Health Care Research Articles

Peers, Parents and Families as agents of influence on adolescents’ perspectives towards people with Mental Health Problems: Mental Health Professionals’ Views

Peers, Parents and Families as agents of influence on adolescents’ perspectives towards people with Mental Health Problems: Mental Health Professionals’ Views

Time series analysis of comprehensive maternal deaths in Brazil during the COVID-19 pandemic

The effects of the COVID-19 pandemic on comprehensive maternal deaths in Brazil have not been fully explored. Using publicly available data from the Brazilian Mortality Information (SIM) and Information System on Live Births (SINASC) databases, we used two complementary forecasting models to predict estimates of maternal mortality ratios using maternal deaths (MMR) and comprehensive maternal deaths (MMRc) in the years 2020 and 2021 based on data from 2008 to 2019. We calculated national and regional standardized mortality ratio estimates for maternal deaths (SMR) and comprehensive maternal deaths (SMRc) for 2020 and 2021. The observed MMRc in 2021 was more than double the predicted MMRc based on the Holt-Winters and autoregressive integrated moving average models (127.12 versus 60.89 and 59.12 per 100,000 live births, respectively). We found persisting sub-national variation in comprehensive maternal mortality: SMRc ranged from 1.74 (95% confidence interval [CI] 1.64, 1.86) in the Northeast to 2.70 (95% CI 2.45, 2.96) in the South in 2021. The observed national estimates for comprehensive maternal deaths in 2021 were the highest in Brazil in the past three decades. Increased resources for prenatal care, maternal health, and postpartum care may be needed to reverse the national trend in comprehensive maternal deaths.

Clinician perspectives on endings and discharges in community mental health work

Clinician perspectives on endings and discharges in community mental health work

Co-evolution, organizational capacity building, logistics capabilities and operational agility during health emergencies

PurposeGlobally, health care facilities often fail to respond quickly to health emergencies, resulting in significant deaths. Thus, the study examines the mediating effect of logistics capabilities in the relationship between co-evolution, organization capacity building and operational agility.Design/methodology/approachSmartPLS 4.0.8.3, variance-based structural equation models (VB-SEM) were used to test direct and indirect hypotheses across 45 health facilities. The respondents were 140 nurses and doctors. Disproportionate stratified simple random sampling was used based on government and private health facilities in Kampala City, Uganda.FindingsA significant and positive relationship exists between logistics capability and operational agility. However, co-evolution and organizational capacity are intimately linked to operational agility via logistics capability.Research limitations/implicationsA quantitative cross-sectional survey was conducted using self-administered questionnaires. The results did not show any variation in the operational agility of health facilities during emergency management; thus, qualitative approaches are needed.Practical implicationsDuring emergency management, health facilities need to cooperate by sharing information, building capacity to increase their responsiveness and flexibility. This should be done by sharing equipment, tools, drugs and medical supplies, and we hope to encourage joint medical research.Originality/valueA complex adaptive systems (CAS) framework is used in this study to examine how co-evolution, organizational capacity building and logistical capability relate to the operational agility of healthcare during times of emergency.

Rethinking Measures and Mortality Attribution in Health Care: The ENT Example.

National performance metrics ultimately enhance patient decision-making and promote meaningful improvements in health care delivery, which makes having valid and reliable measures essential. This study examined US News and World Report metrics from 2019 to 2012 and used electronic health record data, combined with detailed chart review across 3 in-system hospitals, to assess the provision of care compared to the attribution of patients assigned to the ear, nose, and throat (ENT) mortality group. Of the initial 47 ENT-attributed deaths, 23 of those were verified, dimensioning the mortality rate from 1.7% to just 0.8%. These results underscore the necessity of rethinking measures and mortality attribution methodologies to be more accurate. Current methods use Medicare Severity Diagnosis Related Group billing coding to map the attribution. We suggest transitioning away from specialty ranking approaches and towards a procedure and condition "rating" approach to ensure that these ranking types capture data about the provision of care within a given encounter.

Organizational health literacy in German hospitals: a cross-sectional survey among hospital managers

BackgroundOrganizational health literacy (OHL) describes conditions and measures in healthcare institutions to enable patients to make good health-related decisions. By providing easy access to and appropriate communication of understandable information to use and navigate the facility, healthcare organizations can contribute to strengthening patients’ health literacy and self-management. The extent of OHL implementation in German hospitals remains largely unknown. This study aims to fill this gap in our knowledge by investigating OHL-related activities reported by hospital managers.MethodsBetween November and December 2022, we conducted a national online survey among medical, nursing and administrative hospital managers with hospitals that operate more than 50 beds. The data were collected via the health literate health care organization ten item questionnaire (HLHO-10) and supplemented by sociodemographic questions and an open-ended question. We applied variance and correlation analyses to investigate the data.ResultsOf 3,301 invited hospital managers, 371 participated in the survey (response rate 11%). The overall mean score for HLHO-10 was 4.6 (SD = 1.1) on a 7-point Likert scale, indicating a moderate level of OHL implementation. Hospital managers stated that hospitals concentrate on helping patients find their way around and communicating the costs of treatment transparently and clearly; conversely, that active patient participation in the design and evaluation of health information is rare in care settings, and that health information is seldom provided to patients through a range of media. For the practical implementation of the OHL, most hospital managers mentioned activities regarding communication standards, such as providing information materials.ConclusionsGiven their unique position as hubs of human interaction, hospitals provide an ideal opportunity to promote the adoption of OHL. By actively involving patients, hospitals can better tailor their approaches to meet patient needs and preferences. Compared to studies from oncology centres in Germany and 20 Italian hospitals, the average HLHO-10 score of this study is lower. While some aspects of OHL are already embedded in inpatient care, it is imperative that OHL is thoroughly embedded in the hospitals’ organizational culture and plays a fundamental role in the daily operations of the institution. This could be done, for instance, by more explicitly addressing the topic of health literacy in staff communication training.

Implementation of research, education and leadership placements into Operating Department Practitioner training: A 4-pillar practice-based learning approach.

Practice-based learning has traditionally focused on clinical practice in pre-registration courses. However, recent national strategies emphasise the importance of incorporation of all four pillars, clinical, education, leadership and research, into practice-based learning (placements). This article details the introduction of practice-based learning in research, education and leadership alongside clinical placements for BSc Operating Department Practice students at Sheffield Hallam University. It provides insights into the benefits of this approach, outlines the components of each placement with examples of completed projects, shares feedback from students and practice partners and addresses challenges. The authors advocate for adoption of this approach across all pre-registration Operating Department Practice courses, to ensure a workforce capable of meeting evolving health care needs and driving the Operating Department Practice profession forwards.

Application of the Medical Research Council guidance for complex interventions in the development of VIeSA, an intervention to support healthy ageing among community-dwelling older adults

BackgroundThe ageing population, coupled with the desire to age-in-place, highlight the need for programs that target health promotion as a means of maintaining functional ability, autonomy, and independence among community-dwelling older adults. This paper describes the development of the VIeSA intervention, which aimed to model a healthy ageing trajectory, including the identification of the necessary tools and methods, that would allow people older people, in partnership with health and social care professionals, to define personal health-related goals and the actions to achieve them. A key element of the intervention development was the creation of a support tool intended to assist this process.MethodsThe UK Medical Research Council (MRC) guidance on developing and evaluating complex interventions was applied in the development of the intervention and of the support tool. A participatory approach was selected, with stakeholders engaged on different occasions to allow the refinement of the intervention and of the support tool. Following the steps and suggested actions in the MRC development phase, the development process was conducted by identifying (1) the evidence base and (2) the theoretical framework and (3) by modelling the process and outcomes of the intervention.ResultsFollowing a literature review on effective interventions for functional ability, draft 1 of the support tool was designed. Focus groups with stakeholders provided feedback on this draft allowing for its refinement in terms of content, language use, and structure (draft 2). A review of the approaches for health promotion delivery led to further additions to the tool (draft 3) and informed the content of the training of health and social care professionals. After their training, professionals provided feedback on the acceptability, appropriateness, and feasibility of different elements of the intervention. Results suggested that no further major refinement to the intervention or support tool was necessary.ConclusionsThe design and development of the VIeSA intervention using the MRC guidance allowed for a clarity of direction, an optimised content in terms of usefulness and accessibility for all concerned stakeholders, and greater opportunities for its implementation and uptake.

Health care as participatory sense-making: an enactive perspective on relations between patients and health care providers

Health care as participatory sense-making: an enactive perspective on relations between patients and health care providers

Facilitating psychiatric nurses’ advocacy for mental healthcare users’ human rights in a primary healthcare setting: a conceptual framework

BackgroundEven though human rights advocacy is a part of mental health care, psychiatric nurses in South Africa’s primary healthcare (PHC) setting face substantial challenges when advocating for the rights of mental health care users (MHCUs). The study aimed to develop a conceptual framework to facilitate psychiatric nurses’ advocacy for mental healthcare users’ human rights in a PHC setting.MethodsA qualitative, exploratory, descriptive, and contextual design was used to investigate the psychiatric nurses’ experiences advocating for MHCUs’ human rights in a PHC setting. Three phases were followed: the empirical phase, the classification of concepts, and a development phase. Following the empirical phase, a conceptual framework was developed to facilitate psychiatric nurses’ advocacy for MHCUs human rights in a PHC setting.ResultsThree themes were derived from focus group interviews with psychiatric nurses in the empirical phase. These themes yielded the central concept as ‘the facilitation of empowerment’ of psychiatric nurses in advocating for MHCUs’ human rights. The central concepts were also classified. A conceptual framework was developed that included the relationship, working and termination phases.ConclusionThe study described the development of a conceptual framework to facilitate psychiatric nurses’ advocacy for mental healthcare users’ human rights in a PHC setting. Psychiatric nurses play a key role in advocating for the human rights of MHCUs. This task is important and should be implemented from the government to the societal level, including all stakeholders.

Evaluating the effectiveness of social workers as lead community care coordinators of a large integrated veteran affairs health care system in the Southeast region

ABSTRACT A Veteran Affairs Health Care System (VAHCS) in the Southeast region implemented the Social Workers as Lead Community Care Coordinators (SWLCCC) program to prevent delays in care coordination for veterans admitted to community hospitals. This study examines community hospital care coordinators’ perceptions and satisfaction levels with the SWLCCC program. An explanatory sequential mixed method research design was used. Surveys were analyzed using descriptive analysis and chi-square test of association and interviews were analyzed using thematic analysis. Results showed that care coordination assistance has improved since the veteran-centered social work-led program was implemented.

Implementing national care guidelines in local authorities in England and Wales: a theory-of-change

BackgroundThe delivery of high-quality services in chronically underfunded social or long-term care systems is a major challenge internationally. National guidelines, developed by the National Institute for Health and Care Excellence, set out how local authorities in England and Wales should fund and provide care based on best available evidence. Theoretical and participatory approaches can usefully inform the design and evaluation of implementation strategies for guidelines. The aim of the study is to develop a Theory-of-Change for how the implementation of these guidelines is expected to lead to impacts from a local authority perspective.MethodsAs part of a comparative case study (The ‘Valuing Care Guidelines’ study; February 2022 to April 2024) with three local authority sites in England and Wales, we involved altogether 17 participants in two Theory-of-Change online workshops per site, each of 2 hours. Additional data gathered from the same participants as part of the overall study were used to conceptualise and enrich information from the workshops.ResultsParticipants described the Theory-of-Change map as follows: A wide range of activities (categorised in stages of ‘pre-implementation’, ‘implementation’, ‘sustainment and scaling’) and skills were required to implement guidelines, and achieve long-term organisational sustainability and service delivery outcomes, leading to final impacts for service users and carers. Participants described a co-creation implementation model, led by ‘Implementation Support Practitioners’, who utilised relational skills to achieve motivation, trust, and confidence at different organisational levels, addressing contextual barriers such as inadequate staffing, lack of resources and of organisational support systems. Consistent use of guidelines by frontline staff could only be achieved if the value of guideline implementation was promoted widely, and if consideration was given to the roles of stakeholders, such as the inspection body, local health care providers, users and carers.ConclusionsOur study is the first to investigate the implementation of national social care guidelines by local authorities in England and Wales. It generates insights that can guide implementation practice as well as inform the evaluation of future implementation strategies.

Association of early follow-up visits with reduced hospital readmissions of newborns: a French population-based data-linkage study.

Newborn care guidelines recommend assessments within a week of discharge from maternity care. However, the optimal timing and effectiveness to prevent neonatal hospital readmission are debated. This study aimed to determine the association between early follow-up visits (EFVs) within threedays of postpartum discharge and hospital readmission of newborns up to 15days of life. This population-based data-linkage study used data from the French National Health Care Database. "Healthy" singleton term infants with a gestational age (GA) of ≥36weeks, born between January 1, 2017, and November 30, 2018, in Southern France, were included. A multivariate regression analysis was performed. Among the 67,359 included infants, 1519 (2.25%) were hospitalized. The principal causes of hospitalization were infectious diseases (42.4%) and jaundice or growth/nutrition disorders (36.1%). Hospitalized infants were more likely to be born to young and socioeconomically deprived mothers, to be male (54.4% vs. 50.6%, P < 0.001), or born early (GA < 38weeks; 28.5% vs. 20.5%, P < 0.001). They received 6% less EFVs than non-hospitalized infants (63.7% vs. 67.8%, P < 0.001). The multivariable regression logistic analysis revealed that infants who received EFVs had 13% lower odds of being hospitalized than infants without EFVs, with an adjusted odds ratio of 0.87 (95% confidence interval=0.78-0.96; P < 0.01). EFVs within threedays were associated with a 13% reduction in the rate of neonatal hospital readmission. Therefore, EFVs should be implemented to improve infant health and reduce healthcare costs.

Primary Care Guidance for Providers of Care for Persons With Human Immunodeficiency Virus: 2024 Update by the HIV Medicine Association of the Infectious Diseases Society of America.

Advances in antiretroviral therapy (ART) have made it possible for persons with human immunodeficiency virus (HIV) to live a lifespan approaching that of people without HIV, without progressing to AIDS or transmitting HIV to sexual partners or infants. There is, therefore, increasing emphasis on maintaining health throughout the lifespan. To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including ART. Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever. Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic, and individual levels. As the population ages and noncommunicable diseases arise, providing comprehensive health care for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while also attending to HIV-specific health concerns. Clinicians must address issues specific to preventive health, including cancer screening, providing recommended vaccinations, as well as promoting sexual health, including sexually transmitted infection diagnosis, treatment, and prevention. Clinicians also must address issues for specific populations, including persons of childbearing potential, including during preconception and pregnancy; children; adolescents; and transgender and gender-diverse individuals. This guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates the previous 2020 HIV Primary Care Guidance.

Organizational innovations related to Primary Care Access Points (GAP) for unattached patients in Quebec: a multi-case qualitative study

BackgroundBeing attached to a primary care (PC) provider is at the core of a strong primary health care system. Centralized waiting lists (CWL) for unattached patients have been implemented in eight provinces of Canada to support the attachment process. In Quebec, the Ministry of Health mandated the implementation of Primary Care Access Points (GAP) across the province to help unattached patients navigate the health system while awaiting attachment through the CWL. Several local health territories developed complementary innovations to the GAP to respond to local population needs. This paper aims to describe five organizational innovations implemented locally.MethodsThis multi-case qualitative study was conducted in four local health territories in the province of Quebec. Fifty-two semi-structured interviews with healthcare managers, nurses, physicians, other health professionals and administrative staff were conducted between April 2023 and April 2024. An interview guide was developed based on existing frameworks on the implementation of innovations and the evaluation of the GAP. Thematic analysis was conducted using NVivo software. Inductive and deductive approaches were used to develop relevant codes and themes. Logic models were built to describe the organizational innovations.ResultsFive organizational innovations are described. First, a multidisciplinary clinic aimed at responding to patients with mental health issues was implemented. Second, a nurse clinic was implemented to provide temporary care for patients with unstable chronic illnesses. The third innovation is a mobile proximity clinic where unattached GAP patients are first evaluated by a paramedic before receiving care from a nurse. Fourth, a pharmacist trajectory was implemented to increase engagement of community pharmacists to respond to GAP patients. The last innovation is a decentralized GAP offering in-person nursing care to unattached GAP patients.ConclusionsDescriptions of these five innovations are key to inform other territories and provinces on ways to improve access for unattached patients while they are waiting to be attached. The introduction of the GAP and the organizational innovations, suggests a transition where access to PC services does not rely solely on attachment status.

Study on the concentration, distribution, and persistence of health spending for the contributory scheme in Colombia

Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for over 19 million users of Colombia’s health system between 2013 and 2021 (contributory scheme). We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied multivariate statistical techniques such as multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until 60 years, accelerating thereafter abruptly. Health conditions with the highest percentage of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in Amazonía-Orinoquía is almost non-existent, and that outpatient care represents a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure from one year to the next (i.e. they can provide relevant information for prediction), especially in areas with a larger supply of health services such as Bogotá-Cundinamarca. To the authors’ knowledge, this is the most comprehensive and detailed micro-analysis of health spending that has been developed for a Latin American country to date.

What influences interruption of continuous renal replacement therapy in intensive care unit patients: A review with meta-analysis on outcome variables.

Evidence suggests that 8%-10% of ICU patients receive renal replacement therapy. However, there is a high rate of unplanned CRRT interruption, ranging between 17% and 74%. Studies on unplanned interruption of CRRT mainly focused on the retrospective investigation of related risk factors and conclusions have been diverse. This article aims to clarify the main influencing factors related to unplanned interruption of continuous renal replacement therapy (CRRT) in adult patients in intensive care units (ICUs). A literature review and meta-analysis were undertaken. Following the application of the Newcastle-Ottawa Scale (NOS), a total of 15 articles were included in a total of 2132 patients who underwent 3690 CRRT procedures and 2181 unplanned interruption times. The methodological guideline of a scoping review was applied for the evidence synthesis while applying the meta-analysis quantitative methodological guideline to identify and clarify main influencing factors related to unplanned interruption of CRRT. The reporting Prisma Protocol was followed. Longer filter life and prothrombin activation time, higher red blood cell count, greater transmembrane pressure, faster blood flow rate, intermittent saline irrigation, lower creatinine level, low prothrombin activity and pre-dilution are factors identified to potentially affect unplanned CRRT in ICU patients. Available evidence suggests four clinical challenges associated with unplanned CRRT interruption, namely: (a) effects of red blood cell count, filter life, cross-mode pressure, blood flow velocity, prothrombin activity and activated partial thrombin time on unplanned interruption; (b) influence of dilution mode on unplanned interruption; (c) influence of intermittent saline irrigation on unplanned interruption; (d) influence of Scr level on unplanned interruption. The potential to increase the ability to better manage unplanned CRRT in ICUs has been identified in this article and constitutes a relevant potential health care management contribution that can be implemented by nurses.

Evolving Dynamics of Relational Coordination: A Study of Progression of Care Huddles in Hospital Observation Services.

Health care organizations are increasingly using team huddles to enhance communication, improve patient experience, and deliver timely care. However, established practices, resource constraints, and hierarchical role dynamics can hinder the effectiveness of huddling. This study investigates the dynamics of care huddle implementation through interviews with care providers and managers of an observation unit in a U.S. hospital. Qualitative analysis of interview data reveals that huddle adoption enhances relational coordination (RC), thus highlighting the importance of both coaching interventions in fostering proactive behavior and the building of a work environment aligned toward shared goals. The findings affirm RC as a dynamic change model, examining its interplay with organizational processes and structure. The study underscores the significance of adaptations in work processes, the role of informal boundary spanners in facilitating cross-departmental coordination, and structural changes that increase autonomy for low-power actors. We offer actionable recommendations for health care organizations aiming to improve care coordination.

"He Just Wants Someone to Hear Him and Listen to Him": Barriers and Facilitators to Autistic Youth with Anxiety Receiving Quality Mental Healthcare.

About half of autistic youth present with clinically interfering anxiety. Psychotherapies with exposure-focused elements are effective in academic clinical settings and controlled trials. However, there is relatively less research examining the implementation of modified interventions for autistic youth with anxiety in community mental health settings. The current study explores community members' perceptions of barriers and facilitators that impact autistic youth with anxiety's receipt of quality mental health services in their community. Semi-structured interviews were conducted with 15 autistic youth, 15 caregivers of autistic youth, 11 community mental health clinicians, and 8 community mental health clinic leaders. Interviews were analyzed thematically. Participants shared their experiences with facilitators and barriers to autistic youth with anxiety receiving quality mental healthcare. Themes that emerged include (1) characteristics of the autistic youth, (2) engagement of autistic youth and caregivers, (3) building rapport between providers, autistic youth, and caregivers, (4) access to mental health services, (5) intervention fit, and (6) provider characteristics. Based on participants' perspectives and suggestions, future directions for anxiety treatment programs tailored for autistic youth include building more time into the intervention sessions to build rapport, incorporating autistic youth's preferences into provider matches, and providing families with more psychoeducation.

Use of AI in Mental Health Care: Community and Mental Health Professionals Survey.

Artificial intelligence (AI) has been increasingly recognized as a potential solution to address mental health service challenges by automating tasks and providing new forms of support. This study is the first in a series which aims to estimate the current rates of AI technology use as well as perceived benefits, harms, and risks experienced by community members (CMs) and mental health professionals (MHPs). This study involved 2 web-based surveys conducted in Australia. The surveys collected data on demographics, technology comfort, attitudes toward AI, specific AI use cases, and experiences of benefits and harms from AI use. Descriptive statistics were calculated, and thematic analysis of open-ended responses were conducted. The final sample consisted of 107 CMs and 86 MHPs. General attitudes toward AI varied, with CMs reporting neutral and MHPs reporting more positive attitudes. Regarding AI usage, 28% (30/108) of CMs used AI, primarily for quick support (18/30, 60%) and as a personal therapist (14/30, 47%). Among MHPs, 43% (37/86) used AI; mostly for research (24/37, 65%) and report writing (20/37, 54%). While the majority found AI to be generally beneficial (23/30, 77% of CMs and 34/37, 92% of MHPs), specific harms and concerns were experienced by 47% (14/30) of CMs and 51% (19/37) of MHPs. There was an equal mix of positive and negative sentiment toward the future of AI in mental health care in open feedback. Commercial AI tools are increasingly being used by CMs and MHPs. Respondents believe AI will offer future advantages for mental health care in terms of accessibility, cost reduction, personalization, and work efficiency. However, they were equally concerned about reducing human connection, ethics, privacy and regulation, medical errors, potential for misuse, and data security. Despite the immense potential, integration into mental health systems must be approached with caution, addressing legal and ethical concerns while developing safeguards to mitigate potential harms. Future surveys are planned to track use and acceptability of AI and associated issues over time.