Analysis of the implementation of comprehensive provincial health plan: A qualitative study

THE POLITICS OF MENTAL HEALTH: ORGANIZING COMMUNITY MENTAL HEALTH IN METROPOLITAN AREAS Affiliation Lucy D. Ozarin CopyRight https://doi.org/10.2105/AJPH.59.10.1957-a Published Online: August 29, 2011

This paper examines health planning as a form of technocratic ideology in use both by proponents inside government and by outside interest groups in the health field. Ideology and the nature of technocratic power are defined. Health planning is analyzed as occupation, process, and ideology. The ideology in use is analyzed for the following American programs: Hill-Burton, Comprehensive Mental Health Planning, OEO Neighborhood Health Centers, Regional Medical Program, Comprehensive Health Planning. It is concluded that health planning cannot operate in the present sociopolitical context except as an ideology to justify the status quo in health services.

As a result of federal mental health grants-in-aid of 4.2 million dollars to support comprehensive mental health planning in the states, Pennsylvania initiated the development of a Comprehensive Mental Health Plan in mid-1963. This comprehensive plan concerns itself with the development of short and long range goals for a mental health program concerned with the needs of all the citizens of the state. One major phase of the comprehensive plan involves the analysis of future health requirements and the resources which will satisfy these needs. Smith, Kline and French Labs offered the assistance of its Management Research personnel to the Comprehensive Mental Health Planning Committee in this stage of the planning process. Specifically, we agreed to examine the problems associated with locating new Outpatient Psychiatric Clinics.

It is rather amazing that in 1971, the United States does not have a comprehensive health policy or national health plan. Our advanced science and technology have not taken root on a broad basis in the health field. Yet categorical planning has been done in several fields of health ever since the enactment of the Social Security Act in 1935. Planning was initiated in the fields of maternal and child health and crippled children by the federal Children's Bureau. This article gives some examples of both categorical and general approaches to health planning, how they came into being, and what planning concepts and processes were developed and used. These examples may be of some value to planners who have to employ categorical approaches—largely pragmatic—pending the time that comprehensive national health planning becomes feasible. The categorical areas chosen for discussion are: (a) health facilities, (b) heart, cancer, stroke, and kidney disease (Regional Medical Programs), (c) mental health, and (d) American Indian health. The general area includes comprehensive health planning. Following the passage of the Social Security Act of 1935, personal and environmental health services have been fragmented into a number of pieces. In 1971, utter confusion reigns in the federal and state structure and functions of health. Hopefully, the Congress may soon realize that a national system of health services is essential to provide 205 million people with the quality and distribution of services—without financial barriers—that $70 billion dollars a year should buy. Certainly the experiences gained with the categorical approaches to health planning can be of value to governmental leaders and their advisers as they prepare comprehensive health policies and national health plans for the 1970s.

The cost of vision loss in Canada. 2. Results

Comprehensive health planning in relation to environmental problems. II. Catalytic comprehensive health planning. E J PeloquinCopyRight https://doi.org/10.2105/AJPH.61.10.1979 Published Online: August 29, 2011

World Health Assembly adopts Comprehensive Mental Health Action Plan 2013–2020

Background: Health Technology Incubators (HTI) play an important role in paving the way depicted in Iran’s comprehensive health plan in order to achieve the aimed position in 2025. In light of the emerging nature of these centers in Iran, identification of HTI problems and challenges, as well as appropriate planning to resolve those problems can have a significant effect and improve Iran’s health system functionality. Methods: This qualitative study was conducted in Iran in 2016. Data were collected through interviews with 24 experts (Interviewees included managers, deputies, and employees from the country's incubators) in the field. Purposeful sampling continued until data saturation level was achieved. All interviews were recorded and then analyzed, and main themes and subgroups were extracted from them based on a framework analysis. In all the mentioned steps the Atlas-Ti software has been employed. Results: Challenges of Health Technology Incubators in Iran were categorized into eight concepts- Cultural, Rules and Principles, Funding, Concentrated Administrative System, Human Resources, Stewardship and Monitoring, Physical space and Equipment, and Communicational. Then 22 challenges were identified with in these concepts. Conclusion: This study suggests that considering the challenges influencing technology incubators in the health sector, a sustainable program for these centers can be designed.

IN 1963, state mental health directors became involved with the first of several federal programs, introduced at short intervals, designed to initiate a new mental health era in the United States. Each federal program, and I will touch on some but not all, has had considerable impact on state services. Perhaps the impetus came from the monumental work that began with the Mental Health Study Act of 1955, making possible the Joint Commission Monograph Series concluding with Action For Mental Health, The Final Report of the Joint Commission on Mental Illness and Health.1 Many impassioned pleas were made in this report, but major themes seemed to be the need for more funds, manpower, and research focused on the largest segment of the clinical population, those who reside in our nation's state hospitals. The report seemed to stimulate an interest in mental health issues at multiple levels, i.e., the Congress, state legislatures, state mental health program directors and, perhaps most important, the consumer. Shortly thereafter, an NIMH grant program, now referred to as Comprehensive Mental Health Planning, resulted in fairly large grants to the states for a truly concerted effort to study, over a period of two years, state mental health needs with the goal of producing a well organized plan designed to remedy problems and meet needs. For the first time, agency representatives and individuals with many different viewpoints had a mandate to meet together because of a common interest in mental health. In Missouri alone, 500 individuals and representatives from 36 agencies toiled in this great undertaking.2 Similar activities were going on in other states. During the course of Comprehensive Mental Health Planning, two new NIMH programs were launched with the express purpose of uplifting the overall quality of state hospital programs. They were the Hospital Improvement Project (HIP) and Inservice Training (IST). The former grant made possible the development of a program leading to direct and improved benefits to hospitalized patients; the latter was designed to provide a program of inservice training for nursing and attendant personnel. State hospitals, and particu-

Objective To investigate the causes of non-compliance in patients undertakine maintenance hemodialysis (MHD). Methods From September 2018 to January 2019, MHD treatment was carried out in the blood purification center of a tertiary first-class hospital in our city and medical staff were evaluated. After a long in-depth communication with 15 non-compliance MHD patients, We have done the research by adopting the phenomenological qualitative method to find out the causes of non-compliance. Results There are three main reasons for the non-compliance in MHD patients, including insufficient knowledge of relevant maintenance haemodialysis, fluke mind, and with no care of future consequences. Conclusion A good maintenance hemodialysis treatment program is very important, but success will be unachievable if not conducted properly. So, medical staff should pay more attention to find out the reasons for non-compliance treatment, and provide a multi-layered, continuous, individualized, and comprehensive health plan. Education and guidance is essential to build a social, familial and partnering support network and to strengthen psychological counseling. Key words: Hemodialysis; Compliance; Qualitative research

Optimizing breast and cervical cancer screening rates within health plans requires clinician support for screening guidelines, an awareness of whether there are tools available and functioning to aid screening implementation, and a perception of collegial and leadership support for quality screening services. This study investigated clinicians' perceptions of guidelines, reminders for screening, and plan and practice commitment in order to assess where opportunities exist to improve the screening process. A stratified sample of 761 primary care clinicians from three comprehensive health plans were surveyed to assess awareness of and agreement with guideline elements, perception of guidelines' usefulness, awareness of plan strategies to promote guideline adherence, perception of support for high-quality screening services, and ratings of plan efforts to maximize members' access. Clinician awareness of and agreement with guideline elements was high (98% breast, 94% cervical). Across guideline elements, agreement was lower for mammography than cervical screening, notably for upper age limit recommendations (58% breast, 79% cervical). Knowledge of systems that cue patients and clinicians that screening is due varied by cancer test, and clinician report and plan report data about the existence of systems were, at times, not congruent. Views about consistent operation of systems differed by test (mammograms, 74%-92%; Pap, 66%-84%). Clinicians rated local colleagues and local and plan medical leadership as very committed to high-quality screening, albeit with somewhat lower ratings for cervical testing. Although the majority rated overall plan efforts to maximize screening as very good or excellent, perceived consistency of systems to cue a woman that she is due for testing and perception of collegial support were independently and significantly related to ratings of plan efforts. Improvements in knowledge of systems that support guideline implementation varied, and action to ensure accurate perception of reminders, as well as consistent implementation of systems, may be important for improving screening rates and outcomes. Plan efforts and clinician efforts at the practice level are closely linked and need to be aligned to maximize screening rates. This requires plan and practice-level analyses of structures and processes that could be improved.

This new column provides an overview of mental health reforms in Latin America and the Caribbean. Progress has been particularly visible in countries that have implemented policies with strong political support (Brazil, Chile, and Belize, among others). However, lessons may be learned from the collective experience of a region that has faced multiple obstacles to reform. Available resources are still insufficient and inequitably distributed, reform implementation is not complete in most countries, and high levels of unmet need exist. Countries face new challenges related to growing psychosocial problems affecting children and adolescents and increasing violence, which require new responses from mental health services.

This paper simulates the effects of funding a comprehensive health plan (CHP) on consumer spending in the U.S. using a demographically enhanced dynamic Almost Ideal Demand System model. Quarterly observations on personal consumption expenditures and the relevant price indices of seven major commodity and service groups in the U.S. for the period 1963. 1 through 1989.4 comprise our data set. Our results show that the CHP financing causes no significant adjustment on the demand-side of the economy, i.e., consumer expenditures on the seven major commodity and service groups would decrease slightly in the short run under the CHP financing. (JEL D00)

Comprehensive health planning: a study in creative federalism. D A KaneCopyRight https://doi.org/10.2105/AJPH.59.9.1706 Published Online: August 29, 2011

Public health and the law. Comprehensive health planning: audacious law-making. W J CurranCopyRight https://doi.org/10.2105/AJPH.58.6.1100 Published Online: August 29, 2011