Implementation Of Health Services Research Articles

The effects of national mental health plans on mental health services development in Chile: retrospective interrupted time series analyses of national databases between 1990 and 2017

AimsTo describe changes in mental health services in Chile between 1990 and 2017, and to retrospectively assess the effects of national mental health plans (NMHPs) on mental health services development during this period.MethodsService data (beds in psychiatric hospitals, psychiatric beds in general hospitals, forensic psychiatric beds, beds in protected housing facilities, psychiatric day hospital places, and outpatient mental health care centers) were retrieved from government sources in Chile. Data were reported as rates per 100,000 population. We conducted interrupted time series analyses, using ordinary least-square regressions with Newey-West standard errors, to assess the effects of the 1993 and 2000 NMPHs on mental health services development.ResultsRates of short- and long-stay beds in psychiatric hospitals (per 100,000 population) were reduced from 4.3 to 3.2 and from 19.0 to 2.0 over the entire time span, respectively. The strongest reduction of short- and long-stay beds in psychiatric hospitals was seen between the 1993 and 2000 NMHPs (annual removal of − 0.14 and − 1.03, respectively). We observed increased rates of psychiatric beds in general hospitals from 1.8 to 4.0, beds in protected housing facilities from 0.4 to 10.2, psychiatric day hospital places from 0.4 to 5.0, outpatient mental health care centers from 0.1 to 0.8 and forensic psychiatric beds from 0.3 to 1.1 over the entire time span. The strongest annual increase of rates of psychiatric beds in general hospitals (0.09), beds in protected housing facilities (0.50), psychiatric day hospital places (0.16) and outpatient mental health care centers (0.04) were observed after the 2000 NMHP. Forensic psychiatric beds increased in the year 2007 (0.58) due to the opening of a new facility.ConclusionsThe majority of acute care psychiatric beds in Chile now are based in general hospitals. The strong removal of short- and long-stay beds from psychiatric hospitals after the 1993 NMHP preceded substantial expansion of more modern mental health services in general hospitals and in the community. Only after the 2000 NMHP, the implementation of new mental health services gained momentum. Reiterative policies are needed to readjust mental health services development.

Perspectives About Emergency Department Care Encounters Among Adults With Opioid Use Disorder

Emergency departments (EDs) are increasingly initiating treatment for patients with untreated opioid use disorder (OUD) and linking them to ongoing addiction care. To our knowledge, patient perspectives related to their ED visit have not been characterized and may influence their access to and interest in OUD treatment. To assess the experiences and perspectives regarding ED-initiated health care and OUD treatment among US patients with untreated OUD seen in the ED. This qualitative study, conducted as part of 2 studies (Project ED Health and ED-CONNECT), included individuals with untreated OUD who were recruited during an ED visit in EDs at 4 urban academic centers, 1 public safety net hospital, and 1 rural critical access hospital in 5 disparate US regions. Focus groups were conducted between June 2018 and January 2019. Data collection and thematic analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework with evidence (perspectives on ED care), context (ED), and facilitation (what is needed to promote change) elements. A total of 31 individuals (mean [SD] age, 43.4 [11.0] years) participated in 6 focus groups. Twenty participants (64.5%) identified as male and most 13 (41.9%) as White; 17 (54.8%) reported being unemployed. Themes related to evidence included patients' experience of stigma and perceived minimization of their pain and medical problems by ED staff. Themes about context included the ED not being seen as a source of OUD treatment initiation and patient readiness to initiate treatment being multifaceted, time sensitive, and related to internal and external patient factors. Themes related to facilitation of improved care of patients with OUD seen in the ED included a need for on-demand treatment and ED staff training. In this qualitative study, patients with OUD reported feeling stigmatized and minimized when accessing care in the ED and identified several opportunities to improve care. The findings suggest that strategies to address stigma, acknowledge and treat pain, and provide ED staff training should be implemented to improve ED care for patients with OUD and enhance access to life-saving treatment.

Improving Mortality Through a Multihospital, Collaborative Quality Improvement Project.

Improving hospital mortality is a key focus of quality and safety efforts at both the local and national level. Structured interventions can assist organizations in determining whether interventional efforts have led to sustained improvement. The PARiHS framework (Promoting Action on Research Implementation in Health Services) can assist organizations in implementing research into practice. This study investigates the use of the PARiHS framework in implementing a multihospital quality improvement project aimed at improving observed-to-expected mortality as measured by Vizient's Clinical Data Base (CDB). Structured interventions during the study period included mortality reviews, clinical documentation improvement opportunities, educational webinars, training and support in the use of CDB to explore ongoing opportunities for mortality improvement and quarterly reports to each participating hospital's leadership team on their performance. Data were gathered from an improvement collaborative in the Upper Midwest, which comprised 34 hospitals, of which 17 participated in the intervention. Measurement occurred from Quarter 4 2016 through Quarter 3 2020 and consisted of a preintervention, intervention, and postintervention period. Although both participating and nonparticipating hospitals achieved a significant reduction in their mortality observed-to-expected ratio from the preintervention period through the postintervention period, the participating hospitals achieved a greater reduction in their observed-to-expected mortality ratio ( P < 0.0004). In addition, the participating hospitals achieved a relative 21% improvement in the mortality domain rank of the Vizient Quality & Accountability Study.

Evaluating factors that influenced the successful implementation of an evidence-based neonatal care intervention in Chinese hospitals using the PARIHS framework

BackgroundEvidence based interventions (EBIs) can improve patient care and outcomes. Understanding the process for successfully introducing and implementing EBIs can inform effective roll-out and scale up. The Promoting Action on Research Implementation in Health Services (PARIHS) framework can be used to evaluate and guide the introduction and implementation of EBIs. In this study, we used kangaroo mother care (KMC) as an example of an evidence-based neonatal intervention recently introduced in selected Chinese hospitals, to identify the factors that influenced its successful implementation. We also explored the utility of the PARIHS framework in China and investigated how important each of its constructs (evidence, context and facilitation) and sub-elements were perceived to be to successful implementation of EBIs in a Chinese setting.MethodWe conducted clinical observations and semi-structured interviews with 10 physicians and 18 nurses in five tertiary hospitals implementing KMC. Interview questions were organized around issues including knowledge and beliefs, resources, culture, implementation readiness and climate. We used directed content analysis to analyze the interview transcript, amending the PARIHS framework to incorporate emerging sub-themes. We also rated the constructs and sub-elements on a continuum from “low (weak)”, “moderate” or “high (strong)” highlighting the ones considered most influential for hospital level implementation by study participants.ResultsUsing KMC as an example, our finding suggest that clinical experience, culture, leadership, evaluation, and facilitation are highly influential elements for EBI implementation in China. External evidence had a moderate impact, especially in the initial awareness raising stages of implementation and resources were also considered to be of moderate importance, although this may change as implementation progresses. Patient experience was not seen as a driver for implementation at hospital level.ConclusionBased on our findings examining KMC implementation as a case example, the PARIHS framework can be a useful tool for planning and evaluating EBI implementation in China. However, it’s sub-elements should be assessed and adapted to the implementation setting.

Evaluation of home‐based Family Foundations targeting perinatal mental health and couple conflict in Australia

AbstractObjectivesA formative evaluation of a home‐based family intervention, Family Foundations (FF), targeting parent mental health and conflict in the perinatal period was conducted. The aims were to (a) assess parent satisfaction and recommendations for improvement, (b) identify perceived enablers and barriers to engagement, and (c) obtain preliminary outcome data related to parent mental health, conflict, and coparenting.MethodsA mixed‐methods evaluation was conducted with 41 families at risk of or experiencing parental conflict. FF was delivered by two organizations in Australia. Qualitative interviews with parents and FF clinicians were conducted, and intervention outcomes were assessed using parent survey.ResultsFeasibility of reach and recruitment of the target population was demonstrated. Parents' indicated a high level of satisfaction with all aspects of FF and offered recommendations for improvements to resources and delivery. Service, program, clinician, and family characteristics as enablers and barriers to engagement in FF were identified. Both mothers and partners reported a decrease in their child's exposure to conflict. Mothers also reported a decrease in mental health symptoms and parenting hostility and an increase in positive coparenting behavior.ConclusionFeasibility and acceptability of home‐based FF in the perinatal period had been established, with preliminary evidence of positive outcomes for families.ImplicationsThe current findings generate evidence to inform further development of home‐based FF and wider implementation in health and social care services in Australia.

The Impact of the COVID-19 Pandemic on Forensic Mental Health Services and Clinical Outcomes: A Longitudinal Study.

BackgroundThe COVID-19 pandemic has had a substantial impact on forensic mental health service provision and implementation. This study aimed to provide an analysis of the impact of COVID-19 related restrictions on routine outcomes within a large forensic mental health service in London, UK.MethodWe conducted a longitudinal cohort study using data collected routinely prior to the COVID-19 pandemic (April 2018–March 2020) and then stages thereafter (March 2020–March 2021; analyzed as March–May 2020, June–September 2020, October–December 2020, January–March 2021). We used causal impact models (Bayesian structural time-series) to examine the effect of COVID-19 related changes on routine outcomes related to service provision and implementation.ResultsThere was an overall increase in long-term segregation (LTS) hours during the pandemic; 140%, (95% Cl 107, 171%) during Lockdown 1; 113%, (159% Cl 127, 192%) during post-Lockdown 1; 45% (95% Cl 23, 68%) during Lockdown 2 and, finally, 90% (95% Cl 63, 113%) during Lockdown 3. The most negative outcomes were evident during Lockdown 3. Incidents of violence were significantly more frequent during Lockdown 3 than would have been predicted based on pre-pandemic data, including physical assaults to service users (206%, 95% CI 57%, 346%), non-physical assaults to service users (206%, 95% CI 53%, 339%), and self-harm (71%, 95% CI 0.4%, 135%). Use of enforced medication also increased during Lockdown 3 (317%, 95% CI 175%, 456%).ConclusionThe pandemic and its related restrictions negatively affected some service outcomes. This resulted in increased incidents of violence and increased use of restrictive interventions, beyond what would have been expected had the pandemic not occurred.

Ib-M Aisyiyah Group of Tasikmalaya City In Early Detection of Cardiovascular Disease Risk Factors

Non-communicable diseases are the largest cause of death in the world, one of which is cardiovascular disease. Health development goals are directed towards achieving an independent society for healthy living, therefore community empowerment is needed to support these goals. This condition is a shared responsibility, especially Muhammadiyah and Aisyiyah Universities as women's organizations that pay attention to health services to the community. The solution offered is the implementation of health services on an ongoing basis whose activities include cadre training, health counselling and blood pressure checks, body mass index and first aid in emergency cardiac disease. The activity was held in 2021; the target was women’s majelis taklim group organized by the Head of Aisyiyah District of Tasikmalaya City. The implementation of activities is carried out by lecturers and students and assisted by PDA Kota Tasikmalaya.

Expanded Pharmacy Practice Implementation: Lessons from Remote Practice

Aim: The aim of this study is to explore pharmacist perspectives of the implementation of a community pharmacy-based ear health service in rural communities. Method: A community pharmacy-based health service model was designed and developed to provide an accessible ear care service (LISTEN UP—Locally Integrated Screening and Testing Ear aNd aUral Program) and pharmacist’s perspectives of the implementation of LISTEN UP were explored. Thematic analysis was conducted and data coded according to the Consolidated Framework for Implementation Research. Results: A total of 20 interviews were conducted with 10 pharmacists, averaging 30 min. Visualistion of the ear canal was reported as the greatest advantage of the service, whilst the time required for documentation reported as a complexity. The number of pharmacists working at one time and the availability of a private consultation room were identified as the two limiting factors for execution. On reflection, the need for government funding for service viability and sustainability was highlighted. Discussion/Conclusion: Expanded pharmacy practice is emerging for the Australian pharmacy profession. Rural community pharmacists are recognised as integral members of healthcare teams, providing accessible medication supply and health advice to seven million people in Australia who call rural and remote regions home. However, there are no structured models supporting them to provide expanded services to improve health outcomes in their communities. This study provides lessons learnt to guide future design and development of expanded models of pharmacy practice.

Implementation of the Frailty Care Bundle (FCB) to promote mobilisation, nutrition and cognitive engagement in older people in acute care settings: protocol for an implementation science study

Background: Older people are among the most vulnerable patients in acute care hospitals. The hospitalisation process can result in newly acquired functional or cognitive deficits termed hospital associated decline (HAD). Prioritising fundamental care including mobilisation, nutrition, and cognitive engagement can reduce HAD risk. Aim: The Frailty Care Bundle (FCB) intervention aims to implement and evaluate evidence-based principles on early mobilisation, enhanced nutrition and increased cognitive engagement to prevent functional decline and HAD in older patients. Methods: A hybrid implementation science study will use a pragmatic prospective cohort design with a pre-post mixed methods evaluation to test the effect of the FCB on patient, staff, and health service outcomes. The evaluation will include a description of the implementation process, intervention adaptations, and economic costs analysis. The protocol follows the Standards for Reporting Implementation Studies (StaRI). The intervention design and implementation strategy will utilise the behaviour change theory COM-B (capability, motivation, opportunity) and the Promoting Action on Research Implementation in Health Services (i-PARIHS). A clinical facilitator will use a co-production approach with staff. All patients will receive care as normal, the intervention is delivered at ward level and focuses on nurses and health care assistants (HCA) normative clinical practices. The intervention will be delivered in three hospitals on six wards including rehabilitation, acute trauma, medical and older adult wards. Evaluation: The evaluation will recruit a volunteer sample of 180 patients aged 65 years or older (pre 90; post 90 patients). The primary outcomes are measures of functional status (modified Barthel Index (MBI)) and mobilisation measured as average daily step count using accelerometers. Process data will include ward activity mapping, staff surveys and interviews and an economic cost-impact analysis. Conclusions: This is a complex intervention that involves ward and system level changes and has the potential to improve outcomes for older patients.

\u201cI always prefer to withdraw than use a condom\u201d: contextualising condomless sex among East Asian and sub-Saharan African international students in Sydney

BackgroundIncidence and prevalence of blood-borne viruses and sexually transmissible infections among young people continue to necessitate population-based studies to understand how contextualised sexual health services can be developed and implemented to promote protective behaviours such as consistent condom use. This study examined condomless sexual practice among a sample of East Asian and sub-Saharan African international university students in Sydney, Australia.MethodsThis qualitative study was methodologically guided by interpretative phenomenological analysis. Data was provided by 20 international students sampled from five universities in Sydney, who participated in either face-to-face or telephone semi-structured in-depth interviews. The interview sessions were audio-recorded, transcribed verbatim, coded in NVivo and analysed using reflexive thematic analysis.ResultsCondomless sexual practices appear to be common among the study group based on participants’ self-reports of their own practices and the practices of friends and peers. Three themes contextualising condomless among the study participants were generated from the interview transcripts: (1) unanticipated sex, condom related stigma and alcohol use (2) pleasure-seeking, curiosity and intimacy (3) condomless sex as a gendered practice.ConclusionsThe result of this study has implications for public health research, practice and policy around design, implementation and evaluation of multi-layered and population-specific sexual health services that are tailored to addressing the needs of international students, who migrate from traditional sexual cultures to Australia, where sexual norms are more liberal.

The practice of integrated healthcare and the experiences of people in Ghana\u2019s Ashanti region

BackgroundThe Ghanaian government has implemented interventions that integrate traditional medicine (TM) into its national health system in response to the high prevalence of TM use. However, empirical evidence of the experiences of service users and the practice of integrated health in Ghana is scanty. Therefore, this study explored the experiences of people with TM integration into the formal health system in Ashanti region using an adapted TM integration framework.MethodsA sequential explanatory mixed methods study design comprising survey administration and in-depth interviews for data collection was utilised to address the research objective. Framework analysis was used in analysing the qualitative data and for triangulation of results.ResultsParticipants were aware of licensing and training of TM practitioners in a science-based university in Ghana. However, knowledge of the existence of TM units in selected hospitals in the region was minimal. Integration knowledge was largely influenced by sex, marital status, household size and residential status, where males and urban dwellers were more familiar with the process than females and rural dwellers. Low patronage of integrated health services in the region was attributable to weak cross referrals. However, service users who had engaged with the integrated system recounted a satisfactory outcome.ConclusionService users’ unfamiliarity with the presence of integrated facilities in Ghana could be an impediment to the practice of integrated healthcare. Sensitisation of the public about the practice of an integrated system could refine the Ghanaian integrated system. Regular evaluation of patient satisfaction and outcome measures might also serve as an effective strategy for improving health services delivery since evaluation is becoming an important component of health service design and implementation. There is the need for future studies to focus on exploring the perceptions and experiences of health practitioners and hospital administrators regarding the practice of integrated health in Ghana.

Non-Communicable Diseases and their Challenges in India

Background: Non-communicable diseases (NCDs) are one of the major concerns of the 21st century globally. Low- and middle-income countries (LMICs) show a higher burden of NCDs including India. The country has launched various programs for the control and prevention of NCDs, but the organization, integration, and implementation of NCD-related health services and programs face many challenges. The objective of this review article is to study the trends and challenges in the prevention and control of common NCDs in India and find probable solutions to them. Methodology: Search on PubMed and Google Scholar databases was done. Out of 387 relevant articles, 50 were included. Websites of various institutes and government portals were searched. Data were compiled and studied for identifying the challenges and their solutions. Results: The challenges were organized at four levels – community, facility, health system and policy, and research as per the WHO Innovative Care for Chronic Conditions frameworks (WHO ICCC) such as identification of eligible beneficiaries, shortage of infrastructure and workforce, lack of skills and need for training, inadequate data, poor surveillance, and monitoring systems and limited research. Conclusion: India’s growing NCD burden needs to be addressed by health-promoting partnerships, policies, and programs. To create successful national, multisectoral program for prevention and control of NCDs, high-level political commitment, intersectoral coordination, and community mobilization is required. Learnings from various other programs could be incorporated for effective management of NCDs in India. A more scientific research-based focus needs to be given to AYUSH and other non-medical interventions.

Implementation, Patient Satisfaction and Usability of Telemedicine Services for Pediatric Thalassemia Cases in Balochistan During COVID-19 Pandemic and Beyond

<i>Background</i>: Telemedicine health service has revolutionized delivery of health care to the doorsteps of needy and deserving cases especially since the onset of the recent pandemic; COVID-19. Beta thalassemia major children require lifelong medical care, despite any untoward circumstances. Aim of this study is to identify role of telemedicine in diagnosing, treating and following-up of thalassemia cases and assess patient satisfaction. <i>Objective</i>: To assess implementation, patient satisfaction and usability of telemedicine health service for pediatric thalassemia cases in Northern Balochistan. <i>Study place and duration</i>: Study was carried out at District Headquarter Hospital Zhob from April 2021 to September 2021. <i>Material & methods</i>: Telemedicine service was established at Pediatric Department DHQ Hospital Zhob during COVID-19 pandemic. The data of all thalassemia cases that were managed/provided health care via telemedicine was collected and recorded. Patient satisfaction and usability of telemedicine service provided was assessed using a questionnaire prepared after thorough study of literature. The parents and care-givers of thalassemia cases treated via telemedicine were interviewed on mobile cell phones/telephone and the questionnaires were filled. Overall satisfaction was also gauged according to a scale from 1 to 5, where 1 depicted extremely dissatisfaction and 5 showed extreme satisfaction. The data was analyzed with Statistical package for social science (SPSS 21). <i>Results</i>: Total 347 patients of thalassemia received telemedicine health service during the study period. There were 182 (52.4%) males and 165 (47.6%) females with age range of 1 – 15 years (mean age 8.09 + 3.47 years). Total 289 (83.3%) telemedicine service seekers were residing in rural areas and rest 58 (16.7%) resided in urban areas. Ninety seven families (28%) belonged to poor class, 192 (55.35) belonged to lower middle class, 55 (15.9%) belonged to upper middle class and 3 (0.9%) belonged to rich class. Majority of participants (97.4%) were significantly satisfied with telemedicine service (p value 0.001). <i>Conclusion</i>: During current COVID-19 pandemic telemedicine has emerged as an exceptional alternate mode of healthcare delivery. It saves cost and time of travelling for thalassemia cases who require life-long hospital visits and follow-up. People have shown high satisfaction and positive attitude towards telemedicine health service provision.

Reasons and mechanisms for admission of children and adolescents to a psychiatric hospital: the control circuit

Important strides in psychiatric reform include the implementation of mental health services that replace the traditional psychiatric logic. However, admissions to psychiatric hospitals continue to occur, including children and adolescents. This study analyzed the reasons for admission to a psychiatric hospital from the institution's perspective and that of the hospitalized children and adolescents. This was a qualitative study with a hermeneutic-dialectic approach, based on a reading of the institutional documents, open interviews with eight adolescents, and participant observation. The results showed that the main alleged reason for admission reported by the psychiatric hospital was "aggressiveness", justified by the idea of "risk to self and others", while the children reported multiple reasons for their hospitalization, including drug use, minor scuffles, and misdemeanors. The analysis showed that the mechanism for admission to the psychiatric hospital involve, during anamnesis, defining an individual as deviating from social norms and, subsequently, assignment of a diagnosis to back the psychiatric institutionalization. It also showed that the backing and continuity of psychiatric hospitalizations occur in a circuit of control that is operated between different institutions for the deviants' custody. The study demonstrates that to avoid psychiatric hospitalizations, besides closing psychiatric hospitals, it is necessary to overcome the psychiatric paradigm, which in turn requires deinstitutionalization of practices and psychosocial care in open, community and substitutive mental health services.

Expect the Unexpected: A Qualitative Study of the Ripple Effects of Children's Mental Health Services Implementation Efforts.

Strategies to implement evidence-based interventions (EBIs) in children's mental health services have complex direct and indirect causal impacts on multiple outcomes. Ripple effects are outcomes caused by EBI implementation efforts that are unplanned, unanticipated, and/or more salient to stakeholders other than researchers and implementers. The purpose of the current paper is to provide a compilation of possible ripple effects associated with EBI implementation strategies in children's mental health services, to be used for implementation planning, research, and quality improvement. Participants were identified via expert nomination and snowball sampling. Online surveys were completed by 81 participants, each representing one of five roles: providers of mental health services to children or youth, researchers, policy makers, caregivers, and youth. A partially directed conventional content analysis with consensus decision making was used to code ripple effects. Four hundred and four unique responses were coded into 66 ripple effects and 14 categories. Categories include general knowledge, skills, attitudes, and confidence about using EBIs; general job-related ripple effects; EBI treatment adherence, fidelity, and alignment; gaming the system; equity and stigma; shifting roles, role clarity, and task shifting; economic costs and benefits; EBI treatment availability, access, participation, attendance, barriers, and facilitators; clinical process and treatment quality; client engagement, therapeutic alliance, and client satisfaction; clinical organization structure, relationships in the organization, process, and functioning; youth client and caregiver outcomes; and use of EBI strategies and insights in one's own life. This research advances the field by providing children's mental health implementers, researchers, funders, policy makers, and consumers with a menu of potential ripple effects. It can be a practical tool to ensure compliance with guidance from Quality Improvement/Quality Assurance, Complexity Science, and Diffusion of Innovation Theory. Future phases will match potential ripple effects with salient children's mental health implementation strategies for each participant role.

The impact of hospital accreditation on patient safety culture in the health services implementation at Sanglah General Hospital, Bali

Background and purpose: Hospital accreditation is carried out to evaluate hospitals' performance in providing patients with excellent and safe health services. One aspect of service quality is patient safety culture. This study aims to determine the impact of hospital accreditation on patient safety culture in health service implementation at the Sanglah General Hospital in Denpasar City, Bali Province.Methods: This study used a qualitative research design. In-depth interviews were conducted to 11 informants consisting of hospital management, clinicians and nurses which were chosen purposively since they were directly related to the assessment and supervision of health service providers at Sanglah Hospital. The interview guide was based on the Modified Manchester Patient Safety Framework (MaPSaF). Data were analyzed with a thematic approach.Results: The interview results show that the ten dimensions of patient safety culture had been implemented well but still need to be improved in the dimensions of giving priority to safety, system errors and responsibilities, recording incidents and best practices, learning and influencing change, also education and training of staff and teamwork. The maturity level of patient safety culture at Sanglah Hospital is at generative culture in four dimensions and at proactive culture on the six dimensions of patient safety culture.Conclusion: Accreditation had a positive impact on the maturity level of patient safety culture at a proactive level, mainly changes in knowledge, attitudes, and behavior in health service providers. However, in its implementation, there were still constrained on infrastructure, time, and energy.

Disharmony in Regulations of Telemedicine Services During the Covid-19 Pandemic in Indonesia

The Circular Letter of the Minister of Health Number 303 of 2020 concerning the Implementation of Health Services through the Use of Information and Communication Technology in the Context of Preventing the Spread of Covid-19 has created a new norm that is contrary to the Regulation of the Minister of Health Number 20 of 2019 concerning Telemedicine Services between Health Service Facilities. The purpose of this research is to study the position of the circular letter legally-formally and also to examine the material substance of the circular letter through comparison with several related regulations. The research method used is normative juridical by researching legal principles, legal systematics, level of legal synchronization, legal history, and legal comparison. The result of this research indicates that the position of the circular in the positive legal system in Indonesia is not a regulation (regeling) or a state administrative decision (beschikking). There was disharmony of regulations between this Circular of the Minister of Health and several related laws and regulations above. Disharmony occurs because this circular has become a new norm that contradicts the Regulation of the Minister of Health as well as the Regulation of the Indonesian Medical Council which regulates telemedicine services between health facilities. Conflicts also occur with the law on medical practice, health law, the law on information and electronic transactions, .and the Civil Code

Expanding Virtual Health Capabilities Into Trainee Health.

ABSTRACTVirtual health and secure messaging gained newfound relevance in medicine during the coronavirus disease (COVID)-19 pandemic. For a military trainee health care clinic located on Joint Base San Antonio, the McWethy Troop Medical Clinic (TMC), implementation of virtual health and secure messaging services meant decreased risk of COVID-19 exposure for trainees and clinical staff. Through ongoing utilization, these services also made impacts to reduce loss of instruction time and improve access to care for the McWethy TMC trainee population. In defining the challenges, successes, and future implications for virtual health and secure messaging at the McWethy TMC, key lessons emerge for other military trainee clinics. The key concepts explored in this article are virtual health and secure messaging.

Opening a dialogue: lived experience meets Open Dialogue in Israeli mental health services

ABSTRACT Objective This article presents the emerging field of peer-supported Open Dialogue and its implementation in Israeli mental health services. We review the literature on peer support and OD, and conceptualise shared core principles between the two practices. Then we report on the results of a preliminary research exploring the benefits and challenges of integrating lived experience in OD. Method Questionnaires exploring lived experience in OD, as perceived by OD team members, were filled by 11 international participants, and 7 Israeli participants that graduated from the first OD training. These were followed by three in-depth interviews with Israeli lived experience practitioners that graduated from OD training. Results Based on a reflexive thematic analysis of the questionnaires and interviews we portray the benefits and challenges of working with a lived experience perspective within the OD approach. We explore the newly emerging field of OD in Israel, which is greatly influenced by the contribution of lived experience practitioners – both peer specialists and mental health professionals. Discussion We conclude with our own reflections – as a social worker and a psychologist, both with lived experience – and suggest that the meeting point between lived experience and OD holds an exciting potential for developing more inclusive and progressive mental health services that value the role of lived experience, and benefit from peer perspectives.

BELUM TERCAPAINYA INDIKATOR STANDAR PELAYANAN MINIMAL PROGRAM KESEHATAN IBU DAN ANAK (KIA) Studi Kualitatif di Puskesmas Sei Rampah, Kabupaten Serdang Bedagai, Tahun 2021)

The purpose of this research is to explore more deeply about all matters related to the lack Minimum Service Standards (MSS) indicators for Maternal and Child Health Program (KIA) at Sei Rampah Public Health Center, Serdang Bedagai Regency. This research is a qualitative research. The research instrument is the researcher himself who is subjective, so the data obtained is checked for validity using the triangulation technique, namely by extending the time ,source triangulation and triangulation of data collection methods. The informant is the head of the public health center, Coordinator midwives, implementing midwives, nurses and pregnant mother. Data analysis was carried out using the Miles and Hubberman method. The results of research showed the indicators for the Minimum Service Standards for the Maternal and Child Health Program (KIA) at the Sei Rampah Health Center had not reached the 100% target and the lowest indicator coverage was the Indicator Detection of Risk Factors and Complications 17,3%. The reason for not achieveing the SPM for KIA program because the People are hesitant to check their health at the Public health center during the Covic-19 pandemic. The efforts made by the Public health centre management are by increasing the number of midwives, doing home-care, providing information to the community, either by banners or leaflet about the implementation of health services at the puskesmas, carrying out health shipping in accordance with the Covid 19 health protocol procedures. This study produces a Theoritical Framework based on results of data collection, processing and analysis.