Community Public Health Services Research Articles

Australian community and inpatient general public sector mental health services between 2017-18 and 2021-22: Relative stasis in bed capacity, increasing outpatient demand, and stunted expenditure.

To descriptively analyse Australian public sector General Mental Health Services (GMHS) expenditure, ambulatory, and inpatient services, including key performance indicators (KPIs) in comparison with other subspeciality mental health services (MHS). We descriptively analysed data published by the Australian Institute of Health and Welfare (AIHW), including inpatient, ambulatory services, expenditure, and KPIs. From 2017-18 to 2021-22, per capita expenditure for Australian GMHS (18-64) rose by an average annual inflation-adjusted change of 2%. Overall bed numbers remained static, with non-acute beds declining, and commensurate expansion of acute beds. Community GMHS had high outpatient utilisation, with high rates of schizophrenia, schizoaffective disorder, and bipolar affective disorders as primary diagnoses in mid-life. From 2017-18 to 2021-22, GMHS inpatient and ambulatory episodes had decreasing rates of significant improvement and increasing rates of significant deterioration. Although GMHS has the highest overall population and service utilisation, there has been static bed availability and relatively small increases in expenditure which are occurring concurrently with worsening clinical outcomes. Evidence-based modelling of GMHS and outcomes is required to inform future service improvement.

Acceptability and feasibility of recovery-oriented group acceptance and commitment therapy for psychosis in routine practice: an uncontrolled pilot study.

Personal recovery is a persisting concern for people with psychotic disorders. Accordingly, mental health services have adopted frameworks of personal recovery, prioritizing adaptation to psychosis alongside symptom remission. Group acceptance and commitment therapy (ACT) for psychosis aims to promote personal recovery alongside improved mood and quality of life. The objectives of this uncontrolled, prospective pilot study were to determine whether 'Recovery ACT' groups for adults are a feasible, acceptable and safe program within public mental health services, and assess effectiveness through measuring changes in personal recovery, wellbeing, and psychological flexibility. Program feasibility, acceptability and safety indicators were collected from referred consumers (n=105). Adults (n=80) diagnosed with psychotic disorders participated in an evaluation of 'Recovery ACT' groups in Australian community public mental health services. Participants completed pre- and post-group measures assessing personal recovery, wellbeing, and psychological flexibility. Of 101 group enrollees, 78.2% attended at least one group session (n=79); 73.8% attended three or more, suggesting feasibility. Eighty of 91 first-time attendees participated in the evaluation. Based on completer analyses (n=39), participants' personal recovery and wellbeing increased post-group. Outcome changes correlated with the linear combination of psychological flexibility measures. 'Recovery ACT' groups are feasible, acceptable and safe in Australian public mental health services. 'Recovery ACT' may improve personal recovery, wellbeing, and psychological flexibility. Uncontrolled study design, completer analyses, and program discontinuation rates limit conclusions.

Retraction: Sharing the Load by One Health: Integrating Canine Rabies Vaccination with Bovine Foot and Mouth Vaccination Program and Community Public Health Services in Rural Nilgiris District, Tamil Nadu, India.

[This retracts the article on p. 600 in vol. 47, PMID: 36742947.].

Patient and Clinician Experience of Using Telehealth During the 'COVID-19 Pandemic in a Public Mental Health Service in Australia.

During the coronavirus disease 2019 (Covid-19) pandemic, mental health services adopted telehealth to facilitate ongoing assessment and treatment of patients with severe mental illness. We aimed to assess the telehealth experience of mental health patients and clinicians during the COVID-19 pandemic to inform ongoing clinical telehealth service usage. Two participant cohorts were recruited: Patients with severe mental illness at a community public mental health service; and clinicians working within this service. Participants from both cohorts were surveyed regarding their experience of using telehealth. The survey was completed by 44 patients and 51 clinicians. Most participants reported having access to appropriate telehealth technology. Among patients, 80% reported having participated in any telephone consultations, while 39% reported having taken part in video-telehealth consultations with their psychiatrist. Similarly, 77% of clinicians reported having used video telehealth. Patients reported feeling more confident with video telehealth if they were younger, lived with friends, family or partner, or had access to the internet or a smartphone. Patients reported that telehealth consultations were more convenient and may reduce nonattendance. They reported having good rapport when using video telehealth. The majority of clinicians reported feeling positively about assessing risk and delivering therapy using video telehealth but not with telephone consultations. Our study suggests that video telehealth is a feasible way of delivering mental health care and appears to be acceptable to both patients and clinicians. However, clinicians raised concerns about their ability to assess risk and provide therapy using telephone consultations. Patients also reported that the convenience of telehealth may improve engagement.

Risk calculators during COVID-19 pandemic Four innovative examples from Wrocław

Aim. The Internet and e-health solutions have become an integral part of daily life due to the pandemic. We are exploring the most impactful and positive innovations such as risk calculators or dashboards with forecasts and current situations aimed at providing information to the public.
 Concept. We analysed four innovative, Wrocław-based risk calculators which allow users to better understand transmission dynamics, pathogenesis process or infection control. 
 Result. Practical application: We show that: 1) Polish COVID-19 symptom checker for self-diagnosis is among the leading products providing similar services around the world; 2) predicting disease course at its beginning is one of the main challenges of future medicine due to the availability of various kinds of data; 3) analysis of spatio-temporal transmission patterns based on digital surveillance for a given community can help with managing infection control locally; and 4) Sputnik V risk calculator enables patients to estimate probabilities of having given adverse events (probably the first app of this kind) following a given individual's variables (age, gender and dose).
 Conclusion. There are already thousands of disseminated e-health solutions related to the coronavirus pandemic which will shape medicine for the next decade. Risk calculators can impact both individual decisions as well as community public health service.

Does individual advocacy work?: A research and evaluation protocol for a youth anti-sex trafficking program.

Thousands of youth are sexually trafficked each year worldwide. Increased public attention to the commercial sexual exploitation (CSE) of children has resulted in the rapid deployment of hybrid community public health and social service programs for these vulnerable youth. Research on the effectiveness of these advocacy programs is lacking, particularly whether they decrease psychosocial distress and increase readiness to leave CSE. Cisgender girls under age 18 at the time of CSE, and who were identified as at-risk for sex trafficking revictimization, were included in an evaluation of an anti-trafficking advocacy program in the North Texas region of the United States. The program includes crisis response, case management, referral, and mentoring services in collaboration with multi-disciplinary team (MDT) responses to identified youth sex trafficking. Case management notes, needs assessments and individualized treatment plans were collected at intake and every 30 days until study conclusion. Standardized surveys, including the Multidimensional Scale of Perceived Social Support (MSPSS), the Coping Self-Efficacy Scale, and the University of Rhode Island Change Assessment (URICA) were collected at intake and every 180 days until the study concluded. Analyses included descriptive statistics, paired t-tests, chi-square, multivariate linear and logistic regressions, Poisson regressions, and latent profile analysis. This study was approved by the Texas Christian University's Institutional Review Board (IRB). Results of this study will be presented to the scientific community at conferences and in peer-reviewed journals and non-scholarly outlets such as public health and social service conferences.

Sharing the Load by One Health: Integrating Canine Rabies Vaccination With Bovine Foot-and-Mouth Vaccination Program and Community Public Health Services in Rural Nilgiris District, Tamil Nadu, India.

India carries the largest national burden for rabies globally. Coordinating large-scale canine rabies elimination programs is challenging, particularly in rural areas, where the majority of human rabies deaths occur. This study evaluated the feasibility of combining canine rabies vaccination with pre-existing animal-health interventions or public health programs in a rural area of India. Canine rabies vaccination teams collaborated with a bi-annual bovine foot-and-mouth vaccination program coordinated by the Animal Husbandry Department (AH-collaboration) and with a village health program by the Public Health Department (PH-collaboration) in Nilgiris, Tamil Nadu, to vaccinate dogs during the implementation of these government-led health initiatives. A total of 251 dogs were vaccinated over 7 days during the AH-collaboration, and 1083 dogs were vaccinated over 15 days during the PH-collaboration. The AH-collaboration achieved a vaccination coverage of 76% based on same-time sighting survey, and 58% based on post-vaccination survey. The PH-collaboration achieved vaccination coverage of 79% based on the same-time survey and 83% based on the post-vaccination survey. The integration of mass dog vaccination into existing government sector initiatives may facilitate the scaling up of canine rabies vaccination campaigns.

User involvement in developing community-based public health services: a scoping review of methods

Abstract Background User involvement in developing community-based public health services has been on the agenda for decades. User involvement refers to the variety of ways in which service users or public citizens participate in the development of health services: from proving information on their needs to actively being involved in decisions about future services. Former studies found that user involvement is meaningful to the people involved and could have a favorable impact on the quality of services. Thus, it is timely to systematically identify and provide a comprehensive overview of user involvement methods used in public health studies. The aim of this scoping review is to provide an overview of the current body of empirical research where user involvement methods have been used to develop community public health services and identify its possible impact on the individual as well as services. Methods A systematic scoping review of user involvement methods aiming to develop public health services followed Arksey and O'Malley, 2005 framework. Six databases: CINAHL, Cochrane Library, Embase, PsycINFO. PubMed, Scopus and ProQuest, were searched from October till November, 2019. Search terms were: user involvement, methods and health care with corresponding synonym. All hits were double screened. Results 6.044 studies were identified of which 38 studies lived up to the criteria. Preliminary findings from coding and synthesizing studies have identified a variety of user involvement Methods 19 of the studies used complex, multi-facetted packages of methods aiming to identify needs, prioritize and formulate recommendations for future services. 19 studies used different kinds of group meetings and some used certain techniques to facilitate the process. Many reported the impact, and 13 evaluated the methods. The impact of using the methods varied from impact on individual, group, or service/political level. Final results will be presented at the conference. Key messages Studies on user involvement methods in developing community public health services and its impact are sparse. User involvement is privotal in developing sustainable public health community services.

社区公共卫生服务质量评价研究——以西安市为例

社区公共卫生服务质量评价研究——以西安市为例

Development and reliability and validity evaluation of needs questionnaire of the integrated services for medicine, pension, rehabilitation and care of community elderly

Objective The purpose of the research was to draw up the questionnaire of the integrated services demand for medicine, pension, rehabilitation and care of community elderly and to provide elderly people with a effective tool for evaluating the needs of medicine, pension, rehabilitation and care. Methods The theoretical framework of the questionnaire was based on the qualitative interview results of 12 community elderly and community health care workers. A preliminary draft was formed through two rounds of expert consultation and a preliminary survey of 102 elderly people in 3 communities in Taian. Construct validity was used to evaluate the validity of the questionnaire, and Cronbach's alpha coefficient and split half reliability were used to evaluate the reliability of the questionnaire. Results Sixteen experts were invited to conduct two rounds of consultation on 61 items of the questionnaire. The authoritative coefficient of experts was 0.881, and the positive coefficient of experts was 100%. In the first round, items I-CVI, S-CVI/UA and S-CVI/Ave were 0.68-1.00, 0.72 and 0.83, respectively. Seven items were modified, six items were deleted and three items were added. In the second round, one item was deleted and one item was added, and a questionnaire consisting of seven dimensions and 58 items was formed.7 common factors were extracted from exploratory factor analysis, and the cumulative contribution rate was 63.078%. Finally, 7 dimensions and 51 item questionnaires were formed. Each dimension is the community public health service and general services, health education, pension services, rehabilitation services, family beds, service charges The total Cronbach's alpha coefficient was 0.919, the Cronbach' s alpha coefficient of each dimension was 0.615-0.808, the retest reliability coefficient of the total questionnaire was 0.862.and the Guttman half coefficient is 0.865. The total questionnaire CVI was 0.85 and the item CVI was 0.80-1.00. Item analysis showed that the correlation coefficients of the 7 items were lower than 0.3, and the rest were all between 0.3~0.7, and were significantly correlated at P<0.05 level. Conclusion The questionnaire of the integrated services demand for medicine, pension, rehabilitation and care of community elderly had good reliability and validity, and it could be used to evaluate the needs of medicine, pension, rehabilitation and care in the elderly. Key words: The elderly; Combination of medicine and pension care; Service needs; Reliability; Validity; Measurement tools

Research on the status and influencing factors of the integrated service needs of medicine, pension, rehabilitation and care of the community elderly

Objective To explore the status and influencing factors of the integrated service needs of medicine, pension, rehabilitation and care of the community elderly in order to provide a theoretical basis for the construction of an old-age service model in line with the national conditions. Methods A total of 330 elderly people from three communities in Tai'an were selected and investigated by self-made questionnaire of the integrated services needs for medicine, pension, rehabilitation and care of community elderly. Results Nearly 83.54%(259/310) of the elderly had moderate and above pension needs, and the first three were rehabilitation services, family beds and community public health services. Age, educational level, self-rated health and number of chronic diseases were the influencing factors of the integrated service needs of medicine, pension, rehabilitation and care(t=2.374-4.844, all P<0.05). Conclusions The majority of elderly people have the moderate and above health care integration service demand, the elderly have the highest demand for rehabilitation services. Age, education, self-rated health status and the number of chronic diseases have different influence on the needs of the elderly; government, society, education and medical treatment institutions interdisciplinary multi linkage, and strengthen the professionals training of health, rehabilitation, health care, in order to explore the best old-age service model in line with national conditions. Key words: Aged; Medicine, pension, rehabilitation and care; Combination of medicine and pension care; Community; Needs assessment; Influencing factors

Linking Antimicrobial Resistance Surveillance Data to Provincial Hospital Records: A Descriptive Study of Patient and Facility-level Characteristics

IntroductionAntimicrobial resistance (AMR) is an emerging phenomenon where microorganisms develop resistance against treatment antimicrobials, resulting in ineffective clinical interventions. The recent development of AMR surveillance systems at global and national stages highlights the growing importance of this topic from a public health perspective.&#x0D; Objectives and ApproachThe objective was to link standardized population-based hospital AMR surveillance data with hospitalizationrecords to inform patient safety practices in Alberta, Canada. Incident inpatient cases of Methicillin-Resistant Staphylococcus aureus (MRSA),identified by Alberta Health Services Provincial Infection Prevention and Control(IPC) Surveillance from five acute care facilities in the Calgary zone (April 2011 to March 2016),were deterministically linked to the Discharge Abstract Database using Provincial Healthcare Number and gender. The incident cohort was stratified into hospital-acquired (HA-MRSA) and community-acquired MRSA (CA-MRSA) cases. Descriptive statistics were used to describe the patient outcomes and facility characteristics of these two groups.&#x0D; ResultsA total of 2550 unique patients, representing 93.5% of the surveillance cohort, were successfully linked to hospitalization records. A total of 1259 patients belonged to HA-MRSA categories and 1291 patients belonged to CA-MRSA categories. Patients with HA-MRSA had longer hospital stays, were older, were more likely to have prior hospitalizations, had higher Charlson Comorbidity Scores, and were more likely to die in hospital when compared to patients with CA-MRSA. HA-MRSA results emphasized the important roles of in-hospital patient safety practices whereas CA-MRSA results alluded to the impact of community public health and primary care services onthe risk of hospitalization, although detected CA-MRSA numbers were likely underestimated due to selection bias within our linked cohort.&#x0D; Conclusion/ImplicationsThis is first Canadian study describing HA-MRSA and CA-MRSA using linked population databases. It offers a glimpse into the intricate relationship between patient health and our healthcare system. This knowledge represents an important step forwarding building IPC strategies for managing AMR and improving outcomes in Alberta and in Canada.

Community pharmacy minor ailment services: Pharmacy stakeholder perspectives on the factors affecting sustainability.

Self-care advice and management of minor ailments have long been provided in community pharmacies across England. However, formal pharmacy minor ailment service provision is geographically variable and has yet to gain recognition and political support as a valued sustainable service for nationwide adoption and commissioning. To investigate the sustainability potential of pharmacy minor ailment services from the perspective of community pharmacy stakeholders within the North East of England. A mixed methods approach was adopted to survey and interview stakeholders from the North East of England who commission; provide; and/or represent groups influencing the design, delivery and investment in community pharmacy clinical and public health services. The 40-item Programme Sustainability Assessment Tool, a validated instrument to assess a public health programme's capacity for sustainability across eight domains, was administered to fifty-three stakeholders, identified from a pharmacy minor ailments showcase event. The same stakeholders were invited for a semi-structured interview to explore issues further. Interviews were audio-recorded, transcribed verbatim, and underwent framework analysis. Forty-two (79.2% response rate) stakeholders representing commissioning, provider and influencing (e.g. Local Professional Network) organisations completed the assessment tool. Pharmacy minor ailment services were rated as unsustainable across the majority of the domains. Elements within the domain 'Partnerships' demonstrated potential for sustainability. Stakeholder interviews provided detailed explanation for the low scoring sustainability domains, highlighting the multifaceted challenges threatening these services. The Programme Sustainability Assessment Tool allowed stakeholders to evaluate the potential of pharmacy minor ailment services in England. Follow-up interviews highlighted that initial design and implementation of services was poorly conceived and lacked evidence, thereby impeding the services' sustainability. There are many challenges facing a widespread provision of pharmacy ailment services, but it is clear the profession needs to be clear on the service objectives to secure future interest and investment.

Elderly health status and community nursing strategy

Objective To understand elderly health status and service, and explore community elderly health management model, so as to improve the quality of life. Methods Overall 603 elderly who were 60 years old or over and were chosen by cluster sampling method underwent face-to-face investigation by self-design questionnaire, ADL scale, MMSE scale, elderly depression scale, urinary incontinence questionnaire and so on other tools. Results Elderly people had high rate of chronic disease, and from high rate to low was high blood pressure, osteoarticular disease (OAD), coronary disease, diabetes. the abnormal hearing and vision had high rate in elderly and would increase with age increasing; cognitive impairment and depression were high; the incidence of incontinence in females was higher than that of males; elderly urinary and urinary incontinence rate and cognitive impairment would increase with age increasing. The usage of transport had highest rate of impairment in the ability of self-care, followed by shopping, and over half elderly presented they preferred others to help them. Medical service was the first requirement for elderly. Conclusions We should strengthen community public health service, develop continuous community elderly health intervention, build up and consummate professional community training system gradually, so as to let young elderly play a part in community health. Key words: Elderly; Home-based care for the elderly; Community nursing

Exploration and practice of general practitioner responsibility system in an urban community of Shanghai

<h3>Objective</h3> The Minhang district of Shanghai was selected as the subject and its public health management model was investigated. <h3>Methods</h3> Minhang became a pilot location for the implementation of the general practitioner responsibility system (GPRS) in 2011. Since then, the management model of public health services in the district has gradually merged with the GPRS through a series of actions: the adjustment of organizations and the coordination mechanism in community public health services, the integration of basic public health services and clinic practice, the establishment of an informationized Internet service platform, comprehensive budgeting management of public health service programs, and performance assessment management of health workers. <h3>Results</h3> By the end of 2014, the number of residents who had a contractual relationship with a general practitioner (GP) in Minhang had reached 1.4367 million and all of them had family health records. Compared with 2010, both the rate of maternal management and the rate of children management stayed at high level (≥96%), the rate of hypertension management increased (40.73% vs. 28.70%), the rate of blood pressure control increased (82.13% vs. 77.51%), the incidence of diabetes decreased (21.93% vs. 37.85%), the rate of effective control of blood glucose for diabetic patients increased (82.43% vs. 62.77%), and the rate of child health management increased (99.79% vs. 91.54%). <h3>Conclusion</h3> The GPRS has helped to create a better community health environment. However, the development of this system is limited by several factors, including the following: the shortage of GPs, most GPs do not have good public health service skills and a correct public health concept, unclear division of different services, and imperfect department coordination.

“Community Integrated Health and Social Services” Conference February 21 - 22, 2014, Bucharest, Romania

As in many countries in Eastern Europe, the Romanian Health care system was characterised by hospital-based, specialised and centrally managed health care services up to the 1990s. Decentralisation, the introduction of compulsory health insurance and the development of family health services were major steps towards improving access to curative and preventive health services at community level. However, community nursing, which had previously provided outreach to the rural poor, was practically abandoned in the mid-1990s when the salaried general practitioners providing primary health care services for a catchment population were transformed into private practice family doctors with health insurance fund service contracts, providing care based on lists of insured patients. Hence, the community nurses/ health visitors that had been hired previously within the public primary health care setting found themselves unemployed. Community level health prevention and public health services, as well as services for pregnant women, mothers and children, were subsequently stopped. A few mother and child health programmes tried to redress this problem during the early 2000s and some good practices have been documented. The new vision for Romania, The Romanian Government National Strategy for Health 2014 – 2020 [1], addresses this service gap and foresees the development of sustainable integrated socio-medical services at community level. Since 1992, longstanding cooperation between Switzerland and Romania has connected the two countries. After a period of limited collaborative activities following Romania’s accession to the European Union, Switzerland restarted programme activities within the framework of an EU agreement supporting new accession countries. The main goals of the current Swiss support programme are to reduce social and economic disparities between Romania and more advanced EU countries, and between regions within Romania. To this end, Switzerland and Romania signed a Thematic Fund Agreement in 2011, called the Reform Fund linked to Health Issues, effective until 2019. The Swiss Agency for Development (SDC) [2] has mandated a consortium of the Swiss

Using Principles of Community-based Participatory Research to Enhance Health Data Skills Among Local Public Health Community Partners

In a prior statewide health disparities assessment, local community public health and social service professionals indicated a need for technical capacity growth in order to understand and effectively utilize health data. Using a community-based participatory research approach in addressing this need, health data training was provided to 26 individuals with the primary goals being to provide capacity to identify health disparities that result in higher morbidity and mortality, and to provide the skills needed to access, interpret, and utilize health data. Satisfaction surveys showed that an overwhelming majority of participants were extremely pleased with the training. Follow-up telephone interviews (100% response rate) conducted 2 months after the training indicated positive results, with participants discussing how they felt empowered to find, interpret, and use data as a result of the training. Results of a 6-month follow-up questionnaire (54% response rate) further supported the program's desired outcome to expand participants' knowledge and use of health data. This pilot project illustrated how utilizing a community-level partnership approach to program development not only enhances the utilization of such programs but also helps sustain participants' knowledge and skills.

Earthquakes in El Salvador: a descriptive study of health concerns in a rural community and the clinical implications – part II

Results reported in Part I of the Earthquakes in El Salvador series (see Disaster Management & Response 2003;1:105-9) indicated clinically relevant findings. The findings indicated a need for greater public health action within all five categories reviewed: healthcare, access to healthcare, housing, food, water and sanitation. Significant results between urban and rural communities indicated a need for broader community aid, public health and sanitation services to rural areas. Faster and more efficient disaster management and care services throughout the San Sebastian community were also necessary modifications.

The health and social system for the aged in Japan.

Japan implemented a new social insurance scheme for the frail and elderly, Long-Term-Care Insurance (LTCI) on 1 April 2000. This was an époque-making event in the history of the Japanese public health policy, because it meant that in modifying its tradition of family care for the elderly, Japan had moved toward socialization of care. One of the main ideas behind the establishment of LTCI was to "de-medicalize" and rationalize the care of elderly persons with disabilities characteristic of the aging process. Because of the aging of the society, the Japanese social insurance system required a fundamental reform. The implementation of LTCI constitutes the first step in the future health reform in Japan. The LTCI scheme requires each citizen to take more responsibility for finance and decision-making in the social security system. The introduction of LTCI is also bringing in fundamental structural changes in the Japanese health system. With the development of the Integrated Delivery System (IDS), alternative care services such as assisted living are on-going. Another important social change is a community movement for the healthy longevity. For example, a variety of public health and social programs are organized in order to keep the elderly healthy and active as long as possible. In this article, the author explains on-going structural changes in the Japanese health system. Analyses are focused on the current debate for the reorganization of the health insurance scheme for the aged in Japan and community public health services for them.

Charitable Care and the Nonprofit Paradigm

Nonprofit hospitals have begun to focus once again on serving the health needs of their communities. Governmental needs for additional revenue and for-profit hospitals' contention that tax exemptions give nonprofit hospitals an unfair competitive advantage have resulted in changes in laws and regulations and have caused a change in the role of nonprofit hospitals. As local governments become more responsive to the health needs of their communities, they are requiring nonprofit hospitals to become more responsive as well. Laws, regulations, and court decisions have begun to require nonprofit hospitals to provide charity care and services at levels equal to the amount of their exempt taxes. In response, nonprofit hospitals are developing community benefit programs and public health services.