Health Services Commission Research Articles

Knowledge of SCD and psychosocial burden experienced by caregivers of children with SCD at a secondary level hospital in Lagos, Nigeria - A cross sectional study

Background: Sickle cell anemia (SCA) is the most prevalent genetic disease in the world and the most severe of the sickle cell disorders. Individuals with SCA undergo numerous psychosocial problems. The severity of the clinical status of SCA imposes differing degrees of suffering to patients and their relatives, and the overall health of these patients depends on the quality of life and psychological preparedness of the caregivers. This study assessed the knowledge of sickle cell disease (SCD) and the psychosocial burdens of the disease on caregivers. Methods: This was a cross-sectional study conducted at Massey Street Children Hospital. Following consent, an interviewer-administered structured pro forma was utilized for the survey. The study was approved by the Health, Research, and Ethics Committee with permission from the Lagos State Health Service Commission. Data were analyzed using Epi Info™ 7.140. Results: Two hundred and sixteen respondents were interviewed with a mean age of 37.7 ± 7.8 years. Most of the respondents were female (90.7%) and presently married (90.7%). The mean knowledge score was 7.5 ± 2.1, with most (74.1%) of the respondents having good knowledge. The vast majority of respondents had lost income or financial benefits due to time spent caring for the child (91.2%) and reported that a child's illness disturbs activities at home (77.3%). Almost all (96.8%) reported an atmosphere of tension in the homes due to a child's illness, 80.6% reported episodes of depression and feeling sorrowful, 34% felt angry with self or child, and 14.3% felt stigmatized because of child's illness. There was a statistically significant association between respondents' level of education, gender, age, relationship to a child, and knowledge of SCD, and a higher proportion of those with good knowledge had no disruption of family interactions. Conclusion: Majority of the caregivers accessing care for children with SCD had good knowledge of the disease and experienced varied degrees of disruption in their finances, family routine, and family interaction. Improving knowledge of SCD is recommended among caregivers to alleviate psychosocial burdens, especially those associated with family interactions.

Liaison psychiatry—measurement and evaluation of service types, referral patterns and outcomes (LP-MAESTRO): a protocol

IntroductionWe describe the protocol for a project that will use linkage of routinely collected NHS data to answer a question about the nature and effectiveness of liaison psychiatry services in...

Costs and consequences of the Family Nurse Partnership (FNP) programme in England: evidence from the Building Blocks trial

Background: The Family Nurse Partnership (FNP) is a licensed intensive home visiting intervention programme delivered to teenage mothers which was originally introduced in England in 2006 by the Department of Health and is now provided through local commissioning of public health services and supported by a national unit led by a consortium of partners. The Building Blocks (BB) trial aimed to explore the effectiveness and cost-effectiveness of this programme. This paper reports the results of an economic evaluation of the Building Blocks randomised controlled trial (RCT) based on a cost-consequence approach. Methods: A large sample of 1618 families was followed-up at various intervals during pregnancy and for two years after birth. A cost-consequence approach was taken to appraise the full range of costs arising from the intervention including both health and social measures of cost alongside the consequences of the trial, specifically, the primary outcomes. Results: A large number of potential factors were identified that are likely to attract additional costs beyond the implementation costs of the intervention including both health and non-health outcomes. Conclusion: Given the extensive costs and only small beneficial consequences observed within the two year follow-up period, the cost-consequence model suggests that the FNP intervention is unlikely to be worth the substantial costs and policy makers may wish to consider other options for investment. Trial registration: ISRCTN23019866 (20/04/2009)

Costs and consequences of the Family Nurse Partnership (FNP) programme in England: evidence from the Building Blocks trial.

Background: The Family Nurse Partnership (FNP) is a licensed intensive home visiting intervention programme delivered to teenage mothers which was originally introduced in England in 2006 by the Department of Health and is now provided through local commissioning of public health services and supported by a national unit led by a consortium of partners. The Building Blocks (BB) trial aimed to explore the effectiveness and cost-effectiveness of this programme. This paper reports the results of an economic evaluation of the Building Blocks randomised controlled trial (RCT) based on a cost-consequence approach. Methods: A large sample of 1618 families was followed-up at various intervals during pregnancy and for two years after birth. A cost-consequence approach was taken to appraise the full range of costs arising from the intervention including both health and social measures of cost alongside the consequences of the trial, specifically, the primary outcomes. Results: A large number of potential factors were identified that are likely to attract additional costs beyond the implementation costs of the intervention including both health and non-health outcomes. Conclusion: Given the extensive costs and only small beneficial consequences observed within the two year follow-up period, the cost-consequence model suggests that the FNP intervention is unlikely to be worth the substantial costs and policy makers may wish to consider other options for investment. Trial registration: ISRCTN23019866 (20/04/2009).

Implementing the skilled birth attendance strategy in Uganda: a policy analysis

BackgroundUganda, a low resource country, implemented the skilled attendance at birth strategy, to meet a key target of the 5th Millenium Development Goal (MDG), 75% reduction in maternal mortality ratio. Maternal mortality rates remained high, despite the improvement in facility delivery rates. In this paper, we analyse the strategies implemented and bottlenecks experienced as Uganda’s skilled birth attendance policy was rolled out. These experiences provide important lessons for decision makers as they implement policies to further improve maternity care.MethodsThis is a case study of the implementation process, involving a document review and in-depth interviews among key informants selected from the Ministry of Health, Professional Organisations, Ugandan Parliament, the Health Service Commission, the private not-for-profit sector, non-government organisations, and District Health Officers. The Walt and Gilson health policy triangle guided data collection and analysis.ResultsThe skilled birth attendance policy was an important priority on Uganda’s maternal health agenda and received strong political commitment, and support from development partners and national stakeholders. Considerable effort was devoted to implementation of this policy through strategies to increase the availability of skilled health workers for instance through expanded midwifery training, and creation of the comprehensive nurse midwife cadre. In addition, access to emergency obstetric care improved to some extent as the physical infrastructure expanded, and distribution of medicines and supplies improved. However, health worker recruitment was slow in part due to the restrictive staff norms that were remnants of previous policies. Despite considerable resources allocated to creating the comprehensive nurse midwife cadre, this resulted in nurses that lacked midwifery skills, while the training of specialised midwives reduced. The rate of expansion of the physical infrastructure outpaced the available human resources, equipment, blood infrastructure, and several health facilities were not fully functional.ConclusionUganda’s skilled birth attendance policy aimed to increase access to obstetric care, but recruitment of human resources, and infrastructural capacity to provide good quality care remain a challenge. This study highlights the complex issues and unexpected consequences of policy implementation. Further evaluation of this policy is needed as decision-makers develop strategies to improve access to skilled care at birth.

Inside the Black Box: Organisational Buying Behaviour and Strategic Purchasing in Healthcare: A Response to Recent Commentary

We read the Hanson et al1 paper with great interest, utilising as it does our IJHPM paper, ‘What’s Needed to Develop Strategic Purchasing in Healthcare? Policy Lessons from a Realist Review.’2 We very much agree with their statement identifying a key gap in our paper: ‘One empirical finding which is not directly anticipated in either the economics of organisation or the inter-organisational relationships literatures was the critical importance of organisational capacity. Strategic purchasing is technically demanding and requires a number of capacities of the purchaser.’1 The realist review from which our paper was derived included the issue of organisational capacity as a key aspect of strategic purchasing. Limitations of space prevented us from discussing it in the paper, but this correspondence provides an ideal opportunity to do so, albeit briefly. Much of the procurement literature concerns buyer-supplier interactions, with principal-agent, transaction cost and inter-organisational relationships theories centre-stage. This was covered in our recent paper.2 However, there is also a complementary part of the literature that concerns ‘organisational buying behaviour’ (OBB) – research into the structures, cultures, systems, processes, capabilities and behaviours (that together create organisational capacity) that affect whether the buy-side organisation can manage its interactions with suppliers effectively. In what follows, we look at three key aspects of the OBB literature and illustrate their relevance to strategic purchasing via an application to English National Health Service (NHS) commissioning.

A Comparative Analysis of Social Impact Bond and Conventional Financing Approaches to Health Service Commissioning in England: The Case of Social Prescribing

The article compares two social prescribing interventions in Northern England. One was financed through a Social Impact Bond (SIB) and the other was financed in a more conventional way. It utilises a comparative approach to understand the extent to which different methods of financing social prescribing conform to key features of the New Public Management (NPM) or New Public Governance (NPG) in their design and implementation. It finds that a SIB approach tends towards NPM during programme design and implementation and that this creates challenges for social prescribing programmes, the complexity of which appear better suited to an NPG-based relational approach.

Texas health leaders expanding early psychosis treatment

Texas will soon have 23 sites offering mental health services to young adults experiencing early‐onset psychosis, KTAB News reported July 23. The Texas Health and Human Services Commission's (HHSC's) Coordinated Specialty Care Program is adding 13 new sites this year with help from a $4 million mental health block grant from the Substance Abuse and Mental Health Services Administration. “It's critical we reach people early in their diagnosis to create the best opportunity for recovery,” Sonja Gaines, HHSC deputy executive commissioner for intellectual and developmental disability and behavioral health services, said in a released statement. “Connecting people with the right treatment and support can be life changing and dramatically alter the trajectory of a person's future.” Coordinated specialty care helps people ages 15 to 30 years old who have been diagnosed with a psychotic disorder within the last two years. A team of specialists provides medication management, case management, employment and education support, and additional health care. Since 2014, the HHSC's Coordinated Specialty Care Program has helped Texans graduate from high school and college, find stable housing, maintain employment and get on track with independent living.

P196 Chat with WIC: Innovating WIC Services with a Chatbot

Background WIC serves low income pregnant, postpartum, and breastfeeding women and infants and children at nutritional risk by providing food packages and nutrition education. Texas WIC enrollment has declined by 24.1% since 2015. By offering continual availability to answer questions regarding eligibility and schedule appointments, an online chatbot has potential to improve enrollment and retention. Objective To inform the development of a Texas WIC Chatbot prototype by engaging WIC stakeholders and staff. Study Design, Settings, Participants This study involved three sets of group interviews conducted using Zoom with state-level stakeholders, WIC directors, and clinic staff. Participation was invited via email. Demographic surveys were completed before interviews. An interview guide prompted discussion regarding how a chatbot could expedite the WIC flow of services, what desirable chatbot features would be, and how barriers to successful implementation could be overcome. Measurable Outcome/Analysis Interview data were recorded, transcribed, and themed using the classic analysis strategy. Themes informed WIC Chatbot design. Results A total of 11 group interviews with 32 participants were conducted. Themes included support that a chatbot: could improve WIC services by adding flexibility so that clients could determine eligibility and be better prepared for clinic visits; would be most effective with a friendly, personable interface; and could potentially connect clients to other WIC information, such as nutrition education. Participants expressed concern that no chatbot could be a one-size-fits-all solution. Conclusion The prospect of a Texas WIC Chabot was well-received. A chatbot could ideally provide a logical interface aligned with the WIC flow of services, with a friendly and professional interface. Next steps will involve the development of a live-chat launched through the Texas WIC website to investigate user preferences. Collectively, these data will inform WIC Chatbot 1.0. After implementation of WIC Chatbot 1.0, the effect on enrollment and retention can be assessed. Funding Texas Health and Human Services Commission, WIC Program.

Ebola Response: A study of the Psychosocial Factors of Preparedness Among Commissioned Corps Officers of the United States Public Health Service.

The purpose of the cross-sectional study was to explore the relationships between occupational and general-self efficacy, and perceived preparedness among Commissioned Corps officers in the United States Public Health Service (Commissioned Corps). Commissioned Corps officers fight to protect the United States from diseases and care for the survivors of natural disasters and terrorist attacks. Commissioned Corps officers play a vital role in the fight to protect the United States from diseases and care for the survivors of natural disasters and terrorist attacks. The Commissioned Corps provided healthcare services in Liberia during the 2014 Ebola crisis that underscored the challenges of emerging diseases in a globalized community. It is imperative that these health professionals maintain a high level of self-efficacy and feel confident in their overall preparedness training as they respond to public health emergencies. This study used assessment instruments derived from Albert Bandura's concept of self-efficacy to analyze the occupational and general self-efficacy, and perceived preparedness levels of health services officers in the Commissioned Corps. 82 Commissioned Corps officers completed the assessment survey. To date, no study has examined the relationship between these constructs in this population. There was a statistically significant relationship between feeling confident in one's Commissioned Corps training and perceived preparedness (rs = 0.55, p < 0.001). This study reflects the training perceptions and self-beliefs of Commissioned Corps officers, fills an important gap in the empirical research in this population, and advances previous investigations, which suffered from an underrepresentation of female service members.

‘I felt like I was doing something wrong’: A qualitative exploration of mothers' experiences of breastfeeding

Despite its multiple health benefits, rates of breastfeeding to 2 years and beyond remain low in the UK. This qualitative study explored the experiences of support provided by health professionals to mothers breastfeeding beyond infancy. A key finding of the study was that health services are effective at supporting breastfeeding in the postnatal period, but that beyond the 1-year review the focus shifts to rapid weaning. A new approach to support breastfeeding continuation alongside the introduction of complementary foods is needed in line with professional guidance and recommendations. As critical reflective practitioners, health visitors are ideally placed to support and educate women about the wider social complexities of breastfeeding. However, health service commissioners need to recognise the importance of investment in the profession to enable health visitors to use their skills fully.

Efficacy of venetoclax monotherapy in patients with relapsed chronic lymphocytic leukaemia in the post‐BCRinhibitor setting: aUKwide analysis

Venetoclax is a BCL2 inhibitor with activity in relapsed/refractory (R/R) chronic lymphocytic leukaemia (CLL). We conducted a multi-centre retrospective analysis of 105 R/R CLL patients who received venetoclax pre-National Health Service commissioning. The median age was 67years and median prior lines was 3 (range: 1-15). 48% had TP53 disruption. At ≥2 lines, 60% received a Bruton Tyrosine Kinase inhibitor (BTKi) and no prior phosphoinositide 3-kinase inhibitor (Pi3Ki), 25% received a Pi3Ki and no prior BTKi, and 10% received both. Patients discontinued B cell receptor inhibitor (BCRi) because of toxicity in 44% and progression in 54%. Tumour lysis syndrome risk was low, intermediate or high in 27%, 25%, and 48% respectively. Overall response was 88% (30% complete response [CR]). The overall response rate was 85% (CR 23%) in BTKi-exposed patients, 92% (CR 38%) in Pi3Ki-exposed patients and 80% (CR 20%) in both (P=0·59). With a median follow-up of 15·6months, 1-year progression-free survival was 65·0% and 1-year overall survival was 75·1%. Dose reduction or temporary interruption did not result in an inferior progression-free or discontinuation-free survival. Risk of progression or death after stopping a prior BCRi for progression was double compared to those stopping for other reasons (predominantly toxicity) (Hazard Ratio 2·01 P=0·05). Venetoclax is active and well tolerated in R/R CLL post ≥1 BCRi. Reason(s) for stopping BCRi influences venetoclax outcomes.

How LGBT+ Young People Use the Internet in Relation to Their Mental Health and Envisage the Use of e-Therapy: Exploratory Study.

BackgroundLesbian, gay, bisexual, and transgender (LGBT) youth and other young people diverse in terms of their sexuality and gender (LGBT+) are at an elevated risk of mental health problems such as depression. Factors such as isolation and stigma mean that accessing mental health services can be particularly challenging for LGBT+ young people, and previous studies have highlighted that many prefer to access psychological support on the Web. Research from New Zealand has demonstrated promising effectiveness and acceptability for an LGBT+ focused, serious game–based, computerized cognitive behavioral therapy program, Rainbow Smart, Positive, Active, Realistic, X-factor thoughts (SPARX). However, there has been limited research conducted in the area of electronic therapy (e-therapy) for LGBT+ people.ObjectiveThis study aimed to explore how and why LGBT+ young people use the internet to support their mental health. This study also sought to explore LGBT+ young people’s and professionals’ views about e-therapies, drawing on the example of Rainbow SPARX.MethodsA total of 3 focus groups and 5 semistructured interviews were conducted with 21 LGBT+ young people (aged 15-22 years) and 6 professionals (4 health and social care practitioners and 2 National Health Service commissioners) in England and Wales. A general inductive approach was used to analyze data.ResultsLGBT+ youth participants considered that the use of the internet was ubiquitous, and it was valuable for support and information. However, they also thought that internet use could be problematic, and they highlighted certain internet safety and personal security considerations. They drew on a range of gaming experiences and expectations to inform their feedback about Rainbow SPARX. Their responses focused on the need for this e-therapy program to be updated and refined. LGBT+ young people experienced challenges related to stigma and mistreatment, and they suggested that strategies addressing their common challenges should be included in e-therapy content. Professional study participants also emphasized the need to update and refine Rainbow SPARX. Moreover, professionals highlighted some of the issues associated with e-therapies needing to demonstrate effectiveness and challenges associated with health service commissioning processes.ConclusionsLGBT+ young people use the internet to obtain support and access information, including information related to their mental health. They are interested in LGBT-specific e-therapies; however, these must be in a contemporary format, engaging, and adequately acknowledge the experiences of LGBT+ young people.

Lessons for commissioning and health outcomes from Her Majesty’s Prison Birmingham

Purpose This study of HMP Birmingham was part of a much larger investigation of health needs assessment (HNA), in the context of a new “HNA Toolkit” developed by Public Health England for use in the prison service. The paper aims to discuss this issue. Design/methodology/approach In 2015, details of prison healthcare in HMP Birmingham had figured in the authors’ analysis of documents. In 2018, a crisis in Birmingham typified problems developing more widely in England and Wales. Was the crisis predictable from the initial HNA? Findings Recommendations embodied in the 2015 HNA were not acted upon; the eventual problems that combined to overwhelm the running of HMP Birmingham were predictable. Originality/value Lessons from this case study could inform more coherent commissioning of prison health services. This in turn could promote timely developments for improved health and morale in the prison, amongst prisoners and staff. Longer term, this might help to avoid future crises.

Funding the unfunded: Engaging healthcare organisations, governmental agencies and legislative processes

When Texas faced mounting criticism over funding and access to women’s health services, officials and providers across the state addressed the issue together. During the 84th Legislative Session in 2015, healthcare stakeholders testified before health and appropriations committees that women’s healthcare in Texas was flawed and left many people confused about how to navigate a fragmented system. That year, the Texas Legislature directed the Texas Health and Human Services Commission (HHSC) to redesign the Women’s Health Program to improve access to quality services for low-income women. This paper provides perspectives from a public and academic safety-net healthcare system and a state agency on how HHSC successfully addressed critical health policy issues in the state.

Twenty-first century emergency response efforts of the Commissioned Corps of the US Public Health Service.

The impact of the Commissioned Corps of the US Public Health Service (Commissioned Corps) on the health and safety of the nation spans more than two centuries. The public health efforts of the highly qualified health professionals of this often-underreported uniformed service include fighting threats like the great flu pandemic of 1918, the anthrax attacks, Ebola, and natural disasters such as Hurricanes Maria, Irma, and Katrina. As we near the first quarter of the twenty-first century, it is important to take a snapshot of the critical contributions and response efforts the Commissioned Corps has made in the first 18 years of the twenty-first century. Today, the Commissioned Corps faces new challenges in the form of emerging diseases and a rapidly growing opioid epidemic, but under the guidance of the US Surgeon General, it remains vigilant and fully capable of minimizing any public health threat it encounters.

Cost-effectiveness of interventions for perinatal anxiety and/or depression: a systematic review

ObjectivesAnxiety and/or depression during pregnancy or year after childbirth is the most common complication of childbearing. Economic evaluations of interventions for the prevention or treatment of perinatal anxiety and/or depression...

Beyond the parish pump: what next for public health?

BackgroundPublic health has had a history characterised by uncertainty of purpose, locus of control, and workforce identity. In many health systems, the public health function is fragmented, isolated and under-resourced. We use the most recent major reforms to the English National Health Service and local government, the Health and Social Care Act 2012 (HSCA12), as a lens through which to explore the changing nature of public health professionalism.MethodsThis paper is based upon a 3-year longitudinal study into the impacts of the HSCA12 upon the commissioning system in England, in which we conducted 141 interviews with 118 commissioners and senior staff from a variety of health service commissioner and provider organisations, local government, and the third sector. For the present paper, we developed a subset of data relevant to public health, and analysed it using a framework derived from the literature on public health professionalism, exploring themes identified from relevant policy documents and research.ResultsThe move of public health responsibilities into local government introduced an element of politicisation which challenged public health professional autonomy. There were mixed feelings about the status of public health as a specialist profession. The creation of a national public health organisation helped raise the profile of profession, but there were concerns about clarity of responsibilities, accountability, and upholding ‘pure’ public health professional values. There was confusion about the remit of other organisations in relation to public health.ConclusionsWhere public health professionals sit in a health system in absolute terms is less important than their ability to develop relationships, negotiate their roles, and provide expert public health influence across that system. A conflation between ‘population health’ and ‘public health’ fosters unrealistic expectations of the profession. Public health may be best placed to provide leadership for other stakeholders and professional groups working towards improving health outcomes of their defined populations, but there remains a need to clarify the role(s) that public health as a specialist profession has to play in helping to fulfil population health goals.

Miller v Health Service Commissioner for England: Challenging the Exercise of Discretion

Miller v Health Service Commissioner for England: Challenging the Exercise of Discretion

Exploring the Regulation of Task Sharing for Access to Family Planning Services in Uganda

There is an acute shortage of Human Resources for Health in Uganda. While task sharing in the delivery of reproductive services is one of the strategies to avert this crisis, it takes place in an unregulated environment. The consequent lack of legal protection for health care providers poses a potential barrier to task sharing for both providers and the government. We show in this legal and policy review that the approach is not new in the country and that it has provisions in some policy documents. We further show the legal implications if it is rolled out in an unregulated environment and propose six options to guide regulation. These include enforcing the Health Service Commission Act, utilizing the mandate of the Director General to authorize treatment, amending the regulations of health professional regulatory bodies, developing regulation to support implementation of the acts for health professionals, developing a full act of parliament, and enacting ordinances at the district level.