determine whether adult day service use interacts with decreases in primary caregiving hours (i.e. the time caregivers spent on activities of daily living/instrumental activities of daily living, memory problems, and behavior problems for patients) to alleviate caregiver stress and negative mental health over time. METHODS: Three-month longitudinal data from the Adult Day Care Collaborative Study (n=400) were used. RESULTS: Decreases in memory problem hours among adult day service users were associated with reduced feelings of role overload; decreases in ADL hours among non-users were associated with decreases in worry and strain over a three-month period. CONCLUSION: The findings suggest that adult day services are potentially effective in restructuring caregiving time and providing respite to family members.

Activities of Daily Living↗

Changing systems in health and social care for older people in Japan: observations and implications for interprofessional working.

The impact of a rapidly ageing population on the development of insurance policies and health and social care services of older people is a major concern in Japan. The discussion in this paper draws on information gained from recent visits to leaders of these services in Japan. The paper briefly reviews the policy and demographic background to recent legislative changes in the long-term care insurance system, models of care management and assessment and outstanding challenges for health and social care professionals. Some key issues have emerged with implications for interprofessional working, such as the lack of integrated care systems, contradictions within the scope and responsibilities of care management, and the absence of quality and ethical frameworks to safeguard the interests of the service user and carer.

Aged↗

Developing children's nursing through action research.

Action research provides an ideal strategy for the integration of theory and practice, as it focuses on the development of theory in practice. Action research is gaining in popularity and acceptance. The collaborative approaches of action research parallel the dominant philosophies of participation and partnership in contemporary children's nursing. Taking the lead in identifying areas of practice for action research is a natural extension of the children's nurse's role as advocate for the child and family. The challenge for the future is to expand the use of action research in children's nursing and to include service users--the children and their families--in the research teams.

Child↗

Mental health. The route to work.

There are over 1 million people currently claiming incapacity benefit because of mental health problems. Statistically, those that have been signed off work because of mental health problems are unlikely to return. South West London and St George's Mental Health trust is working on strategies to employ service users and improve their employment prospects.

Employment↗

Service profiling and outcomes benchmarking using the CORE-OM: toward practice-based evidence in the psychological therapies. Clinical Outcomes in Routine Evaluation-Outcome Measures.

To complement the evidence-based practice paradigm, the authors argued for a core outcome measure to provide practice-based evidence for the psychological therapies. Utility requires instruments that are acceptable scientifically, as well as to service users, and a coordinated implementation of the measure at a national level. The development of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is summarized. Data are presented across 39 secondary-care services (n = 2,710) and within an intensively evaluated single service (n = 1,455). Results suggest that the CORE-OM is a valid and reliable measure for multiple settings and is acceptable to users and clinicians as well as policy makers. Baseline data levels of patient presenting problem severity, including risk, are reported in addition to outcome benchmarks that use the concept of reliable and clinically significant change. Basic quality improvement in outcomes for a single service is considered.

Benchmarking↗

Whether and where community health center users obtain screening services.

This study measures associations between minority and low socioeconomic status and the use of screening services for secondary prevention among adult community health center users. Among those who obtained timely screening services, the study also measures associations between minority and low socioeconomic status and obtaining these preventive services at a community health center. The data include 1,175 individuals ages 18 and older from a 1995 survey of community health center users. Minority and lower socioeconomic status adult community health center users were not less likely to obtain timely screening services than other adult community health center users. This differs from the trend in the general population. Minority and lower socioeconomic status community health center users who used timely screening services were more likely to obtain them at community health centers, which appear to facilitate the use of timely screening services for minority and low socioeconomic status users.

Adult↗

The sharing of injecting paraphernalia by intravenous drug users (IDUs) within a Worcestershire cohort, with specific reference to water and filters.

Britain continues to have a drug misuse health strategy that is HIV led. Because of this, little attention has been paid to other blood-borne viruses such as hepatitis. Moreover, while the provision of needle exchange schemes has been particularly successful in containing the spread of HIV, they have had less impact on the prevalence of hepatitis within IDU cohorts. Thus, it is necessary to understand more about the potential pathways through which the hepatitis viruses can be transmitted. One way of achieving this is to assess the propensity of IDUs to share other items of injecting paraphernalia such as water and filters. In addition, it is useful to gauge the level of opinion with respect to health hazards associated with sharing such items, amongst injecting drug users. This study reports on a small pilot project initiated to assess the degree of sharing of filters and water among 40 needle exchange service users in Worcestershire. Results based on questionnaires show that sharing of water and filters is very high within the sample group. Indeed, only 10% of clients reported never sharing either water or filters. The study also demonstrates that although injectors are aware of the health risks associated with sharing (including hepatitis transmission), they continue to participate in high risk sharing activities. Moreover, the majority of IDUs questioned have a mis-conception with respect to the most hygienic sources of water for injecting. For example, only 10% consider sterile water to be the most hygienic source for injecting, with >70% considering tap water in one form or another to be safe. The study is important because it highlights the value of providing sterile water and filters to IDUs to meet their basic and fundamental needs. It is hoped that the findings from this small project will have a wider transferability to other IDU cohorts throughout the UK and beyond.

Journal Article↗

A strategic assessment of the reproductive health and responsible parenthood programme of Buenos Aires, Argentina.

Since 1991, Argentina has had provincial reproductive health laws, a far-reaching national programme and strong public consensus in support of reproductive health policies. Nevertheless, the challenges of strengthening public services, increasing the number of programme sites and resisting conservative attacks remain. This article describes an assessment of the reproductive health programme of the city of Buenos Aires, passed in 2000, whose objectives are to prevent unwanted pregnancies and sexually transmitted diseases/HIV and to train health personnel. The programme operates in every public hospital and primary health care centre in the city. The assessment was conducted jointly by the Ombudsperson's Office of Buenos Aires and the Centre for the Study of State and Society (CEDES). Hormonal contraceptives, IUDs and male condoms were mostly available, but emergency contraception, female condoms and other barrier methods were not Some health professionals and service users were knowledgeable about the new laws and the reproductive rights recognised under the law. Over 90% were satisfied with quality of care in service delivery but many professionals described excessive workloads, deficient infrastructure, and shortages of supplies and staff. Wanting help to obtain a tubal ligation was the most frequent reason for the claims lodged with the Ombudsperson's Office, followed by HIV, quality of care, and abortion. Information and training for both health care providers and women's and human rights NGOs was carried out.

Adolescent↗