Organization Of Care Services Research Articles

GERIATRIC ASPECTS OF THE ORGANIZATION OF MEDICAL-SOCIAL, PALLIATIVE AND HOSPICE CARE IN THE CONDITIONS OF THE WAR: COMBINATION OF MEDICAL, PSYCHOLOGICAL AND SOCIAL PROBLEMS

The aim of the study is to characterize, from the point of view of geriatric aspects, the current problems of the organization of medico-social, palliative and hospice care (PHC) and social services for palliative care in the war conditions based on multidisciplinary, interagency and inter-sectoral approaches, as well as a combination of medical, psychological and social problems. Materials and methods. The research materials were scientific literary sources and regulatory documents. A pilot survey of 200 people was conducted to study the psychological state and psychological support needs of the elderly and internally displaced persons (IDPs). The survey results of 3,705 client’s questionnaires of the “Vseturbota” Project were also evaluated, of which 63.6 % are people aged 67-84 years, 26.4 % are 85–101 years old. The following research methods were used in the work: bibliosemantic, sociological, system approach and system analysis. Results and discussion. After February 24, 2022, IDPs will experience significant difficulties, suffer from reduced income, increased dependence on humanitarian aid, do not feel safe and protected. All these are reflected in their psychological state. It was found that among respondents aged ≥75 years had the most people with medium (57.1 %) and low (25.0 %) levels of anxiety, 71.4 % had a low level of mood. 32.17 % of the “Vseturbota” Project clients needed additional consultation with a family doctor, 3.83 % needed consultation with a psychologist, and 3.35 % with other specialists. Most often, they needed help around the house (26.02 %), buying medicines/foodstuff (22.43 %), 34.97 % needed information, and 13.36 % needed psychological counseling. An important condition for providing geriatric patients, including IDPs, with affordable, high-quality and effective PHC is the creation of a system and service of ambulatory/mobile and inpatient PHC facilities and medico-social care. Conclusions. The military aggression of the Russian Federation caused considerable suffering to the population of Ukraine. The state of anxiety and fear has a negative impact not only on the psycho-emotional, but also on the physical sphere of the elderly, which necessitates the implementation of psychological services and effective strategies for overcoming stress and distress, which requires the development and implementation of mechanisms for interagency coordination and cooperation, involving and training of multidisciplinary teams’ specialists and volunteers, effective advocacy activities, etc.

The Osservasalute Health Report 2010: the contribution of a wide and independent Italian research network to decision making in healthcare

Background: The Italian Observatory Healthcare Report (IOHR - 8th edition) [1] aims to help policy makers in the process of decision making through a set of validated indicators resulting from the multidisciplinary activity of several public health experts. Its main task is to gather comparable data on the health status and the quality of health care services throughout the Italian regions. Methods: The report adopts a European approach in order to build a benchmarking activity and the selection criteria of indicators include: meaning, feasibility and quality, comparability and reliability. Each indicator is analyzed by experts in terms of meaning, pattern, validity and limits, graphic representation; recommendations are included for decision makers. A peer reviewing is performed for quality assessment. Results: The IOHR 2010 included 96 indicators, analysed by 203 authors. Through comparable regional data coming from different sources, an overview of the Italian Health System, and a gauging of the impact that different regional organizational and institutional arrangements have on the quality of health services, have been provided. Though data analysis showed a North-South gradient in the quality and the organization of health care services, nevertheless, the overall health status of Italian population is good. Risk factors, lifestyles and prevention together with geographical and social differences in health status and service access are the main priorities. Conclusions: The IOHR helps monitoring the health status in the Italian regions through specific indicators characterized by scientific strictness. It contributes to identifying the situations of excellence and disseminating public health care control tools in order to facilitate the decision making process.

Navigating Aged Care Services with GIS: Trends, Developments, and Future Directions

BackgroundWith the growing challenge of an aging population, emerging technologies are increasingly being integrated into the production, organization, and delivery of aged care services. Geographic Information System (GIS), a computer-based tool for spatial information analysis and processing, has made significant strides in the allocation of care recources and service delivery for older adults, a notably vulnerable group. Despite its growing importance, cross-disciplinary literature reviews on this theme are scare. This scoping review was conducted to encapsulate the advancements and discern the future trajectory of GIS applications in aged care services.MethodsA comprehensive search across nine databases yielded 5941 articles. Adhering to specific inclusion and exclusion criteria, 61 articles were selected for a detailed analysis.ResultsThe 61 articles span from 2003 to 2022, with a notable increase in publications since 2018, comprising 41 articles (67% of the total) published between 2018-2022. Developed countries contributed 66% of the papers, with 45% focusing on accessibility issues. In the domain of aged care services, GIS has been predominantly utilized for model construction, mapping, and site selection, with a growing emphasis on addressing the unique needs of different subgroups of older adults.ConclusionThe past two decades have seen substantial growth in the application of GIS in aged care services, reflecting its increasing importance in this field. This scoping review not only charts the historical development of GIS applications in aged care services but also underscores the need for innovative research approaches. Future directions should emphasize the integration of GIS with diverse methodologies to address the heterogeneous needs of older adults and improve the overall delivery of aged care services. Such advancements in GIS applications have the potential to significantly enhance the efficiency, accessibility, and quality of care for the aging population.

OP33 Child And Adolescent Mental Health Care Models: A Scoping Review

IntroductionMental illnesses are among the most common health problems in children and adolescents worldwide, and their prevalence has recently increased. At the same time, many countries face gaps in care and a shortage of services. To address these challenges, countries are developing child and adolescent mental health (CAMH) strategies and adopting their models of care. This paper aimed to give an international overview of these strategies and care models to support decision makers and stimulate mutual learning and improved CAMH care.MethodsWe identified core topics within published CAMH strategies and care model documents from seven selected countries within the Global North, which represented different healthcare systems, geographical regions, and public health traditions to maximize variety. We systematically extracted data on the identified topics and summarized them narratively by applying qualitative content analyses.ResultsThe documents addressed the following core topics: awareness raising activities; prevention and promotion; detection; treatment; telemedicine; care pathways; transitional psychiatry; vulnerable patient groups; user participation; infrastructure; workforce development; implementation; digital tools for case management; and data acquisition and research. A stand-alone CAMH strategy exists in most countries.Recommendations on CAMH care often followed a public mental health approach and placed a high priority on mental health promotion and cross-sectional organization and funding of CAMH care services. Key principles of future CAMH care included: increased flexibility of care settings; early intervention; an open and non-judgmental attitude among staff; and strengths orientation instead of focusing on deficits and diagnoses.ConclusionsReducing the prevalence of mental illness and current shortcomings in care requires action at the policy level (e.g., developing a CAMH strategy with a focus on mental health promotion and installing cross-sectoral governance), organizational level (e.g., reorganizing treatment settings and pathways of care), and individual level (e.g., strengthening user involvement and workforce development). Applying the recommended approaches in other countries will likely require redesign, ideally with a participatory approach and evaluation alongside piloting.

Healthy Finland survey as the latest uptake for 50 years of population health monitoring in Finland

Abstract In Finland, population-based health examination surveys (HESs) have been conducted in regularly since early 1960's to obtain information on population health and health determinants. These surveys have covered adult population living in the mainland Finland. Surveys have always been conducted by specially trained personnel using international standardized protocols such as WHO MONICA protocol or EHES protocol. The latest HES, Healthy Finland, is ongoing and will run until June 2023. The Finnish Institute for Health and Welfare (THL) had the responsibility of the coordination of the preparation phase as well as conducting the survey. Survey planning was started already in early 2021 with a multidisciplinary group including representatives from different stakeholders. Survey sample includes 66.000 randomly selected adults aged 18+ years living in Finland. In the 1st phase, they receive a questionnaire to be filled in. Questionnaire covers topics such as quality of life, health, use of health care services, lifestyles, background information, work ability and functional capacity, wellbeing, accidents, and sexual and reproductive health. In the 2nd phase, 10.000 of those selected to the survey were invited to health examination including for example anthropometric measurements, blood pressure, spirometry test, collection of biological samples and sub-studies. This from these national HESs has been widely used for policy making, planning and evaluation of the prevention programmes, as epidemiological background for clinical treatment guidelines of several diseases, and for research. Information obtained from the Healthy Finland survey will be used for the evaluation of wellbeing service counties which are responsible for the organization of social and health care services in Finland. Survey will generate new information about health inequalities by providing information not only by age and sex but also by education and other socio-economic indicators.

Spanish‐speaking 988 staff remove language barriers to care

Prioritizing efforts to remove language barriers in a behavioral health emergency, a national health care services organization announced this month its operation of the largest Spanish‐language 988 call center for text and chat response. The move is helping to reduce the stigma that pushes the Hispanic community away from seeking care, officials stated.

60 NICU Manager’s Perception of High Unit Activity and Its Association with Patient Care in the Neonatal Intensive Care Unit

Abstract Background Each year, 15,000 critically ill neonates require specialized care that is offered in only 32 tertiary neonatal intensive care units (NICUs) in Canada. Previous studies have shown associations between nurse-to-patient ratios and higher bed occupancy with patient outcomes. Objective To explore neonatal managers’ perceptions of organizational factors in Canadian NICUs. Methods This was a web-based cross-sectional survey, consisting of 20 questions pertaining to the determinants of resource allocation, the ascertainment of high occupancy state, as well as the different challenges and mitigation strategies implemented during periods of high unit strain. The survey was designed following the CHERRIES guidelines and was critically reviewed through a two-round validation process prior to deployment. It was sent by e-mail to the unit managers of all Canadian Level-3 NICUs between August and November 2022. They were invited to respond based on their unit’s practices in 2021. The analysis was conducted using descriptive statistics, where units were dichotomized by size (small unit ˂36 beds, large unit ≥36 beds). Results A total of 24 unit managers (75%) completed the survey. Most respondents relied exclusively on clinical judgment to estimate the total number of nurses required per shift (33%) and the individual nurse-to-patient ratios (67%) as opposed to nursing workload assessment tools (8% and 21%, respectively). The response for the proportion of nursing shifts perceived as adequately staffed was: 0% for 100% adequately staffed, 37% for ˃80% adequately staffed, and 27% for 60%-80% adequately staffed. The response for the proportion of nursing shifts perceived as understaffed to the point of being unsafe for patient care was: 17% for no understaffed, 52% for ˂20% understaffed, and 9% for 20%-40% understaffed. The most common organizational challenges were personnel recruitment and unit occupancy (each reported as being a major issue by 38% of respondents). Although most (75%) respondents believed that high occupancy, especially when exceeding 90%, likely increases the risk of adverse patient outcomes, they revealed implementing mitigation strategies to reduce occupancy only when it exceeded 95%. At that point, the most common strategies implemented were to call for additional voluntary nurses, implement voluntary nursing overtime, and accelerate patient transfer. Conclusion Although Canadian NICUs form a very heterogeneous group, managers shared similar perspectives in terms of staffing and occupancy challenges. This emphasizes the need for collaborative NICU person-power resource management practices to improve neonatal intensive care service organization.

Engaging Stakeholder Advisors Around Health-Related Social Needs Research, Policy, and Practice Priorities.

As health care systems invest significant resources to address social needs associated with poor health such as food, financial, and housing insecurity, many eligible patients are still not obtaining the resources they need. The recently initiated PURPLE Project (Promoting Understanding in Social Needs Research Projects by Listening and Engaging) engages stakeholder advisors to help address 2 challenges: (1) many patients do not accept offered assistance, and (2) of patients who accept assistance, less than half have their needs addressed. This article presents the team's engagement with local advisors, garnering real-life insights from patients with social needs, staff and leadership in public health, health care, and community service organizations. The team shares these organizations' priorities and recommendations and how these can be applied to these major challenges. This article can assist others in the social care arena who seeks to involve local partners as advisors to improve practices and policies in addressing social needs.

Factors related to the internal social capital of elderly-caring social organizations: a cross-sectional study in Chongqing, China

BackgroundAging has given birth to the demand for high-quality elderly care service and social organizations (ESOs) are gradually taking on a supportive role in the field of elderly care services.. In view of this, our study is designed to examine influencing factors of social capital within the elderly-caring social organizations.MethodThe study was conducted in four districts of Chongqing Province and a multi-stage random sampling method was used to sample 80 ESOs as subjects for the research. Through a meticulously crafted questionnaire, we gathered valuable data on internal social capital, basic information about the organization, and other variables. Univariate and Binary Logistic Regression analysis were performed on the data to explore the factors associated with social capital within the elderly-caring social organizations using IBM SPSS version 26.0.ResultThe results showed that 67(83.8%) OF ESOs surveyed were A-type institutions and 13(16.3%) B-type institutions. Among them, 49(61.3%) institutions covered an area of more than 50m2.The institutions of ≤ 2 years were 33(41.3%), 21(26.3%) were established for ≤ 3 ≤ 8 years, and residual 26(32.5%) were institutions ˃ 8 years old. ESOs that possessed 4–6 management employees were 52.422 times more likely to score high for social support (p<0.05, OR = 52.422). Accommodating special care objects and hiring 16–30 employees were significantly linked to the shared language and shared vision dimension (p<0.001, OR = 0.8) and (p<0.05, OR = 8.672), respectively. and the overall social capital dimension (p<0.01, OR = 0.221) (p<0.05, OR = 5.730).ConclusionESOs with different basic conditions have different amounts of social capital. Factors such as the presence of special care and volunteer staff, a certain number of full-time staff as well as types of services rendered are accompanied with the higher internal social capital of ESOs.

Impact of Regional Network on the Management of STEMI Patients in North Cairo

Abstract Background Worldwide, coronary artery disease (CAD) is the single most frequent cause of death. Over seven million people every year die from CAD. The management of patients with STElevation myocardial infarction (STEMI) is influenced by health care service organizations. Regional STEMI networks for acute myocardial infarction facilitate primary percutaneous coronary intervention (PPCI) and its efficacy in reducing mortality and improving its outcomes. Aim of the Work The aim of the present study was to examine the impact of regional STEMI network on patients' management and on hospital outcomes in north Cairo governorate, Egypt. Methods The present study is a Prospective observational multicenter study that was conducted on 352 patients with STEMI and symptom onset within 48 hours who presented to north Cairo hospitals. The patients were divided into 2 groups, group I in the first six months before establishment of a network between the north Cairo hospitals and group II in the second six months when the network between those hospitals was activated. Comparison was done between the two groups as regards patients' demographics, logistics of presentation and in hospital outcomes. Results The number of patients upon implementation of STEMI network increased from 140 to 212 (51.4%) to the same hospitals with the same facilities and in equal periods of time (6 months). It was found that the mean time of chest pain to first medical contact (FMC) between the two groups before and after establishment of STEMI network did not change, it was 4 hours in both groups (P = 0.36) while the mean door to balloon time improved from 54.3 to 44.1 minutes (P = 0.01). In our study thrombolytic therapy use declined from 36.4% before STEMI network set up to only 7.5% (P &amp;gt; 0.001), Ejection fraction (EF) improved from 51.3% to 55.4% (P &amp;gt; 0.001), mitral regurge (MR) also improved upon establishment of STEMI network from 53.6% to 78.8 with (P &amp;gt; 0.001), the mean CCU stay in group II was 2 days versus 3 days before implementation of STEMI network (P &amp;gt; 0.001), the mean door in door out from the spokes was 40 minutes. In-hospital mortality improved upon establishment of STEMI network from 6.4% to 2.8% (P = 0.10). Conclusion The establishment of the STEMI network in Egypt is feasible and can lead to improvement of patients' outcomes. Thrombolytic therapy was no longer the main reperfusion therapy and primary PCI was offered to most patients after establishment of STEMI network.

Nurses' professional discretion in the purchaser-provider split in home care in Norway.

To explore how nurses' professional discretion is operationalized in home care services that follow a purchaser-provider organization in Norway. A qualitative descriptive study. Semi-structured interviews with open-ended questions were used, and data were collected from in-depth interviews with 15 registered nurses working in home care in four Norwegian local authority areas between April and November 2020. Braun and Clark's six-step analysis was used to analyse the empirical data. The analysis yielded two main themes, namely 'The purchaser's instructions: facilitating and constraining care' and 'Professional discretion meets the purchaser-provider organisation of healthcare,' with five associated codes. Nurses are dependent on an organizational framework due to the complexity of health care services and the number of tasks involved. At the same time, they perform considerable compensatory work and need the ability to be flexible to enable this work and to perform actions related to the unforeseen needs of individual patients or those involving professional discretion. The purchaser-provider model both facilitates and constrains nursing practice and professional responsibility in home nursing. Home nursing services need to be well organized because of their complexity and the wide variety of tasks they involve. In this context, the element of constraint is associated with the need for flexibility and professional discretion. Despite a strict framework, the nurses perform additional and compensatory tasks. Reforms inspired by 'New Public Management,' such as the purchaser-provider split, limit the workload for nurses; however, there is still a need to exercise discretion. The findings of this study may help home care managers and health policy-makers understand the interaction between management logic and health care logic, leading to a more appropriate organization of health care services where the nurses, as actors, gain more trust. This study highlights home care nurses' opportunities to exercise discretion in an organizational framework that strives towards standardization. The nurses' ability to exercise discretion is important for individual and holistic patient care. At the same time, an organizational framework is needed because nurses cannot attend to all the needs the patients may have, as this will overload both home health services and the nurses.

Contraception-related knowledge, attitude, belief contexts among US women experiencing homelessness: A scoping review.

Contraception provision may help reduce undesired pregnancies, but women experiencing homelessness may have low health literacy, specific attitudes, and certain beliefs that influence contraception uptake. This scoping review identifies what is known about pregnancy prevention and contraception knowledge, attitudes, and beliefs among US women experiencing homelessness. This review examined English articles that measured the context of knowledge, attitudes, and beliefs related to contraceptive use for avoiding pregnancy among US women experiencing homelessness. Using PRISMA-ScR guidelines, articles published before May 2022 were located via PubMed, EBSCOhost, and Embase. The initial search identified 1204 articles, and 10 met the inclusion criteria. There were five quantitative, four qualitative, and one mixed-methods study, published between 2000 and 2022, with samples of 15-764 women ranging from ages 15-51. Contraception knowledge, attitudes, and beliefs related to pregnancy prevention suggested several knowledge gaps (e.g., contraception efficacy), contraception preferences and past experiences, interpersonal relationship influences, and vulnerability to clinic and shelter-specific barriers. These findings may ultimately inform contraception interventions in partnership with the community of US women who experience homelessness and the health care and social service organizations who serve them.

Availability of cancer care services and the organization of care delivery at critical access hospitals.

Critical access hospitals (CAHs) provide an opportunity to meet the needs of individuals with cancer in rural areas. Two common innovative care delivery methods include the use of traveling oncologists and teleoncology. It is important to understand the availability and organization of cancer care services in CAHs due to the growing population with cancer and expected declines in oncology workforce in rural areas. Stratified random sampling was used to generate a sample of 50 CAHs from each of the four U.S. Census Bureau-designated regions resulting in a total sample of 200 facilities. Analyses were conducted from 135 CAH respondents to understand the availability of cancer care services and organization of cancer care across CAHs. Almost all CAHs (95%) provided at least one cancer screening or diagnostic service. Forty-six percent of CAHs reported providing at least one component of cancer treatment (chemotherapy, radiation, or surgery) at their facility. CAHs that offered cancer treatment reported a wide range of health care staff involvement, including 34% of respondents reporting involvement of a local oncologist, 38% reporting involvement of a visiting oncologist, and 28% reporting involvement of a non-local oncologist using telemedicine. Growing disparities within rural areas emphasize the importance of ensuring access to timely screening and guideline-recommended treatment for cancer in rural communities. These data demonstrated that CAHs are addressing the growing need through a variety of approaches including the use of innovative models that utilize non-local providers and telemedicine to expand access to crucial services for rural residents with cancer.

The complementary feeding practices of low-income Black mothers with infants between 6 and 24 months of age: A qualitative study.

The period from 6 to 24 months in an infant's life presents a critical window for understanding feeding practices and for designing culturally appropriate interventions. However, little is known about the complementary feeding practices of Black mothers and how this period can be used to optimise the long-term health of their children. The present study aimed to identify factors that influence the complementary feeding practices of low-income Black mothers with children aged 6-24 months. Participants were recruited through Research Match, Facebook advertising, flyers, and snowballing techniques. Low-income, Black mothers, with a 6-24-month-old infant, and who lived in Franklin County, Ohio, USA, were eligible for the study. A cross-sectional design using in-depth interviews was used. Reflexive thematic analysis was utilised to analyse and interpret the feeding practices of Black mothers. Mothers (n = 8) were aged between 18 and 30 years old and most completed college or had some college education (n = 6). Half (n = 4) were married, employed, and rated their diet quality and their children's as very good. Three themes emerged: (a) complementary feeding at ≥ 6 months of age; (b) involvement of health care providers and service organisations in feeding decisions; and (c) use of responsive feeding cues. All mothers breastfed exclusively and most (n = 6) initiated complementary feeding at 6 months. Paediatricians, other health providers and service organisations were instrumental in helping Black mothers adopt complementary feeding practices. Mothers also engaged in responsive feeding practices. These findings point to the critical nature of access and education in helping Black mothers in the study achieve feeding recommendations for their infants.

The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review.

Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate health care services. The emergence of telehealth services has provided the public with various tools for educating themselves and for evaluating, monitoring, and improving their health and nutrition-related behaviors. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences. This scoping review's primary objective was to identify the key digital tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined. A 5-step scoping review methodology was used to map relevant literature published between January 1, 2010 and March 31, 2022. Electronic searches were performed in the MEDLINE, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention that combined self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles and extracted the data. The results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least 1 health professional were synthesized. The health professionals participating in these studies were physicians, dietitians, nurses, and psychologists. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices. We classified the features of these technologies into eight categories, depending on the intervention objective: (1) monitoring of glycemia levels, (2) physical activity monitoring, (3) medication monitoring, (4) diet monitoring, (5) therapeutic education, (6) health professional support, (7) other health data monitoring, and (8) health care management. The patient-logged data revealed behavior patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management, and therapeutic education, translate into better control of glycemia levels and the adoption of healthier lifestyles. Likewise, they seem to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise automatically generated reports. This scoping review synthesizes multiple studies that describe the development and evaluation of complex telehealth interventions used in combination with health professional support. It suggests that combining different digital tools that incorporate diabetes self-management and monitoring features with a health professional's advice and interaction results in more effective interventions and outcomes.

Mutual Assistance in Aging Issues and Countermeasures in the Central Urban Area of Chongqing

As the aging population intensifies, the service supply of elderly care institutions such as nursing homes and community elderly care service centers is relatively insufficient, failing to adequately address the diverse elderly care needs. The combination of mutual assistance elderly care and the framework of “Family + Community + Institution” enables the elderly to have a better elderly care experience within their familiar environment. This approach better fulfills the demands of home-based elderly care and optimizes the efficient allocation of elderly care resources. It is a new elderly care model widely accepted by urban community residents. A survey of mutual assistance elderly care practices across nine districts of the main city of Chongqing revealed representative models of community mutual assistance elderly care, including community mutual care organizations, “time bank” mutual care models, elderly care service organizations, and elderly community universities. Some practices and innovations in urban mutual assistance elderly care in Chongqing have provided useful exploration for actively addressing the issue of aging. However, there are still issues such as an incomplete urban community mutual assistance elderly care system, poor management and supervision, low social participation, and resource scarcity. Hence, this study seeks to explore the developmental obstacles encountered by mutual assistance and elderly care in Chongqing urban communities. It aims to propose practical and feasible suggestions and plans, ultimately promoting the healthy and sustainable development of the mutual assistance and elderly care model in urban communities in Chongqing.

The Concept of Recovery – a Contribution to the Development of Community Mental Health Services

Mental health, along with physical and social well-being, constitutes the general health of an individual, and it is considered that there is no health without mental health. According to the dual model of mental health, the mental state of an individual does not depend solely on the presence of a diagnosis of mental illness, but also on the subjective feeling of well-being. This means that a person with a mental disorder or illness can have good mental health and vice versa. New approaches in the protection of mental health and the treatment of people with mental illnesses are based on the principles of empowerment, recovery, social inclusion, human rights, multidisciplinarity and multisectoral cooperation. The aim of this paper is to present the concept of recovery of people with mental health problems, starting from a holistic understanding of mental health. Recovery is understood as a process that involves an individual who has hope and is aimed at overcoming psychological suffering, but also experts who shape and conduct their professional procedures with the aim of creating conditions for increasing the well-being and productivity of the individual. Also, the approach to recovery is incorporated into the development and organization of modern Community mental health care services. Under this aspect, the paper will present the development of psychiatric care and Community mental health services on the example of Centers for mental health in Bosnia and Herzegovina. Despite the knowledge and clear documents that focus on mental health care and support services for everyone in the community, there are significant challenges in implementing that type of mental health care system.

Improve-mentation for Faster Testing and Spread of Health Service Delivery Innovations.

Can we speed the testing, implementation and spread of management innovations in a systematic way to also contribute to scientific knowledge? Researchers and implementers have developed an approach to test and revise a local version of an innovation during its implementation. The chapter starts with a case example of an application of this combination of implementation and quality improvement sciences and practices (improve-mentation). It then summarizes four examples of this approach so as to help understand what improve-mentation is and how it is different from traditional quality improvement and traditional implementation of evidence-based practices. It considers gaps in knowledge that are hindering both more use of improve-mentation to generate scientific knowledge about spread and implementation, as well as more use of improve-mentation by health care service organizations and researchers. It closes by proposing fruitful research and development that can address these knowledge gaps to speed the implementation, sustainment and spread of care and management innovations.

How Do Primary Care Organizations Rate Their Level of Organizational Health Literacy? Results of a Swiss Pilot-Study

Primary care organizations offer a suitable setting to promote organizational health literacy (OHL) since they are a crucial interface for patients and clients. However, a clear picture on the OHL situation in primary care is lacking. The aim of this study was to assess OHL in Swiss primary care organizations by evaluating (i) how they rate their level of OHL and which improvement measures they accordingly plan (organizational level), (ii) what knowledge and attitudes among health professionals in primary care regarding OHL exist (individual level) and (iii) how teams working in general practitioners' practices and a home care service organization differ regarding OHL (organizational and individual level). The research design included an online survey (N = 74, health professionals) on the individual level and a checklist and intervention documentation (N = 10, primary care teams) on the organizational level. The study reveals a crucial demand regarding organizationally embedded OHL practices in the participating primary care teams, despite a rather comprehensive understanding of the concept. The greatest need for action was identified in strengthening health literacy of staff members, which underlines the necessity to develop interventions to systematically strengthen the health literacy of health professionals.

Health Professionals’ Experience with the First Implementation of the Organizational Health Literacy Self-Assessment Tool for Primary Care (OHL Self-AsseT)—A Qualitative Reflexive Thematic Analysis

Organizational health literacy (OHL) is crucial for public health, in turn health care organizations play vital roles in improving populations' health literacy. Therefore, the aim of this qualitative study was to explore how the organizational health literacy self-assessment tool (OHL Self-AsseT) was implemented, used, and understood by primary care teams from a network of general practices and a Home Care Service Organization in Zurich, Switzerland. Reflexive thematic analysis with a constructivist orientation was used to analyze data from 19 interviews pre- and post-OHL Self-AsseT use. Normalization Process Theory supported structuring of inductively developed themes. Findings show that the participants experienced working with the OHL Self-AsseT meaningful, as it helped with "Addressing OHL construction sites" so that they could "build momentum for change". The experience of "Succeeding together in construction" led to a "feeling of team-efficacy during change". Practical use of the tool and/or discussions about OHL led to a growing conceptual understanding, which was described as "Using a construction plan-making sense of ongoing OHL activities". To conclude, the OHL Self-AsseT encouraged teams to initiate change, led to greater team-efficacy and supported the construction of OHL. Improved implementation strategies will support this intervention's scale-up as a base for effectiveness testing.