Existing Health Services Research Articles

Field Hospitals

Abstract Background The need for field hospitals arise when existing health services fall behind in case of a disaster or an emergency. This study is intended to generate a standard level for the capacity of field hospitals with different levels. Methods In the descriptive study, standard levels (SS) were generated for field hospitals upon assessment of specifications of the field hospital models designed or applied onsite in the literature through content analysis. Results The field hospitals were standardized in four categories in the research: SS I, SS II, SS III and SS IV. SS is divided into two parts as health units and support services, and their use among the SS's depends on the need. Health units consist of Triage+Reception, Operating Room, 4 Bed ICU, Surgical Preparation, Laboratory/ Blood Bank, Radiology, CT, Resuscitation Room, Emergency Service, Ambulatory Care, Pharmacy, Dentistry, Dermatology, Psychiatry, Birth Consultation, Pediatric Department, Patient Admission, Doctors' Room, Sterilization, Morgue, Contagious Diseases, and Ophthalmology, while support services consist of Management, Office, Workshop (Medical Gas), Staff Dorm, Storage / Transportation, WC / Bathroom, Generator, Fresh / Waste Water, Dining Hall, Kitchen, Cold Storage Room, Laundry Room, Solid Waste, Staff Rest Room, and Reception. SS I provides emergency services and transfer to an upper level, and contains specific health units only. SS II allows for short term ambulatory treatment for the patients and contains specific health and support units. Since SS III has fundamental ambulatory care services and SS IV has wide range of ambulatory care services, they contain various health and support units. Conclusions Specifications of the field hospital SS's were defined in line with the need for health service that might arise during the disaster preparation planning. Key messages Health and support units forming the field hospital SS’s were determined. SS’s enables sustainability of the public health services following a disaster.

Assessment of role perception and job performance of ASHAs in Vijyapaura district, Karnataka

Introduction: ASHAs play an important role in the rollout of government health programmes such as the Janani Suraksha Yojana (JSY), a conditional cash transfer scheme to incentivise women to give birth in a health facility. The ASHAs work closely with other frontline workers like Auxiliary Nurse Midwives (ANMs) and Anganawadi Workers (AWWs) to conduct community-level activities. ASHAs also act as health activists in the community who will create awareness on health and its determinants, counsel mothers on key healthy behaviours and mobilise the community towards local health planning and increased utilisation and accountability of the existing health services. Objectives: To evaluate the Role perception and Job Performance of ASHAs. Materials and Methods: A cross sectional study was done on 617 ASHAs. A pre-designed, semi- structured schedule was prepared in accordance with the study objectives. The questionnaire was prepared in English and the interview was conducted in Kannada language by explaining them questions one by one. Data collection was done by interview technique. Results: 603 (97.7%) of ASHAs had positive attitude towards mobilising the community for accessing health services such as ANC, 602 (97.5%) for ANC, 599(97.08%) for institutional delivery, 597 (96.7%) for birth preparedness, 601(97.4%) for new born care, 600(97.2%) towards exclusive breast feeding. 405 (65.6%) ASHAs told that they are actively involved in distributing Iron and Folic acid tablets to pregnant women. 597 (96.7%) ASHAs informed that they educate mothers about exclusive breast feeding, while 471(76.3%) told that they encourage mothers to continue breast feeding when the child is suffering from diarrhoea. It was found that job performance of ASHAs was significantly associated with Age, Days of Training and Duration of service of ASHAs. Conclusion: In order to orient the ASHAs on their job profile and responsibility, there is a need to assess the knowledge and skills of Accredited Soc

Addressing Inequities in Indigenous Mental Health and Wellbeing through Transformative and Decolonising Research and Practice

Aim: This paper discusses the current mental health and social and emotional wellbeing in Indigenous Australian mental health and wellbeing, the gaps in research, the need for transformative and decolonising research and practice, and the opportunities and recommendations to address existing mental health inequities. Method: This paper reviews key mental health and social and wellbeing policy documents and frameworks, and examines relevant literature documenting current decolonising strategies to improve programs, services and practice. It also draws on the key findings of the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP) and Transforming Indigenous Mental Health and Wellbeing research projects. In addition this work builds on the substantial work of the national Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) which outlines a range of solutions to reduce the causes, prevalence, and impact of Indigenous suicide by identifying, translating, and promoting the adoption of evidenced based best practice in Indigenous specific suicide prevention activities. Discussion and Conclusion: This paper details the challenges as well as the promise and potential of engaging in transformative and decolonising research and practice to address the existing health service inequities. Acknowledging and addressing these health inequities is an urgent and critical task given the current COVID-19 pandemic and potential for further increasing the adverse mental health and wellbeing gap for Indigenous Australians.

The role of telehealth in supporting mothers and children during the COVID-19 pandemic

The role of telehealth in supporting community has become increasingly important during the COVID-19 pandemic as we found this coincidently in delivering the Healthy Beginnings program over the phone. We would urge an action to be taken to integrate telehealth into existing health services.

An Efficient Authentication Scheme for Electronic Health Records based Block Chain

This paper presents our current electronic health record ( EHR) systems with a blockchain based architecture.Designed on top of established databases held by health care organizations, the framework incorporates a blockchain approach to ensure data record accuracy and enhance network interoperability by monitoring all incidents that occurt on top of existing health service provider-maintained databases, the architecture implements a blockchain solution to ensure data record integrity and improve system interoperability by tracking all events that occur in database data. We 're also implementing a new reward system in this revised design to build new blocks on the blockchain. The design is autonomous of any particular blockchain network and accessible to more extensions; it may also be combined with other electronic storage structures needing security. It will then theoretically tie in with other electronic storage schemes needing protection from data misuse.

Uptake and acceptability of human papillomavirus self-sampling in rural and remote aboriginal communities: evaluation of a nurse-led community engagement model

BackgroundAboriginal women experience disproportionately higher rates of cervical cancer mortality yet are less likely to participate in screening for early detection. This study sought to determine whether a community-based HPV self-sampling service model can effectively recruit never-screened and under-screened Aboriginal women to participate in cervical cancer screening; assess the clinical outcomes; and explore the acceptability of the model from the perspective of the participants.MethodsAboriginal women aged 25–69 years of age were recruited from eight rural and remote communities in New South Wales, Australia to participate in HPV self-sampling via a community-based service model. Outcome measures were: number of women screened by HPV self-sampling, their prior cervical screening status (under-screened or never-screened), clinical outcomes and participation in follow-up pathways of care, and satisfaction with the service model.ResultsIn total, 215 women conducted a HPV self-sampling test and 200 evaluation surveys were completed. One-fifth of participants (n = 46) were never-screened and one-third (n = 69) were under-screened. Many were unsure of their screening status. Nine women were HPV 16/18 positive and eight had completed all follow up by the conclusion of the study. A further 30 women tested positive for a high risk type other than HPV 16/18 (HPV other), of which 14 had completed follow up at the conclusion of the study. Satisfaction with the HPV self-sampling kit, the process of self-sampling and the service model was high (> 92% satisfied on all items). Many women had difficulty understanding their official HPV results and placed high importance on the nurse explaining it to them.ConclusionsA community-based service model that respects Aboriginal Women’s Business can effectively recruit under-screened and never-screened Aboriginal women to complete cervical cancer screening. Furthermore, this service model supports them to complete recommended follow-up care and engage with their local existing health services.

Trends in Human Immunodeficiency Virus and Sexually Transmitted Infection Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men After Rapid Scale-up of Preexposure Prophylaxis in Victoria, Australia.

Scale-up of human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has raised concerns regarding its impact on clinic capacity and access to HIV testing. We describe enrolment in PrEPX, a large PrEP implementation study in Victoria, Australia, and the impact of PrEP uptake and maintenance on existing health services. We describe enrolment between July 26, 2016, and March 31, 2018, and trends in HIV testing among PrEPX participating and nonparticipating gay and bisexual and other men who have sex with men (GBM) at 5 study clinics participating in a sentinel surveillance system (ACCESS). We evaluated HIV and STI testing trends using segmented linear regression across the prestudy (January 2015 to June 2016) and PrEPX study (July 2016 to March 2018) periods. There were 2,049 individuals who registered interest in study participation: 72% enrolled into the study. Study clinics enrolled participants rapidly; of 4265 people enrolled in PrEPX (98% GBM), 1000 enrolled by week 3, 88% (n = 876) of whom enrolled at ACCESS sites.Prestudy period HIV testing rates were increasing at all ACCESS sites. In the month PrEPX commenced, there was an additional 247 HIV tests among PrEPX participants (P < 0.01) and no significant change among non-PrEPX GBM (P = 0.72). Across the study period, HIV testing increased by 7.2 (P < 0.01) and 8.9 (P < 0.01) tests/month among PrEPX participants and non-PrEPX GBM, respectively. The HIV testing increased among non-PrEPX GBM at sexual health clinics (18.8 tests/month, P < 0.01) and primary care clinics (7.9 tests/month, P < 0.01). Similar trends were observed across testing for all measured STIs. Rapid PrEP scale-up is possible without a reduction in HIV testing among GBM not using PrEP.

Women\u2019s retention on the continuum of maternal care pathway in west Gojjam zone, Ethiopia: multilevel analysis

BackgroundThe continuum of maternal care has been one of the effective approaches for improving the health of mothers and newborns. Although large numbers of Ethiopian women do not use maternal health services, points of drop out along the continuum are not understood well. Understanding of a particular point of maternal care dropout on the continuum, however, helps governments make effective interventions. This study aimed to assess the extent of women’s service utilization and the factors affecting retention on the continuum of care in West Gojjam Zone, Ethiopia.MethodsA community-based study linked to health facility data was conducted in June 2018. Data were obtained from 1281 mothers who gave birth to their last baby within the preceding 12 months from a two-stage cluster sampling. Data were collected via face-to-face interviews using a pretested questionnaire. Multilevel logistic regression models were used to examine the effects of individual and cluster-level factors on key elements of the continuum of care. The measure of fixed effects was expressed as Odds Ratio with 95% confidence interval.ResultsThe study revealed that only 12.1% of women completed the continuum of maternal care services (ANC4+, SBA, and PNC within 2 days after birth); while 25.1% of them did not receive any care during their recent births. There were commonalities and differences in the predictors of the three indicators of maternal health service utilization. Variables related to services received during antenatal care such as early initiation of ANC (AOR = 7.53, 95%CI, 2.94, 19.29) and receiving proper contents (AOR = 3.31, 95%CI, 1.08, 10.16) were among the predictors significantly associated with the completion of the continuum of care.ConclusionsThe continuum of maternal care completion rate was extremely low, indicating that women were not getting the maximum possible health benefit from existing health services. The results also revealed that maternal health service utilization was influenced by factors operating at various levels-individual, household, community, and health facility. Since antenatal care is considered an entry point for the subsequent use of maternal services, strategies that aimed to improve maternal health service utilization should target early initiation and antenatal care quality.

On the frontline against COVID-19: Community pharmacists' contribution during a public health crisis.

The global spread of COVID-19 is placing unprecedented demands on healthcare services. In this time of crisis, innovative and adaptive methods of practising will be required across all health professions. In order to maximise the use of current available resources, it is vital that existing services are comprehensively reviewed and full use is made of any unrealised potential among healthcare providers. Community pharmacy is one of a number of health professions that has a key role to play in responding to the current pandemic. As the scope of community pharmacy practice varies considerably across countries, it is important to examine ways in which the profession can assist with the public health response to COVID-19 and maintaining the continuity of healthcare services. This article seeks to highlight roles and activities that community pharmacists can undertake to help in relieving pressure on other areas of the health service, such as general practice. This information could help to inform future decisions about the restructuring of existing health services by governments, public health bodies and policy makers in response to public health crises such as COVID-19.

Case-studies of displacement effects in Dutch hospital care

BackgroundUnder a constrained health care budget, cost-increasing technologies may displace funds from existing health services. However, it is unknown what services are displaced and how such displacement takes place in practice. The aim of our study was to investigate how the Dutch hospital sector has dealt with the introduction of cost-increasing health technologies, and to present evidence of the relative importance of three main options to deal with cost-increases in health care: increased spending, increased efficiency, or displacement of other services.MethodsWe conducted six case-studies and interviewed 84 professionals with various roles and responsibilities (practitioners, heads of clinical department, board of directors, insurers, and others) to investigate how they experienced decision making in response to the cost pressure of cost-increasing health technologies. Transcripts were analyzed thematically in Atlas.ti on the basis of an item list.ResultsDirect displacement of high-value care due to the introduction of new technologies was not observed; respondents primarily pointed to increased spending and efficiency measures to accommodate the introduction of the cost-increasing technologies. Respondents found it difficult to identify the opportunity costs; partly due to limited transparency in the internal allocation of funds within a hospital. Furthermore, respondents experienced the entry of new technologies and cost-containment as two parallel processes that are generally not causally linked: cost containment was experienced as a permanent issue to level costs and revenues, independent from entry of new technologies. Furthermore, the way of financing was found important in displacement in the Netherlands, especially as there is a separate budget for expensive drugs. This budget pressure was found to be reallocated horizontally across departments, whereas the budget pressure of other services is primarily reallocated vertically within departments or divisions. Respondents noted that hospitals have reacted to budget pressures primarily through a narrowing in the portfolio of their services, and a range of (other) efficiency measures. The board of directors is central in these processes, insurers are involved only to a limited extent.ConclusionsOur findings indicate that new technologies were generally accommodated by greater efficiency and increased spending, and that hospitals sought savings or efficiency measures in response to cumulative cost pressures rather than in response to single cost-increasing technologies.

Where to enhance rural palliative care? Developing a spatial model to identify suitable communities most in need of service enhancement

BackgroundIn Canada, access to palliative care is a growing concern, particularly in rural communities. These communities have constrained health care services and accessing local palliative care can be challenging. The Site Suitability Model (SSM) was developed to identify rural “candidate” communities with need for palliative care services and existing health service capacity that could be enhanced to support a secondary palliative care hub. The purpose of this study was to test the feasibility of implementing the SSM in Ontario by generating a ranked summary of rural “candidate” communities as potential secondary palliative care hubs.MethodsUsing Census data combined with community-level data, the SSM was applied to assess the suitability of 12 communities as rural secondary palliative care hubs. Scores from 0 to 1 were generated for four equally-weighted components: (1) population as the total population living within a 1-h drive of a candidate community; (2) isolation as travel time from that community to the nearest community with palliative care services; (3) vulnerability as community need based on a palliative care index score; and (4) community readiness as five dimensions of fit between a candidate community and a secondary palliative care hub. Component scores were summed for the SSM score and adjusted to range from 0 to 1.ResultsPopulation scores for the 12 communities ranged widely (0.19–1.00), as did isolation scores (0.16–0.94). Vulnerability scores ranged more narrowly (0.27–0.35), while community readiness scores ranged from 0.4–1.0. These component scores revealed information about each community’s particular strengths and weaknesses. Final SSM scores ranged from a low of 0.33 to a high of 0.76.ConclusionsThe SSM was readily implemented in Ontario. Final scores generated a ranked list based on the relative suitability of candidate communities to become secondary palliative care hubs. This list provides information for policy makers to make allocation decisions regarding rural palliative services. The calculation of each community’s scores also generates information for local policy makers about how best to provide these services within their communities. The multi-factorial structure of the model enables decision makers to adapt the relative weights of its components.

A study on knowledge and practice in maternal health care by accredited social health activists of Vijyapaura district, Karnataka, India

Background: One of the key components of national rural health mission was to create a band of female health volunteers, appropriately named “accredited social health activist” (ASHA) in each village within the identified States to act as a bridge between the rural people and health services outlets. They act as health activists in community who will create awareness on health and its determinants, counsel mothers on key healthy behaviors and mobilize the community towards local health planning and increased utilization and accountability of the existing health services. Objectives of the study was to describe the socio-demographic profile of ASHAs working in Vijayapur district and to evaluate the knowledge, attitude, practice of ASHAs towards the maternal care.Methods: A cross-sectional study on 617 ASHAs of Vijayapur district. A pre-designed, semi- structured questionnaire was prepared in English and the interview was conducted in Kannada by explaining them questions one by one.Results: Out of 617 ASHAs interviewed, 427 (69.2%) of them told a pregnant woman should have antenatal care (ANC) visits and 413 (65.3%) ASHAs opined that a minimum of four ANC visits are required. While 542 (87.2%) ASHAs told that they should accompany pregnant woman transport to health centre during labour pains and 570 (92.8%) told that they should stay with the pregnant lady until her delivery is over. Also, it was found that knowledge of ASHAs regarding maternal care was significantly associated with age and duration of service of ASHAs.Conclusions: On the whole, knowledge of ASHAs about care during pregnancy and care of new-born was considerably good.

Evaluation of knowledge and practice of ASHAs, regarding child health services in Vijyapaura District, Karnataka.

Background and Aims:NHM has created a cadre of trained female community health activists called Accredited Social Health Activists (ASHAs) to mobilize the community toward increased utilization of existing health services. ASHAs play an important role in the rollout of government health programs such as the Janani Suraksha Yojana (JSY), a conditional cash transfer scheme to incentivize women to give birth in a health facility. The ASHAs work closely with other frontline workers like Auxiliary Nurse Midwives (ANMs) and Anganawadi Workers (AWWs) to conduct community-level activities.Method:A cross-sectional study was conducted in 11 months. A pre-designed, semi- structured questionnaire was prepared in accordance with the study objectives. The questionnaire was prepared in English and the interview was conducted in Kannada language by explaining them questions one by one. Data collection was done by interview technique.Results:Out of 617 ASHAs interviewed, 580 (94%) ASHAs had proper knowledge about exclusive breast feeding and the duration, 560 (90.7%) told colostrum was necessary to the baby. Only 323 (52.3%) ASHAs had correct knowledge regarding schedule of immunization. 580 (94%) ASHAs could tell when the weaning should be started correctly and 611 (99%) ASHAs knew about ORS packets and the steps that went in preparing it.Conclusion:Generally, knowledge of ASHAs about care of new-born and child health care was considerably good. However, knowledge of ASHAs about the immunization schedule was found to be inadequate.

Prevalence of Mental Disorder among the Client Visiting Outpatient Department in Karnali Academy of Health Science

Introduction: Mental illnesses are health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities. So the study was carried out to find the pattern of mental disorders of OPD patients in Karnali academy of health science. Method: This was a retrospective study conducted among the patients attending for OPD check up in Karnali Academy of Health Science (KAHS) in the department of psychiatric. The study was done from April 1, 2018 to March 31, 2020. Only mental disorders were included. Data were collected from the register of psychiatric OPD which were maintained in the medical department. Total number of sample taken was 944 in first year and 1685 in second year that is 2629 of all age group. Result: A total of 2629 mental disorder cases reported in Karnali Academy of health Science. 578 (61.22%) were females and 366 (38.77%) were males in first year and 1009 (40.11%) were females and 676 (59.89%) were males in the second year. Mental disorder was more among females than in male in both years. Most commonly occurred mental disorder was anxiety, depression, somatoform disorder, alcohol dependence disorder, bipolar affective mood disorder and psychosis. Of all the cases, most of commonly occurring case was mood disorders. Conclusion: Mental illness is seen in increasing trend so that the existing health service facilities must be given attention and priorities. More study is needed to find the contributing factors of mental illness among the female community. Attention and care will be the solution for improving the condition of the mental disorders. These findings can be utilized for planning the National Mental Health programme.

Effectiveness of Prompt Mental Health Care, the Norwegian Version of Improving Access to Psychological Therapies: A Randomized Controlled Trial

Background: The innovative treatment model Improving Access to Psychological Therapies (IAPT) and its Norwegian adaptation, Prompt Mental Health Care (PMHC), have been evaluated by cohort studies only. Albeit yielding promising results, the extent to which these are attributable to the treatment thus remains unsettled. Objective: To investigate the effectiveness of the PMHC treatment compared to treatment as usual (TAU) at 6-month follow-up. Methods: A randomized controlled trial with parallel assignment was performed in two PMHC sites (Sandnes and Kristiansand) and enrolled clients between November 9, 2015 and August 31, 2017. Participants were 681 adults (aged ≥18 years) considered for admission to PMHC due to anxiety and/or mild to moderate depression (Patient Health Questionnaire [PHQ-9]/Generalized Anxiety Disorder scale [GAD-7] scores above cutoff). These were randomly assigned (70:30 ratio; n = 463 to PMHC, n = 218 to TAU) with simple randomization within each site with no further constraints. The main outcomes were recovery rates and changes in symptoms of depression (PHQ-9) and anxiety (GAD-7) between baseline and follow-up. Primary outcome data were available for 73/67% in PMHC/TAU. Sensitivity analyses based on observed patterns of missingness were also conducted. Secondary outcomes were work participation, functional status, health-related quality of life, and mental well-being. Results: A reliable recovery rate of 58.5% was observed in the PMHC group and of 31.9% in the TAU group, equaling a between-group effect size of 0.61 (95% CI 0.37 to 0.85, p < 0.001). The differences in degree of improvement between PMHC and TAU yielded an effect size of –0.88 (95% CI –1.23 to –0.43, p < 0.001) for PHQ-9 and –0.60 (95% CI –0.90 to –0.30, p < 0.001) for GAD-7 in favor of PMHC. All sensitivity analyses pointed in the same direction, with small variations in point estimates. Findings were slightly more robust for depressive than anxiety symptoms. PMHC was also more effective than TAU in improving all secondary outcomes, except for work participation (z = 0.415, p = 0.69). Conclusions: The PMHC treatment was substantially more effective than TAU in alleviating the burden of anxiety and depression. This adaptation of IAPT is considered a viable supplement to existing health services to increase access to effective treatment for adults who suffer from anxiety and mild to moderate depression. A potential effect on work participation needs further examination.

Internal Analysis of Factors Influencing the Use of Sleeping Beds (Utility Rate)

Good service will increase the utilization of hospitalization (Utility rate) in Hospital, the factors that influence the utilization of service are procedure of service, service of doctor and nurse as well as facilities and infrastructure that exist in Hospital. The purpose of this study is to internal analysis of factors that affect the utilization of inpatient beds (Utility rate) in Caruban Hospital Madiun District. This research design using descriptive quantitative with Cross Sectional approach. The sample in this study amounted to 133 respondents. Random sampling sampling technique. The research instrument used questionnaire with Ordinal regression statistic test with α = 0,05. As many as 60.2% (80 respondents) stated that the service procedure is in good category. 50.4% (67 respondents) stated that the Doctor Service at Caruban Hospital of Madiun Regency is good. 81.2% (108 respondents) stated that Nurse Service is in good category. 45.9% (61 respondents) stated that the facilities and infrastructure in the category is quite good. 60.2% (80 respondents) stated that the utilization of the bed at Caruban Hospital of Madiun Regency is good. There is no influence of service procedure, there is influence of doctor service, nurse service and facility and infrastructure with utilization of inpatient bed (Utility rate) at RSUD Caruban Regency of Madiun. With good service from doctors and nurses as well as facilities that support the patient will provide information to families, relatives and others to take advantage of existing health services in hospitals Caruban Madiun District

Effectiveness of Prompt Mental Health Care: Preliminary results from a randomized controlled trial

Abstract Background Prompt Mental Health Care (PMHC) service is a Norwegian initiative, adapted from the English ‘Improved Access to Psychological Therapy’ (IAPT), aimed at improving access to primary care treatment for anxiety and depression. Thus far, both PMHC and IAPT have been evaluated by cohort studies only. Albeit yielding promising results, the extent to which these are attributable to the treatment thus remains unsettled. This study investigates the effectiveness of PMHC compared to treatment as usual (TAU) at six months follow-up. Methods Randomized controlled trial with parallel assignment in two PMHC sites from November 2015 to March 2018. Participants were 681 adults (aged ≥18 years) considered for admission to PMHC due to anxiety and/or mild to moderate depression. These were randomly assigned on a 70:30 ratio. Main outcomes were recovery rates and changes in symptoms of depression and anxiety between baseline and follow-up. Primary outcome data were available for 73%/67% in the PMHC/TAU group. Sensitivity analyses based on observed patterns of missingness were conducted. Results A reliable recovery rate of 58.5% was observed in the PMHC group and 31.9% in the TAU group, yielding a between-group effect size (ES) of 0.61 [95% CI 0.37-0.85, p&amp;lt;.001]. The differences in degree of improvement between PMHC and TAU yielded an ES of -0.88 [95% CI -1.23-0.43, p &amp;lt; 0.001] for symptoms of depression and -0.60 [95% CI -0.90-0.30, p &amp;lt; 0.001] for symptoms of anxiety in favour of PMHC. All sensitivity analyses pointed in the same direction with small variations in point estimates. Findings were slightly more robust for depressive than anxiety symptoms. Conclusions The PMHC treatment was substantially more effective than TAU in alleviating symptoms of anxiety and depression. This adaptation of IAPT is considered a viable supplement to existing health services to increase access of effective treatment for adults who suffer from anxiety and mild to moderate depression. Key messages This study is the first to evaluate the effectiveness of an IAPT-like treatment model in terms of a randomized controlled trial. Prompt Mental Health Care was substantially more effective than TAU in alleviating symptoms of depression and anxiety at 6-months follow-up.

Workshop: MigHealthCare - strengthening Community Based Care to minimize health inequalities

Abstract Over the past few years, a large number of refugees, migrants and asylum seekers have reached the south-eastern points of entry of the EU, challenging health and social systems of bordering countries with a spillover effect to the rest of the EU. Refugees, asylum seekers and migrants are at higher risk of poverty and social exclusion compared to the local populations, while the different vulnerable groups face diverse barriers when accessing health services. In many cases they do not receive appropriate health and social care that best meets their needs. Furthermore, in the EU MS, different practices apply to health and social care delivery for migrants/refugees. Research has shown the importance of community-based models to improve health care access of vulnerable migrants and refugees. Such models include elements of good communication, cultural awareness, sensitivity and respect for the diverse cultural and ethnic backgrounds by community health care staff as well health education and primary healthcare services. Mig-HealthCare - strengthening Community Based Care to minimize health inequalities and improve the integration of vulnerable migrants and refugees into local communities, is a 3-year project, launched in 2017, with the financial support of the European Commission. It is implemented by a consortium of 14 partners among them universities, national authorities and NGOs from ten countries across Europe (Greece, France, Malta, Germany, Austria, Italy, Cyprus, Spain, Sweden and Bulgaria). The overall objective of Mig-HealthCare is to improve health care access for vulnerable migrants and refugees, support their inclusion and participation in European communities and reduce health inequalities. The project’s specific objectives are: Describe the current physical and mental health profile of vulnerable migrants and refugees including needs, expectations and capacities of service providers.Develop a roadmap and toolbox for the implementation of community based care models, following an assessment of existing health services and best practices.Train community service providers on appropriate delivery of health care models for vulnerable migrants and refugees.Pilot test and evaluate community based care models which emphasize prevention, physical and mental health promotion and integration. The project results are presented on behalf of the Mig-HealthCare consortium. Key messages The overall objective of Mig-HealthCare is to improve health care access for vulnerable migrants and refugees. The Mig-HealthCare project focuses on developing a roadmap to facilitate the effective implementation of community care models.

Prevalence of Physical Disability in Iran: Do Existing Health Services Meet the Needs of Older People? A Letter to Editor

Prevalence of Physical Disability in Iran: Do Existing Health Services Meet the Needs of Older People? A Letter to Editor

A Scoping Review of Interventions to Promote Health and Well-Being of Left-behind Children in Mainland China

Abstract Approximately 65 million children in mainland China are left behind in rural areas while their parents work in the cities. Research has highlighted their health needs. However, current research on interventions for this population is unknown. The purpose of this study was to systematically review existing health service interventions for left-behind children in China. The study team identified interventions for left-behind children by conducting a comprehensive search of major academic databases for Chinese and English research. Articles were retained in the study if they were original empirical intervention studies that target health and related well-being outcomes of left-behind children. A total of eighteen unique studies met inclusion criteria. The majority of them demonstrated positive outcomes using various modalities, including education, sport and nutrition guidance and nursing services. However, the shortcomings in research design and intervention limit their replication. Intervention research for left-behind children shows an enormous gap in the knowledge about this at-risk group. Of the existing programs identified, we observe considerable promise for interventions based on inter-disciplinary approaches to services. We provide additional recommendations for conducting future research and for building collaborative relationships with social workers to better serve the needs of children.