Community Health Care Services Research Articles

The Importance of Competent and Equitable Healthcare Services and Data Collection Methods for SGM Communities

The Importance of Competent and Equitable Healthcare Services and Data Collection Methods for SGM Communities

More that unites us than divides us? A qualitative study of integration of community health and social care services

BackgroundThe integration of community health and social care services has been widely promoted nationally as a vital step to improve patient centred care, reduce costs, reduce admissions to hospital and facilitate timely and effective discharge from hospital. The complexities of integration raise questions about the practical challenges of integrating health and care given embedded professional and organisational boundaries in both sectors. We describe how an English city created a single, integrated care partnership, to integrate community health and social care services. This led to the development of 12 integrated neighbourhood teams, combining and co-locating professionals across three separate localities. The aim of this research is to identify the context and the factors enabling and hindering integration from a qualitative process evaluation.MethodsTwenty-four semi-structured interviews were conducted with equal numbers of health and social care staff at strategic and operational level. The data was subjected to thematic analysis.ResultsWe describe three key themes: 1) shared vision and leadership; 2) organisational factors; 3) professional workforce factors. We found a clarity of vision and purpose of integration throughout the partnership, but there were challenges related to the introduction of devolved leadership. There were widespread concerns that the specified outcome measures did not capture the complexities of integration. Organisational challenges included a lack of detail around clinical and service delivery planning, tensions around variable human resource practices and barriers to data sharing. A lack of understanding and trust meant professional workforce integration remained a key challenge, although integration was also seen as a potential solution to engender relationship building.ConclusionsGiven the long-term national policy focus on integration this ambitious approach to integrate community health and social care has highlighted implications for leadership, organisational design and inter-professional working. Given the ethos of valuing the local assets of individuals and networks within the new partnership we found the integrated neighbourhood teams could all learn from each other. Many of the challenges of integration could benefit from embracing the inherent capabilities across the integrated neighbourhood teams and localities of this city.

A Community Partnered Approach for Defining Child and Youth Thriving.

To develop a community-informed definition of child and youth thriving and identify community priorities for child/youth thriving. Through concept mapping, a mixed-methods community-based participatory research method, this study examined community and health professionals' conceptualizations of child and youth thriving. We conducted brainstorming, sorting and rating, and interpretation sessions in 3 geographically distinct neighborhoods with concentrated disadvantage; simultaneously, researchers and health professionals participated in online sessions. Participants included 91 community members, health care and social service professionals, and researchers who identified 104 items related to child and youth thriving and grouped these items into 7 distinct clusters. Two clusters focused on child-level factors (Strong Minds and Bodies; Positive Identity and Self-Worth), 2 focused on place-based factors (Healthy Environments; Vibrant Communities), and 3 focused on relationships and interactions between children and their environments (Caring Families and Relationships; Safety; and Fun and Happiness). The community-informed conceptualization of child thriving builds on previous models, adding dimensions of physical health and safety. Participants ranked having "someone to talk to," being "comfortable in their own skin," having "pride in themselves," and having a "strong sense of self and self-worth" as most important to child and youth thriving. By integrating perspectives of community members from diverse neighborhoods with those of researchers and health professionals, this study captures novel domains to inform a conceptual model of thriving that focuses on stakeholder priorities. Findings will guide development, implementation, and evaluation of community-based interventions and their impact on child and adolescent health and thriving.

A critical occupational perspective on user engagement of older adults in an assisted living facility in technology research over three years

ABSTRACT Digital assistive technology has potential for supporting older adults who depend upon community healthcare services. To boost the efficiency of those services, technological devices are often installed for care recipients as part of governed practice. However, the varying adoption of technology risks widening the digital divide. In response, the Assisted Living project engaged older adults in co-creating knowledge about users’ needs, to guide the development of technological solutions designed to support everyday living. This study sought to investigate how eight older adults in an assisted living facility in Norway, aged 81–92 years, evaluated user inclusion in a 3-year technology-oriented research project. Individual interviews, dialogue cafés, interventions with environmental sensors, and a final focus group discussion constituted sites for co-creation of knowledge. Participants’ answers to standardised questionnaires and statements during dialogue café meetings were collated into tables and the focus group discussion was thematically analyzed, with three themes identified: motivation for project engagement, experiencing and understanding participation in the project, and mixed feelings towards environmental sensors at home. The project revealed that older adults with impairments could nevertheless meaningfully contribute opinions about their needs. Applying a critical occupational perspective raised awareness regarding sociocultural assumptions about older adults in assisted living as frail and unable to participate, which may reinforce ageist and ableist stereotypes, as well as promote occupational injustice.

<p>Community Health Care Workers’ Experiences on Enacting Policy on Technology with Citizens with Mild Cognitive Impairment and Dementia</p>

PurposeAssistive technologies and digitalization of services are promoted through health policy as key means to manage community care obligations efficiently, and to enable older community care recipients with mild cognitive impairment (MCI) and dementia (D) to remain at home for longer. The overall aim of this paper is to explore how community health care workers enacted current policy on technology with home-dwelling citizens with MCI/D.Participants and MethodsTwenty-four community health care workers participated in one of five focus group discussions that explored their experiences and current practices with technologies for citizens with MCI/D. Five researchers took part in the focus groups, while six researchers collaboratively conducted an inductive, thematic analysis according to Braun & Clarke.ResultsTwo main themes with sub-themes were identified: 1) Current and future potentials of technology; i) frequently used technology, ii) cost-effectiveness and iii) “be there” for social contact and 2) Barriers to implement technologies; i) unsystematic approaches and contested responsibility, ii) knowledge and training and iii) technology in relation to user-friendliness and citizen capacities.ConclusionThis study revealed the complexity of implementing policy aims regarding technology provision for citizens with MCI/D. By use of Lipsky’s theory on street-level bureaucracy, we shed light on how community health care workers were situated between policies and the everyday lives of citizens with MCI/D, and how their perceived lack of knowledge and practical experiences influenced their exercise of professional discretion in enacting policy on technology in community health care services. Overall, addressing systematic technology approaches was not part of routine care, which may contribute to inequities in provision of technologies to enhance occupational possibilities and meaningful activities in everyday lives of citizens with MCI/D.Trial registrationNSD project number 47996.

Effects of Perceived Risk and Patient Anxiety on Intention to Use Community Healthcare Services in a Big Modern City

In Shanghai, one of the biggest modern cities in the world, community-based health care providers are largely underutilized. As a result, valuable medical resources are wasted. The present study examined the relationship between the variables of perceived risk and patient anxiety on intentions to use community health clinics, because these two variables are closely related to decision making. A survey measuring these variables was distributed near community health clinics in Shanghai ( n = 869), and structural equation models were constructed to analyze the data. Results show that patient anxiety was associated with contracting diseases and positively related to the intention to seek services from community-based providers, whereas their perceived risk of these providers had a negative relationship with such an intention. Moreover, the knowledge that some community clinics were not as good as large hospitals was positively related to perceived risk. Policy implications are discussed based on the findings.

Effectiveness of Cooperative Treatment Using Community Medical Systems and Healthcare Services for Second-Line Therapy in Advanced Urothelial Cancer Patients : Impact on Survival

Chemotherapy and immune-checkpoint inhibitors, used as second-line treatments for advanced urothelial cancer (UC), can have adverse effects in some patients, such as decreased organ function. We investigated the effectiveness of cooperation with medical/welfare services, so-called cooperative medicine, in these cases. A total of 137 UC patients who had undergone second-line therapy were analyzed. Of these 137 patients, 49 were categorized in the "cooperative"treatment group, in which a general practitioner performed blood tests and transfusions ; and, administered medication, while nurses and case workers from a community health care institution provided mental and social support. There were 50 in the "joint" treatment group, who were treated jointly by a urologist and general practitioner ; and, 38 in the "solo" treatment group who were treated by a urologist only. The Short Form Health Survey, SF-36, was used to evaluate quality of life (QoL). We observed that the overall survival after the second-line treatment was significantly longer in the cooperative group than in the other two groups, with multivariate analyses confirming cooperative treatment as a significant factor for better prognosis (P=0.005). The period of second-line treatment in the cooperative group was significantly longer (P=0.003) than that in the solo group, whereas the proportion of patients who subsequently received third-line treatment was higher in the cooperative group, 58. 5%, than in the solo and joint groups, 26. 5% and 25. 5%, respectively. Posttreatment QoL measurements in the joint and solo groups were significantly lower for 3 and 6 items, respectively, whereas there was no appreciable decrease in post-treatment QoL measurements in the cooperative group. Multivariate analysis showed that cooperative treatment was particularly beneficial for female patients ≥75 years of age, and patients with status 2 performance.

Identifying children suspected for maltreatment: The assessment process taken by healthcare professionals working in community healthcare services

Healthcare professionals working in community settings are well-placed to detect suspected child maltreatment cases. Yet, child maltreatment presents particular diagnostic challenges given that the assessment has to be made fast due to the potential harm to the child and under conditions of great uncertainty. The purpose of this article is to examine how healthcare professionals working in community health services clinics make judgments about the likelihood that a child's clinical condition was caused by maltreatment. The study was conducted in the largest health-management organization in Israel, across fourteen clinics in the north of the country. Semi-structured interviews were conducted with 21 healthcare professionals from six occupational branches, including pediatrics, nursing, social work, physiotherapy, speech-therapy and occupational-therapy. It was found that healthcare professionals' assessment of possible child maltreatment involves the recognition of emerging vulnerability about the child's condition, interpretation of suspicions as the outcome of maltreatment, and looking for accountable, after the fact, justifications. The participants' assessment was guided by explicit knowledge and intuitive judgment, and was influenced by individual characteristics and factors in the organizational environment. According to the participants, efforts to advance practice should focus on alerting them to consider maltreatment as a possible explanation for a child's condition. Strategies such as focused training sessions, opportunities for rapid consultation, and nudges were proposed as helpful ways to achieve this function. The authors also emphasize the importance of providing healthcare professionals with a reliable and regular supply of feedback and opportunities for reflection.

Improving primary healthcare for the homeless

Homelessness is an increasing problem in the UK. One of the biggest issues faced by the homeless is their health; they have greater healthcare needs and significantly higher morbidity and mortality rates compared with the general population. However, the homeless population is far less likely to engage with community healthcare services, including general practice. Despite measures to help GPs treat the homeless population, there is still a lack of knowledge about how best to manage the health of the homeless within the community setting. This article aims to inform GPs about effective measures to improve the health of homeless patients.

Non-use of community health-care services – an exploratory cross-sectional study among family care-givers for older, home-dwelling persons with dementia

AbstractCommunity health-care services for older, home-dwelling persons with dementia tend to be underutilised. Family care-givers provide substantial care, and they often arrange for and co-ordinate health-care services on behalf of persons with dementia. The aim of this study was to examine family care-givers’ knowledge of unused services and their self-reported reasons for non-use of such services. We gathered cross-sectional survey data from 430 family care-givers of older persons with dementia in Northern Norway. Multinomial logistic regression analysis was used to identify predictors of family care-givers’ knowledge of unused services. An open-ended question regarding reasons for non-use of services was analysed by thematic text analysis. Characteristics of family care-givers (e.g.education level) and factors related to the care-giving circumstances (e.g.negative impact of care-giving) predicted family care-givers’ knowledge of unused services. Reasons for non-use of services were multifaceted and complex, and were related to attributes of the person with dementia and/or the family care-giver (e.g.reluctance to use services) and/or the health-care services (e.g.low quality). Although services were unused, several family care-givers indicated substantial needs for the services. Strategies aimed at addressing the non-use of services should emphasise individuals’ and families’ needs and the adaptation of information about available services and their benefits for both care recipients and family care-givers. A relationship-centred care approach is thus recommended in dementia care.

Electricity Access, Community Healthcare Service Delivery, and Rural Development Nexus: Analysis of 3 Solar Electrified CHPS in Off-Grid Communities in Ghana

Over 600 million people living in sub-Saharan Africa do not have access to electricity. Modern healthcare services, including vaccine refrigeration, which require electricity are therefore lacking in such energy-deprived communities. In this work, analysis has been conducted on how electricity access can help improve healthcare service delivery and rural development, with a case study on 3 different off-grid solar photovoltaic (PV) systems in community-based health planning and services (CHPS) in Ghana. Analysis from this study showed that for the 3.0 kWp solar PV systems installed at the various sites, the in-house electricity consumptions are between 4.30 and 7.58 kWh per day. It was found out that excess electricity generation of 148–304 kWh per month is available and can be used to provide other economic services including phone charging, torchlight battery charging, and small-sized cold storage services to generate income for the maintenance of the systems, which is critical for sustainability of solar PV installations in rural poor communities. The study results also showed that electrified health facilities which are able to provide basic healthcare services have potential impact on community health outcomes and rural development. Assessment conducted at the CHPS compounds revealed that, generally, there is improvement in healthcare service delivery resulting in time savings of 15-43 hours per month for the inhabitants which can potentially be used for productive work. The time savings were more significant in females and children than in males. In many rural agro-based communities in developing countries, female and children are usually the workforce engaged in various farming activities. This paper concludes that access to electricity in CHPS compounds helps to improve community health outcomes and increases time availability for women to engage in productive work that can potentially result in significant socioeconomic activities and rural development.

Perinatal mental health around the world: priorities for research and service development in China.

China's healthcare is improving together with rapid economic growth. Yet, mental healthcare is lagging behind. Prevalence of perinatal depression is high among women of the one-child generation, but access to qualified care is limited. Chinese healthcare professionals, policy makers and patients alike express concerns about insufficient knowledge among the public as well as healthcare providers regarding mental disorders. There appears to be a general lack of help-seeking behaviour for mental disorders owing to perceived risk of social stigmatisation. Social support through family and friends, use of online resources and community healthcare services are preferred, rather than seeking help from mental health specialists.

Access to primary and community health-care services for people 16 years and over with intellectual disabilities: a mapping and targeted systematic review

Background In 2015, approximately 2.16% of adults were recorded as having intellectual disabilities. UK government policy is that adults with intellectual disabilities should access mainstream health services. However, people with intellectual disabilities experience challenges when accessing primary and community health services that can lead to inequalities and shorter life expectancy. Objectives To map and review the evidence on access to primary and community health-care services for adults with intellectual disabilities and their carers. To identify influencing factors for gaining access to primary and community health-care services. To determine which actions, interventions or models of service provision improve entry access to these services for people with intellectual disabilities and their carers. Finally, to identify the gaps in evidence and provide implications for health care and recommendations for research. Data sources MEDLINE, The Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC) were searched from 2002 to 2018. Review methods The mapping review methodology included an extensive literature search, article selection and data extraction of relevant abstracts. Findings from the mapping review informed the scope of the targeted systematic review. Methodology for the targeted systematic review included an extensive literature search informed by the mapping review, article selection, data extraction, quality appraisal and narrative synthesis. Results The mapping review included 413 studies with data extraction completed on abstracts. The targeted systematic review synthesised the evidence from 80 studies reported in 82 publications. During the review process, the team identified three key points at which people with intellectual disabilities potentially interacted with primary and community health-care services: identifying needs, accessing services and interaction during a consultation. In addition, there were a number of papers about interventions or innovations to improve access. Evidence from the studies was synthesised within the four clusters. Influencing factors were identified: staff knowledge/skills, joint working with learning disability services, service delivery model, uptake, appointment making, carer/support role, relationship with staff, time, accessible information and communication. The influencing factors were cross-cutting through the literature, with certain factors having more importance in certain clusters. Limitations The main limitation was the weak evidence base. The studies generally had small samples, had study designs that were open to potential biases and measured only short-term outcomes. Conclusions Health checks were found to help identify health needs and improve the care of long-term conditions. Important factors for accessing health services for adults with intellectual disabilities were consistency of care and support, staff training, communication skills and time to communicate, and provision of accessible information. Health professionals need to ensure that there is joint working between different services, clear communication and accurate record-keeping. Future research questions centre on the need to develop and value creative study designs capable of addressing the complex issues identified in the findings of the review for this complex population. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 5. See the NIHR Journals Library website for further project information.

Management of the emergency response to the SARS-CoV-2 (COVID-19) outbreak in Stockholm, Sweden, and winter preparations.

INTRODUCTION Sweden is unique in adopting a 'no-lockdown' public health approach to the SARS-CoV-2 (COVID-19) outbreak. There were fears that health services would not be able to care for high numbers of COVID-19 patients. AIM To describe and review the emergency response of a public primary and community health-care organisation in Stockholm, Sweden, to the demand for care for COVID-19 and non-COVID-19 patients during March-July 2020, and summarise preparations for the months to follow. METHODS This was a rapid implementation action research case study, which also draws on one author's experience as Chief Executive Officer and other members' experience in an emergency management group. RESULTS Sweden experienced similar mortality per million population to the UK, despite the different public health strategy used to address the COVID-19 outbreak. The Stockholm-integrated public primary and community health-care service, serving a population of 2.3 million, made many changes quickly. One change included coordinating non-acute private health-care services, following the local government emergency directive to do so. DISCUSSION It is possible that the fast and effective response by management and services in primary and community health care reduced infection and hospital demand, which contributed to a lower mortality than otherwise expected. The actions and preparations described for Stockholm's response may provide ideas for other health-care systems. The partnership research approach between the Karolinska Medical University and the Region Stockholm health-care system used in this project shows that rapid research methods have advantages for both partners in an emergency situation.

Doctors without Distance: Using AI Tools Based on T2D Math-Physical Medicine Research Results to Assist a Community's Healthcare Service Remotely

Doctors without Distance: Using AI Tools Based on T2D Math-Physical Medicine Research Results to Assist a Community's Healthcare Service Remotely

Impact of socioeconomic status on morbidities, disabilities, activity limitation, and participation restriction in the geriatric population living in urban area: A comparative study

Introduction: Socioeconomic inequalities have been considered as an important factor for disparity in the prevalence of disabilities among geriatric population belonging to different socioeconomic strata with significantly increased of disability in elderly population belonging to lower socioeconomic status. The impact of socioeconomic status on the morbidity and disability profile of elderly in India is very scarce. This study would help in planning geriatric health care services for different communities depending upon their socioeconomic status. Aim: The aim of this study was to compare the morbidity profile, disability profile, and perceived health care needs in Indian elderly population belonging to two different socioeconomic strata residing in city of western India. Methodology: This was a cross sectional qualitative comparative study done in Aug 2016 to Dec 2016. In this study two geriatric cohorts one belonging to high income group staying in a gated community and other belonging to low income group staying in a urban slum were compared. House to house survey was done based on prevalidated WHO DAS scale predesigned questionnaire to assess the activity limitation and participation restriction of the elderly population in city dwellers in Western India. After initial sensitisation workshops to sensitise and train the medical students, paramedics and the social workers, the house to house survey was on holidays. Results: Total 406 elderly patients were interviewed in HIG and 409 were interviewed in LIG. Females outnumbered the males in both the cohorts with 53.7% in HIG and 63.8% in LIG. It was noted that 14.5% of the elderly were staying alone in HIG where as against 10.2% in LIG. It was also noted that 14.5% of elderly in HIG required help of outside caregiver from doing the activities of daily living (ADLs) where as 28.9% in LIG required outside help to do ADLs. It was noted that there was a significant difference in the activity limitation score in both the cohorts with 64% of elderly in HIG having a good score (0-18) as against 13.9 % in LIG. in participation restriction score with 77% of elderly belonging to HIG having a good participation score as against 40.6% in the elderly belonging to LIG. Conclusion: The morbidity profile, disability profile, and perceived health care needs in Indian elderly population belonging to two different socioeconomic strata residing in city of western India are different. Public health care penetration was poor in the elderly living in LIG as most of them visited the doctor only during emergencies and that too majority of them had access to alternative medicine system. Dedicated geriatric services along with provision of medicines, ambulance and geriatric helpline was the most felt needs in the society.

Rural mental health service utilization in a Texas telepsychology clinic.

To determine if service utilization behaviors varied with the remoteness of clients served by a telepsychology clinic in a predominantly rural health professional shortage area (HPSA) in Texas. Archival data from 290 low-income clients were analyzed to test associations between service utilization behaviors and clients' distance from the nearby access points where they traveled to receive counseling services from remotely located counselors. Distance to access points did not predict differences in service utilization behaviors. However, clients in rural counties traveled farther to receive services than clients in metropolitan areas. Some utilization behaviors varied by demographic variables and depressive symptom severity. A "hub and spoke" model of telehealth service delivery is an acceptable model for improving access to mental health care services in rural and underserved communities, even for clients who live relatively far from access points. Telehealth providers should consider geographic, socioeconomic, transportation, and health-related barriers to care experienced by clients when implementing services and policies.

What is the role of cultural competence in ethnic minority consumer engagement? An analysis in community healthcare

BackgroundEffective patient engagement has been associated with high quality health care. There is a dearth of evidence around effective engagement with consumers from ethnic minority backgrounds; specifically in relation to the role of cultural competence amongst healthcare professionals in effective engagement with consumers from ethnic minority backgrounds. To address this knowledge gap, we analysed the role of cultural competence in the consumer engagement approaches taken by community healthcare professionals working with consumers from ethnic minority backgrounds.MethodsSemi-structured individual interviews were conducted with 21 healthcare professionals employed across four community healthcare and affiliated services in four local government areas in Australia.ResultsAdopting patient-centric approaches (that seek to understand and be responsive to the patient as an individual) featured as an underpinning theme that transcended other emerging themes. Recognition of diversity within communities and individuals in those communities, all with their own story, was described as pivotal to effective engagement. This was encapsulated in the theme of Cultural standpoints and personal context that contained four further themes of: (1) Build foundations of trust and respect; (2) Diversify communication channels; (3) Generate system, service and community partnerships; (4) Take the time.ConclusionOur findings indicate that cultural competence and effective consumer engagement are closely linked in ethnic minority populations. Embedding cultural competence as a health system, service and professional capability is therefore critical to ensure equitable healthcare quality for consumers from all ethnic backgrounds.

Age-friendly communities for older persons with intellectual disabilities

Purpose The life expectancy for persons with intellectual disabilities (ID) has increased significantly, resulting in an increasing number of aging persons with ID. To promote healthy and active aging of persons with ID, discussions on new initiatives to design age-friendly communities have begun at local and international levels. The purpose of this paper, a qualitative research study, is to identify features of an age-friendly community, and facilitators and barriers from the perspectives of older adults with mild ID and their caregivers who live in the city of Winnipeg in Canada. Design/methodology/approach Seven older persons with mild ID were interviewed, and 15 caregivers participated in focus group discussions. All participants were asked questions about features of community living and their experiences in eight broad topic areas (i.e. transportation, housing, social participation, respect and social inclusion, opportunities for community involvement, communication and information, community support and healthcare services, and outdoor spaces and buildings). Findings The results indicated that many of the current features of the city of Winnipeg do not adequately address the needs of aging persons with ID; specifically, participants revealed that issues related to accessibility, social participation, social disrespect and inclusion, and lack of resources were important barriers to independence. Originality/value The findings will increase awareness of the needs of aging persons with ID and inform programme planning, service delivery, coordination of community-based services and policies to support healthy and active aging for this vulnerable population.

EUPHA strategy 2020-2025: Achieving a triple A rating for health in Europe

Abstract The challenges we face are complex in nature, and require multidisciplinary and intersectoral action at different governance levels. Therefore, EUPHA will reinforce its two-tier approach. On the one hand, we will support our members in providing high quality and efficient public health and health care services in European countries, regions and local communities. On the other hand, we will advocate for health and support evidence-informed health policy-making at the international level. Stimulating and facilitating mutual learning and the exchange of knowledge and experiences across experts, members and countries will be an essential element of EUPHA’s approach. Not only with a focus on optimal support for our members, but also with an explicit focus on overcoming health inequalities within and between European countries. Our new vision is to enable everyone in Europe to achieve the highest possible level of health by providing independent and authoritative analysis of the evidence, combined with targeted advocacy to achieve co-ordinated action by all key stakeholders. Our vision: builds on the commitments of our governments and international agencies to achieve the health-related Sustainable Development Goals;recognises the importance of placing Health in All Policies;draws on the Vienna Declaration to embrace the entire range of health determinants, including the biological, social, environmental, occupational, political, and commercial, the health care system, and everything that influences the health of our planet. Our mission will be: To ensure that there is a strong evidence base, built on sustained investments in data, research capacity, and knowledge translation in all parts of Europe that can inform policies that impact on health;To identify, develop, and advocate for actionable policy recommendations to improve health;andTo support capacity-building and collaborations that can achieve public health action.