People Access Health Services Research Articles

Informing the development of a fit-for-purpose mental health nursing curriculum: A survey of mental health nurse academics in Australia.

Inadequate mental health nursing content in pre-registration nursing curricula has been the topic of debate and concern since the introduction of comprehensive nursing education in Australia. Government-initiated inquiries and the efforts of mental health professional organizations and leaders have not successfully addressed this problem. The aim of the current study was to garner the perspectives and experiences of mental health nurse academics regarding the adequacy of mental health content in producing graduates able to work effectively in mental health settings and identify barriers and enablers to implementing and sustaining sufficient mental health content in pre-registration programs. A survey was distributed to mental health academics in Australian universities offering pre-registration nursing degrees. In total, 44 complete responses were included in the analysis. The results demonstrated the following: Most participants considered the current mental health content, theory and clinical hours insufficient to prepare graduates for practice in mental health settings. They reported a scarcity of tenured mental health nurse academics to deliver content effectively. Most participants were dissatisfied with the comprehensive approach to nurse education and preferred a double degree (nursing and mental health nursing), or a direct entry mental health nursing program. These findings provide further evidence for the current crisis in mental health nursing education and highlight the need for urgent action. People accessing health services have the right to receive high-quality care from appropriately qualified nurses. The inadequacy of mental health content in these programs effectively denies vulnerable people the standard of care and treatment they should be entitled to.

“Frustrated with the whole system”: a qualitative framework analysis of the issues faced by people accessing health services for chronic pain

BackgroundChronic non-cancer pain (CNCP) is complex and often requires multimodal management comprising of both pharmacological and non-pharmacological treatments. To inform delivery of CNCP management, it is important to understand how current health services providing non-pharmacological treatments are accessed by exploring the experiences of people attempting to access services. In doing so, this study sought to explore the underlying drivers of service access barriers.MethodsThis study explored the experiences of Australians accessing services for CNCP using semi-structured telephone interviews undertaken between 01 October 2020 and 31 March 2021. Thematic analysis was guided by Levesque et al.’s 2013 conceptual framework of access to health care, with emerging themes mapped to five dimensions of accessibility and corresponding abilities of consumers: Approachability/Ability to perceive; Acceptability/Ability to seek; Availability and Accommodation/Ability to reach; Affordability/Ability to pay; and Appropriateness/Ability to engage.ResultsThe 26 participants (aged 24–78 years, 22 female) reported accessing a range of services including general practitioners (GP), allied health services, and specialised pain clinics, for a variety of conditions. Three themes were mapped to accessibility dimensions (in brackets): ‘GP as guide or gatekeeper’ (Approachability); ‘Outside of my control’ (Availability and Accommodation; Affordability); and ‘Services aren’t always good enough’ (Appropriateness). A fourth identified theme illustrated how participants responded to encountering these barriers: ‘Leading my own pain management’. Participant experiences suggest problems with the translation of contemporary pain management principles into practice, including continued application of biomedical health models as opposed to the biopsychosocial model, and demonstrate systemic issues with service delivery, including a lack of benchmarking of specialised services.ConclusionsThe identified themes highlight several evidence-to-practice gaps in the delivery of health services for people with CNCP in Australia. To address these gaps, there is a need for improved clinician training, increased investment in specialised pain services, and development of clear primary care pathways for CNCP management for evidence-based multimodal pain management to be accessible and equitable.

Society of Family Planning Clinical Recommendations: Contraceptive Care in the Context of Pandemic Response

The coronavirus disease 2019 (COVID-19) pandemic has posed a burden to healthcare systems around the world and has changed the way people access health services, including contraception. This document sets forth guidance from the Society of Family Planning for providing contraceptive care in the context of the COVID-19 pandemic, including when access to healthcare is restricted due to pandemic response. It also outlines the role of telehealth for providing contraceptive care beyond the pandemic. Clinicians can use synchronous telemedicine visits and other forms of telehealth to provide many aspects of contraceptive care. Both audio-video and audio-only visits are acceptable forms of telemedicine. Access to permanent contraception should be maintained, especially in the postpartum period. Combined hormonal contraceptive (CHC) users who have asymptomatic or mild COVID-19 infection may continue their contraceptive method, while those admitted to the hospital with severe infection should suspend CHC use until they are clinically recovered. CHC users who take Paxlovid for mild-moderate COVID-19 infection can consider a back-up contraceptive method for the duration of therapy, but clinically relevant drug interactions are unlikely. Future research should examine contraceptive outcomes in people who receive care via telemedicine; and access to telemedicine among historically excluded populations such as adolescents, people of color, people of low socioeconomic status, disabled people, or people who do not speak English as a primary language.

Perancangan Antarmuka Berdasarkan Evaluasi Usabilitas Penggunaan Aplikasi KlikDokter Untuk Pralansia dan Lansia

The situation and condition of the spread of Covid-19 in Indonesia have forced everyone to reduce the intensity of going out of the house, including activities related to the need for health services. Therefore, a solution is needed so that people can meet their health needs without leaving the house. Taking into account that the elderly as the community group that is most vulnerable to contracting the virus and has the highest mortality rate, it can be said that the elderly is the group of people who most need online health services. Along with the growing penetration of internet usage and the increasing number of smartphone ownership in Indonesia, m-health is the right choice to help people access health services online via smartphones. KlikDokter is an example of m-health or a mobile-based application that provides various online health services. However, it was found that there were complaints that the KlikDokter application was too complicated and difficult for the elderly to use. From this problem, a usability test was finally carried out on the KlikDokter application interface, to identify what interface elements in the KlikDokter application were difficult for elderly users. The research respondents were divided into two groups with 16 and 17 people respectively. The first group is the elderly group aged >60 years. And the second group is the pre-elderly group with ages between 45 to 59 years. A pre-elderly group is a comparison group (control group). This test is carried out by measuring several aspects of usability, namely effectiveness, efficiency, user satisfaction, error, and cognitive load.

Supporting people living with dementia and care partners throughout the COVID‐19 pandemic: Health service directions from the first wave in Calgary, Alberta

BackgroundThe emergence of COVID‐19 (SARS‐CoV‐2) as a novel coronavirus in late 2019 necessitated public health measures that have impacted the provision of care for people living with dementia and their families. The rapid shift to virtual care across health and social care sectors meant that providers did not have the opportunity to benefit from an evidence‐based understanding about how and which services can safely and effectively be delivered virtually prior to public health measures being implemented. Additionally, isolation resulting from social distancing may be harming well‐being for families as formal and informal supports become less accessible.MethodTo understand lived experiences and necessary changes in models of care delivery for people living with dementia during the COVID‐19 pandemic in Canada, we remotely interviewed 20 dyads of people living with dementia and their care partners who normally attend a dementia specialty clinic in Calgary, Alberta, during a period where essential businesses were closed and health care had abruptly transitioned to telemedicine. Participants were 50% female and a majority of clinic patients in the dyad had a diagnosis of Alzheimer’s Disease (75%). A reflexive thematic analysis was used to analyze the interview and field note data.ResultThemes regarding virtual service provision emerged through the iterative qualitative data analysis: (1) continuation of community‐based services for care partners and families delivered in innovative ways to meet support needs during the pandemic; (2) guidance in adapting to technology to enable accessible and effective treatment in a virtual care environment; (3) adapting the process and structure of virtual appointments to operationalize critical information provision while maintaining dignity for the person living with dementia.ConclusionThe rapid move to virtual healthcare has influenced how and when people access health services. Health system innovation in the way we structure service models and care provision can mitigate barriers to maintaining high quality virtual health care for people living with dementia. In‐depth understandings of how health systems can provide high‐quality care in new virtual settings is key to maintaining quality of life for community‐dwelling people living with dementia and care partners in times of public health emergencies.

Implementing a brief E-training opportunity for mental health practitioners working with non-binary clients

ABSTRACT Objective Evaluate the utility of brief online training for facilitating mental health professionals’ perceived knowledge, confidence, and comfort in working with non-binary clients, and building positive attitudes. Method Baseline participants were 79 Australian registered mental health professionals, of whom 38 completed online training and a one-week follow-up assessment. Participants completed an assessment of attitudes, comfort, confidence, and perceived knowledge pertaining to non-binary people before and after completing online training. The training (30-minute average completion time) provided information on non-binary people’s lives using text, images, embedded video, and links to optional resources. Results Follow-up measures completed one-week post-intervention indicated engagement in the training may lead to increased perceived knowledge, confidence and comfort. Attitudes were positive at baseline and were not significantly different at follow-up. Conclusions Providing brief online training for working with non-binary people in mental health might improve practitioner perceived knowledge, confidence and competence at low cost and with easy access. Future research is required to account for limitations and build on current outcomes. Key Points What is already known on this topic: Little is known about the effects of brief online training regarding non-binary genders on mental health practitioner’s attitudes, confidence, comfort, and perceived knowledge. Previous research has shown that brief training can increase positive attitudes for, knowledge of, behavioural intent, and cultural competence for working with sexual and gender minorities, though has not specifically focused on non-binary people. Previous literature has highlighted positive associations between practitioner knowledge and the well-being of non-binary people accessing health services. What this paper adds: This paper adds to the ongoing genesis of options for training mental health practitioners about non-binary people and relevant issues. Findings suggest beneficial outcomes from both prior professional training in this area and the brief training used in the study. The brief online training used in the study was associated with higher perceived knowledge, confidence, and comfort for working with non-binary clients, but further research is needed to understand reasons for change in these variables.

Experiences of patient-centred care in alcohol and other drug treatment settings: A qualitative study to inform design of a patient-reported experience measure.

A growing body of literature supports the use of patient-reported experience measures (PREMs) to monitor the provision of patient-centred care to people accessing health services. However, there is an absence of research into PREMs in the alcohol and other drugs (AOD) field. The aim of this study was to explore patient experiences of AOD care and to develop a PREM for AOD treatment settings. Five focus groups were conducted with people accessing AOD treatment services in New South Wales, Australia (N = 39). Data were analysed using iterative categorisation. A draft PREM was developed based on focus group findings and was modified following a subsequent review by consumers and service providers. Participants emphasised the importance of timely access to integrated care delivered in a structured program by staff members who genuinely care. Furthermore, participants described positive experiences when services addressed the problems that maintain addiction, held them responsible for themselves and facilitated self-reflection. The PREM for Addiction Treatment (PREMAT) is a 33-item measure that captures what participants said regarding their experience of patient-centred care in AOD treatment. The experiences of people accessing AOD treatment provided useful feedback that can be translated into service improvements and that informed the design of a PREM for AOD treatment settings. Future research is necessary to further investigate the validity of the PREMAT.

Young Aboriginal People's Perspective on Access to Health Care in Remote Australia: Hearing Their Voices.

Young Australian Aboriginal people experience poor health outcomes, yet young people and Aboriginal people have low use of health care. To identify barriers and enablers of access for adolescent and young adult Aboriginal people at Derby Aboriginal Health Service (DAHS), a remote Western Australian Aboriginal Community Controlled Health Service (ACCHSs), to assist in improving access. This qualitative study was in the remote Kimberley town of Derby and three Aboriginal communities serviced by DAHS. Semistructured interviews with 26 young Aboriginal people in 2014 and 2015 were used to identify barriers and enablers to accessing local health care services. Participants appreciated interacting with Aboriginal staff, local staff, and longer term DAHS staff. This improved communication and interpersonal interactions, which were reported to be of prime importance for young Aboriginal people accessing health services. Maintaining confidentiality, minimizing shame, and gender matching with health staff were also key issues for young people. Seeking health care was often based on acute need rather than proactive or preventive care; however, participants recognized that providing health education and health promotion should be a priority for the service. A number of approaches to improving health service use by young remote Aboriginal people may be effective. Improving youth engagement seems to be central to increasing acceptability and, hence, use. This requires that staff able to engage with young people are recruited, trained, and retained. More immediately, a range of simpler changes to service provision focus and environment for young people could potentially make important differences.

Screening for Malnutrition Among People Accessing Health Services at Greek Public Hospitals: Results From an Observational Multicenter Study.

Malnutrition is associated with increased hospital stay and subsequently higher healthcare costs. Early detection of malnutrition among people accessing health services at public hospitals is vital to identify and treat malnutrition effectively and in a timewise and cost-effective manner. The aim of this study was to evaluate the nutrition risk of this population. Nutrition screening was performed for 2970 patients (52% male; 55.3 ± 20.1 years old) at 34 hospitals. Nutrition risk was evaluated through 3 nutrition screening tools-Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Mini Nutritional Assessment-Screening Form (MNA-SF). Malnutrition risk was found: 25.3% with NRS-2002, 22.9% with MUST, and 60.5% with MNA-SF. Nutrition risk among patients accessing health services at public hospitals increases with age (high-risk patients among those ≥80 years old: NRS-2002, 9.8%; MUST, 16.9%; MNA-SF, 43.9%). The highest prevalence of nutrition risk was found at the oncology departments (16.7%, NRS-2002; 23.4%, MUST). According to the NRS-2002 and MUST, surgical patients have a greater risk for malnutrition vs internal medicine patients (adjusted odds ratio [OR] = 1.0, P < .001; adjusted OR = 1.17, P < .001, respectively), whereas according to MNA-SF, surgical patients have 30% lower probability for malnutrition risk against internal medicine patients (adjusted OR = 0.7, P < .001). A high prevalence of malnutrition risk was reported among patients accessing health services at public hospitals. Early detection of malnutrition is vital to allow the allocation of the needed workforce to manage it effectively.

Access to, and experiences of, healthcare services by trafficked people: findings from a mixed-methods study in England.

Physical and psychological morbidity is high in trafficked people but little is known about their experiences of accessing and using healthcare services while, or after, being trafficked. To explore trafficked people's access to, and use of, health care during and after trafficking. A mixed-methods study - a cross-sectional survey comprising a structured interview schedule and open-ended questions - was undertaken in trafficked people's accommodation or support service offices across England. Participants were asked open-ended questions regarding their use of healthcare services during and after trafficking. Interviews were conducted with professionally qualified interpreters where required. Thematic analysis was used to analyse the data. In total, 136 trafficked people (from 160 contacted) participated in the open-ended interviews of whom 91 (67%) were female and 45 (33%) male. Participants reported being trafficked for domestic servitude (n = 40; 29%), sexual exploitation (n = 41; 30%), and labour exploitation (for example, agriculture or factory work) (n = 52; 38%). Many responders reported that traffickers restricted access to services, accompanied them, or interpreted for them during consultations. Requirements to present identity documents to register for care, along with poor access to interpreters, were barriers to care during and after trafficking. Advocacy and assistance from support workers were critical to health service access for people who have been trafficked. Trafficked people access health services during and after the time they are exploited, but encounter significant barriers. GPs and other practitioners would benefit from guidance on how these people can be supported to access care, especially if they lack official documentation.

Reflexiones para la política sectorial de salud en Perú a partir de las Cuentas Nacionales de Salud

The objective of this article is to offer those responsible for the Peruvian health rectorship reflections on sectoral policy derived from the study of the country’s National Health Accounts (1995-2014). While it is true that the country has increased its spending on health from 4.4 to 5.2% of GDP, 33% of its total funding comes from household «out of pocket expense», which indicates that change is necessary. Problems in the responsiveness of the health system to greater funding and public expenditure, linked to issues of rectorship and service organization, are apparent.Although there has been an increase in numbers of people with insurance, the restrictions on what is covered prevent the great majority of these people accessing health services. The most important change in the public administration of expenditure has been decentralization, while in the private administration it has been the vertical integration of providers and insurers, which has given rise to a new agent: the health investor.The article concludes that the country is still far from being able to finance the aim of universal access to health care. Recommendations to improve the funding, joint administration, and expenditure point, almost simultaneously, towards generating greater public funding and social security within an active policy aimed at improving the global efficiency and institutionality ofthe system, which should work to the advantage of better health results as well to drastically decrease household pocket expense. Therefore, the success of the financial function is closely related to the adequate performance of the functions of rectorship and provision.

Mental health, mental illness, or some of each? The need for care with the use of language

Mental health, mental illness, or some of each? The need for care with the use of language

Ensuring Sexual and Reproductive Health for People Living with HIV: An Overview of Key Human Rights, Policy and Health Systems Issues

Despite rhetorical attention there is little programmatic guidance as to how best to ensure that women and men living with HIV have access to sexual and reproductive health services that help them realise their reproductive goals, while ensuring their human rights. A dynamic relationship exists between the manner in which health services and programmes are delivered, and the individuals who seek these services. A review of the literature shows clear gaps and highlights areas of concern not yet sufficiently addressed. The delivery and use of health services and programmes is shaped by the underlying determinants of people's access to and use of these services, the health systems in place at community and country level, and the legal and policy environment these systems operate in. Few governments can provide the full range of services that might be required by their populations. In most places, people access health services from a variety of formal and informal providers, and health-related behaviour is influenced from many directions. The synergistic roles of health systems, law and policy and underlying social determinants in helping or hindering the development and delivery of adequate programmes and services for HIV positive people must be addressed.RésuméMalgré une attention rhétorique, il existe peu de conseils sur la meilleure manière de garantir l'accès des hommes et des femmes vivant avec le VIH aux services de santé génésique qui les aideront à réaliser leurs objectifs de procréation, tout en respectant leurs droits humains. Une relation dynamique existe entre la manière dont les services de santé et les programmes sont assurés et les individus qui recherchent ces services. Une étude des publications montre clairement des lacunes et dégage des domaines insuffisamment abordés. Les prestations des services et programmes de santé et le recours à ceux-ci sont façonnés par les facteurs sous-jacents qui déterminent l'accès des personnes à ces services et l'utilisation qu'elles en font, les systèmes de santé en place aux niveaux communautaire et national, et l'environnement juridique et politique dans lequel ces systèmes fonctionnent. Peu de gouvernements peuvent offrir tous les services qui seraient nécessaire à la population. En général, les patients ont accès aux services de santé par le biais de différents prestataires formels et informels, et le comportement sanitaire est influencé par de nombreuses orientations. Il faut s'intéresser à la synergie des systèmes de santé, de la législation et des politiques, et des déterminants sociaux sous-jacents qui aide ou entrave le développement et la prestation de programmes et services appropriés pour les personnes séropositives.ResumenPese a la atención retórica, no existe mucha orientación programática en cuanto a la mejor forma de garantizar que las mujeres y los hombres que viven con VIH tengan acceso a servicios de salud sexual y reproductiva que les ayuden a realizar sus objetivos reproductivos, a la vez que garantizan sus derechos humanos. Existe una relación dinámica entre la forma en que los servicios y programas de salud son proporcionados y los usuarios. Una revisión del material publicado muestra las brechas y resalta las áreas preocupantes que no han sido tratadas lo suficiente. La prestación y el uso de servicios y programas de salud es definida por los determinantes de la accesibilidad y uso de estos servicios, los sistemas de salud en el nivel comunitario y nacional, y el ambiente jurídico y normativo en el cual funcionan estos sistemas. Pocos gobiernos pueden proporcionar la gama completa de servicios que pueda necesitar la población. En la mayoría de los lugares, las personas acceden a los servicios de salud por medio de una variedad de prestadores de servicios oficiales y extraoficiales, y el comportamiento relacionado con la salud es influenciado desde muchas direcciones. Es imperativo tratar las funciones sinérgicas de los sistemas de salud, derecho y políticas y los determinantes sociales implícitos en ayudar o perjudicar la creación y prestación de programas y servicios adecuados para las personas seropositivas.

School based youth health nurses' role in assisting young people access health services in provincial, rural and remote areas of Queensland, Australia

People living in rural and remote areas have poorer health and more limited access to health services than those in urban areas. Adolescence, generally a period of optimum health, is fraught with risky health behaviours, increasing morbidity and mortality. Increasingly, mental health problems including depression, alcohol and drug use, suicide, self-harm, sexual health, inappropriate nutrition and physical activity are key areas of adolescent health concern in Queensland, Australia. To address the health and well being needs of young people the School Based Youth Health Nurse (SBYHN) Program was introduced into State high schools in Queensland in 1998. SBYHN responsibilities include individual consultations and health promotion within the high school environment. This study was undertaken to explore the referral role of SBYHN in provincial, rural and remote Queensland and to ascertain the availability of referral services. A self-report survey was posted to all SBYHN in Queensland. Forty-four (62%) nurses participated; 27 from provincial, 11 from rural and 6 from remote areas. SBYHN consult with young people in provincial, rural and remote State high schools in the areas of psychological concerns, drug and alcohol concerns and/or abuse, family conflict and/or abuse, sexual and reproductive health, social and isolation concerns and nutritional advice. However, the frequency with which SBYHN reported themselves as an appropriate source for young people to seek assistance from varied from over 90% for areas such as sexual and nutritional advice to approximately 30% for areas such as physical abuse and drug and alcohol abuse. When required by the SBYHN, referral services were locally accessible to young people less than 50% of the time. Access to some referral services was reduced because some young people do not want parental involvement in their health and the service requires parental consent. When referral services were unavailable SBYHN used phone counselling, available generalists, supported and monitored the young people until a service was available, or they accepted this as an aspect of residing outside the metropolitan areas and did the best they could. Sometimes, when a young person was reluctant to attend a recommended service or there was a long wait for an appointment, SBYHN provided ongoing support while endeavouring to persuade attendance at the recommended service. Situations like these, experienced by at least half those studied, place SBYHN in the precarious position of practicing beyond their scope of practice. Health problems during adolescence can be reduced by ensuring assistance and support are available for young people when and if they require it. Thorough confidential individual consultations are provided by SBYHN and young people are availing themselves of this service. SBYHN are practicing at an advanced level and need to be recognised as such. Additionally, the availability of services in rural and remote regions needs consideration. As rural youth are more vulnerable to a number of health concerns, it is imperative that services are available for them. The issue of parental consent remains a barrier to young people seeking health services and it may be timely for community debate on this issue.