Community-based Health Care Research Articles

A Community-Based Reproductive Health Care Model Effectively Enhances Reproductive Health Among Lahu Women in Northern Thailand.

Inadequate and delayed access to sexual and reproductive health services among the Hill Tribe population can be attributed to the intersection of socioeconomic challenges and distinct cultural practices. To address this limitation and create a tailored model capable of addressing it, this study assesses the effectiveness of the Community-Based Reproductive Health Care Model (CRHC) in enhancing reproductive health knowledge, attitudes, and practices among Lahu women, a prominent hill tribe population in Northern Thailand. Implementing the CRHC model includes training programs for community influencers and subsequent education for Lahu women using culturally adapted courses. The effectiveness of the model is assessed through pre-test and post-test comparisons of knowledge, attitudes, and practices related to reproductive health care and analyzed using paired t-tests and repeated ANOVA. The scores for knowledge, attitudes, and practices among Lahu women changed from 8.92 ± 2.02, 52.99 ± 5.54, and 27.76 ± 6.67 to 10.47 ± 2.32 (p < 0.001), 56.61 ± 5.54 (p < 0.001), and 29.47 ± 6.76 (p = 0.030), respectively. Significant improvements are observed in these areas, particularly in maternal health practices among pregnant Lahu women (n = 11). This study additionally evaluates the model's impact on the healthcare system by analyzing changes in government performance indexes, showing increased access to high-quality antenatal care and contraceptive usage. This study highlights the challenges faced by hill tribe populations in accessing healthcare, emphasizing the need for tailored reproductive health education and the importance of addressing health insurance barriers. The CRHC model's success illustrates the potential of community-based, culturally sensitive interventions in improving reproductive health outcomes, providing valuable insights for similar interventions in other indigenous or marginalized communities.

How Community-Based Health and Social Care Professionals Support Unpaid Caregivers: Experiences From One Health Authority in Ontario, Canada.

In Ontario, Canada, rising rates of caregiver distress have been the 'canary in the coal mine' for a health system out of balance with the needs of an ageing population. Community-based health and social care professionals are well placed to play an important role in the caregiver support process; however, a gap has remained in the understanding of if and how caregiver support strategies are operationalized or experienced by community service providers (CSPs). The goal of this study was to describe how CSPs interpreted policy and how those interpretations may enable their work in supporting unpaid caregivers. Using a qualitative constructionist design, we interviewed 24 participants and reviewed 92 publicly available documents. Braun and Clarke's method of thematic analysis was used for analysis strategy. Four overarching themes were identified: (1) community care as a priority, (2) sidewalk accountability, (3) creative care planning through partnerships, and (4) challenges to care delivery. We found that the importance of caregivers to the health system was reflected in organizational policy and strategy. There is an opportunity to improve health outcome for caregivers and the population alike through strong leadership and a clear shared vision. Our findings also suggested that social capital was a significant factor in enabling providers in their work, leveraging long-standing relationships, and accumulated local knowledge to implement highly creative care plans.

Psychiatric disorders in childhood cancer survivors: A retrospective matched cohort study of inpatient hospitalisations and community-based mental health services utilisation in Western Australia.

We examined the impact of long-term mental health outcomes on healthcare services utilisation among childhood cancer survivors in Western Australia using linked hospitalisations and community-based mental healthcare records from 1987 to 2019. The study cohort included 2977 childhood cancer survivors diagnosed with cancer at age < 18 years in Western Australia from 1982 to 2014 and a matched non-cancer control group of 24,994 individuals. Adjusted hazard ratios of recurrent events were estimated using the Andersen-Gill model. The cumulative burden of events over time was assessed using the method of mean cumulative count. The annual percentage change in events was estimated using the negative binomial regression model. The results showed higher community-based service contacts (rate/100 person-years: 30.2, 95% confidence interval = [29.7-30.7] vs 22.8, 95% confidence interval = [22.6-22.9]) and hospitalisations (rate/1000 person-years: 14.8, 95% confidence interval = [13.6-16.0] vs 12.7, 95% confidence interval = [12.3-13.1]) in childhood cancer survivors compared to the control group. Childhood cancer survivors had a significantly higher risk of any event (adjusted hazard ratio = 1.5, 95% confidence interval = [1.1-2.0]). The cumulative burden of events increased with time since diagnosis and across age groups. The annual percentage change for hospitalisations and service contacts significantly increased over time (p < 0.05). Substance abuse was the leading cause of hospitalisations, while mood/affective and anxiety disorders were common causes of service contacts. Risk factors associated with increased service events included cancer diagnosis at age < 5 years, leukaemia diagnosis, high socioeconomic deprivation, and an attained age of < 18 years. The elevated utilisation of healthcare services observed among childhood cancer survivors emphasises the need for periodic assessment of psychiatric disorders, particularly in high-risk survivors, to facilitate early management and optimise healthcare resources.

The Epidemiology of Rheumatic Diseases in India

Epidemiological studies, referred to as the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) studies, have been conducted under the aegis of the International League against Rheumatism and the World Health Organization to evaluate the epidemiology of rheumatic and musculoskeletal (RMSK) diseases in India. These COPCORD studies conducted in rural Bhigwan and urban Pune in Maharashtra, rural Calicut and rural Trivandrum in Kerala and rural and urban Lucknow in Uttar Pradesh, along with data from the Global Burden of Diseases study have helped to understand the burden of rheumatic diseases in the community. Based on these studies, RMSK diseases, which are amongst the top 25 causes of disability in the Indian population, are prevalent in nearly 25%–30% of the Indian population. The common rheumatic diseases in the community are soft tissue rheumatism, neck and back pain, fibromyalgia and unspecified pains and osteoarthritis (most commonly affecting the knee). These diseases most commonly affect young persons between the third to the fifth decade of life, more often affect females, are prevalent in both rural and urban populations, and account for considerable disability in up to one-fifth of individuals leading to loss of livelihood and dependence on others for self-care. Community-based national healthcare programs to manage RMSK diseases at the community level are urgently needed. There also remains an unmet need to train more doctors to diagnose and manage rheumatic diseases at the primary, secondary and tertiary levels of care.

Suicide mortality among individuals in federal prisons compared with the general population: a retrospective cohort study in the USA from 2009 to 2020

IntroductionSuicide is one of the leading causes of death in US prisons. Yet, administrative data lags years behind and reporting rarely accounts for differing age distributions between suicide rates between...

Perspectives from community-based pediatric healthcare providers on sleep health practices among children in economically stressed urban environments

Perspectives from community-based pediatric healthcare providers on sleep health practices among children in economically stressed urban environments

Developing countries' health policy: A critical review and pathway to effective healthcare systems

This paper provides a concise overview of a comprehensive review exploring the health policies of developing countries, critically assessing their strengths, weaknesses, and proposing pathways towards building effective healthcare systems. In developing countries, health policies play a pivotal role in determining the accessibility, quality, and equity of healthcare services. This critical review examines the current state of health policies in developing nations, acknowledging both achievements and shortcomings. The analysis encompasses key areas such as infrastructure, workforce capacity, disease prevention, and financial sustainability. The review identifies common challenges faced by developing countries, including limited financial resources, inadequate healthcare infrastructure, and disparities in healthcare access among different socio-economic groups. It also sheds light on successful strategies employed by certain nations, emphasizing the importance of community-based healthcare, technology integration, and innovative financing models. Moreover, the review critically assesses the effectiveness of existing health policies in addressing prevalent health issues, such as infectious diseases, maternal and child health, and the growing burden of non-communicable diseases. It delves into the role of governance, political will, and international collaborations in shaping and implementing health policies. In proposing a pathway to effective healthcare systems, the review emphasizes the need for tailored, context-specific approaches that consider the unique challenges of each developing country. It advocates for increased investment in primary healthcare, capacity-building for healthcare professionals, and the harnessing of digital technologies to enhance healthcare delivery. Ultimately, this critical review aims to inform policymakers, healthcare professionals, and stakeholders in developing countries, providing insights to shape evidence-based health policies that lead to resilient, accessible, and equitable healthcare systems. By learning from both successes and failures, these countries can pave the way for transformative changes in their health policies, ensuring the well-being of their populations and contributing to global health advancement.

An integrated knowledge translation (iKT) approach to advancing community-based depression care in Vietnam: lessons from an ongoing research-policy collaboration

BackgroundEvidence-based mental health policies are key to supporting the expansion of community-based mental health care and are increasingly being developed in low and middle-income countries (LMICs). Despite this, research on the process of mental health policy development in LMICs is limited. Engagement between researchers and policy makers via an integrated Knowledge Translation (iKT) approach can help to facilitate the process of evidence-based policy making. This paper provides a descriptive case study of a decade-long policy and research collaboration between partners in Vietnam, Canada and Australia to advance mental health policy for community-based depression care in Vietnam.MethodsThis descriptive case study draws on qualitative data including team meeting minutes, a focus group discussion with research team leaders, and key informant interviews with two Vietnamese policy makers. Our analysis draws on Murphy et al.’s (2021) findings and recommendations related to stakeholder engagement in global mental health research.ResultsConsistent with Murphy et al.’s findings, facilitating factors across three thematic categories were identified. Related to ‘the importance of understanding context’, engagement between researchers and policy partners from the formative research stage provided a foundation for engagement that aligned with local priorities. The COVID-19 pandemic acted as a catalyst to further advance the prioritization of mental heath by the Government of Vietnam. ‘The nature of engagement’ is also important, with findings demonstrating that long-term policy engagement was facilitated by continuous funding mechanisms that have enabled trust-building and allowed the research team to respond to local priorities over time. ‘Communication and dissemination’ are also crucial, with the research team supporting mental health awareness-raising among policy makers and the community, including via capacity building initiatives.ConclusionsThis case study identifies factors influencing policy engagement for mental health system strengthening in an LMIC setting. Sustained engagement with policy leaders helps to ensure alignment with local priorities, thus facilitating uptake and scale-up. Funding agencies can play a crucial role in supporting mental health system development through longer term funding mechanisms. Increased research related to the policy engagement process in global mental health will further support policy development and improvement in mental health care in LMICs.

Trends in Detection of Adenoma and Sessile Serrated Lesions Over a Decade in a Community-Based Healthcare System.

Adenoma detection rate (ADR) is an accepted benchmark for screening colonoscopy. Factors driving ADR and its relationship with sessile serrated lesions detection rate (SSLDR) over time remain unclear. We aim to explore patient, physician, and procedural influences on ADR and SSLDR trends. Using a large healthcare system in northern California from January 2010 to December 2020, a total of 146,818 screening colonoscopies performed by 33 endoscopists were included. ADR and SSLDR were calculated over time using natural language processing. Logistic regression was used to calculate the odd ratios of patient demographics, physician attributes, and procedural details over time. Between 2010 and 2020, ADR rose from 19.4% to 44.4%, whereas SSLDR increased from 1.6% to 11.6%. ADR increased by 2.7% per year (95% confidence interval 1.9%-3.4%), and SSLDR increased by 1.0% per year (95% confidence interval 0.8%-1.2%). Higher ADR was associated with older age, male sex, higher body mass index, current smoker, higher comorbidities, and high-risk colonoscopy. By contrast, SSLDR was associated with younger age, female sex, white race, and fewer comorbidities. Patient and procedure characteristics did not significantly change over time ( P -interaction >0.05). Longer years in practice and male physician were associated with lower ADR and SSLDR in 2010, but significantly attenuated over time ( P -interaction <0.05). Both ADR and SSLDR have increased over time. Patient and procedure factors did not significantly change over time. Male endoscopist and longer years in practice had lower initial ADR and SSLDR, but significantly lessened over time.

Measuring quality-of-care in treatment of young children with attention-deficit/hyperactivity disorder using pre-trained language models.

To measure pediatrician adherence to evidence-based guidelines in the treatment of young children with attention-deficit/hyperactivity disorder (ADHD) in a diverse healthcare system using natural language processing (NLP) techniques. We extracted structured and free-text data from electronic health records (EHRs) of all office visits (2015-2019) of children aged 4-6 years in a community-based primary healthcare network in California, who had ≥1 visits with an ICD-10 diagnosis of ADHD. Two pediatricians annotated clinical notes of the first ADHD visit for 423 patients. Inter-annotator agreement (IAA) was assessed for the recommendation for the first-line behavioral treatment (F-measure = 0.89). Four pre-trained language models, including BioClinical Bidirectional Encoder Representations from Transformers (BioClinicalBERT), were used to identify behavioral treatment recommendations using a 70/30 train/test split. For temporal validation, we deployed BioClinicalBERT on 1,020 unannotated notes from other ADHD visits and well-care visits; all positively classified notes (n = 53) and 5% of negatively classified notes (n = 50) were manually reviewed. Of 423 patients, 313 (74%) were male; 298 (70%) were privately insured; 138 (33%) were White; 61 (14%) were Hispanic. The BioClinicalBERT model trained on the first ADHD visits achieved F1 = 0.76, precision = 0.81, recall = 0.72, and AUC = 0.81 [0.72-0.89]. Temporal validation achieved F1 = 0.77, precision = 0.68, and recall = 0.88. Fairness analysis revealed low model performance in publicly insured patients (F1 = 0.53). Deploying pre-trained language models on a variable set of clinical notes accurately captured pediatrician adherence to guidelines in the treatment of children with ADHD. Validating this approach in other patient populations is needed to achieve equitable measurement of quality of care at scale and improve clinical care for mental health conditions.

Capacity Assessment of Community Clinic (CC) as an Information and Support Hub during Future Outbreaks: Lessons Learnt from the COVID-19 Outbreak

The study delves into the potential of Community Clinics (CCs) in Bangladesh to function as crucial information and support hubs during pandemics and outbreaks. By examining both internal and external factors, including organizational structure, roles, responsibilities, infrastructure, skills, tools, existing organogram, government policies, and community clinic dynamics, the research assesses the capability of CCs in this role. Through a telephonic survey of 100 Community Health Care Providers (CHCP) and Key Informant Interviews (KII) with Community Based Health Care (CBHC) officials, valuable insights were gained. While the findings reveal that CCs may not be comprehensive treatment centers for pandemics, they can effectively serve as information and support hubs, aligning with their mandates. To enhance their efficiency in this role, upgrading the WASH sensitivity of CCs is recommended, along with other measures to improve their capacity during disease outbreaks. The study underscores the significance of recognizing CCs as vital assets in combating emerging health hazards, and strategic improvements can further strengthen their contributions in addressing public health challenges.&#x0D; The Dhaka University Journal of Earth and Environmental Sciences, Vol. 12(1), 2023, P 41-56

GPs' views on emergency care treatment plans: an online survey.

A holistic approach to emergency care treatment planning is needed to ensure that patients' preferences are considered should their clinical condition deteriorate. To address this, emergency care and treatment plans (ECTPs) have been introduced. Little is known about their use in general practice. To find out GPs' experiences of, and views on, using ECTPs. Online survey of GPs practising in England. A total of 841 GPs were surveyed using the monthly online survey provided by medeConnect, a market research company. Forty-one per cent of responders' practices used Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans for ECTP, 8% used other ECTPs, and 51% used Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms. GPs were the predominant professional group completing ECTPs in the community. There was broad support for a wider range of community-based health and social care professionals being able to complete ECTPs. There was no system for reviewing ECTPs in 20% of responders' practices. When compared with using a DNACPR form, GPs using a ReSPECT form for ECTP were more comfortable having conversations about emergency care treatment with patients (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.1 to 2.69) and family members (OR =1.85, 95% CI = 1.19 to 2.87). The potential benefits and challenges of widening the pool of health and social care professionals initiating and/or completing the ECTP process needs consideration. ReSPECT plans appear to make GPs more comfortable with ECTP discussions, supporting their implementation. Practice-based systems for reviewing ECTP decisions should be strengthened.

Social Resilience and Community-Based Healthcare for Older Adults During COVID-19: A Phenomenological Case Study

Social Resilience and Community-Based Healthcare for Older Adults During COVID-19: A Phenomenological Case Study

Support Supervision for Community Health Workers in Uganda: Implications of Village Health Teams in Mitooma District

Background: Support supervision for Community Health Workers is a field that is undervalued worldwide. The performance of Uganda’s Community Health Workers, also known as Village Health Teams, is impacted by their lack of supportive supervision. This study evaluated the impact of support supervision on VHT involvement in community-based healthcare in Uganda’s Mitooma area. Method: This article’s empirical analysis is based on data gathered between September and October 2021 from 341 Village Health Teams from eight Sub-counties in the Mitooma area as part of a cross-sectional study. Data were gathered via semi-structured questionnaires, focus groups, and key informant interviews. STATA version 14.2 was used for descriptive analysis, and manual methods were used for qualitative (thematic and content) analysis. Results: In Mitooma district, support supervision is still dispersed even though it is thought to be a tool for encouraging Village Health Teams, facilitating continuing training, and keeping them accountable for their work. Lack of funds, irregular supervision, and a lack of guidelines were among the challenges limiting support supervision in the district. Conclusion: It was generally acknowledged that support supervision is still undervalued in the VHT program. Stakeholders suggested that in order to solve these issues, there should be more financing, supervisor job descriptions that are explicit, and in-person supervisory meetings.

Geriatric Health Care Utilization in Selected Rural Area of Assam

Health care utilization is a critical aspect reflecting the effectiveness and accessibility of services, shaped by factors such as proximity, waiting times, privacy, affordability, and treatment efficacy. To delve into this realm, a community-based cross-sectional survey was undertaken, focusing on the geriatric population. Employing a multi-stage random sampling technique, 350 individuals aged 60 years and above were selected from two Community Development Blocks in Kamrup district, Assam. Data collection involved a structured interview schedule, incorporating socio-demographic profiles through Pareek and Trivedi's socio-economic Rural scale and an additional 25 items to assess health care service utilization among the elderly. The results highlighted a higher percentage of females (61.28%) compared to males (48.63%), with a significant portion being widows, illiterate, and unemployed. Socio-economic class-IV accounted for the majority (62.57%) of the participants. Notably, 65.71% of the elderly moderately utilized health care services, while 24.57% inadequately accessed them. Marital status, family type, occupation, and socio-economic class exhibited varying impacts on health care service utilization. The study underscores the pressing need to enhance the overall wellbeing of rural elderly individuals. Proposing community-based geriatric health care services, leveraging existing rural health infrastructure, emerges as a viable solution to address the needs of this demographic group.

Health Disparities in Hospital Readmissions in Rural vs Urban Populations in the United States: A Comprehensive Review of Factors and Reduction Strategies

Background: Health disparities between rural and urban populations in the United States significantly impact health outcomes, access to medical services, and overall care quality. These disparities are influenced by factors such as socioeconomic status, geographic isolation, availability of healthcare providers, and the prevalence of chronic health conditions. Hospital readmission rates serve as critical indicators of care quality and post-discharge management effectiveness. High readmission rates often highlight issues in patient care management, discharge planning, and follow-up care efficacy, necessitating targeted interventions to improve patient outcomes and reduce healthcare costs. Rural areas face unique challenges in addressing these issues due to limited resources and access barriers. Method: A comprehensive approach was employed to investigate health disparities between rural and urban populations in the United States, focusing on strategies to mitigate hospital readmission rates in rural areas. The literature review involved searching electronic databases, including PubMed, Google Scholar, and Scopus, with keywords like "rural health disparities," "urban-rural differences," "hospital readmission," and "healthcare interventions." Articles were selected based on their relevance to hospital readmissions and interventions targeting rural populations. Data extraction encompassed study characteristics, participant demographics, outcomes related to hospital readmissions, and intervention details such as telehealth and care coordination programs. National data from guides and reports were also included to capture broader trends and efforts at reducing readmissions. Results: The review revealed significant disparities in hospital readmission rates between rural and urban populations in the United States. Rural areas exhibited higher readmission rates due to limited healthcare access, higher prevalence of chronic conditions, and socioeconomic challenges. Strategies such as enhanced telehealth services, improved primary care access, and care coordination programs demonstrated potential in mitigating these disparities. Conclusion: Addressing health disparities between rural and urban populations requires a multifaceted approach. Effective strategies include expanding telehealth services, improving care coordination, and strengthening community-based healthcare resources. Policymakers should focus on addressing socioeconomic disparities and ensuring equitable distribution of funding and resources. Continuous evaluation of healthcare policies can provide insights into improving outcomes for rural populations. Future research should standardize methodologies, foster interdisciplinary collaborations, and incorporate qualitative insights to inform effective, equitable healthcare interventions and policies.

Sex Workers in Canada Face Unequal Access to Healthcare: A Systems Thinking Approach.

Despite Canada's universal health system, sex workers across the country face an alarmingly high number of barriers when they seek to healthcare services. This has resulted in unmet healthcare needs and substantially poorer health outcomes than the general Canadian population. The objective of this study was to use a systems thinking approach to gain an in-depth understanding of the barriers sex workers face and how access could be improved. The analysis was conducted using a systems thinking methodology, which incorporates systems tools and inquiry processes. The methodology comprised 2 domains of inquiry: (1) Problem Landscape, (2) Solutions Landscape. Systems tools and methods, such as causal loop diagrams, iceberg diagram, and systems mapping, investigated the problem landscape for understanding the interconnected nature of the issue, alongside review of both published and gray literature. An environmental scan explored the current solutions landscape. These methods connected through systemic inquiry processes, including ongoing review and application of diverse perspectives, boundary judgments, interrelationships; enabled gaps and levers of change to be determined. The main barriers sex workers face are stigma, criminalization, accessibility, and cost of healthcare. The stigma of sex work stems from otherization, paternalism, and moralistic, faith-based beliefs. The barriers unique to sex work are stigma and criminalization; both of which surface as avoidance, dislike, and/or fear of medical professionals. Five gaps each with a lever of change to improve access were identified: (1) Stigma - Collectivization and external collaboration, (2) Criminal status of sex work - Decriminalization, (3) Lack of adequate education - Improved healthcare professional training and anti-discriminatory health policies, (4) Lack of support - Increased community-based healthcare services, (5) Cost of healthcare - Universal coverage of "secondary" healthcare components. Through reducing the stigma surrounding sex work, making changes that improve the healthcare services that sex workers receive, and collaboration between involved parties, sex workers can be prevented from falling through the cracks of the Canadian healthcare system; lessening the health inequities sex workers face and improving their health outcomes.

Hospital-to-Home: logic model and theory of change exercise to identify outcomes arising from integrated health and social care.

Introduction: Although Canada boasts universal access to hospital-based services, bed capacity has been a challenge with long wait times for acute admissions to a hospital bed from the Emergency Department. The use of hospital beds by ‘alternate level of care’ (ALC) patients is a critical concern. These ALC patients exist because of a lack of an appropriate level of care in the community. Integrated health and social care (IHSC) can limit avoidable acute care utilization including in-patient stays in hospitals. CHATS--Community &amp; Home Assistance to Seniors is a community-based agency that provides transportation, meals, in-home services, caregiver relief, education and support, community wellness, and 24/7 assisted living among other services, with the aim of supporting ageing in place. CHATS has partnered with several local hospitals and homecare providers to create a number of hospital-to-home programs (HTH) that provide seamless and coordinated care from hospital to home for older adults enabling safe and effective transitions. Hospital-based data has shown that ALC days and inpatient and ED hospital readmissions declined following implementation of HTH programs. Although hospital-based data is available, community-based health and social care outcome-based metrics have not been developed nor collected. Despite limited qualitative data showing high levels of client and caregiver satisfaction with its HTH services, the lack of outcome-based data makes it difficult for CHATS to articulate the benefits of the HTH programs from a community-based perspective that reflects both health and social care outcomes with the aim of informing policy and programming decisions in the future, including program scale and spread.&#x0D; Methodology: A logic model (LM) and theory of change (ToC) exercise was undertaken by a broad representation of CHATS staff at all levels of the organization to identify the theory of change for the HTH programs and critical activity-based and outcome-based metrics to support future measurement and evaluation work. The development of these models clarified the fundamental program theory behind community agency contributions to the HTH programs that enable their success.&#x0D; Results: The theory of change noted that the HTH program was able to achieve hospital to home transition success because it facilitates older adult clients to achieve greater self-determination that can support more independent living. The HTH program’s components, case management, personal support, transportation, training, counselling, and assessments ensure that the personal goals of clients and their caregivers are identified and addressed. Feelings of empowerment, improved mental health, health and social care navigation literacy, and reduced acute care readmissions are some of the outcomes perceived as being attributable to the HTH programs. These outcomes, in turn, allow for greater overall health and wellbeing, and sense of independence among older adult clients and their caregivers. Ultimately, the HTH programs contribute towards greater systems efficiency and enhanced quality of life for clients and their family/caregivers.&#x0D; Next steps: The results of the LM and ToC exercises have enabled CHATS to identify critical input, activity and outcome measures for the HTH programs that reflect the contributions of CHATS, and a towards a future summative evaluation of the HTH programs.&#x0D;

What is successful integrated community care? A systematic literature review.

Introduction: The ageing process vastly impacts the need for care and support, as it is often associated with a decrease in health and function. Governments of ageing populations are using “ageing in place” as the main policy perspective, in which people receive care and support in their personal environment. Although great value is within this perspective, recent studies accentuate that the location where people live vastly impacts their need for care and support. This highlights the need for the development of new, long-term care systems to address these challenges. Scholars argue that the issue can be resolved by implementing locally, integrated and community-based health and social care. Integrated community care (ICC) has been defined as a range of strategies to support multiple stakeholders to co-develop and health, care and social support services and infrastructures, aiming to achieve several goals. However, it is unclear of which key elements ICC consists of. &#x0D; Method: The main goal of this systematic literature review was to identify the key elements which successful ICC consists of. We searched five electronic databases with several search strings which we defined as closely related to, a part of or the same as ICC based on the preliminary results of the literature review. A total of 65 articles were included in the review based on eligibility criteria, divided into two groups. The first group included twenty articles mentioning ICC or one of the search strings in the title or abstract, the second group contains forty-five articles linked to ICC but clearly focus on a different issue or topic. Thematic analysis was used to code the articles. &#x0D; Results: Eight key elements of integrated community care were identified, namely: (1) asset-based, (2) person-centred, (3) co-development, (4) governance, (5) locality, (6) improvement of mental and physical health, (7) improvement of the existing health care system, (8) tackling determinants of health. Different perspectives and possible difficulties related to these elements were discussed. &#x0D; Discussion: We identified eight key elements of ICC, dealing with the starting point (asset-based and person-centred), strategies and stakeholders (co-development, governance, locality) and aims or ambitions (improvement of mental and physical health, improvement of the existing health care system, and tackling health determinants). However, it is still unclear how these elements correlate with each other. Some of these key elements remain rather vague or abstract. Further research should focus on formulating specific definitions for these elements in the context of ICC as well as codifying ways to implement these key elements in practice.

The Belgian Integrated DEpression Care (IDECA) project: implementation and scientific evaluation protocol

Background: Depression creates a substantial personal burden for affected individuals and their families, and produces significant economic and social hardships that affect society as a whole. In Belgium, depression is a leading cause of disability, measured as disability-adjusted life years. The COVID-19 pandemic has greatly exacerbated the already substantial health and socioeconomic consequences of depression and has led to major changes in the need for and delivery of mental health services. Integrating mental health services into primary care is the most viable way to closing existing treatment gaps. The majority of people with mental disorders treated in primary care have good outcomes, particularly when linked to a network of services at secondary level and in the community. A balanced model of depression care calls for a system with community-based mental health care, delivered by primary care physicians and supported by other professionals in an eco-system of care.&#x0D; Aim: Implementation of an integrated depression care (IDECA) intervention in two regions in Flanders, Belgium with evaluation of the intervention’s working components, its acceptance by patients and care providers, and the contextual conditions which needs to be fulfilled to safeguard success of the model of care.&#x0D; Methods: A scientific steering committee including multiple academic expertise areas and patient representatives guided the development of the intervention and its scientific evaluation. Moreover, feedback was obtained from the Flemish Institute for Primary Care (VIVEL), the Family Doctors Medical Association (Domus Medica), and a mental health interest group(Psyche VZW). This resulted in an implementation design without control group and a targeted heterogeneous patient population with depression to obtain real-world evidence. IDECA consists of three intervention pillars: (i) the integration of two reference persons mental health (case management function) into general medical practice and who provide diagnostic support, coordination, follow up care, and patient education; (ii) the implementation of a validated shared care treatment protocol; and (iii) professional training on depression screening and management. The three pillars will be further operationalized in co-creation with the selected regions. The intervention will run for 15 months.&#x0D; Data will be collected from both participating care providers and patients. Evaluation will take place using a Realist Evaluation approach in combination with the NoMad questionnaire for care providers which measures the four implementation metrics of the Normalization Process Theory: i. coherence, ii. cognitive participation, iii. collective action, and iv. reflexive monitoring. NoMad process data will serve as a basis for semi-structured qualitative research on Context-Mechanism-Outcome constellations. Questionnaires will be used to measure depression and anxiety levels, health literacy, quality of life, patient satisfaction, therapy adherence and self-efficacy, and healthcare resource utilization in patients.&#x0D; Results: Patient enrollment will start at the beginning of 2023. Preliminary data on patient characteristics and first data on care providers’ acceptance and engagement with the IDECA project will be presented, next to the co-creative development process of the intervention.&#x0D; Conclusion: The IDECA-study aims at the implementation of integrated depression care and evaluation of its feasibility in two different regions in Belgium.&#x0D;