Health Care Services For Persons Research Articles

A quality perspective on the ideal of coherent care pathways for patients with complex, long-term healthcare needs. A policy document analysis

Background: Policy documents’ rhetoric emphasize coherent care pathways as an expression of integrated and person-centred care in healthcare services for persons with complex long-term needs. Various measures are introduced to achieve these ideals. Norwegian policy highlights personal responsibility for one professional as a coordinator, cross-sectional individual care plans, services provided by multidisciplinary teams, formal collaboration structures between primary and specialized care, and implementation of different types of pathway organization. Policy documents rarely specify how quality in terms of goal achievement is to be understood, assessed, or evaluated. It has proved difficult to show outcomes of the measures as well as whether they contribute to achievement of the ideals. 
 Theoretical framework: Four quality paradigms have been demonstrated as a common basis for assessing quality in integrated care: the empirical paradigm which focus on measuring reality, the reference paradigm where care is evaluated according to models or frameworks, the reflective paradigm where quality cannot be defined, just discussed. And finally, the emergence paradigm where all stakeholders explore and co-create new solutions together.
 Aim: To analyse how ideals of coherent care pathways are described in policy documents, and how they resonate with different quality paradigms. 
 Methods: An analysis of two central Norwegian policy documents is in process. The meaning of ‘care pathway’ is interpreted in the context of each paragraph, and categorized according to which quality paradigm(s) is considered relevant. 
 Preliminary results and discussion: The concept ‘coherent care pathways’ is used as an expression of, and as an argument for, a variety of models, care organization, care values, and desirable patient experiences related to process-oriented care. Achievement of coherent care pathways for persons with long-term complex healthcare needs, can therefore imply different types of “success”. 
 One type of model is standardized clinical pathways. Here quality is defined as timely accomplishments of defined tasks. This is in accordance with the empirical paradigm. In the Norwegian coordination reform, care pathways is defined as the chronological chain of events that make up the patient's encounters with various parts of the health and care services. In good pathways these events are put together in a rational and coordinated way to meet the patient's various needs. Pathway in this meaning must be evaluated in perspective of the individual patient’s situation, considering the degree of predictability and the prerequisites for planning during the process. This in accordance with the emergence paradigm.
 Van Kemenade, van der Vlegel et al. (2019, 2020, 2021, 2022) have introduced the quality paradigms in analysis of, and recommendations for, integrated care research, to show different understandings and values at play in a patient case, and to propose a new definition of integrated care. In this paper we intend to discuss how conceptualizations of coherent care pathways in policy documents has consequences for how quality can be understood and evaluated. And further, that we can draw relevant knowledge from this of benefit to discussions and plans for realizing the measures and the ideals of integrated person-centred care. 
 Keywords: Care pathways, integrated care, person-centred care, quality paradigms.

Cost and utilization of healthcare services for persons with diabetes

AimsDescribe and compare healthcare costs and utilization for insured persons with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes in the United States. MethodsUsing a nationally representative healthcare claims database, we identified matched persons with T1D, T2D, and without diabetes using a propensity score quasi-randomization technique. In each year between 2009 and 2018, we report costs (total and out-of-pocket) and utilization for all healthcare services and those specific to medications, diabetes-related supplies, visits to providers, hospitalizations, and emergency department visits. ResultsIn 2018, we found out-of-pocket costs and total costs were highest for persons with T1D (out-of-pocket: $2,037.2, total: $25,652.0), followed by T2D (out-of-pocket: $1,543.3, total: $22,408.1), and without diabetes (out-of-pocket: $1,122.7, total: $14,220.6). From 2009 to 2018, out-of-pocket costs were increasing for persons with T1D(+6.5 %) but decreasing for T2D (−7.5 %) and without diabetes (−2.3 %). Medication costs made up the largest proportion of out-of-pocket costs regardless of diabetes status (T1D: 51.4 %, T2D: 55.4 %,without diabetes: 51.1 %). ConclusionsGiven the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (i.e., wide-ranging problems stemming from healthcare costs). In addition, policies that aim to lower out-of-pocket costs of cost-effective diabetes related healthcare are needed with a particular focus on medications.

Examining the impact of spatial accessibility to rehabilitation facilities on the degree of disability: A heterogeneity perspective

The positive effect of healthcare facilities on residents’ health has been extensively studied. However, few studies have focused on the role of rehabilitation services as unique healthcare services for persons with disabilities. This study aimed to examine the relationship between the spatial accessibility of rehabilitation facilities and the degree of disability. To this end, an approach of measuring the spatial accessibility of rehabilitation facilities to persons with disabilities was proposed. This approach integrates multiple key elements including the characteristics of facilities (i.e., the capacity, frequency of use and service radius), characteristics of the mobility of persons with disabilities (i.e., the mode of travel, escort support, transportation fee and barrier-free environment requirements) and travel time obtained from a routing application programme interface. The accessibility of rehabilitation facilities was calculated at the neighbourhood level within the Central Urban Area of Tianjin Municipality. The ordinal logistic regression analysis revealed that higher accessibility to rehabilitation facilities generally corresponded to lower severity of disability. However, the impact varied depending on the type of disability. Increased accessibility was associated with greater severity of intellectual disability, whereas it was linked to reduced severity of visual, hearing, limb, mental and speech disabilities. It is suggested to incorporate disability diversity and the accessibility of rehabilitation facilities into spatial planning and governance.

Health access for transgender people in Latin America: a scoping review protocol

Background Globally, trans people face barriers in living with society due to cis-heteronormative standards that impair access to healthcare. Objective: This study aims to map and analyze the literature to elucidate if access to health services and goods meets the health needs of transgender persons in Latin America. The study will describe the factors that impact health access for transgender persons in the area, the differences and similarities between the access in the region's countries, and the factors that justify them. The results will characterize the Latin American health access capacity, strengths, and difficulties in meeting the needs and rights of that group. Materials and methods: This review consists of a search in PubMed, SciELO, and LILACS databases on the health of transgender people in Latin America and, after, the selection of the controls and included articles. The selection of studies occurs in three stages, conducted in pairs of researchers: reading the title, reading the abstract, and floating the complete text, according to inclusion criteria. There is no language restriction. The pair of researchers will conduct data extraction by filling in the extraction framework information of each study. Data synthesis comprises the categorization of the data. The analysis takes place from the perspective of three factors of access to health: enabling factors, health needs, and individual health behaviors. Data analysis comprises the application of quantitative measures in the data overview and subsequent qualitative analysis of the major categories. The review will present a narrative summary of the findings. The protocol was built based on the instructions from the Joanna Briggs Institute Scoping (JBI) Reviews Manual. Reports follow the Scoping Reviews framework PRISMA-ScR. Discussion: Findings will provide subsidies to improve healthcare services for transgender persons, construct public policy in the Latin American region, and further scientific production. Protocol registration number osf.io/7rjat/

1010-P: Cost and Utilization of Health Care Services for Persons with Diabetes

Objective: To describe and compare healthcare costs and utilization for persons with type 1 diabetes (T1D), type 2 diabetes (T2D), and those without diabetes. Methods: Using a nationally representative healthcare claims database, we identified matched persons with T1D, T2D, and those without diabetes using a propensity score quasi-randomization technique. In each year between 2009-2018, we summed costs (total and out-of-pocket) and utilization for all healthcare services and those specific to medications, diabetes-related supplies, visits to healthcare providers, hospitalizations, and emergency room (ER) visits. Costs and utilization were scaled using total patient follow-up in each year. Results: In 2018, we found that out-of-pocket costs and total costs were highest for persons with T1D (out-of-pocket: $950, total: $10,626), followed by persons with T2D (out-of-pocket: $670, total: $7,516), and persons without diabetes (out-of-pocket: $447, total: $4,483). Medication costs made up the largest proportion of out-of-pocket costs regardless of diabetes status (T1D: 78.2%, T2D: 76.2%, control: 70.5%). From 2009-2018, utilization of hospitalizations (T1D: +23.7%, T2D: +17.3%, controls: +22.0%) and ER visits (T1D: +54.9%, T2D: +56.0%, controls: +50.1%) increased regardless of diabetes status, and use of diabetes-related supplies (+22.1%) were increasing for persons with T1D. Conclusions: Given the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (i.e., wide-ranging problems stemming from these healthcare costs). In addition, policies that aim to lower out-of-pocket costs of cost-effective diabetes related healthcare are needed with a focus on medication related costs. Disclosure E.L.Reynolds: None. K.R.Mizokami-stout: None. N.Putnam: None. M.Banerjee: None. D.Albright: None. J.M.Lee: Advisory Panel; GoodRx, Consultant; Tandem Diabetes Care, Inc. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. E.L.Feldman: None. B.C.Callaghan: None. Funding National Institutes of Health (K99DK129785 to E.V.L.), (1K23DK13129601A1 to K.R.M-S.), (D300P30, 12959224, UH3HD087979, UH3HD087979-04S1 to J.M.L.), (R01DK115687 to B.C.C.), (R01DK129320, R01DK107956, R01DK130913 to E.L.F.); National Institute of Diabetes

Access to healthcare for people with sickle cell disease: Views of healthcare professionals on policies and practices.

Sickle cell disease is a genetic disorder with its highest prevalence in Nigeria. The condition causes red blood cells to turn rigid, and consequently, results to several complications including organ damage. This study aimed at assessing views of health practitioners in Nigeria on policies and practices in the area of access to healthcare services for sickle cell disease. A cross-sectional study was undertaken amongst healthcare professionals in Nigeria. Data were collected using a self-administered questionnaire, and analyses were undertaken using Statistical Package for Social Sciences software. A significant proportion of the participants (42.8%) disagreed that relevant legislative framework exists to facilitate optimal access to high-quality healthcare services for persons with sickle cell disorder in Nigeria. Two-thirds of the study cohort were of the opinion that public health surveillance towards sickle cell disease was suboptimal (61.2%). Also, more than three-quarters of the respondents (78.7%) indicated that the cost of managing sickle cell disease was not affordable to majority of affected Nigerians. This study provides critical insights into access to healthcare services for sickle cell disease. As such, challenges preventing access to healthcare services for sickle cell patients which have been identified in this study can underpin the development of contextual policies to address them.

Health care providers' and persons with disabilities' recommendations for improving access to primary health care services in rural northern Ghana: A qualitative study.

In Ghana, many persons with physical disabilities are members of populations who face health disparities including physical, structural, knowledge, attitudinal and financial barriers to various health care services compared to those without disabilities. However, there is limited evidence on how to improve access to primary health care services for persons with physical disabilities. This study aimed to understand persons with physical disabilities’ experiences and health care providers’ perspectives for improving access to primary health care for persons with disabilities in rural Ghana. We used a qualitative approach and interviewed 33 persons with physical disabilities and health care providers, and thematically analysed data from in-depth interviews. We identified 4 major themes. According to the participants, health care could be more accessible by: i) Making it more affordable; ii) Increasing the availability of providers and services; iii) Providing more education about system navigation; and iv) Improving access to disability friendly health facilities and equipment. Participants’ recommendations were nested in the areas of policy and practice modifications. Policy makers need to consider supporting persons with physical disabilities who cannot afford non-medical services (i.e., cost of transportation). In terms of practice, the provision of education and training related to physical disability issues should be extended to both clinical and nonclinical health workers for better client centered care. There is an urgent need for policy makers and relevant key stakeholders to include persons with physical disabilities in designing and implementing policies and programs to ensure that they are meeting their needs.

Barriers and facilitators when implementing family involvement for persons with psychotic disorders in community mental health centres – a nested qualitative study

BackgroundThe uptake of family involvement in health care services for patients with psychotic disorders is poor, despite a clear evidence base, socio-economic and moral justifications, policy, and guideline recommendations. To respond to this knowledge-practice gap, we established the cluster randomised controlled trial: Implementation of guidelines on Family Involvement for persons with Psychotic disorders in community mental health centres (IFIP). Nested in the IFIP trial, this sub-study aims to explore what organisational and clinical barriers and facilitators local implementation teams and clinicians experience when implementing family involvement in mental health care for persons with psychotic disorders.MethodsWe performed 21 semi-structured focus groups, including 75 participants in total. Implementation team members were interviewed at the initial and middle phases of the intervention period, while clinicians who were not in the implementation team were interviewed in the late phase. A purposive sampling approach was used to recruit participants with various engagement in the implementation process. Data were analysed using manifest content analysis.ResultsOrganisational barriers to involvement included: 1) Lack of shared knowledge, perceptions, and practice 2) Lack of routines 3) Lack of resources and logistics. Clinical barriers included: 4) Patient-related factors 5) Relative-related factors 6) Provider-related factors. Organisational facilitators for involvement included: 1) Whole-ward approach 2) Appointed and dedicated roles 3) Standardisation and routines. Clinical facilitators included: 4) External implementation support 5) Understanding, skills, and self-efficacy among mental health professionals 6) Awareness and attitudes among mental health professionals.ConclusionsImplementing family involvement in health care services for persons with psychotic disorders is possible through a whole-ward and multi-level approach, ensured by organisational- and leadership commitment. Providing training in family psychoeducation to all staff, establishing routines to offer a basic level of family involvement to all patients, and ensuring that clinicians get experience with family involvement, reduce or dissolve core barriers. Having access to external implementation support appears decisive to initiate, promote and evaluate implementation. Our findings also point to future policy, practice and implementation developments to offer adequate treatment and support to all patients with severe mental illness and their families.Trial registrationClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.

SHUBHCHINTAK

With the proliferation of IoT technology, it is anticipated that healthcare services, particularly for the elderly persons, will become a major thrust area of research in the coming days. Aim of this work is to design a fit-band containing multiple sensors to provide remote healthcare services for the elderly persons. An application has been designed to capture health data from the fit-band, pre-process the data and then send them to cloud for further analysis. A wireless Bluetooth enabled connection is proposed to establish communications between sensors and the application for data transmission. In the proposed application, there are three different front-end interfaces for three different users: system administrator, patient and doctor. The data collected from the patient’s fit-band are sent to a cloud data storage, where the data will be analyzed to detect anomaly (e.g., heart attack, sleep apnea, etc.). A Convolution Neural Network (CNN) model is proposed for anomaly detection. For the classification of anomaly, a Long Short Term Memory (LSTM) model is proposed. In the presence of anomaly, the system immediately connects a doctor through a phone call. A prototype system termed as Shubhchintak has been developed in Android/IOS environment and tested with a number of users. The fit-band provides data tracking with an overall accuracy of 99%; the system provides a response with 3000 requests in less than 100 ms. Also, Shubhchintak provides a real-time feedback with an accuracy of 97%. Shubhchintak is also tested by patients and doctors of a nearby hospital. Shubhchintak is shown to be a simple to use, cost effective, comfortable, and efficient system compared to the existing state of the art solutions.

A23 ESTIMATING INDIRECT AND OUT-OF-POCKET COSTS IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: A NATION-WIDE CROSS-SECTIONAL ANALYSIS

BackgroundIdentifying disease-related costs is a crucial step to plan for proper allocation of resources and future healthcare services for persons with inflammatory bowel disease (IBD). Data on pediatric inflammatory bowel disease-associated costs are limited.AimsWe aimed to estimate indirect and out of pocket (OOP) pediatric IBD-associated costs in Canada.MethodsIn a nation-wide cross-sectional analysis, caregivers of children and young adults (<17 years) with IBD were invited to complete a questionnaire on lost work hours and OOP costs related to IBD in the 4 weeks prior to the survey. Participants were re-invited to periodically answer the same questionnaire every 3–9 months for 2 years. Lost productivity was calculated using the Human Capital method. Costs were reported in 2018 inflation-adjusted Canadian dollars. Predictors of high cost users (top 25%) were examined using negative binomial regression.ResultsConsecutive 243 (82 incident cases) of 262 (92.7%) approached participants completed the first survey with a total of 450 surveys longitudinally completed over 2 years. The annual median indirect costs per patient were $5,951 (IQR $1,812- $12,278), with $5,776 (IQR $1,465-$11,733) for Crohn’s disease (CD) and $6,084 (IQR $2,470-$13,371) for ulcerative colitis (UC) (p=0.77). The annual median per patient OOP costs were $2,925 (IQR $978- $8,125) with $3,021 (IQR $978- $8,125) for CD and $2,600 (IQR $975- $8,125) for UC (p=0.55). Older age (10-17y) at diagnosis (p=0.04) and parents in part-time employment (p=0.01) were predictors of higher indirect costs, while female sex (p<0.001), parents with a lower education level (p<0.001) and lower annual family income (p<0.01) were associated with higher OOP costs.ConclusionsIndirect and OOP IBD-associated costs are substantial and more likely to affect families with unstable employment and lower annual income. Examining different strategies and interventions to reduce these costs such as virtual platforms, telephone and outreach clinics especially in poor communities and families with low annual income is warranted.Funding AgenciesCIHRThe Children’s Hospital Research Institute of Manitoba

P632 Estimating indirect and out-of-pocket disease-associated costs in paediatric Inflammatory Bowel Disease: a nation-wide cross-sectional analysis

Abstract Background Identifying disease-related costs is a crucial step to plan for proper allocation of resources and future healthcare services for persons with inflammatory bowel disease (IBD). Data on paediatric inflammatory bowel disease-associated costs are limited. We aimed to estimate indirect and out of pocket (OOP) paediatric IBD-associated costs in Canada. Methods In a nation-wide cross-sectional analysis, caregivers of children and young adults (&amp;lt;17 years) with IBD were invited to complete a questionnaire on lost work hours and OOP costs related to IBD in the 4 weeks prior to the survey. Participants were re-invited to periodically answer the same questionnaire every 3–9 months for 2 years. Lost productivity was calculated using the Human Capital method. Costs were reported in 2018 inflation-adjusted Canadian dollars. Predictors of high cost users (top 25%) were examined using negative binomial regression. Results Consecutive 243 (82 incident cases) of 262 (92.7%) approached participants completed the first survey with a total of 450 surveys longitudinally completed over 2 years. The annual median indirect costs per patient were $5,951 (IQR $1,812- $12,278), with $5,776 (IQR $1,465-$11,733) for Crohn Disease (CD) and $6,084 (IQR $2,470-$13,371) for Ulcerative Colitis (UC) (p=0.77). The annual median per patient OOP costs were $2,925 (IQR $978- $8,125) with $3,021 (IQR $978- $8,125) for CD and $2,600 (IQR $975- $8,125) for UC (p=0.55). Older age (10-17y) at diagnosis (p=0.04) and parents in part-time employment (p=0.01) were predictors of higher indirect costs, while female sex (p&amp;lt;0.001), parents with a lower education level (p&amp;lt;0.001) and lower annual family income (p&amp;lt;0.01) were associated with higher OOP costs. Conclusion Indirect and OOP IBD-associated costs are substantial and more likely to affect families with unstable employment and lower annual income. Examining different strategies and interventions to reduce these costs such as virtual platforms, telephone and outreach clinics especially in poor communities and families with low annual income is warranted.

The impact of the first wave of the COVID‐19 pandemic on health service use by persons with dementia in Ontario, Canada: A population‐based time series analysis

BackgroundLittle has been quantified, at a population‐level, about the magnitude of heath service disruption to persons living with dementia in community settings during the COVID‐19 pandemic. Sustained access to health care services is particularly important for persons with dementia and other neurodegenerative diseases as they are vulnerable to decline.MethodHealth administrative data from Ontario, Canada were used to examine patterns of health service use among all persons with Alzheimer disease and related dementias (dementia) who were alive and living in the community. This cohort was compared to persons with Parkinson’s disease (PD) as well as all older adults (age 65+ years) without neurodegenerative diseases. Rates of all‐cause hospital admissions, emergency department visits, primary care and specialist physician visits and home care visits were analyzed for all individuals alive and eligible for provincial health insurance at the start of each weekly period from March 1, 2020 to September 20, 2020 (pandemic period) and from March 3, 2019 to September 22, 2019 (pre‐pandemic period). Rates of health service use during specific weeks in the pandemic period (i.e., lowest week, last available week) were compared to corresponding weeks in the pre‐pandemic period within each cohort using percent changes.ResultsOn March 1, 2020, 128,696 persons with dementia, 30,099 with PD and 2,460,358 older adults were eligible for provincial health services. Across cohorts and services, dramatic declines in use of health services were observed at the lowest week: hospitalization (‐38.7% dementia, ‐72.3% PD, ‐44.2% older adults); emergency department (‐54.9% dementia, ‐57.7% PD, ‐53.6% older adults); home care (‐14.8% dementia, ‐19.4% PD, ‐7.4% older adults). Health services varied in how quickly they rebounded to pre‐pandemic levels within cohorts; notably, by the end of the study period, emergency department visits had increased to a level higher than corresponding 2019 weekly rates (24.2% dementia, 15.2% PD, 7.4% older adults).ConclusionsThe first wave of the COVID‐19 pandemic meaningfully and immediately disrupted use of health care services for persons living with dementia and PD and may have resulted in long‐term consequences that should be monitored.

Technically Accessible, Practically Ineligible: The Effects of Medicaid Expansion Implementation on Chronic Homelessness.

Homeless policy advocates viewed Medicaid expansion as an opportunity to enhance health care access for this vulnerable population. We studied Medicaid expansion implementation to assess the extent to which broadening insurance eligibility affected the functioning of municipal homelessness programs targeting chronic homelessness in the context of two separate governance systems. We employed a comparative case study of San Francisco, California, and Shreveport, Louisiana, which were selected as exemplar cases from a national sample of cities across the United States. We conducted elite interviews with a range of local-level stakeholders and combined this data with primary-source documentation. Medicaid expansion did not substantially enhance the functioning of homelessness programs and policies because of Medicaid access challenges and governance conflicts. Administrative burden and funding limitations contributed to limited provider networks, inadequate service coverage, and lack of linkages between Medicaid enrollment and homelessness programming. Governance conflicts reinforced these functional challenges, with homelessness under the administration of local municipalities and nongovernmental organizations while states administer Medicaid. Improving access to health care services for persons experiencing homelessness cannot occur without intentional coordination between sectors and levels of government and thus necessitates the development of targeted policies and programs to overcome these challenges.

Types of Perception of Home Visiting Oral Health Care Services for Korean Older Persons: A Q Methodology Study.

This study was conducted using the Q methodology to categorize Korean older persons’ subjective perceptions of home visiting oral health care services. Various opinions regarding home visiting oral health care services were collected based on related literature, and by conducting in-depth interviews with 12 people. Thirty-two statements were finally selected, and Q classification was applied. Based on data analysis with the PC-QUANL program, six factors (seven types) were derived, which accounted for 49.6% of the total variance. By comprehensive analysis of the types of subjective perceptions of home visiting oral health care services, the following two characteristics were identified. Korean older persons were expected to promote their own oral health activities, or improved access to expert health care services, through the home visiting oral health care services. Additionally, they had a need for social, economic, emotional, and informational support. Therefore, home visiting dental personnel should be able to provide customized visiting oral health care services based on evaluation of the need and type of perception of older persons. Thus, it is essential for visiting dental personnel to be trained in the knowledge of social welfare, and to develop diverse competencies.

Access to basic needs and health care for Malawian prosthetic and orthotic users with lower limb physical disabilities: a cross-sectional study

Purpose To investigate access to basic human rights such as health, a standard of living adequate for health, education, work, marrying and establishing a family, and voting for prosthetic and orthotic users with lower limb disabilities in Malawi. Materials and methods A cross-sectional design and a questionnaire were used to collect data from 83 participants. Results Most participants reported their overall physical and mental health as good (60 [72%] and 50 [60%], respectively) and said they could access medical care (69 [83%]). Fifty (60%) participants had access to food, 72 (87%) had access to basic water, and 55 (66%) lived in housing adequate for their health. Most participants had studied in school (74 [89%]) but only 27 (33%) of the participants were working. Forty-three (52%) were married and 53 (64%) had children. Seventy-six (92%) participants could vote if they wished. Conclusions Rurality and high costs of transport and medication increase the barriers to accessing several basic human rights for people with lower limb physical disabilities. Interventions to target these barriers and increase access to secondary school, employment, and income could improve health equity for people with physical disabilities in Malawi and similar contexts. Implications for Rehabilitation In Malawi, the convention on the rights of persons with disabilities is yet to be implemented. Policy makers in Malawi need to take actions to increase access to regular and specialized healthcare services for persons with physical disabilities including financial support to afford medications and transport to reach health services. Policy makers in Malawi need to take actions to increase access to secondary and higher education, and employment for persons with physical disabilities to increase their possibilities to earn an income.

Descriptive Cost-Effectiveness Analysis of a Counseling and Coordination Model in Psychosocial Care. Integration of Health Care and Social Rehabilitation.

IntroductionA psychosocial outreach clinic was established to offer counseling and coordination of healthcare and complementary services for persons with psychosocial and mental problems. The cost-effectiveness of these services was measured based on a pre-post comparison.MethodsA prospective observational study was conducted with clients of the outreach clinic. Data on resource consumption and quality of life were collected at baseline and follow-up after 3, 6, and 12 months using the Client Sociodemographic and Service Receipt Inventory to assess service utilization, and the 12-Item Short Form Health Survey to assess quality of life. The objective of the present analysis was to estimate the relation between monetary expenditure and QALYs (quality-adjusted life-years), before and after the outreach clinic was established, descriptively. The analysis was constructed from payer’s perspective and was supplemented by a sensitivity analysis.ResultsA total of 85 participants were included. Total annual expenditures before the intervention were 5,832 € per client for all service segments. During the 12-months study duration expenditures decreased to 4,350 € including the costs associated with outreach clinic services. QALYs for the 12-month study period were 0.6618 and increased about 0.0568 compared to the period before.DiscussionDespite methodological limitations due to small sample size, a pre-post comparison and the retrospective cost data collection, this study suggests acceptability of the outreach clinic as cost-effective.ConclusionThe activities of the outreach clinic as an integrated care model seem to be cost-effective regarding the relation between monetary expenditures and clients’ quality of life.

Implementation of user organizations in Swedish health care and social services for persons with substance use disorders

ABSTRACT Background: In Sweden, the National Guidelines for Substance Abuse Treatment includes new recommendations concerning integrating a user perspective. From 2009 to 2014, the Swedish National Board of Health and Welfare supported and financed the development of organizations serving regional users. The programme was evaluated, and the results showed a development of user influence in substance use treatment services in 20 out of 21 regions by 2014. The implementation of user organizations’ influence was evaluated in 2018 for this follow-up study. Aim: The aim of this four-year follow-up study was to evaluate whether user organizations continued existing once national support ended, and whether their influence in social services and health care, at both organizational and individual levels had been implemented. Method: A questionnaire was dispatched to 20 regional user organizations. It included information and questions focused on their situation, and on participants’ experiences of the influence of user organizations in health care and social service. Results: The results obtained from the questionnaire show that 14 out of 20 user organizations still existed and reported a developed influence in social services and health care at organizational and individual levels. National support was perceived as necessary for the ongoing development of user organizations and to continue increasing their influence. Conclusions: Support at the national level initiated the development of user influence in Sweden, which has increased at both organizational and individual levels in the context of social services, as well as in health care for persons with substance use disorders.

Integration of health and social care services for persons in opioid substitution therapy – results of a case study in Austria

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Tailor-made services: Cooperation and supervision are essential for older people with dementia and challenging behaviour

Dementia is a public healthcare priority in Norway. The aim of this study was to explore and describe users’ and professionals’ experiences of a Norwegian ambulatory psychiatric team treating older people with dementia and challenging behaviour. Patients with symptoms such as anxiety, depression, and agitation need special health care, which they rarely receive. Caring for these patients can be a burden for both relatives and nursing home staff. Little is known about the organisation of healthcare services for older persons with dementia and behavioural and psychiatric symptoms living at home or in a nursing home. The need for psychogeriatric teams that offer ambulatory services is in great demand. Such services might be particularly needed in rural districts, because the team we studied is unique in our region. This qualitative study involved interviews with relatives, ambulatory team members, and staff from four nursing homes. The analyses were inspired by systematic text condensation. Ambulatory team members developed a close relationship with patients, their relatives, and nursing home staff. This bonding made it possible to develop a tailor-made service for each patient. Staff in nursing homes wanted to be observed and to receive feedback about their daily care of patients. Relatives believed that their contributions were important and that health services needed to understand their limited resources. All informants agreed that better cooperation among healthcare levels was crucial for improving these services. More research and national guidelines are needed to determine how municipalities can best provide services for older people with dementia and psychiatric symptoms.

My husband is not ill; he has memory loss - caregivers\xb4 perspectives on health care services for persons with dementia

BackgroundTo explore informal caregivers’ perspectives and perceived needs related to health care services/activities for older adults with dementia, in order to understand barriers and facilitators to participation. The study represents a first step, and explores challenges to overcome, in order to design new activities and services adapted to older adults with dementia.MethodsWe used a qualitative approach where eight caregivers of people with a dementia diagnosis were included. We recruited participants from a counselling service centre, for home dwelling people with dementia and their families, in a Norwegian municipality. We transcribed data from two focus group interviews and completed analyses by use of Systematic Text Condensation method.ResultsThe findings indicate that current health care services for people with dementia do not meet the needs of either the people with dementia or their caregivers. The few activities/services offered are characterised by passivity and lack of individual and personalised care. Existing health care services and new activities should consider each individual’s resources, interests, and physical function to ensure that both people with dementia and their caregivers want to accept support.ConclusionsTo develop health care services and activities for people with dementia, participation and involvement from both people with dementia and their caregivers is necessary. People with dementia are more than their diagnosis. Future health care providers have to widen their focus and consider the individual person with dementia.