Physical Health Services Research Articles

Social Policy Priorities to Promote Health and Social Work.

At the start of the Biden–Harris administration and the 117th Congress, the National Association of Social Workers (NASW, 2021) outlined critical policy recommendations across an array of topics in the 2021 Blueprint of Federal Social Policy Priorities. These resolutions were developed through an evidence-based lens closely aligned with the Grand Challenges for Social Work supported by the profession (American Academy of Social Work and Social Welfare, 2017). These policy priorities recognize that social workers perform essential functions in mental, behavioral, and physical healthcare within varied settings and among diverse populations across the country. The 2021 blueprint frames health in a comprehensive manner wherein mental and behavioral health are regarded as essential elements in one’s overall health and wellness. From this all-inclusive perspective, the profession endorses a national health care policy that ensures access to a full, coordinated continuum of physical and mental health and social care services for all people. A single-payer system that ensures universal access to these services is the best means to achieve this goal, and the [Patient Protection and] Affordable Care Act (ACA) moves the nation in the right direction. The ACA should be preserved and expanded.” (NASW, 2021, p. 9)

OP103 Enhancing Legitimacy And Coherent Value Appraisal Across Interventions In Healthcare And Social Services: Strategy Of The Québec Agency

IntroductionThe Institut national d’excellence en santé et en services sociaux (INESSS) makes recommendations regarding introduction, coverage, optimal use or withdrawal of interventions in physical and mental health and social services to support fair and reasonable decisions. The objectives of this work were to develop a statement of principles and ethical foundations for a common appraisal framework across diverse interventions, to enhance legitimacy and coherence of evaluation practices, and develop reflective approaches throughout the institution to operationalize the principles.MethodsTo develop this statement, INESSS reviewed its practices across different units, surveyed the literature on innovative practices and the evolution of HTA, and undertook an extensive internal and external consultative process. The principles are used to develop reflective activities as part of a continuous improvement strategy.ResultsThe adopted approach to value appraisal considers the contributions of interventions to the Triple Aim of health and social services systems as well as their organizational and sociocultural feasibility and impacts (clinical, populational, economic, organizational, sociocultural dimensions). This approach is articulated around five principles including: (i) evaluating the most relevant objects and adapting evaluation modalities; (ii) mobilizing and integrating diverse types of knowledge; (iii) supporting multidimensional deliberation including diverse perspectives; (iv) developing fair and reasonable recommendations; (v) promoting value creation by supporting the implementation of recommendations and re-evaluation. Although all principles contribute to the legitimacy and credibility of the recommendations, which we aim to implement and consolidate through a set of activities, deliberation is an important part of the process that we are striving to improve. A first set of reflective activities are planned to support its operationalization, including: materials to promote a common understanding of the diverse aspects of the deliberation, reflective workshops on selected past projects, and sharing emerging reflections across INESSS units to further continuous improvement in operationalizing the principles.ConclusionsMoving forward, INESSS’s strategic intention is to mobilize its staff and collaborators to facilitate the rigorous, agile and coherent application of these principles.

Socio-demographic disparities in receipt of clinical health care services during the COVID-19 pandemic for Canadian children with disability

BackgroundLittle is known about the experience of receiving in-person and virtual clinical health care services during the COVID-19 pandemic for Canadian children with developmental disabilities and delays facing multiple layers of vulnerability (e.g., low income, low educational attainment families). We examined the relationship between socio-demographic factors and the receipt of these services (physical and mental health services) during COVID-19 for Canadian children with these conditions.MethodsData collected in Canada for the Global Report on Developmental Delays, Disorders and Disabilities were used. The survey: (1) was developed and disseminated in collaboration with caregivers of children with disabilities, (2) included topics such as response to the pandemic and receipt of services and supports, and (3) documented the experiences of a non-random convenience sample of caregivers of children (any age) with these conditions during and prior to the pandemic. We used four logistic regression models to assess the association between socio-demographic factors and receipt of services.ResultsBeing a single parent, having low educational attainment (high school or less), having low income (making less than $40,000 per year), working less than full time (working part-time, working reduced hours due to COVID, retired, stay home parent or student), as well as male gender and older age of the child with disability were factors associated with decreased likelihood of receiving services.ConclusionOur findings point to the need for tailoring services for families of children with disabilities, particularly low socioeconomic status families, to ensure continuity of care during public health emergencies.

Mortality in Schizophrenia-Spectrum Disorders: Recent Advances in Understanding and Management.

Schizophrenia is a life-shortening disease and life expectancy in patients may be 15-20 years shorter than in the general population, with increasing longevity gap over time. Premature mortality in schizophrenia-spectrum disorders is mainly due to preventable natural causes, such as cardio-vascular disease, infections, respiratory tract diseases and cancer, alongside suicide, homicide and accidents. There is a complex interplay of factors that act synergistically and cause physical morbidity to patients and subsequent mortality. Smoking, alcohol/substance abuse and sedentary life style, alongside disease-related factors, such as metabolic abnormalities and accelerating aging contribute to physical morbidity. Moreover, the symptomatology of psychosis and stigma may limit patients' access to quality medical care. Interventions to promote physical health in those patients should be multifaceted, and should target all patient-related modifiable factors, but also should address service-related healthcare disparities. Long-term antipsychotic use (including clozapine and long-acting injectables) is associated with substantially decreased all-cause mortality, including suicide and cardiovascular mortality, in patients with schizophrenia despite the well-known cardiometabolic adverse effects of second-generation agents. Integrated care may involve co-location of physical and mental health services, liaison services, shared protocols and information sharing systems, and has emerged as a way to address the physical health needs of those patients. Interventions to address mortality in schizophrenia and related syndromes should take place as early as possible in the course of the patients' treatment, and could be an integral component of care delivered by specialized early intervention services.

Characteristics of suicide decedents with no federally funded mental health service contact in the 12months before death in a population-based sample of Australians 45 years of age and over.

More than half of suicide decedents have no contact with mental health services 12months before death. It is uncertain if they have different characteristics than decedents who use mental health services. A case-series design. Participants 45 years and older, who died by suicide (2006-2018). Comparisons were made between those who did and did not have contact with mental health services, using individually linked data from federal services in the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). Of 186 cases, 71% had no contact with mental health services. Physical health services were used equally by 75%. Psychiatric medication use was uncommon, except for antidepressants, 50% with mental health service contact and 20% with no contact. Older age, lower income, involuntarily unemployed, firearms as suicide method, greater physical disability, less functional impairment due to emotional problems and lesser proportions with mental illness, were associated with no contact with mental health services. For suicide prevention, middle-older aged adults may have less requirement for mental health intervention, and greater requirement for the development of complementary interventions focused on physical health and social issues, which are not necessarily best delivered by clinical mental health services.

SCREENING AND PHYSIOTHERAPY SERVICES FOR MUSCULOSKELETAL COMPLAINTS IN THE ELDERLY DURING THE COVID-19 PANDEMIC AT TRESNA WERDHA WANA SOCIAL ORIGINAL SERAYA

The number of elderly people in Indonesia from year to year continues to increase. With the increasing amount of elderly, it is followed by an increase in musculoskeletal complaints. The outbreak of Covid-19 has resulted in limited and disrupted physical activity and health services for the elderly. The elderly are a group at risk of death if infected with Covid-19 because there is a degenerative process and there are co-morbidities. Community service activities carried out at the Tresna Werdha Wana Seraya Social Home in Ketalanggu Village aims to provide health services so that during the Covid-19 pandemic the quality of life for the elderly will be better. Activities carried out using blood pressure screening methods and examination of musculoskeletal complaints as well as providing physiotherapy services related to musculoskeletal complaints such as exercise and infrared therapy for free to the elderly. The participation in this community service activity was 34 people with the most aged 66-70 years. The results of this activity are the presence of the elderly, and the results of blood pressure screening and services for musculoskeletal complaints in the elderly at the Tresna Werdha Wana Seraya Social Institution during the Covid-19 pandemic.

Technology-Enabled Collaborative Care for Diabetes (TECC-D): Feasibility and Acceptability of a Disruptive Integrated Care Model

Currently, individuals living with type 2 diabetes (T2D) and mental health issues navigate a fragmented health-care system to seek physical and mental health services. To address these gaps, we co-re-designed a person-centred Technology-Enabled Collaborative Care for Diabetes (TECC-D) model through iterative patient, provider and partner input.

Family team decision meeting and child welfare service disparities: The influence of race and poverty

Family Team Decision Meeting (FTDM) aims to engage families whose children are involved in the child welfare system. This study seeks to understand differences in participants’ satisfaction with FTDM and further examine disparities in offering child welfare services to families who participate in FTDM. Logistic regression results indicated that participants’ race and education and a family’s level of engagement significantly predicted satisfaction with FTDM outcomes. FTDM participants’ age and satisfaction with the facilitators’ skills as well as a family’s level of engagement were significantly associated with their satisfaction with FTDM facilitators. Regarding disparities in offering social services, logistic regression results indicated that White family members were more likely to be offered financial services than family members of color. Age of the family member was a significant predictor of being offered employment services, with family members who were older in age being less likely to be offered employment services. Furthermore, family members who have completed a higher level of education were more likely to be offered mental or physical health services. Families who were below the poverty line were more likely to be less satisfied with the facilitator overall and were less likely to be offered financial services, employment services, mental or physical health services, education and social support services, and any types of services; however, these findings did not reach statistical significance. The results of this study can inform both policy and practice to improve FTDM implementation and ultimately reduce disparities in social services among FTDM participants in child welfare.

Health, Libraries, Research and Education

Researchers in LIS have been working on projects related to health and wellness in various environments, whether related to medical libraries, public libraries, health information behavior, or health information-related community interventions. At the same time, researchers have explored new methods to educate students on both research and on health and wellness as it relates to LIS. It is our goal to bring together the two and create a collaborative panel in which both the panelists and audience participate in a dialog that highlights our research and our engagement with our students over the past couple of years examining health information and practices in our libraries, communities, and classrooms.
 This non-traditional panel focuses on health and wellness research and its impact on student education and engagement in research activities. The session aims to provide an opportunity for both the organizers and the audience to share their research and/or research agendas and engage in conversations and feedback that can contribute to a cohesive understanding as to what researchers are doing in the area of health and wellness. Our objective is also to discuss current pedagogical practices or student engagement opportunities related to these topical areas. Some examples will be physical and mental health programs and services in public libraries, health literacy courses taught by LIS students in public libraries, health insurance education, using the OCLC Call to Action Opioid toolkit with public libraries, public library staff as health information facilitators, and much more.
 The session will begin with the Health SIG members presenting their research through five-minute lightning talks. While the panelists describe their research, they will begin creating a visualization on Google Jamboard that represents the research being discussed. After these first presentations, the audience will be invited to share their own research, which will also be added to the collaborative board. Throughout this process, participants will be invited to offer constructive feedback on each contributor’s ideas. Through this process, we hope to create an exciting, interactive session in which the SIG members and the audience will have the opportunity to share research and teaching strategies and potentially find new collaborators.

A roadmap toward equitable, coordinated, quality reproductive care for women with chronic conditions.

A roadmap toward equitable, coordinated, quality reproductive care for women with chronic conditions.

328 Emergency Department Preparedness to Care for Sexual Assault Survivors: A Nationwide Study

Ideally, emergency departments (EDs) provide trauma-responsive care to sexual assault (SA) survivors and connect them with longitudinal physical and mental health services. However, qualitative studies indicate that ED care may retraumatize survivors, and a 2013 survey found that only ∼20% of US hospitals provide comprehensive services. The aims of this study were to 1) document updated trends in the quality-of-care and resources offered to SA survivors, and 2) identify potential disparities according to geographic regions in the US, urban versus rural clinic locations, and the availability of sexual assault nurse examiners (SANEs).

Norwegian health personnel’s compliance with new legislation on children of ill parents: an exploratory cross-sectional multicentre study

BackgroundIn 2010 the Norwegian Parliament introduced amendments to the Health Personnel Act requiring all health personnel to inform and offer help to their patients’ children and families. We evaluated whether health personnel adhered to their obligations outlined in the Act and investigated whether family and health services characteristics were associated with the degree of compliance with the legislation. Our study was part of a larger Norwegian multi-site study conducted in five health trusts across Norway, assessing the situation for families living with parental illness.MethodA cross-sectional study using quantitative data obtained from 518 patients 246 children and 278 health personnel was performed. All informants completed a questionnaire, including an instrument corresponding to the obligations in the legislation. Descriptive analyses, factor analysis and logistic regression analysis were used.ResultsThe legislation was only partially implemented in the clinics of the health trusts. Compared to estimates prior to the introduction of the new legislation, the situation had improved somewhat, but much work remains to be done to fulfil the obligations decreed by law. The more time-consuming the obligations were, the less often they were met. The substance abuse and mental health services followed up on their obligations to a greater extent than did the physical health services. Conversely, children of physically ill parents were better informed by their families than were children of parents with mental health and substance abuse disorders. When asked the same questions, reports from health personnel were more positive compared to those of children and patients regarding the legislation’s fulfillment.ConclusionData suggest that there has been a change in the support offered to children of ill parents. Additional work is required, however, for the Health Personnel Act to function as fully intended.

Mental health care for older adults: recent advances and new directions in clinical practice and research.

The world's population is aging, bringing about an ever-greater burden of mental disorders in older adults. Given multimorbidities, the mental health care of these people and their family caregivers is labor-intensive. At the same time, ageism is a big problem for older people, with and without mental disorders. Positive elements of aging, such as resilience, wisdom and prosocial behaviors, need to be highlighted and promoted, both to combat stigma and to help protect and improve mental health in older adults. The positive psychiatry of aging is not an oxymoron, but a scientific construct strongly informed by research evidence. We champion a broader concept of geriatric psychiatry - one that encompasses health as well as illness. In the present paper, we address these issues in the context of four disorders that are the greatest source of years lived with disability: neurocognitive disorders, major depression, schizophrenia, and substance use disorders. We emphasize the need for implementation of multidisciplinary team care, with comprehensive assessment, clinical management, intensive outreach, and coordination of mental, physical and social health services. We also underscore the need for further research into moderators and mediators of treatment response variability. Because optimal care of older adults with mental disorders is both patient-focused and family-centered, we call for further research into enhancing the well-being of family caregivers. To optimize both the safety and efficacy of pharmacotherapy, further attention to metabolic, cardiovascular and neurological tolerability is much needed, together with further development and testing of medications that reduce the risk for suicide. At the same time, we also address positive aging and normal cognitive aging, both as an antidote to ageism and as a catalyst for change in the way we think about aging per se and late-life mental disorders more specifically. It is in this context that we provide directions for future clinical care and research.

Canadian Veteran chronic disease prevalence and health services use in the five years following release: a matched retrospective cohort study using routinely collected data

BackgroundOccupational exposures may result in Canadian military Veterans having poorer health and higher use of health services after transitioning to civilian life compared to the general population. However, few studies have documented the physical health and health services use of Veterans in Canada, and thus there is limited evidence to inform public health policy and resource allocation.MethodsIn a retrospective, matched cohort of Veterans and the Ontario general population between 1990–2019, we used routinely collected provincial administrative health data to examine chronic disease prevalence and health service use. Veterans were defined as former members of the Canadian Armed Forces or RCMP. Crude and adjusted effect estimates, and 95% confidence limits were calculated using logistic regression (asthma, COPD, diabetes, myocardial infarction, rheumatoid arthritis, family physician, specialist, emergency department, and home care visits, as well as hospitalizations). Modified Poisson was used to estimate relative differences in the prevalence of hypertension. Poisson regression compares rates of health services use between the two groups.ResultsThe study included 30,576 Veterans and 122,293 matched civilians. In the first five years after transition to civilian life, Veterans were less likely than the general population to experience asthma (RR 0.50, 95% CI 0.48–0.53), COPD (RR 0.32, 95% CI 0.29–0.36), hypertension (RR 0.74, 95% CI 0.71–0.76), diabetes (RR 0.71, 95% CI 0.67–0.76), myocardial infarction (RR 0.76, 95% CI 0.63–0.92), and rheumatoid arthritis (RR 0.74, 95% CI 0.60–0.92). Compared to the general population, Veterans had greater odds of visiting a primary care physician (OR 1.76, 95% CI 1.70–1.83) or specialist physician (OR 1.39, 95% CI 1.35–1.42) at least once in the five-year period and lower odds of visiting the emergency department (OR 0.95, 95% CI 0.92–0.97). Risks of hospitalization and of receiving home care services were similar in both groups.ConclusionsDespite a lower burden of comorbidities, Veterans had slightly higher physician visit rates. While these visits may reflect an underlying need for services, our findings suggest that Canadian Veterans have good access to primary and specialty health care. But in light of contradictory findings in other jurisdictions, the underlying reasons for our findings warrant further study.

P05-12 Objectively measured physical activity, chronic illness and health service utilisation - a latent class analysis of activity behaviours in older adults

BackgroundPhysical activity contributes to the prevention of chronic illness as well as promotion of physical and mental health, but most adults remain inactive. Chronic illness affects mainly middle aged and older adults, and very little objectively measured data on physical activity behaviours and associated health outcomes of this population is published. The aims of this study are to: 1. Objectively measure physical behaviour outcomes of adults participating in the Move for Life study; 2. Develop distinct activity profiles based on six behaviour variables; 3. Investigate whether health outcomes differ across the activity profiles.MethodsParticipants were Irish adults aged 50 years and older. Using the activPAL, objectively measured data were collected on average daily: light intensity physical activity (hours); moderate to vigorous intensity physical activity (minutes); step count; time in bed (hours); standing time (hours); and waking sedentary time (hours). Data were obtained on chronic illness and health service utilisation. Validated questionnaires were used to collect data on wellbeing, loneliness and social isolation. Hierarchical cluster analysis using squared Euclidian distance was used to cluster behaviours based on similarity, using SPSS version 26. Regression models explored associations between health outcomes and activity profiles, adjusted for age and sex.ResultsData from 485 participants were analysed, and four activity profiles were identified: sedentary (n = 50, 10.3% of total), low active (n = 295, 60.8%), moderate active (111, 22.9%) and higher active (n = 29, 6%). We will present the differences across the activity profiles for chronic illnesses, multi-morbidity, health service utilisation and validated health tools, comparing to data from the Irish Longitudinal Study on Ageing (TILDA) and the English Longitudinal Study on Ageing (ELSA).ConclusionsThe use of physical activity behaviour clusters may identify people with multi-morbidity and higher utilisation of health services. These findings could be factored into the development of future targeted physical activity interventions.

Exploring the voices of health promotion stakeholders concerning the implementation of physical activity programs for the social and emotional wellbeing of young Aboriginal and Torres Strait Islander girls

Physical activity and sport programs have been promoted as a strength-based way to enhance social and emotional wellbeing in young Aboriginal and Torres Strait Islanders. However, there is limited evidence that describes how these programs may be tailored for girls. Semi‐structured interviews with health promotion stakeholders (N = 11) explored organizational perceptions of the needs and preferences of young Aboriginal and Torres Strait Islander girls in relation to physical activity and social and emotional wellbeing. Interviews also investigated best practice approaches for implementing holistic health programs for the population. Thematic analysis revealed two overarching themes: (1) Perceived physical activity and health service needs, preferences and behaviours and (2) Best practice engagement strategies and associated challenges. A need for culturally safe, youth-friendly services was emphasized, where physical activity and sport may play an influential role. Program development recommendations included focussing upon health literacy, utilizing co-design and creating culturally secure, fun environments.

Food insecurity during COVID-19: An Australian university experience.

The aim of this study was to describe the prevalence, severity, coping strategies and precipitating factors of food insecurity in university students in a large multi‐campus Australian university during the COVID‐19 lockdown in 2020, in context of providing information to inform institutional support. This was a cross‐sectional analysis which was part of a larger university‐led research project, the Thrive@Home study conducted at Monash University during the COVID‐19 pandemic. The main outcome measures included: Sociodemographic characteristics, PROMIS anxiety, PROMIS depression and the six‐item US Department of Agriculture Household Food Security Survey Module. All variables were reported according to the four levels of food security status (high (H), marginal (M), low (L) and very low (VL)). Chi‐squared tests were used to compare all categorical variables including demographic, mental health and food security status. A multivariable regression was conducted between food security status and mental health variables. Overall, n = 1315 students were included in the analysis. Of which, 5% were classified as having VL food security, 13% L, 14% M and 68% H. As food security worsened the likelihood of being unemployed looking for work, living alone and deteriorating physical health, diet quality and mental health increased. As food security status deteriorated the prevalence of needing to ask family or friends for food, shopping at multiple outlets for discounts, accessing emergency food relief, subsidised meals and financial assistance from organisations increased (p < 0.002). In regression models adjusting for covariates, depression (b (95%CI): VL = 7.2(4.1–10.3), L = 3.7(1.7–5.7), M = 2.0(0.1–3.8)) and anxiety (VL = 7.4(4.5–10.4), L = 3.5(1.5–5.4) and M = 2.0(0.3–3.8)) were positively associated with worsening food security. Food insecurity during COVID‐19 was associated with worsening mental health. This paper provides targets for future university‐led initiatives to promote student food security and supporting better access to physical and mental health services.

Mental Health Problems during COVID-19 Pandemic

Mental health is essential to achieving a comprehensive degree of health, but it has not become a top priority in some developing countries. The COVID-19 pandemic has made it difficult for people to access physical and mental health services. The situation of this pandemic pushes WHO and mental health services as an integral component of the condition. Only a third of healthcare providers in the United States can receive standardized mental health care. In developing countries with low and middle incomes, 75% more people experience neurological disorders, mental disorders, and addictive substance abuse. The prevalence of patients affected by Post-Traumatic Stress Disorder (PTSD) is around 4-41%, and the prevalence of major depression due to the epidemic - increased by 7%. Unfortunately, of those with mental disorders, only a tiny percentage get proper treatment.

Patient satisfaction with mental and physical health services: Findings from a UK-wide online survey.

Introduction - Despite extensive debate surrounding mental health services in the UK, there is little empirical evidence regarding the views of those who use them. We therefore used data collected as part of a wider survey to examine satisfaction amongst those seeking treatment from mental and physical health services. Methods - An online survey designed with input from people with experience of mental illness was used to measure satisfaction with NHS mental and physical health services at first contact and in the previous 12 months. Results - A total of 2187 people responded. During the 12 months prior to the survey, 526 respondents had sought mental health care and 1379 had sought physical health care. Participants were significantly more satisfied with their most recent contact with mental health services (48.1% very/satisfied) than with their first contact (38.2% very/satisfied). More than 1 in 10 respondents who sought mental health care (11.4%) stated that they received no treatment/support from the NHS, compared to approximately 1 in 20 respondents who sought physical health care (4.6%). Of those who received the mental health treatment they requested (n = 424), most were satisfied or very satisfied with their care (54.7%), although this was lower than the corresponding figure (77.9%) for satisfaction with physical health care received (n = 1190). Conclusion -There was evidence that mental health services are satisfactory for a slim majority of users, but people were generally more satisfied with NHS physical health care. This survey was conducted in the year prior to the coronavirus disease 2019 pandemic. Future research could examine what influences satisfaction with care and whether this picture has changed following the emergence of the pandemic and consequent impact on health service delivery and daily life.

Associations between Physical Activity Level and Health Services Use in Spanish Adults.

One of the main concerns of governments and organisations worldwide is the cost and burden of health services, with sedentary lifestyles being a significant impacting factor, and physical activity is one of the potential solutions. Therefore, this study aims to analyse the possible associations between the physical activity level, hospitalisation prevalence, and the use and number of visits to emergency services in the Spanish population, examining potential differences between sex and age groups. This is a cross-sectional study based on data from the Spanish National Health Survey 2017 (ENSE 2017), the last one before the COVID-19 pandemic, with 17,199 participants. A descriptive analysis was performed using median and interquartile range (continuous variables) and absolute and relative frequencies (ordinal variables). Intergroup differences were analysed with non-parametric tests: chi-square and z-test for independent proportions (categorical variables), and Kruskal–Wallis and Mann–Whitney U (continuous variables). Spearman’s rho was used to study correlations between variables. A multiple binary regression analysis was performed to predict hospitalisations. Hospitalisations and emergency services use showed a dependence relation with the physical activity level (p < 0.001): those who performed moderate and/or vigorous physical activity used those services less than sedentary individuals and those whose only activity was walking. Thus, associations could be drawn between the hospitalisation prevalence, the use and number of visits to emergency departments, and the physical activity level in the Spanish population aged 18–69 years in the pre-pandemic period.