Care Service Model Research Articles

2009 Integrated physical-mental health care models for older people under specialist mental health services: a systematic review

Abstract Background Older people have complex health needs, with the inter-play between physical and mental health being a prominent issue. The ageing population has resulted in a large proportion of older people living with co-occurring physical and mental health disorders, which can prove challenging to manage simultaneously, particularly for serious mental illness. The aim of this systematic review was to explore models of integrated physical-mental health care available for older people, and whether these result in improved health outcomes. Sources of heterogeneity in the current evidence base alongside limitations were also explored. Methods Medline, Embase, CINAHL, PsycINFO and Scopus were searched with a predefined search strategy, generating 5257 articles. Studies were suitable for inclusion where an integrated physical-mental health care service model was utilised in a population of older people (aged >60 years) with a mental health diagnosis and at least one concomitant physical health condition requiring physical health care input. All studies were quality assessed for risk of bias and results were synthesised narratively. Results Ten studies met the inclusion criteria. All studies incorporated service models involving integrated and/or multidisciplinary care. These included joint medical-mental health wards as well as the implementation of multidisciplinary teams in hospital and care facilities. Overall, this enhanced the quality of care for elderly patients with benefits including but not limited to, enhanced patient experience, the expansion of multidisciplinary team practice, improved management of illness, and timely intervention. Conclusions Multidisciplinary and integrated care resulted in improvement of a range of health outcomes for older people with combined physical and mental health needs. Larger and more robust studies are needed to explore the development of these service models further, with cost-effectiveness analyses.

Leveraging e-health for enhanced cancer care service models in middle-income contexts: Qualitative insights from oncology care providers

Leveraging e-health for enhanced cancer care service models in middle-income contexts: Qualitative insights from oncology care providers

Healthy ageing in remote Cape York: a co-designed Integrated Allied Health Service Model.

Allied health services in rural and remote hospitals often work in siloed and solo discipline-specific positions. They are often part of general multi-disciplinary teams without a clearly articulated service model that integrates care for individuals and addresses broader community health needs. Integrated care service models for clients with complex disabilities or chronic health needs have demonstrated improved outcomes, but feasible service models are rarely described in the context of rural, remote and Aboriginal and Torres Strait Islander communities. Integration can support primary health care in remote communities where resources are thin, and the breadth of multidisciplinary service providers is not available. A remote health service, in collaboration with a University Department of Rural Health and community partners, developed a community rehabilitation and lifestyle service for adults who experience chronic disease, disability or were at risk of functional decline due to frailty. Using an integrated approach, this model of care improves access to specialist and primary healthcare services, delivers targeted group-based rehabilitation and preventative activities, and addresses community and workforce capacity to meet the needs of the remote community. This paper describes a remote primary health care, Integrated Allied Health Service Model, developed with a focus on the co-ordination and integration of care and resources between the health service, education and community.

Exploring the 'citizen organization': an evaluation of a regional Australian community-based palliative care service model.

Little Haven is a rural, community-based specialist palliative care service in Gympie, Australia. Its goals are to provide highest quality of care, support and education for those experiencing or anticipating serious illness and loss. Families and communities work alongside clinical services, with community engagement influencing compassionate care and support of dying people, their families and communities. Public Health Palliative Care promotes community engagement by community-based palliative care services and is grounded in equal partnerships between civic life, community members, patients and carers, and service providers. This takes many forms, including what we have termed the 'citizen organization'. This paper reports on an evaluation of Little Haven's model of care and explores the organization's place as a 'citizen' of the community it services. A co-designed evaluation approach utilizing mixed-method design is used. Multiple data sources obtained a broad perspective of the model of care including primary qualitative data from current patients, current carers, staff, volunteers and organizational stakeholders (interviews and focus groups); and secondary quantitative survey data from bereaved carers. Thematic analysis and descriptive statistics were generated. This model of care demonstrates common service elements including early access to holistic, patient/family-centred, specialized palliative care at little or no cost to users, with strong community engagement. These elements enable high-quality care for patients and carers who describe the support as 'over and above', enabling good quality of life and care at home. Staff and volunteers perceive the built-in flexibility of the model as critical to its outcomes; the interface between the service and the community is similarly stressed as a key service element. Organizational stakeholders observed the model as a product of local activism and accountability to the community. All participant groups agree the service model enables the delivery of excellent care. The construction of a community palliative care service as a citizen organization emerged as a new concept.

Constructing a non-face-to-face oral health care service model using my data: proposal

Constructing a non-face-to-face oral health care service model using my data: proposal

A Study of the Construction of Smart Healthy Elderly Care City: An Aspect of Foshan City, Guangdong Province

The smart healthy elderly care city takes the integration of healthy elderly care resources with information technology as its basic feature, and innovates the healthy elderly care service model to accurately serve the elderly. In recent years, all parts of the country have gradually promoted the construction of smart, healthy and elderly care cities, which have achieved good results, but also face many problems. In order to evaluate the current situation of the construction of smart healthy elderly care cities, the author has built a smart healthy elderly care city evaluation index system based on the research results and standards of smart city and healthy elderly care city evaluation index system. The evaluation index system of smart health care city involves five fields, including smart health care infrastructure, smart health care environment, smart health care economy and smart health care services, which can comprehensively and systematically reflect the construction of smart health care city. Taking Foshan City, Guangdong Province as an example, this paper empirically analyzes the current situation and problems of the construction of a smart healthy elderly care city using the data from 2020-2021, and then puts forward high-quality development strategies for the construction of a smart healthy elderly care city in Foshan.

PATTERN RECOGNITION AND INNOVATION OF HOME-BASED CARE IN CHINA: FROM THE PERSPECTIVE OF MULTINATIONAL COMPARISON

Abstract The development trend of family structure’s miniaturization and nucleation in China and the overlapping occurrence of population aging and associated frailty and morbidities have created an urgent need for innovation in the home care service model. In this paper, home-based care is regarded as a dynamic pension method. Based on the analysis of dynamic changes in population structure and family structure, this paper uses multi-stage microsimulation technology to scientifically predict the evolution of the older adult population’s distribution state and multi-health state. This approach leads to early identification of the risks of various home-based care models in the process of family structure changes. Based on this, with reference to the home-based care model cases in China, Japan, Europe, and the United States, this paper proposes the innovation of the multi-health state and the “ integrated care at home” model for households with an aging resident and brings up the optimization plan of home-based care service for accelerating the aging process. Implications for policies and practices to support family members to realize this optimized home care model will be discussed.

LATER-LIFE EXPERIENCES OF VETERANS AND THEIR CAREGIVERS

Abstract Military service is a defining life-course event that is consequential for the well-being of older adults and their caregivers. Although there has been increased attention to veteran status differences in later-life experiences, critical gaps in knowledge persist. This symposium features four presentations that address existing gaps from various perspectives. Kurth and colleagues use data from an online survey of community-dwelling combat veterans. They find that Vietnam Veterans exhibit more PTSD symptoms than veterans in two younger cohorts, and observed cohort differences are explained by military and post-service experiences. Spiro and colleagues examine later-adult trauma re-engagement (LATR) across multiple samples of Vietnam-era veterans and find that there is variation in LATR by gender and warzone experience. London and colleagues analyze data from adults aged 50+ in the 2021 National Health Interview Survey and find that: non-combat and combat veterans have more difficulty remembering/concentrating than nonveterans; hearing difficulty mediates some of the association between military service experiences and remembering/concentrating; and combat experiences moderate the relationship between hearing difficulty and difficulty remembering/concentrating. Haverhals and colleagues assess the Redefining Elder Care in America Program (RECAP) piloted recently in two VA health care centers and find that combat veterans and their caregivers reported shortcomings and challenges associated with program participation even though they were satisfied overall. Collectively, these papers underscore the enduring influence of combat exposure on older adults and the importance of innovative health care service models that are designed to provide support to caregivers. This is an Aging Veterans: Effects of Military Service across the Life Course Interest Group Sponsored Symposium.

Investigating the association between characteristics of local crisis care systems and service use in an English national survey.

In England, a range of mental health crisis care models and approaches to organising crisis care systems have been implemented, but characteristics associated with their effectiveness are poorly understood. To (a) develop a typology of catchment area mental health crisis care systems and (b) investigate how crisis care service models and system characteristics relate to psychiatric hospital admissions and detentions. Crisis systems data were obtained from a 2019 English national survey. Latent class analyses were conducted to identify discernible typologies, and mixed-effects negative binomial regression models were fitted to explore associations between crisis care models and admissions and detention rates, obtained from nationally reported data. No clear typology of catchment area crisis care systems emerged. Regression models suggested that provision of a crisis telephone service within the local crisis system was associated with a 11.6% lower admissions rate and 15.3% lower detention rate. Provision of a crisis cafe was associated with a 7.8% lower admission rates. The provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with a 12.8% higher admission rate. The configuration of crisis care systems varies considerably in England, but we could not derive a typology that convincingly categorised crisis care systems. Our results suggest that a crisis phone line and a crisis cafe may be associated with lower admission rates. However, our findings suggest crisis assessment teams, separate from home treatment teams, may not be associated with reductions in admission and detentions.

Los Angeles County among key agencies tackling social determinants

Los Angeles County, where public policies are often seen as a national barometer based on its status as the country's largest county government, is engaged in an ambitious effort to address social needs within its integrated behavioral health and primary care service model. Leaders of the initiative hope to demonstrate that the primary care clinic serves as the ideal setting for achieving the results they seek.

Corrigendum: Construction of smart older adults care service model driven by primary health care

Corrigendum: Construction of smart older adults care service model driven by primary health care

Process of co‐production of mental health service plans for refugee children in Turkey

AbstractRefugee children and young people have high levels of unmet mental health needs. A trauma‐informed service transformation framework was applied with 14 professionals in Turkey. Through participatory focus groups, professionals co‐produced service plans and considered enabling and challenging factors for implementation. Data were analysed through a thematic codebook approach. Established themes suggested that implementation should concurrently address societal barriers, agency fragmentation, lack of contextual interventions and sustainability. These led to the development of a Theory of Change. A trauma‐informed and scaled service model of collaborative care can holistically meet refugee children and young people's complex needs, while maximising sparse resources.

DENTAL AND ORAL HEALTH CARE MODEL IN PEDIATRIC PATIENT

Background: Basic Health Research in 2018 stated that 57.6% of the Indonesian population had dental and oral health problems with the largest proportion in the 5-9 year old group at 67.3%, 10-14 year olds 55.6%. The presentation of caries in primary teeth and permanent teeth in children is 62-65.8%. Factors that cause dental caries are influenced by the behavior of children who do not maintain oral hygiene, amounting to 2.8% in Indonesia, because children have characteristics that are not yet capable of being responsible for doing things, so they need treatment. Objective: Develop a model design, carry out expert validation tests for feasibility and prove that the dental and oral health care service model is effective in an effort to reduce the anxiety level of pediatric patients in treatment. Method: Research and Development with a Quasy experimental Pretest-Posttest group design. The sampling technique used purposive sampling for Dental and Oral Therapists and Child Patients at RSGM UNIMUS. 10 Dental and Oral Therapists intervened, 11 child patients were given the Care Model Results of Development and Control, 10 Dental and Oral Therapists, 11 child patients at RSGM Unimus were given the 2006 Minister of Health Decree 284 Care Model. Data collection techniques in this research were interviews, pre-test and post-test. The validity of expert data was tested using the Intraclass Correlation Coefficient (ICC) and the effectiveness of the model was tested using Wilcoxon and Mann-Whitney. Results: The dental and oral health care model for pediatric patients is suitable as dental and oral health care for pediatric patients in specialist pediatric dentistry clinics with expert validation results of p 0.002, knowledge of Dental and Oral Therapists with a value of ?=3.90, attitude ?=23.50 , skills ?=4.20, pediatric patient anxiety ?=14.36, pediatric patient satisfaction ?=18.36. Conclusion: The dental and oral health service model is feasible and effective in reducing the anxiety level of pediatric patients during treatment

Local Implementation of the Symbiotic Community Model to Achieve Aging in Place

<p>進入高齡社會的臺灣，偏鄉與原住民族應如何在諸多不利因素影響下，回應在地社區高齡者的生活照顧和醫養需求，成為落實在地老化高齡社會保障政策的重要一環。本文透過余尚儒以臺東都蘭診所推動的共生社區與在宅醫療模式，以及林依瑩在臺中和平區達觀部落伯拉罕長照機構的共生型照顧服務模式與地域營造方案，來檢視高齡社會下，透過在地組織連結資源、以特色服務解決高齡醫養困境的可能性；同時也檢視目前長照2.0在原鄉的執行困境及可能的解決方向。</p> <p> </p><p>In response to Taiwan’s aged society, rural and indigenous communities experience various challenges and unfavorable conditions while attempting to meet the caregiving and healthcare needs of older residents. Attending to such needs has become a crucial constituent of policy implementation aimed at ensuring social security in an aged society to achieve aging in place. This study explored two models to examine the feasibility of addressing the aforesaid problem by integrating local organizational resources and providing specialized services. The first model was the symbiotic community and home-based care model promoted at the Home Clinic Dulan in Taitung. The second model was the symbiotic care service model and place-making program promoted at the Plahan Long-term Care Institution in L’olu Tribe, which is located in Heping District, Taichung. Additionally, this study delved into existing challenges concerning the local implementation of Long-Term Care Plan 2.0 in indigenous communities, proposing possible solutions to these challenges.</p> <p> </p>

38 Operational teams leads-stuck in the middle?

Abstract Background Middle managers have a crucial role in implementing integrated care service models, but very little research has been undertaken on their experiences. A key element of the National Clinical Programme for Older People’s support for the implementation of the National Older Person’s Service Model is the establishment of Community Specialist Teams for Older People (CST-OP). These interdisciplinary teams are critical to supporting older people with complex care needs necessitating integrated care. Operational Team Leads (OTLs) are responsible for coordinating the interdisciplinary team effort to meet that aim. This research is focused on capturing OTLs experiences as they commence their roles in supporting inter-professional collaboration to achieve integrated care. Methods We employed a qualitative case study design. The unit of analysis was the process of OTLs establishing their roles over two-time points. A total of 18 OTLs participated in interviews (n = 11), and focus groups (n = 7) documentary summaries were reviewed. Results OTLs are creating networks to share knowledge to advance their work Key factors impacting some OTLs included a lack of induction and preparation for the role. They noted a need for national centralised resources and guidance, national standards development, education and networking and feedback loops. Locally there are some tensions in role clarity and clear reporting lines. Work is required to position the CSTs within community governance structures. Developing a team’s vision, mission and goals, building trust and ensuring psychological safety are necessary. Resources on how to undertake change were stressed. Recognition by OTLs of managing expectations of their role as they focus on shifting from acute to the community with some recruitment challenges, need for a shared ICT system, and enabling collaborative team spaces. Conclusion The role of managers within integrated care systems is evolving. There is an evidence gap in understanding the operations of implementing integrated care for older people. This research responds to these gaps and will be shared across the CSTs network.

Research on the Current Situation and Policy Optimization of Smart Home-Based Care Model: Take Yunhe District as an Example

At the beginning of the 21st century, with the deepening the increasing degree of aging, it has become a major problem to solve the problem of solving the elderly to support and rely on. The research topic of this paper is the current situation and policy optimization of the home-based care model in Cangzhou city. This paper mainly uses the method of case analysis to analyze and study the home-based care service model of Cangzhou Yunhe District, and master the home-based care status of Cangzhou Yunhe District through a questionnaire survey. The study found that Yunhe District of Cangzhou city actively promotes home-based care services and provides professional services for the elderly, but it is still in the early stage of development, and there are problems such as pension care policies and the mismatch of resource allocation. Therefore, it is necessary to promote home-based care as a whole, meet heterogeneous social needs, and promote the development of home-based care services in Yunhe District, Cangzhou City.

The discourse of delivering person-centred nursing care before, and during, the COVID-19 pandemic: Care as collateral damage.

The global COVID-19 pandemic challenged the world-how it functions, how people move in the social worlds and how government/government services and people interact. Health services, operating under the principles of new public management, have undertaken rapid changes to service delivery and models of care. What has become apparent is the mechanisms within which contemporary health services operate and how services are not prioritising the person at the centre of care. Person-centred care (PCC) is the philosophical premise upon which models of health care are developed and implemented. Given the strain that COVID-19 has placed on the health services and the people who deliver the care, it is essential to explore the tensions that exist in this space. This article suggests that before the pandemic, PCC was largely rhetoric, and rendered invisible during the pandemic. The paper presents an investigation into the role of PCC in these challenging times, adopting a Foucauldian lens, specifically governmentality and biopolitics, to examine the policies, priorities and practical implications as health services pivoted and adapted to changing and acute demands. Specifically, this paper draws on the Australian experience, including shifting nursing workforce priorities and additional challenges resulting from public health directives such as lockdowns and limitations. The findings from this exploration open a space for discussion around the rhetoric of PCC, the status of nurses and that which has been lost to the pandemic.

Towards Cultural Adequacy of Experience-Based Design: A Qualitative Evaluation of Community-Integrated Intermediary Care to Enhance the Family-Based Long-Term Care for Thai Older Adults.

In this qualitative study, we provided an in-depth understanding of how Community-Integrated Intermediary Care (CIIC), a new service model for family-based long-term care (LTC), was perceived by its users. The CIIC, established in Chiang Mai, Northern Thailand, consisted of three main interventions: (1) A temporary respite care center; (2) A family-centered care capacity building; (3) Functional training delivered as community group exercise and home exercise to improve healthy ageing for independent older adults. Ten pairs of dependent Thai older adults, their primary family caregivers, and ten village health volunteers were recruited using the purposive sampling method. Data were collected via semistructured in-depth interviews. A thematic descriptive qualitative analysis was used for data analysis. The findings revealed that CIIC helped reduce the burden of family caregivers by providing respite, relief, and care coordination. The experiences of the CIIC users indicated possibilities for service redesign, development, and delivery strategies to better meet the LTC needs of older adults and family caregivers. Following the local stakeholders' commitment and local community health volunteers' network, a well-integrated formal and informal care CIIC model can be implied as an effective and sustainable ageing care service model in Thailand and other Asian countries in the future.

The influence of individual and municipality characteristics on allocation of long-term care services: a register-based cross-sectional study

BackgroundVariation in service allocation between municipalities may arise as a result of prioritisation. Both individual and societal characteristics determine service allocation, but previous literature has often investigated these factors separately. The present study aims to map variation in allocation of long-term care services and investigate the extent to which service allocation is associated with characteristics related to the individual care recipient and the municipality.MethodsThis cross-sectional study used register data from the Norwegian Registry for Primary Health Care on all 250 687 individuals receiving municipal health and care services in Norway on 31 December 2019. These individual level data were paired with municipal level data from the Municipality-State-Reporting register and information on the care models in Norwegian long-term care services, derived from a nationwide survey. Multilevel analyses were used to identify individual and municipal factors that were associated with allocation of home care, practical assistance and long-term stay in institutions.ResultsIn total, 164 634 people received home care services and 97 380 received practical assistance per 31 December 2019. Furthermore, 64 404 received both types of home-based services and 31 342 people had a long-term stay in an institution. Increased disability was strongly associated with being allocated more hours of home care and practical assistance, as well as allocation of a long-term institutional stay. The amount of home care and practical assistance declined with increasing age, but the odds of institutional stay increased with age. Care recipients living alone received more home-based services, and women had higher odds of a long-term institutional stay. Significant associations between the proportion of elderly in nursing homes and allocation of a long-term institutional stay and more practical assistance emerged. Other associations with municipalities’ structural characteristics and care service models were weak.ConclusionsThe influence of individual characteristics outweighed the contribution of municipality characteristics, and the results point to a limited influence of municipality characteristics on allocation of long-term care services.

EFFECTIVENESS OF FAMILY EMPOWERMENT INTERVENTION WITH HOME CARE SERVICE MODEL ON SELF MANAGEMENT OF TYPE 2 DIABETES MELLITUS PATIENTS

Type 2 DM can affect aspects of the sufferer's quality of life and has a risk of complications. DM requires continuous therapy to be able to control glucose levels properly, in addition to pharmacological therapy, non-pharmacological therapy is also needed to maximize blood glucose control, including in this case self-management measures. One of the efforts that can be made to improve the self-management of DM patients in managing their disease is through family empowerment with a home care service model. The purpose of this study was to examine the effect of family empowerment interventions using the home care service model on self-management of type 2 DM patients. The quasi-experimental research design used a one group pre and posttest approach without a control group. The research was conducted in the Andalas Padang Health Center Work Area. Sampling with consecutive sampling technique with a sample size of 19 people. The intervention was given for 2 weeks. Self-management was assessed using The Summary of Diabetes Self Care Activities (SDSCA) questionnaire. The results of the difference in self-management scores before and after giving the intervention amounted to 34.26. Based on the t-dependent test statistic (paired test) it was found that p value = 0.000 (?<0.05), meaning that the family empowerment intervention using the home care service model is effective in improving the self-management of type 2 DM patients. Family empowerment using the home care service model can be applied to community nurses to ensure continuity of patient care and prevent complications.