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PubMed2004

Return to the asylum: the search for clients with enduring mental health problems in Italy.

Deinstitutionalization and community care were the most influential movements in the field of mental health in the last 30 years. In 1978 Italy was the first country to pass laws that would eliminate mental hospitals and replace them with community-based services. Italian ideas about community care provided inspiration for care in the community legislation when this was introduced in the UK. In order to be able to fairly assess and describe the benefits of Italian mental health care, the author visited a range of care facilities in a prescribed region in the north of Italy. In the course of investigation, the author sought to discover if the implementation of what were regarded by some as radical community attitudes in the care of people with mental health problems had led to innovative approaches when dealing with patients/clients requiring long-term care and treatment. Although the Italian approach is enlightened in many areas of care, the system still has to face up to the problems presented in caring for clients/patients with enduring mental health problems. The circumstances relating to care were unexpected and caused the author to revise his opinion of the Italian approach to community care.

Chronic Disease↗
PubMed2006

Health professionals' readiness for infant hearing screening in Lagos, Nigeria.

The authors set-out to ascertain the readiness of professional healthcare workers in Nigeria for the implementation of the country's new national health policy, which for the first time, seeks to address the impact of infant hearing loss on early childhood development through early detection and timely intervention. A cross-sectional survey of nurses and doctors showed that health professionals had positive attitudes towards early hearing detection but were limited in their knowledge about current possibilities with infant screening. The need for relevant/on-going professional education is indicated to effectively promote hearing screening services in early childhood.

Child, Preschool↗
PubMedDate not supplied

International collaboration in health promotion and disease management: implications of U.S. health promotion efforts on Japan's health care system.

For more than 25 years, health promotion and disease management interventions have been conducted by large employers in the United States. Today there are more than 100 studies of such multifactorial, comprehensive interventions that all demonstrate positive clinical outcomes. For those interventions that have also been evaluated for return on investment, all but one have demonstrated cost-effectiveness. This article is an evidence-based overview of the clinical and cost outcomes research to elaborate on the insights gained from this research in the areas of implementation and evaluation of such programs; integration of health promotion and disease management programs into conventional, occupational medicine; accessing difficult to reach populations, such as mobile workers, retirees, and/or dependents; areas of potential conflict of interest and privacy/confidentiality issues; health consequences of downsizing and job strain; and, finally, recommendations for improved integration and evaluation of such programs for both clinical and cost outcomes. With medical costs rapidly escalating again on a global scale, these interventions with evidence of both clinical and cost outcomes can provide the foundation to improve the health, performance, and productivity of both individuals and their corporations.

Cost-Benefit Analysis↗
PubMedDate not supplied

Substance abuse treatment and HIV services: Massachusetts' policies and programs.

States and communities use many strategies and policies to facilitate the integration of HIV and AIDS services with alcoholism and drug abuse treatment and prevention programs. Massachusetts' policy initiatives that promoted collaboration between substance abuse programs and AIDS services are outlined. The review begins with an overview of the HIV epidemic in Massachusetts and reflects on the initial challenges of building system capacity so that HIV and substance abuse services could become more closely integrated. The discussion summarizes specific policy strategies implemented to encourage system development and to develop program and staff skills for working with men and women with HIV/AIDS and at risk of infection. The initiatives included integration of alcoholism and drug abuse treatment programs, expansion of Medicaid reimbursement for substance abuse treatment, training and skills development for counselors, and coordinated service development and advocacy for substance abuse and development for counselors, and coordinated service development and advocacy for substance abuse and AIDS/HIV services.

Alcoholism↗
PubMed1996

Evaluation strategy for Finland's suicide prevention project.

Finland's suicide prevention project (1987-1996) has proceeded to its final phase, evaluation. In this article the general structure of the evaluation and the strategy for evaluating the implementation phase (1992-1996) are presented. The evaluation aims to look at the success of the project in its target areas and the critical factors involved. It deals with the intervention strategies evolved, as well as indicators of progress in suicide prevention activities. A process evaluation approach is used to evaluate the national strategy and the project. The first follow-up (1993) and preliminary results from the ongoing evaluation (1996) show that the project is being largely successful in meeting the operative challenges formulated in the national strategy.

Finland↗
PubMed2003

Implementation of an open access scheduling system in a residency training program.

BACKGROUND AND OBJECTIVES: Open access is one method of improving the quality of clinical practice. Leaving the majority of appointments open to be scheduled the same day allows patients to have control of their access to care. These appointments can be used for all visit types, including physical exams. Our objective was to implement this system to improve efficiency, and patient/provider satisfaction, while maintaining financial profitability. METHODS: We implemented open access at our academic practice on January 2, 2002. Clinical teams are essential for continuity, and implementation required extensive patient, provider, and staff education. We prebook the first three patient appointments for patients requiring language interpretation, prearranged transportation, and procedures. A phone triage system is still necessary for clinical questions or hesitancy about the system. RESULTS: Charges and revenues have increased since implementing the new system, as have patient satisfaction, visits per full-time equivalent, and total monthly volumes. Patient satisfaction is improved, as measured by the percent of abandoned phone calls, average time to make appointments, and the number of no-shows. Nursing work, as measured by triage, nursing callbacks, and bumped appointments, has declined markedly. CONCLUSIONS: Open access has improved revenue, simplified office processes, decreased nursing work, and improved patient satisfaction without any increase in provider time or clinic expansion.

Appointments and Schedules↗
PubMed1996

Obstacles to extending fluoridation in the United States.

The purpose of this paper is two-fold: (1) to describe the current extent of water fluoridation in the United States; (2) to address the major obstacles to attaining 75 per cent fluoridation by the year 2000. While 62.1 per cent of the US population has access to fluoridated public water systems, more than 32 million people need to be added to the fluoridation census, primarily from the cities. The legal framework for implementing fluoridation is considered at the state level; a review of fluoridation actions at the local level is presented. The impact of forces affecting the extension of fluoridation in the United States is described: (1) demographic trends--urbanisation, race, ethnicity, language, immigration, age, education levels, housing, income and poverty levels; (2) external environmental forces/political climate; (3) media influence on public opinion and public policy; (4) voter apathy/lack of awareness of the benefits of fluoridation; (5) perceptions of risks vs. benefits; (6) lack of political campaign skills; and (7) legal issues.

Fluoridation↗
PubMed2004

Implementing the ICPD Programme of Action: what a difference a decade makes.

The Programme of Action adopted at the International Conference on Population and Development in Cairo in 1994 was conceived as a 20-year programme. Now, at its mid-point in 2004, we have reached a time for assessment and re-commitment to its goals. This paper is a reflection on some of the political and other changes that have taken place during the first ten years of the Programme of Action and their implications for its implementation in the coming decade. Many countries have gone ahead and integrated sexual and reproductive health services into primary health care, whether or not the concept has been supported at the international level, and are doing what they can to accommodate the needs of those requiring information and services. The shape of the "playing field" has changed in the past ten years and the goal posts have moved. Yet many countries are adjusting and adapting. The big question, which has yet to be answered, is whether the international community will help or hinder the efforts at country level to achieve the goal of access for all to sexual and reproductive health by 2015.

Adolescent↗
PubMed2006

Collaborative care for bipolar disorder: part I. Intervention and implementation in a randomized effectiveness trial.

Outcome for bipolar disorder remains suboptimal despite the availability of efficacious treatments. To improve treatment effectiveness in clinical practice, a Veterans Affairs study team created a care model conceptually similar to the lithium clinics of the 1970s but augmented by principles of more recent collaborative care models for chronic medical illnesses. This intervention consists of improving patients' self-management skills through psychoeducation; supporting providers' decision making through simplified practice guidelines; and enhancing access to care, continuity of care, and information flow through the use of a nurse care coordinator. In this article, which is part I of a two-part report, the authors summarize the conceptual background and development of the intervention, describe the design of a three-year, 11-site randomized effectiveness trial, and report data describing its successful implementation. Trial design emphasized aspects of effectiveness to support generalizability of the findings and eventual dissemination of the intervention. Part II (see companion article, this issue) reports clinical, functional, and overall cost outcomes of the trial.

Adult↗
PubMed1990

Policy networks and the implementation of community care policy for people with mental handicaps.

Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, 'in few areas can the gap between political rhetoric and policy on the one hand or between policy and reality in the field on the other hand have been so great'. This paper examines the extent and causes of this 'implementation gap' in respect of services for people with mental handicaps--a consistent priority group for national policymakers. We examine centre-periphery relations in the health and personal social services in the light of Rhodes' power-dependence framework and his concepts of policy networks and policy communities. The NHS has been described as the archetypal professionalised policy network but we conclude that it is possible to account for implementation failures in community care only partly in terms of the dominance of the medical professions' values and interests and the deficiencies of accountability and control due to clinical autonomy. Such failures are due also to the inherently limited power of the centre. Sub-central units are not merely its meek agents. Moreover, the centre must explicitly structure local environments by itself providing a coherent framework of service and resource policies compatible with the national objectives it is seeking to achieve.

Community Mental Health Services↗
PubMed2006

[Prophylactic examinations of workers formerly employed in asbestos processing plants: outcome of the Amiantus project in 2000-2004].

BACKGROUND: Prophylactic examinations of workers formerly employed in asbestos processing plants were performed by virtue of the Act, dated 19 June 1997, putting a ban on the production of asbestos-containing products. To enforce the provisions of the Act, the Ministry of Health has initiated the Amiantus project implemented by 13 Occupational Medicine Centers throughout the country and coordinated by the Nofer Institute of Occupational Medicine (IMP) in Lódź. MATERIAL AND METHODS: All the Centers perform diagnostic procedures according to the same criteria (clinical, radiological, spirometric and histological), based on the 1997 Helsinki criteria, to diagnose asbestos-related diseases. A specific "Examination Form", developed for the needs of the Amiantus project, is completed by an occupational physician during examinations and sent to the IMP, where health effects in the whole population covered by the project are monitored. Periodical medical examinations are performed at least every three years and they include: general examination, chest x-ray, resting spirometric examination and supplementary examinations (e.g., resting gasometric examination) or other diagnostic examinations if necessary (e.g., computed tomography). RESULTS: Owing to the project implementation, it was possible to collect in the database information on 5466 persons who underwent 8763 prophylactic examinations in 2000-2004. Of the total population examined during a five-year period, occupational disease was certified in 728 (13%) persons. Asbestosis was diagnosed in 790 persons, lung cancer in 19 persons and pleural mesothelioma in 12 persons. Pleural changes in x-ray imaging were found in 1662 (30%) persons and opacities in pulmonary parenchyma in 2088 (38%) persons. Having compared these results with those from previous examinations, the total health condition deterioration was observed in 882 (16%) persons, including worsening of the lung x-ray imaging in 512 (9%) persons. An analysis showed the highest incidence of asbestos-related pathologies in workers of asbestos-cement plants. The collected data also confirmed an upward trend in the incidence of asbestosis and changes in the lung x-ray imaging related to age, duration of employment and latency. CONCLUSION: The implementation of the Amiantus project has contributed to an increased detection of pathologies related with exposure to asbestos fibers. A growing proportion of radiograms, which indicate worsening of health condition provides evidence that morbid processes in the respiratory system are progressing in persons who in the past were occupationally exposed to asbestos dust.

Adult↗
PubMedDate not supplied

Community-based heart health promotion: perceptions of facilitators and barriers.

This paper examines factors that facilitate or impede the implementation of heart health activities in Ontario public health departments using survey (n = 262) and depth interview (n = 56) data from Canadian Heart Health Initiative-Ontario Project (CHHIOP). The data were consistent in revealing factors related to leadership, staffing, resources, internal organization, and characteristics of the surrounding community as the primary facilitators or barriers. Diversity within these common themes reflected variation due to external factors in the communities served by the health unit and factors internal to the health unit itself. The findings advance knowledge of the factors that influence predisposition and capacity to undertake community-based heart health promotion in public health departments, and they underscore the challenge of achieving integrated programs among partner agencies.

Attitude of Health Personnel↗
PubMed1999

Interventions to implement a clinic-based smoking cessation guideline within a staff model HMO.

Smoking cessation guideline development has become widespread, outpacing guideline implementation efforts. To address this problem, HealthPartners undertook a randomized trial of strategies to enhance compliance of a smoking cessation guideline. The intervention aimed at clinic leadership resulted in significantly more compliance, as measured by physicians coding "tobacco use" on a billing form. The intervention aimed at all clinic physicians had no significant effect. The study suggests that smoking cessation guideline efforts should focus on clinic leadership and system changes rather than on all staff physicians.

Follow-Up Studies↗
PubMed2003

Maintenance of a health promotion program in elementary schools: results from the CATCH-ON study key informant interviews.

To better understand the institutionalization process in Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention and control schools, 199 key informant interviews were conducted with school food service staff, physical education teachers, classroom teachers, and administrators at the four CATCH-ON field centers. School personnel were asked to talk about the degree of CATCH program implementation, who at the school or school district was instrumental in promoting CATCH, and the conditions that facilitated or impeded the institutionalization of CATCH activities and philosophies. The CATCH Physical Education (PE) component appeared to have the highest level of institutionalization, and the CATCH classroom curriculum and family components appeared to have the lowest levels of institutionalization. The primary barriers expressed included the low priority for health promotion activities and time constraints of schools: lack of mechanisms for training of school staff; and lack of sufficient funds for materials, equipment, and lower fat vendor products.

Cardiovascular Diseases↗
PubMed2005

Microcounseling skills training for informal helpers in Uganda.

BACKGROUND: Years of political instability, civil unrest, and disease have left scores of Ugandans in need of mental health services. However, there are few formal mental health services available in the country. Professional helpers such as clergy, teachers, and healthcare workers who have strong ties to their communities are frequently placed in formal counseling roles. AIMS: To develop, implement, and evaluate a training model for developing micro-counseling skills designed specifically for informal helpers in Uganda. METHODS: Forty-four professional helpers were provided with a one-week, 40-hour training program in microcounseling skills. RESULTS: Following the training program, trainees demonstrated proficiency in basic counseling skills and attained an increased knowledge of those skills. CONCLUSIONS: This training was readily assimilated and supported the ecological validity of the microcounseling model.

Adult↗
PubMed2006

Effects of a polypharmacy edit and reduced quantity limits on the utilization of triptans and overall costs in an integrated health system.

On January 1, 2004, Intermountain Healthcare Health Plans implemented a polypharmacy edit and reduced the quantity limits of triptans to minimize the risks associated with triptan polypharmacy. The intervention covered one oral triptan brand per month and allowed one alternate formulation, limited monthly oral triptan quantities, and recommended use of prophylactic medication. During 2003, the prescription count per quarter for triptans increased from 4,816 to 5,359. The number of utilizing members increased from 2,659 to 2,781 over the course of the year. Total ingredient cost for fourth-quarter 2003 was dollar 932,950. For first-quarter 2004, the prescription count was 4,131 (used by 2,423 members) at a total ingredient cost of dollar 583,988. Fourth-quarter 2004 utilization was 4,763 prescriptions, 2,719 members, and dollar 700,534 total ingredient cost. The total triptan spend was dollar 872,718 lower during 2004 compared with 2003. Total medical claims remained constant over the two-year period for members who had a history of at least one triptan during that time. Educating members and health care professionals about the appropriate use of triptans can improve outcomes, and reevaluation of polypharmacy edits and quantity limits based on evolving clinical data improves the appropriate use of triptans.

Antidepressive Agents, Second-Generation↗
PubMed1997

Community Treatment Teams: an alternative to state hospital.

This article describes the implementation of Community Treatment Teams as a strategy to provide services to patients discharged from a state psychiatric hospital. The closing of Philadelphia State Hospital was the impetus for the development of an alternative long term care treatment system for the seriously mentally ill which was based on a variation of the community treatment team model. This article provides a description of the teams, their functioning, structure, and the impact they have had on the service system.

Adult↗
PubMed2006

Fair Access to Care Services (FACS): implementation in the mental health context of the UK.

Since April 2003, all adults requiring social care services must have an assessment to determine their eligibility, which is set within the four-level framework of Fair Access to Care Services [FACS; LAC (2002)13]. This paper examines the implementation of FACS by community mental health teams in eight sites in mental health partnership trusts, and one in a mental health and social care trust in the UK. Twenty-eight respondents (managers within trusts and social services departments) participated in in-depth qualitative interviews, which were undertaken between August 2004 and February 2005. The interviews covered: consultation with users and partner organisations; training and briefings for staff; FACS thresholds; integration of FACS and the Care Programme Approach; and the impact of implementing FACS on budgetary arrangements between health and social care. Using the framework analysis approach to analyse data, it was found that FACS implementation in mental health services has been somewhat haphazard, and has identified real differences between health and social care approaches to eligibility determination, assessment and priorities. In particular, the type and amount of consultation, training and induction into FACS was variable, and in some cases, unacceptably poor. While FACS may have reduced variability between authorities, the exercise of professional judgement in the operation of FACS and the lack of high-quality preventative services remain as potential sources of inequity within the system. The authors conclude that FACS has revealed and reinforced a growing separation rather than an integration of mental health and social care ideas and practices, at least in the participating sites.

Adult↗