Simple Things.

Background:Women's health is a key factor affecting the health of the whole population. Tackling inequality in determinants of health is recognized as the main path toward reducing the inequality in health outcomes. This study aimed to analyze the provincial inequality in determinants of women's health and health care in Iran.Methods:Using the Moss's model (2002) as a comprehensive framework of determinants of women's health, including “geopolitical environment,” “culture, norms, sanctions,” “women's roles in reproduction and production,” “health-related mediators,” and “health outcome” categories, we chose 13 indicators. Afterward, using data sources including the Iranian Multiple Indicators of Demographics and Health Survey, the National Organization for Civil Registration, and Statistics Centre of Iran, we analyzed provincial inequality in these indicators in Iran (2011). Gini coefficient and Lorenz curve were used for measuring inequality.Results:Gini coefficients calculated as follows; life satisfaction level (0.027), literate women (0.398), women with proper knowledge about HIV/AIDS prevention (0.483), unemployed women (0.380), women without an income (0.384), women who use at least one type of mass media (0.389), women who used computer or internet (0.467), women who had received pregnancy care from a skill birth attendant (SBA) (0.420), women who had delivered with the help of an SBA (0.426), women who currently smoke cigarettes (0.603), women who currently consume hookah (0.561), women with at least one chronic disease (0.438), and women's deaths in 2010 and 2011 (0.393 and 0.359, respectively).Conclusions:We found large provincial disparities in determinants of women's health in Iran. Determinants such as lifestyle, health behavior, health knowledge, and health-care services availability should be considered by health policymakers in addressing the inequality in women's health at a provincial level.

This book is the first to investigate what role religion plays in health care in East Africa. Taking into account the geopolitical and economic environments of the region, the authors examine the roles played by individual and group beliefs, government policies, and pressure from the Millennium Development Goals in affecting health outcomes.

Change is a constant in human life. In this document, members of the International Work Group on Death, Dying, and Bereavement examine a number of different trends for their implications for those involved in dying, death, and bereavement; ultimately, whether professionally or personally, that encompasses all of us. Trends examined include: demographic changes, changes in the relationship of the individual to the community, changes in the geopolitical and social environment, and changes in health care. These trends have cultural implications as well as an anticipated impact on patient and family care, end-of-life care, bereavement, death education, and preparation for mass death. Recommendations are made regarding patient and family care, death education, and for future research, as well as for the implementation of these recommendations. The document is presented as a call to further discussion and action so that needed changes are recognized and implemented in order to improve the lives of persons affected by dying, death, and bereavement.

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV

Nursing leadership: new initiatives in case management

Summary : This study aims to analyse and define the role of the case manager (CM) in Spain. The qualitative technique of semi-structured interviews together with the literature review technique have been chosen for the information gathering process. This study constitutes the first of the several stages of a broader research project whose ultimate goals are to create a Network of Integrated Care professionals (NIC) and to reach some conclusions about the CM role in Spain. The rise of chronic diseases, partly caused by demographic changes and increased longevity, requires the development of new strategies on health and social care policies. High levels of dependency associated to chronic patients imply that health care and social problems need to be addressed through coordinated actions of these two public services. The implementation of the CM seek to respond to this need. CM for chronic patients usually undertake coordination tasks within different levels of the health care system and between the health care and social systems. This coordination substantially enhances the continuity of care. Case management enables the integration of the social and health care systems and, therefore, the integrated and needs-centered health care service that patients require. The definition of the role played by the CMs is highly ambiguous; pluripathologies management, single collective (fragile elderly) and single disease management, to name only a few, are amongst them. Nevertheless, there have been also identified some of the CM most basic elements including; patients identification, problems and need assessments, care plan setting, etc. Methodology : Through the usage of an explorative methodology, the numerous roles played by the CM in Spain will be identified and classified. More concretely we will be looking at the main similarities and differences, and analysing impact results. Ultimately patterns and potential scenarios will be considered. This methodology is composed by various stages; 1- Semi-structured interviews and literature review techniques will be used to gather information from professional interviewees (professional profiles, services offered, population target, etc). In addition, a theoretical framework will support the information provided by these professionals. The objective of this first stage is to obtain an initial document which describes and simplifies the complexity that characterises the practices related to the CM. 2- Focus group; the next step will involve naming a group of professionals from the social and health care sectors to discuss the different ideas appearing in the initial document. The purpose of this stage is to reach some conclusions on the CM different realities. The resulting document will ultimately serve as a basis from which the NIC will be created. Bearing in mind that the ultimate goal of this study will only be reached in the mid-term, the main purpose of this initial paper is to elaborate a document which will serve as the basis for following stages of the research project. Preliminary results : The CM is characterised by a significant lack of homogeneity in its implementation, both within and between Spanish regions. - Despite the CM presence in most Spanish regions, its characteristics and functions vary considerably. The main differences are found in the professional profile, services offered, and duties carried by the CM, and its relationship with inner and outer professionals. These variances occur within and between regions. - The different CM functions will be categorised using the five-stages model (case finding, assessment, care planning, care coordination and case closure) based on Ross.S et al (2011). CM functions have been intuitively obtained by applying an explorative methodology in a number of CM experiences. - In Spain it is possible to observe different levels of policy development regarding the CM role (design, pilot, implementation process...). For instance, in Catalonia, Castile y Leon and the Basque Country, the role of the CM has been considerably successful whereas in Navarra no implemented practice, related to this specific actor, was found. Similarly, whilst a number of experiences where the CM has been especially dedicated to coordinate a specific treatment process, others have been implemented, in a broader sense. - Furthermore, the consequences resulting from these practices widely differ depending on the context and, a part of in the case of Andalucia, there are no major publications on the consequences of these practices. As an example, in Andalusia the CM has supposed a sort of driving force for change towards a broader model of integrated care where new roles and new ways of care management have arisen.

I thought that most health care professionals, and ertainly case managers, were beyond segregating physical health, mental health, and behavioral health. However, I was mistaken. As recently as last week, I overheard a hospital case manager tell her manager that she was not trained in mental health

Statistical Benchmarks for Process Measures of Quality of Care for Mental and Substance Use Disorders

Objectives:This is the second of a 2-part article that discusses essential case management practices and strategies amidst the novel coronavirus disease 2019 (COVID-19). The series showcases the potential professional case managers have in support of managing during a crisis such as a global pandemic. Part II continues to describe reenvisioned roles and responsibilities of case managers and their leaders to meet the needs of patients/support systems during the crisis. It focuses on the increased need for end-of-life care, impact on workers' compensation case management practice, and the self-care needs of the professional case manager.Primary Practice Settings:Applicable to the various case management practice settings across the continuum of health and human services, with special focus on acute care.Findings/ConclusionsThe COVID-19 global pandemic has resulted in a crisis case managers and other health care professionals never faced something like it before. At the same time, it has provided opportunities for innovation and creativity including use of digital and telecommunication technology in new ways to ensure the continued delivery of health and human services to those who need them regardless of location. It has also resulted in the development of necessary and impactful partnerships within and across different health care organizations and diverse professional disciplines. Most importantly, this pandemic has required special attention to the increased need of patients for timely palliative and end-of-life care. In addition, it has prompted a focus on the safety, health, and well-being of case managers and other health care professionals, resulting in expanded workers' compensation case management practice coupled with the need for self-care and resilience.Implications for Case Management Practice:Professional case managers are integral members of interprofessional health care teams. Their roles and responsibilities are even more necessary during the uncertainty of a global pandemic such as COVID-19. So far, the experience of this crisis has resulted in a deliberate need to ensure the safety of both, those who are the recipients of health care services and those who are responsible for the provision of care. Self-care and resilience of health care professionals and case managers, especially due to the complex dynamics of the COVID-19 pandemic, have advanced a desirable and necessary view of remote/virtual practice and as a strategy for enhancing the person's health and well-being. This pandemic has forced the development of impactful partnerships and collaborations among the diverse contexts of health care organizations and support service providers. These contexts of care delivery have also emphasized the necessary legal and ethical practice of case managers and the other involved parties. Experts agree that the innovative care delivery methods practiced during the pandemic will undoubtedly remain as desirable beyond the current crisis period.

With high rates of psychiatric and substance use problems, homeless women need a wide variety of services. This study, focusing on homeless women with and without symptoms of mental illness, examined the association of predisposing, enabling, and need factors (based on Aday-Andersen's health services utilization model) with use of behavioral, medical, and human services. Data from 738 homeless women from the National Survey of Homeless Assistance Providers and Clients were analyzed. Homeless women with symptoms of mental illness showed higher rates of service use in behavioral, medical, and human domains, a finding that indicates that there are stronger service linkages for this group than for women without symptoms of mental illness. Predictors associated with service use differed by psychiatric symptoms among homeless women: predisposing and enabling factors influenced service use among homeless women without symptoms of mental illness, whereas need factors influenced service use among women with symptoms of mental illness. Mental illness symptoms may be a trigger for receiving an array of services for homeless women once they gain entrance into a service system. There was a negative association between symptoms of mental illness and use of behavioral health services among homeless mothers, which may be the result of the fear of child welfare service intervention and loss of child custody. This service distribution inequity among homeless women using mental health services deserves attention by policy makers, researchers, and providers.

In October 2018, the Case Management Society of America (CMSA) and the greater case management community celebrates National Case Management Week, a time to honor and recognize all professional case managers across the continuum of care in the United States. Case management has been practiced in the United States for over half of a century, and through that period we have assisted our patients and our clients in developing their plans to “move to wellness.”This year's National Case Management Week logo reflects that movement; just as the CMSA's Standards of Practice for Case Management prescribe, we assess, plan, collaborate, implement, monitor, and evaluate our patients and clients to achieve improved outcomes. True professional case management requires a patient or client-centered approach, with influencers assisting along the way. If someone asked you “what you do” in more detail, what would you say? What is the true value of a case manager from the perspective of the patient or family caregiver? Although we know our value, here are some facts to ponder about our very significant work. Case Management Services Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of service resources, and service facilitation. The case manager helps identify appropriate providers and facilities throughout the continuum of services, while utilizing available resources timely and cost-effectively to obtain optimum value for both the patient and the reimbursement source. Coordination of care, managing multidisciplinary teams, and achieving better transitions of care are the pillars of effective case management. We provide expertise and clarity to complex medical issues, including identifying obstacles to the delivery of prompt quality health care treatment and coordinating resources. We are professionals who provide strategies to address challenges and ensure that care is patient-centered, safe, and effective. The key is in the coordination of care, with identified time frames for accomplishing appropriate care outcomes. Case management also provides a well-coordinated care experience to improve the care outcome, decrease the length of stay, and use multiple disciplines and services efficiently. Transitions of care for people with multiple, serious chronic illnesses are critical points for promoting quality of care and reducing preventable, expensive, and debilitating hospital admissions and readmissions as well as avoidable emergency department visits. Most people with multiple chronic illnesses, which are often accompanied by functional and cognitive deficits, cannot manage their care on their own. Wherever and however they originate, care transitions are about addressing change over time and this must be addressed in health care reform, which must support reimbursements accordingly. Case management is neither linear nor a one-way exercise, but rather a longitudinal approach across health care settings that is imperative to coordinate inpatient and postdischarge care. Facilitation, coordination, and collaboration occur throughout the client's health care encounter. Legal and Care Reform From a legal perspective, there is a myth and faulty belief among case managers and other experts that the standard of care is static, fixed, and permanent. The standard of care is a very important legal construct, as it is the standard against which we are judged in malpractice suits and licensing board hearings. Most broadly, the standard of care is defined as the usual and customary professional standard practice in the community. It describes the qualities and conditions that prevail, or should prevail, in a particular mental health service and that a reasonable, average, and prudent practitioner follows. Generally, as more therapists practice in a new and unique way, this new way gradually becomes part of the standard of care. The standard of care is derived from statutes, case law, licensing board regulations, consensus of the professionals and community, and ethical codes. The standard of care is not a standard of perfection, black and white, determined by outcome, permanent, or fixed. It does not follow any particular theoretical orientation, nor is it guided by risk management principles. Health care and case management are constantly changing, and it is our job as professionals, clinicians, and community members to make sure that we can continue to provide the highest level of care coordination possible for our citizens. We at CMSA feel that we are doing our best work to ensure the role of the professional case manager is known and respected by all health care professionals, policy makers, and consumers of health care services. Future of Case Management Anyone who reads the aforementioned discussion will recognize the importance, weight, and responsibility involved in being a case manager. The practice of case management is not easy, but the reward of rich relationships with clients, their families, and colleagues is immeasurable. We have come a long way in our educational endeavors, but we have more work that needs to be accomplished. If you are not already a member of CMSA, please visit cmsa.org to learn not only about how we are celebrating National Case Management Week but also about all of the resources we make available for you to be successful throughout the year in this wonderful practice. Truly, I am blessed to be a member and leader of CMSA and to learn from our membership each and every day. I often say that you were born caring, you worked hard to gain the experience, and with the right tools we can change the world. Finally, when you're having a rough day, remember this phrase: “I'm not saying I'm wonderwoman, I'm just saying no one has ever seen me and wonderwoman in a room together.” We are wonderwomen and men! During National Case Management Week 2018, we will celebrate the fabulous world of case management, right alongside you! Sincerely, Kathleen Fraser, MSN, MHA, RN-BC, CCM, CRRN CMSA Executive Director

Case Management: Transforming Health Care Environment.

Recently, a great deal of attention has been paid to the health needs of individuals with developmental disabilities and the significant difficulties they face in accessing appropriate health care services (Nehring, 2005; Parish, Moss, & Richman, in press). Significantly less attention has been paid to interventions intended to help adults with developmental disabilities obtain needed health care (Kastner & Walsh, 2006; Lennox et al., 2004).We reviewed the research literature and used our review to develop a model to help adults with developmental disabilities access primary health care in their communities. The model was designed for adults with developmental disabilities who have severe communication difficulties, who are unable to advocate for their own health care needs, and whose health care is paid for by Medicaid. Unfortunately, we were unable to fully implement and evaluate the model because of a large reorganization of human services in North Carolina. Nevertheless, most of the public and private stakeholders with whom we partnered to develop this model were impressed by it and excited about its potential. Thus, our goal here is to describe the rationale for the model, its four components, and lessons we learned from initial efforts to implement it.Our model, which we call the North Carolina Primary Healthcare for Adults with Developmental Disabilities (NC PHAADD) model, is in large part, based on four premises drawn from literature and practice. First, treating individuals with developmental disabilities is often difficult for physicians, most of whom have little training and experience in treating members of this population (Rubin & Crocker, 2006). Second, many services and activities related to health care, such as helping persons with communication difficulties and their physicians understand one another during medical appointments and monitoring individuals' health conditions at home, can be provided by nonphysician professionals, family members, residential staff, and other individuals who support adults with developmental disabilities (Lennox et al., 2004). Third, written guidelines and checklists can help support individuals know when medical attention is needed (Massachusetts Department of Mental Retardation, n.d.). Fourth, a well-organized medical record brought to all office visits can help keep physicians abreast of current health issues and assist them in providing the best possible care (Lennox et al., 2004).Several interventions have been tried previously to help adults with developmental disabilities obtain appropriate health care; these interventions also helped guide the development of our model. A 5-year medical diary that contained medical records and other personal information, brought by adults with intellectual disabilities to medical appointments, was found promising in improving communication with physicians and increasing patients' involvement in their health care (Lennox et al., 2004). An educational tool intended to accompany the medical diary also appeared promising in teaching health advocates how to prepare individuals with developmental disabilities for medical visits (Lennox et al., 2004). A primary care service model that included a strong care-management component and took advantage of Medicaid managed-care funding appeared effective in providing adults with developmental disabilities with a primary care "medical home" and specialized managed care–case management (Kastner & Walsh, 2006).We designed our model to improve access to appropriate medical services for adults with developmental disabilities. This goal is accomplished through four types of activities: (a) helping family members, residential staff, or other support individuals recognize when medical care is needed; (b) facilitating communication between these individuals and health care providers during and between medical visits; (c) providing care management for adults with developmental disabilities who are Medicaid recipients and have high-risk medical conditions; and (d) coordinating services and supports provided by the pertinent health care and developmental disabilities public agencies.Our model consists of four components, which are adaptations of the promising interventions identified in the literature (Kastner & Walsh, 2006; Lennox et al., 2004). The components consist of a health care tool kit, the use of health advocates, medical care management, and coordinating health care and developmental disabilities services.We developed a Healthcare Tool Kit by adapting materials from the Massachusetts Department of Mental Retardation (n.d.). Our Tool Kit (available on request) contains information about common health risks and conditions and a health-record form on which to record an individual's medical and social history. It provides forms and checklists to help family members, direct support staff, developmental disabilities case managers, and medical providers identify and communicate health care needs and appropriate treatments. Tool Kit forms and checklists are to be regularly updated and brought to all medical encounters.The small amount of literature published on health advocacy suggests that, for people with disabilities who are unable to speak, unable to understand others, or unable to be understood by others, a "health advocate" appears promising (Lennox, 2004). The health advocate can be a family member, residential staff person, or other trusted individual who spends enough time with the adult to recognize changes in his or her health status. Health advocates are trained to make timely medical appointments, to assist during clinical encounters, to help with activities such as monitoring health status changes outside the health care setting, and to communicate care recommendations to other caregivers.To remain healthy and avoid unnecessary hospitalizations, many adults with developmental disabilities need help managing their chronic illnesses. Our model provides this help by access to medical care managers working within the Medicaid managed-care program. Medicaid managed-care programs typically use care managers for patient groups who are deemed at risk for high rates of service use and high costs, such as those with diabetes and heart conditions. Care managers typically coordinate the interactions between the patient and physicians and other health services, provide education and training to patients and families, help schedule appointments, arrange for special equipment, facilitate transportation, and, in some cases, provide actual care (Kastner & Walsh, 2006).In our model, we sought to coordinate the services of developmental disabilities case managers and Medicaid care managers. The model requires both case and care managers to share information about clients' health and service needs, to consult and coordinate with one another, and, together, to recognize and fill gaps in care. We also hope that getting Medicaid care managers to focus on people with developmental disabilities will, in turn, help educate and build interest among their physician colleagues in treating members of this population.Although we have not yet been able to fully test our model, we have learned enough through our 2-year trial to recommend changes for state policymakers interested in improving health care access of adults with developmental disabilities. Developmental disabilities case managers play the central role in coordinating most nonmedical services received by people with developmental disabilities, and they should be required to incorporate health care needs within person-centered and other individualized service plans. These case managers should be fully and effectively trained to use tools like those in our health care Tool Kit to help them recognize heath care needs and know how to interface with Medicaid care managers.Interventions need to be developed and rigorously tested to help Medicaid care managers recognize and work with adults with developmental disabilities who have common health conditions like hypertension, diabetes, and obesity. After effective protocols are developed, Medicaid care managers should be trained in their use.Formal mechanisms should be instituted to require information sharing and service coordination between developmental disabilities case managers and Medicaid care managers. Case–care managers who share responsibility for serving the same individual must be brought together in joint orientation and training sessions. Furthermore, formal mechanisms should be established for referring individuals with developmental disabilities who need medical care management.The ongoing deinstitutionalization movement means that adults with developmental disabilities principally rely on community-based services and care. States should proactively adopt policies, fund programs, and support research that facilitates individualized, coordinated health care for community-dwelling adults with developmental disabilities. The elements and approaches of our model are a promising start.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Differences in HIV Care Between Patients With and Without Severe Mental Illness