Publicly-funded Health Services Research Articles

The impact of the early COVID-19 pandemic on healthcare system resource use and costs in two provinces in Canada: An interrupted time series analysis.

The aim of our study was to assess the initial impact of COVID-19 on total publicly-funded direct healthcare costs and health services use in two Canadian provinces, Ontario and British Columbia (BC). This retrospective repeated cross-sectional study used population-based administrative datasets, linked within each province, from January 1, 2018 to December 27, 2020. Interrupted time series analysis was used to estimate changes in the level and trends of weekly resource use and costs, with March 16-22, 2020 as the first pandemic week. Also, in each week of 2020, we identified cases with their first positive SARS-CoV-2 test and estimated their healthcare costs until death or December 27, 2020. The resources with the largest level declines (95% confidence interval) in use in the first pandemic week compared to the previous week were physician services [Ontario: -43% (-49%,-37%); BC: -24% (-30%,-19%) (both p<0.001)] and emergency department visits [Ontario: -41% (-47%,-35%); BC: -29% (-35%,-23%) (both p<0.001)]. Hospital admissions declined by 27% (-32%,-23%) in Ontario and 21% (-26%,-16%) in BC (both p<0.001). Resource use subsequently rose but did not return to pre-pandemic levels. Only home care and dialysis clinic visits did not significantly decrease compared to pre-pandemic. Costs for COVID-19 cases represented 1.3% and 0.7% of total direct healthcare costs in 2020 in Ontario and BC, respectively. Reduced utilization of healthcare services in the overall population outweighed utilization by COVID-19 patients in 2020. Meeting the needs of all patients across all services is essential to maintain resilient healthcare systems.

Community participation and stakeholder engagement in determining health service coverage: A systematic review and framework synthesis to assess effectiveness.

Community and stakeholder involvement in decision-making to determine publicly-funded health services and interventions is advocated to fulfil citizens' rights and improve health outcomes. The inclusion of public actors, particularly disadvantaged populations, in priority setting for universal health coverage (UHC) is also enshrined in guidance from the World Health Organization (WHO). However, challenges remain in operationalising this policy aim and ensuring that these approaches are effective and equitable. This study aimed to synthesise published evidence on the role of community and stakeholder participation in determining health service coverage. A systematic review was conducted, searching the Web of Science, Ovid Global Health, and PubMed Central databases from 2000 onwards, including all study types. A framework synthesis approach was used for charting and synthesising data on mechanisms, effectiveness (equity, depth, and stage), and barriers and facilitators for engagement. Twenty-seven relevant studies were identified that involve community actors and other stakeholders in priority setting and decision-making processes for defining health benefit packages and UHC, health technology assessment, and pharmaceutical coverage. Mechanisms of engagement include a wide variety of consultation approaches; participation in decision-making committees, advisory councils, and local planning meetings; and appeals mechanisms. Participation occurs primarily at Data and Dialogue stages of decision-making processes, and we found limited depth of engagement among identified cases. Limited consideration of equity was observed in planning and reporting on community involvement in priority setting. A number of challenges are identified in the literature, which we typologise as institutional, procedural, technical, and structural / normative barriers to meaningful participation. This systematic review identifies key gaps and opportunities in the literature and practice related to effective and equitable community and stakeholder participation in determining health service coverage. It offers essential considerations for planning and executing inclusive approaches to priority setting for publicly-funded health services and interventions and defining health benefit packages for UHC.

Psychometric Assessment of the Eyberg Child Behavior Inventory in Children with Autism in Community Settings.

TheEyberg Child Behavior Inventory (ECBI) is a frequently used measure to assess interferingbehaviors in children and psychometric properties have recently been examined in children with autism spectrum disorder (ASD). There is a need to confirm the identified factors and examine the factor structure in a racially/ethnically diverse, community-based sample. The current study conducts apsychometric analysisof theECBIin a sample of children with ASD receiving publicly-funded mental health services. Data werecollected from 201 children with ASD ages 5-13years (60% Hispanic/Latinx) participating in a community effectiveness trial. Confirmatory factor analysis indicated poor model fit using previously identified factors and a new four-factor solution was identified. Clinical and research implications of these findings are discussed.

Characterizing the psychological distress of treatment-seeking youth and adults impacted by Hurricane Harvey

Hurricane Harvey was one of the most destructive hurricanes in U.S. history, resulting in widespread flooding and property damage in the greater Houston-metropolitan area. This study aims to characterize a group of treatment-seeking youth and adults up to 2.5 years following Hurricane Harvey. A total of 154 children, 165 adolescents, and 531 adults who presented to publicly-funded mental health services were assessed on demographics, depressive and anxiety symptomatology, and hurricane impact. Age, sex, race/ethnicity, family/social support, time since the hurricane, and hurricane impact were examined as correlates of depressive and anxiety symptoms at treatment initiation. Overall, participants presented with elevated depressive and anxiety symptoms to the clinic. Greater hurricane impact was correlated with depressive and anxiety symptoms in adults and adolescents, but not in children. In addition, poorer family/social support was linked to greater anxiety in children and higher depression scores in children and adolescents. Adolescent females had higher anxiety and depression than adolescent males. Days since Harvey and anxiety symptoms were negatively associated for adults. Clinical and research implications for psychological distress in the medium-to-long-term post-natural disaster period are discussed. • Treatment-seeking youth and adults reported elevated depressive and anxiety symptoms up to 30 months after Hurricane Harvey. • Greater diasaster impact was associated with more depressive and anxiety symptoms in adults, but not youth. • Further research is warranted to examine factors that affect individuals who do not recover in the post-acute disaster period.

Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: a best-worst scaling choice experiment

BackgroundCommunity behavioral health clinicians, supervisors, and administrators play an essential role in implementing new psychosocial evidence-based practices (EBP) for patients receiving psychiatric care; however, little is known about these stakeholders’ values and preferences for implementation strategies that support EBP use, nor how best to elicit, quantify, or segment their preferences. This study sought to quantify these stakeholders’ preferences for implementation strategies and to identify segments of stakeholders with distinct preferences using a rigorous choice experiment method called best-worst scaling.MethodsA total of 240 clinicians, 74 clinical supervisors, and 29 administrators employed within clinics delivering publicly-funded behavioral health services in a large metropolitan behavioral health system participated in a best-worst scaling choice experiment. Participants evaluated 14 implementation strategies developed through extensive elicitation and pilot work within the target system. Preference weights were generated for each strategy using hierarchical Bayesian estimation. Latent class analysis identified segments of stakeholders with unique preference profiles.ResultsOn average, stakeholders preferred two strategies significantly more than all others—compensation for use of EBP per session and compensation for preparation time to use the EBP (P < .05); two strategies were preferred significantly less than all others—performance feedback via email and performance feedback via leaderboard (P < .05). However, latent class analysis identified four distinct segments of stakeholders with unique preferences: Segment 1 (n = 121, 35%) strongly preferred financial incentives over all other approaches and included more administrators; Segment 2 (n = 80, 23%) preferred technology-based strategies and was younger, on average; Segment 3 (n = 52, 15%) preferred an improved waiting room to enhance client readiness, strongly disliked any type of clinical consultation, and had the lowest participation in local EBP training initiatives; Segment 4 (n = 90, 26%) strongly preferred clinical consultation strategies and included more clinicians in substance use clinics.ConclusionsThe presence of four heterogeneous subpopulations within this large group of clinicians, supervisors, and administrators suggests optimal implementation may be achieved through targeted strategies derived via elicitation of stakeholder preferences. Best-worst scaling is a feasible and rigorous method for eliciting stakeholders’ implementation preferences and identifying subpopulations with unique preferences in behavioral health settings.

Impact of Therapist Training on Parent Attendance in Mental Health Services for Children with ASD

ABSTRACT Objective The current study explored the impact of training therapists in a mental health intervention for children with autism spectrum disorder (ASD) on parent attendance in their children’s therapy sessions. We also examined family, therapist, and program factors as potential moderators. Method Data were drawn from a cluster-randomized community effectiveness trial of “An Individualized Mental Health Intervention for ASD (AIM HI)”. Participants included 168 therapists yoked with 189 children recruited from publicly-funded mental health services. Data included family (caregiver strain, parent sense of competence, race/ethnicity), therapist (background, experience), and program (service setting) characteristics, and parent session attendance. Multilevel models were used to evaluate the effectiveness of AIM HI therapist training on caregiver attendance and identify moderators of training effects on parent attendance. Results Parents attended a higher percentage of sessions in the AIM HI training condition compared to the Usual Care condition. Program service setting moderated the effect of AIM HI training, with higher parent attendance in non-school (mostly outpatient) settings compared to school settings and a significantly smaller difference between the settings in the AIM HI condition. Conclusions Effective strategies to promote parent engagement, especially in service settings such as schools, are warranted. Findings support the effectiveness of AIM HI training in promoting parent attendance across multiple publicly-funded mental health service settings. The larger effect in school-based programs supports the utility of training in evidence-based interventions such as AIM HI to increase the feasibility of parent attendance in such services.

Potemkin redux: the re-disorganisation of public mental health services in Australia.

This paper discusses the phenomenon of re-disorganisation as it applies to publicly-funded mental health services. The term refers to the constant reorganisation of services in the absence of evidence and of unclear benefit. We illustrate the problems of re-disorganisation with some hypothetical examples, as well as discussing the context of these problems. The re-disorganisation of public mental health services may be considered a politically expedient administrative response resulting in the illusion of activity and progress. It may be intentional or unintentional. Re-disorganisation can detract from effective policy, planning and implementation of improvements in provision of public mental health services.

Implementation of public health genomics in Pakistan.

There has been considerable recent progress in the implementation of public health genomics policy throughout the developed world. However, in the developing world, genetic services still remain limited, or unavailable to most. Here, we discuss challenges and opportunities related to the implementation of public health genomics in developing countries. We focus on Pakistan, a country with one of the world's highest rates of inter-family marriages and prevalence of inherited genetic conditions. Pakistan still lacks a national newborn screening programme, clinical genetic testing services, or public health genomics framework. The medical infrastructure in Pakistan, characterized by limited publicly-funded health services and a significant burden of infectious disease, may contribute to de-prioritization of genetic health services. In addition, there are a number of societal, cultural and religious factors to consider. Recently a number of large research studies have been conducted in populations of Pakistani descent, mostly in collaboration with major US, UK and European institutions. Some of these have yielded high-impact scientific findings, but have yet to translate into public health outcomes in Pakistan. Before the benefits of genomics can be realized in developing countries, the first initial steps towards strategic prioritization, resourcing, and long-term goal setting are required. We propose some practical recommendations and possible first steps forward.

Analisis Faktor Yang Mempengaruhi Pemilihan Kelas Kepesertaan Jaminan Kesehatan Nasional

Akhir Tahun 2004 pemerintah menetapkan Undang-Undang No. 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional, dengan salah satu programnya adalah Jaminan Kesehatan Nasional (JKN). Diharapkan dengan adanya JKN pembiayaan pelayanan kesehatan masyarakat dilaksanakan dalam sistem asuransi dan JKN menjadi sistem jaminan yang bersifat wajib. Data dari Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan Kota Tarakan diketahui bahwa desa tertinggi yang terdaftar dalam BPJS Kesehatan adalah Desa Sei Pancang Kecamatan Sebatik Utara sebanyak 1.017 jiwa peserta mandiri. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang memengaruhi masyarakat Desa Sei Pancang dalam pemilihan kelas kepesertaan JKN. Metode yang digunakan dalam penelitian ini adalah metode penelitian observasional dengan pendekatan cross sectional study. Populasi dalam penelitian ini adalah warga Desa Sei Pancang yang terdaftar sebagai peserta Mandiri BPJS Kesehatan dengan sampel sebanyak 156 responden yang dipilih secara simple random sampling. Data dianalisis menggunakan uji univariat dan uji bivariat dengan Chi Square. Hasil analisis Chi Square menunjukkan adanya hubungan antara pendapatan (p value = 0,001) dengan pemilihan kelas kepesertaan JKN dan tidak ada hubungan antara aksesibilitas (p value = 0,131) serta mutu pelayanan (p value = 0,091) dengan pemilihan kelas kepesertaan JKN. Dalam hal ini, diharapkan pihak BPJS Kesehatan melakukan sosialisasi kepada masyarakat tentang manfaat dan fasilitas yang didapatkan dalam setiap kelas kepesertaan JKN dan diharapkan masyarakat untuk memilih kelas kepesertaan JKN sesuai dengan pendapatan yang didapatkan demi terwujud pembiayaan kesehatan secara adil.

Privacy-Preserved Data Sharing for Evidence-Based Policy Decisions: A Demonstration Project Using Human Services Administrative Records for Evidence-Building Activities

Privacy-Preserved Data Sharing for Evidence-Based Policy Decisions: A Demonstration Project Using Human Services Administrative Records for Evidence-Building Activities

The organization and financing of public health services in Slovenia

The organization and financing of public health services in Slovenia

2.F. Workshop: The organization and financing of public health services in Europe

2.F. Workshop: The organization and financing of public health services in Europe

2.F. Workshop: The organization and financing of public health services in Europe

2.F. Workshop: The organization and financing of public health services in Europe

The organization and financing of public health services in Europe – key policy lessons

The organization and financing of public health services in Europe – key policy lessons

The organization and financing of public health services in England

The organization and financing of public health services in England

The organization and financing of public health services in Europe – key policy lessons

The organization and financing of public health services in Europe – key policy lessons

The organization and financing of public health services in Slovenia

The organization and financing of public health services in Slovenia

The organization and financing of public health services in England

The organization and financing of public health services in England

Implementing an intervention to address challenging behaviors for autism spectrum disorder in publicly-funded mental health services: Therapist and parent perceptions of delivery with Latinx families.

As implementation of evidence-based practices (EBPs) in publicly funded children's mental health services has become increasingly common, concerns have been raised about the appropriateness of specific EBPs to the diverse client populations served in these settings. Exploring stakeholder perspectives can provide direction for refinements of EBPs when delivered with Latinx families. The current study used qualitative methods to examine therapist and Latinx parent perceptions of therapist-parent interactions and the intervention process when therapists are trained to deliver AIM HI (An Individualized Mental Health Intervention for ASD), a structured, parent-mediated intervention for autism spectrum disorder (ASD). Therapist and parent participants were a subset of participants from a large-scale community effectiveness trial. Perceptions were gathered through focus groups with therapists (n = 17) and semistructured interviews with Latinx parents (n = 29). Therapists were 94% female, 35% Latinx, and 47% were fluent in Spanish. Parents were 93% female, 100% Latinx, and 66% preferred Spanish. A coding, consensus, co-occurrence and comparison approach was used to analyze data. Three primary themes emerged: (a) limited parental knowledge about ASD and the need to address knowledge gaps; (b) differing perceptions regarding parental participation in treatment; and (c) identification of influences on parent-therapist interaction, including the cultural value of respeto/deference (emphasized by therapists), and importance of personalismo/personal connection (emphasized by parents). The themes provide specific direction for enhancements to AIM HI to maximize engagement of Latinx families. The themes also have broader implications for intervention development and community implementation including refinement of EBPs to facilitate fit and sustained implementation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Motivations, Expectations and Experiences in Being a Mental Health Helplines Volunteer.

Volunteers in non-government organisations are increasingly providing mental health support due to increasing demand and in the context of overstretched publicly-funded mental health services. This descriptive, cross-sectional study explored a knowledge gap in the literature of mental health telephone counselling by examining the motivation and retention determinants of helpline volunteers. In total, 25 participants were recruited across four focus groups and five individual interviews from a non-government organisation which provides a national phone counselling service to callers in New Zealand. Interviews were electronically recorded, transcribed and thematically analysed. Volunteers were found to have a high regard for their role and enjoyed many aspects including initial training, ongoing supports (formal/informal) and nature of the phone calls. However, organisational priorities/communication, disconnectedness, technological issues, lack of recognition and lack of a sense of belonging were reasons cited for intention to leave but previous mental health experiences, autonomy/flexibility, self-discovery/skills development and being there for someone else were key factors for volunteers to start and remain in their role. Understanding these crucial factors may help modulate volunteer satisfaction and retention in mental health organisations but may also potentially be relevant to other types of volunteer organisations.