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PubMed1999

The influence of health needs assessment on health care decision-making in London health authorities.

OBJECTIVES: Health needs assessment gained prominence under the model of health care purchasing developed to support the 1991 reforms of the UK National Health Service (NHS). The objectives of this paper are to determine how needs assessment has been used in the NHS, to assess the influence it has had on decision-making, and to relate the observed uses of needs assessment to competing theoretical models of health care policy-making. METHODS: A survey of needs assessment activity in 14 London health authorities identified 217 needs assessments conducted between 1993 and 1996. Semi-structured interviews were conducted with public health and commissioning staff in each authority. RESULTS: The survey indicated that needs assessment directly supported decision-making and action in two-thirds of the studies identified, but up to 20% of needs assessments had no impact on service provision. Four key functions of health needs assessment were observed: identifying a problem; planning detailed changes to services; providing post hoc justification for earlier decisions; and using participation in needs assessment to build 'ownership' of subsequent decisions. CONCLUSIONS: The survey suggests that needs assessment is, in practice, consistent with a 'mixed scanning' model of decision-making. Needs assessment is used to help select issues for detailed investigation and to direct analytical and decision-making resources. However, certain key areas are not amenable to technical analysis and solution, and are resolved through bargaining.

Data Collection↗
PubMed1998

A study to determine how needs assessment is being used to improve health.

OBJECTIVE: To determine how needs assessment is being used in Health Authorities and General Practice. DESIGN: A postal survey of a one in two sample of Scottish GPs, semistructured interviews with selected health authority executives and a random sample of GPs. SUBJECTS: Nine hundred and sixty-five GPs (54% of those sent the postal questionnaire), 47 randomly selected GP practices and 36 selected health authority (called health boards in Scotland) executives. RESULTS: In health authorities, a view of commissioning/planning emerged with three components: (1) planning (including needs assessment); (2) leadership; and (3) strong relationships with stakeholders. Health authority executives believed that GP involvement is one of several vital components but doubted the commitment of all but a few GPs to the planning process. GPs welcomed enhanced influence but feared increases in workload and admitted to a lack of training in the skills required for needs assessment. Health authority executives aspired to place needs assessment at the centre of planning but admitted that, at present, cost and volume issues predominate. Most GPs were not involved in needs assessment and argued that it is not part of a GPs core activity. National needs assessment documents were well received by health authorities but made little or no impact on GPs. CONCLUSIONS: Needs assessment will have little involvement from primary care until there are changes in the attitudes and skills of the majority of GPs. Fundamental changes are required in health authority priorities and practice if their rhetoric about needs assessment is to be turned into reality. The role of needs assessment could be enhanced but this will only happen if it can be shown to lead to improved health outcomes while addressing the financial pressures that currently dominate the agenda.

Attitude of Health Personnel↗
PubMedDate not supplied

Continuity of care: a nursing needs assessment instrument.

Based on testing of the Uniform Needs Assessment Instrument (UNAI), a nursing needs assessment tool for adult hospitalized patients was integrated into nursing practice. Some content and format changes to the UNAI occurred as a result of the research process. The revised assessment form is called the Nursing Needs Assessment Instrument (NNAI). Community providers, including nursing home and home health care personnel, use the NNAI to derive necessary admission data for assessing patients, planning care, and communicating with other staff regarding patient needs. Instituting an evidence-based practice change in hospital discharge forms enables the next care provider to consistently meet the patient's continuing needs.

Adult↗
PubMed1979

The nature of needs assessment in community mental health.

Confusion in defining needs assessment is discussed. A tripartite model of needs assessment is proposed: an identification of a problem; a statement about priorities; and a chosen solution. The parts can be used independently or linked together to plan new or altered services. Various needs assessment techniques are examined for their usefulness in each area. Two examples of needs assessment processes are given.

Community Mental Health Services↗
PubMed1999

Identifying approaches to meet assessed needs in health visiting.

An action research project, based in a single fundholding practice on the south coast of England, aimed to identify the health needs of families with resident children, then use the contracting system to redirect health visiting services to meet those needs. After assessing the health needs, it was necessary to assess the potential of a range of health visiting approaches that might be proposed to meet those needs. This paper explains how the approaches were assessed for use in the local area and why funding for two additional, innovative posts was deemed necessary. Despite the unsophisticated evidence base for health visiting interventions, a case can be made for commissioning particular service approaches by using a combination of survey data and results from controlled and uncontrolled service evaluations. The supportive focus of health visitor home visiting remains an appropriate use of existing resources, but the usual intensity of visiting may be insufficient for full effectiveness. To rationalize such services by targeting them only at individuals with established needs risks an exacerbation of deteriorating health trends across an area. Alternatively, augmenting home visiting with a community development approach to improve the adverse social environments in which families live may help to change the underlying factors that contribute to ill-health and prove more widely cost-effective.

Adult↗
PubMed1999

The needs assessment checklist: a clinical approach to measuring outcome.

OBJECTIVE: To evaluate the outcome of the Needs Assessment and Goal Planning Programme used in the rehabilitation of people with spinal cord injuries. The Needs Assessment Programme incorporates a behavioural indicator rating scale to detail the individual's progress and rehabilitation needs. This can also be used to evaluate the outcome of the rehabilitation programme in general. The Needs Assessment Checklist (NAC) forms part of the programme and is a tool which is used to evaluate rehabilitation outcome. SETTING: A purpose built, national spinal injuries centre in the United Kingdom. SUBJECTS: 82 patients who had completed the Needs Assessment Checklist, both at the beginning and towards the end of the rehabilitative process. RESULTS: Independence, as measured by the Checklist, was significantly greater in all domains at the time of the second Needs Assessment. CONCLUSIONS: The Needs Assessment and Goal Planning Programme is successful in establishing greater client independence, whether assessed at a verbal or physical level. Team members have used the Needs Assessment Checklist as a behavioural indicator of rehabilitation outcome based on available standards of rehabilitative care. Further development of the Needs Assessment Checklist now needs to focus on establishing concurrent validity and test/retest reliability. The measure developed proved to be a useful, clinically relevant and patient friendly assessment of rehabilitation outcome.

Activities of Daily Living↗
PubMed1984

Needs assessment and hospice planning in a rural setting.

A needs assessment is a research and planning activity designed to determine a community's service needs and utilization patterns. One of the most practical ways to plan services is to gather information accurately about a defined population and use that information to revise existing programs or develop new ones. Unfortunately, needs assessment findings often go unused. This article describes how a needs assessment was designed to assess the need for hospice services in a rural Pennsylvania county and how the results of this assessment were useful in determining priorities for program planning and service development. The implications of a model needs assessment such as the one proposed are discussed.

Health Services Needs and Demand↗
PubMed1998

A pilot study of needs assessment in acute psychiatric inpatients.

The needs of acute psychiatric patients have been less studied than those of long-term patients. A pilot study of needs assessment using the MRC Needs for Care Assessment Schedule is reported in 35 consecutive acute inpatients who had been in hospital for 1 month or more. Unmet clinical needs included treatment of drug side effects and dangerous and socially embarrassing behaviour. Unmet social needs were widespread and included household shopping, cooking meals, occupation and money management. Although the MRC Needs for Care Assessment was found unsuitable for assessing needs in very acutely ill patients whose mental status was rapidly changing, we did find it a useful instrument in more stable acute patients, both on an individual basis and for identifying service underprovision.

Acute Disease↗
PubMed1997

Needs assessment for mentally disordered offenders and others requiring similar services. Theoretical issues and methodological framework.

BACKGROUND: The government has highlighted the service needs of mentally disordered offenders (MDOs) and has introduced policies which have driven MDO needs assessment. METHOD: Based on a literature review and a national survey of agencies likely to be conducting needs assessment, the paper reviews government policy regarding MDO needs assessment and examines the particular problems of conducting needs assessment for MDOs. RESULTS: A methodological framework for MDO needs assessment is presented, and different needs assessment approaches are discussed. The methodological and practical limitations of conducting MDO needs assessment are emphasised, as is the role of subjective judgement in both research design and interpretation. CONCLUSIONS: Needs assessment is value-laden. Also, no single needs assessment approach can address all the issues of importance to purchasers and providers. Substituting the term 'perspectives on need' for the term needs assessment would help to reflect the lack of a single 'truth' about need and emphasise the role of subjective political judgement in designing and interpreting research on 'need'.

Dangerous Behavior↗
PubMed1982

Needs assessment in continuing medical education: a practical guide.

The identification and assessment of learning needs and the setting of priorities are the foundation of successful program planning in continuing medical education (CME). The present report includes recommendations concerning optimal procedures for the assessment of the learning needs of individual physicians, small groups, and large groups. The vital role of learners and their perceived needs in emphasized. Appropriate and accurate needs assessment contributes greatly to the success of CME programs. The most effective needs assessment involves the dynamic interaction of teachers, learners, and experienced program planners. The recommendations in this report are based on studies and interviews conducted in several major academic health centers in the United States and Europe over a period of one year. Research efforts to improve needs assessment techniques are greatly needed. As improved methods of needs assessment are adopted, CME planners may be assured that their programs will become more attractive and effective.

Clinical Competence↗
PubMed1996

Needs assessment: taking stock.

In 1994, the Scottish Needs Assessment Programme (SNAP) carried out a stocktaking review of all needs assessment reports in 14 topic areas produced in Scotland on the previous three years. National needs assessment documents from England in the relevant topic areas were also reviewed. The review identified two particular points for comment. First, in respect of content, the definition of need as "the ability to benefit'-while appropriate for NHS purchasing- must be balanced by a greater emphasis on the wider concerns for the public's health. At the same time, relevant economic and costing information should be incorporated. Secondly, the process of information collation for purchasing could be made more efficient. Closer links between clinical experts and public health specialists would ensure assessments based on timely opportunities for change. National reviews should provide generally applicable intelligence and comparative analyses; short local reports can then focus on local quantification and priority setting.

Contract Services↗
PubMed2003

From research to practice: a local mental health services needs assessment.

BACKGROUND: Service planning based on aggregated needs assessment is rarely practised. There is a lack of research into how population-based needs assessment approaches can be translated into routine clinical settings. AIMS: This study aimed to ascertain the 2-month period prevalence of psychosis in Gloucester City, to investigate the level of need among those in contact with mental health services, and to identify the compromises which are involved in routine collection of data to inform services, compared with specifically funded research studies. Method People with ICD-10 diagnosis of functional psychosis were identified by searching General Practice and mental health service records in Gloucester City. The needs of the sub-sample in touch with mental health services were assessed using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). RESULTS: Four hundred and seventy-four cases were identified, including 403 in contact with mental health services. Staff CANSAS data were collected for 225 patients, with a mean rating of 7.0 met and 3.6 unmet needs per patient. Unmet need was higher in the non-Caucasian group. CONCLUSIONS: In this locality, patients with functional psychosis were largely in contact with mental health services, were in employment, were disproportionately looked after by a few City centre General Practitioners, and high levels were in supported accommodation. Higher levels of need were found than previously demonstrated. Systematic assessment of needs with research instruments to contribute to locality service planning is possible without a major research grant, but involves compromises on established research designs.

Adolescent↗
PubMedDate not supplied

Development of an HIV educational needs assessment tool.

The learning needs of persons with HIV/AIDS continue to grow more complex as new treatments are developed and HIV disease shifts from being a terminal to a chronic illness. Clinicians could use a simple tool to help them to focus on what clients think is important to know about living with HIV/AIDS. This article describes the development of the HIV Educational Needs Assessment Tool (HENAT). HIV+ persons (N = 363) who were receiving health care in a variety of ambulatory and institutional settings participated in this research during 1990 and 1993-1994. Factor analysis was used to shorten the instrument into a form that could be used in any nurse/client interaction. Principal axis factor extraction and varimax rotation deleted 16 items. The remaining 34 items were grouped into six factors: Treatments, Entitlements, Relationships, Preventing Infections, Social Support, and Working. Cronbach's alphas were computed and results ranged from .70 to .88. Two month test-retest correlations for a subset of participants (n = 195) ranged from .54 to .67. HENAT can be used (a) to examine differences in perception of learning needs between clients with HIV disease and their health care providers, (b) to measure shifts in learning needs over time, (c) to relate HIV-specific learning needs to length of time living with HIV disease, (d) to give clients an opportunity to assess their learning needs, and (e) as part of a larger intervention study that evaluates the effectiveness of patient education.

Adult↗
PubMed1998

A qualitative approach to community and provider needs assessment in a telehealth project.

OBJECTIVE: Needs assessment is a critical part of the design and implementation of telehealth projects. This study assessed the need for a telehealth link between a local community and a tertiary-care medical center. METHODS: The assessment was conducted using multiple focus groups in a remote community and at a tertiary-care pediatric and women's medical center. Participants were physicians and allied health professionals at both sites and the parents of pediatric patients. Data were analyzed for comment categories and thematic items. RESULTS: The focus groups revealed a number of important positive and negative attitudes regarding telehealth and priorities for implementation. Uncertainty and trust were two themes that emerged from all groups. The resulting design of the telehealth program incorporated these responses. CONCLUSION: Qualitative methods, including focus groups, can yield useful data on complex behavior and explore attitudes toward new and unfamiliar technology.

British Columbia↗
PubMed1993

Needs assessment for reducing infant mortality in Baltimore City: the Healthy Start Program.

Needs assessments are essential for policy formulation and the appropriate design of intervention programs. Recent nationwide data show that among large metropolitan areas of the United States, Baltimore has one of the highest infant mortality rates and ranks in the worst top 10 for blacks and the top 5 for whites for most indicators of poor pregnancy outcome. In this paper, we present the methods and results of a needs assessment that used multiple sources of routinely collected data and was conducted for the purpose of identifying intervention factors contributing to infant mortality in Baltimore City. This needs assessment was used by the Baltimore City Health Department to successfully secure funding for the federal Healthy Start Infant Mortality Prevention Initiative. We present the results of the analyses, along with some of the proposed interventions that resulted from the needs assessment. We also discuss the limitations of this type of needs assessment as well as suggestions for future needs assessments for the design of interventions to improve perinatal health.

Black or African American↗
PubMed1997

Needs assessment and palliative care: the views of providers.

BACKGROUND: A key element within the programme of reform introduced into the UK National Health Service in the 1990s has been the concept of health needs assessment, which must be undertaken by health care purchasers as a guide to the planning process. As part of a wide-ranging study of the impact of the NHS reforms on hospices and specialist palliative care services, providers' perceptions of needs assessment for palliative care were examined, including the extent to which needs assessments had been carried out in local districts, together with the implications. METHODS: The study comprised two key elements. In spring 1995 a postal survey was conducted among all UK hospices and specialist palliative care in-patient units (n = 203) eliciting factual information concerning needs assessment and contracting, together with perceptions and evaluations of the local impact of the NHS reforms. A total of 128 (63 per cent) questionnaires was completed and returned. In addition to the survey, 12 case studies were conducted with a stratified random sample of NHS, independent and large or small hospices and specialist palliative care units. Each of the 12 case study sites was visited by a member of the research team, who conducted interviews with senior staff and analysed financial, planning and management data. Thus the survey allowed a wide analysis of the impact of the NHS reforms, which was enhanced by the more in-depth qualitative data gathered from the case studies. RESULTS: In the survey 49 per cent of those responding reported that their main purchaser had conducted a needs assessment for palliative care in the last five years. Palliative care needs assessment was seen as valuable by providers: 73 per cent considered it very important and 28 per cent of hospices had gone so far as to request a needs assessment from their health authority. In an open-ended question seeking views on the impact of health needs assessment, 66 per cent of those responding (71/107) stated that the impact had been or would be positive. The case studies, however, revealed a more mixed picture. The 12 hospices or specialist palliative care units had contracts with a total of 24 health authorities, 12 of which had conducted some type of needs assessment for palliative care. On close examination the comprehensiveness of these was questionable. Few providers had participated in the design and there were low levels of knowledge about the findings. High expectations of the value of needs assessment were often not fulfilled. There was also a tendency for providers to view needs assessment in a purely instrumental light, as a vehicle to further promote their own interests. CONCLUSIONS: Palliative care needs assessment has considerable potential to influence future purchasing and service provision, yet not all health commissions are undertaking it. There is a high level of provider enthusiasm for palliative care needs assessment, albeit coupled to low levels of technical knowledge and a lack of involvement in the process at local level. Purchaser-provider dialogue on needs assessment should focus on both raising awareness of appropriate techniques and debating 'ethical neutrality' about the outcome.

Attitude of Health Personnel↗
PubMed1993

Needs assessment in continuing medical education. Its feasibility and value in a seminar about skin cancer for general practitioners.

OBJECTIVE: To investigate the acceptability, feasibility and value of needs assessment in planning and conducting a seminar about skin cancer for general practitioners. METHOD: A self-administered questionnaire was developed to assess general practitioners' educational needs in skin cancer prevention, early detection and management. Registrants for a one-day interactive skin cancer seminar conducted by the NSW Cancer Council were each mailed this questionnaire. Responses received before the seminar were collated and discussed with resource persons involved in the seminar. RESULTS: We achieved an 80% response rate to the pre-seminar needs assessment. Responses indicated gaps in knowledge, widespread differences in views about skin surveillance recommendations and a hierarchy of preferences for practical procedures. The seminar was modified, contributing to high levels of participant satisfaction with its educational content. CONCLUSIONS: It is feasible to conduct a needs assessment in continuing medical education which achieves high response rates and provides vital information to resource persons about the educational needs of participants. Needs assessment holds promise as a strategy to assist general practitioners to identify their own goals for learning. Needs assessment as described here is necessary also to evaluate the outcome of continuing medical education. We recommend needs assessment as an integral part of educational programs for general practitioners although the time, planning and resources required to assess learning needs should not be underestimated.

Adult↗
PubMed2000

Needs assessment in primary care: general practitioners' perceptions and implications for the future.

BACKGROUND: Health needs assessment can guide the appropriate shift to primary care by identifying the most effective and efficient resource allocation to meet the needs of populations. Assessing health care needs will be a continuing challenge for primary care trusts in Scotland (or equivalent groups in other parts of the United Kingdom); however, lessons must be learned from the experience of needs assessment that followed the 'internal market' reforms of the 1990s. AIM: To examine general practitioners' (GPs') awareness and experience of needs assessment, to identify barriers to needs assessment in primary care, and to ascertain how better progress might be made in the future. METHOD: A postal questionnaire survey of 1777 Scottish GPs (a one-in-two sample) was combined with a semistructured interview survey of 'lead' GPs from a random sample of 64 mainland Scottish practices between May and August 1996. RESULTS: Sixty-five per cent (1154) of GPs responded to the questionnaire, of which 54% (965) were completed. Over 73% (47) of interviews were completed. Most GPs were unfamiliar with the concept of needs assessment and there was no evidence that needs assessment had influenced commissioning decisions. Most GPs argued that it was not a 'core' activity and that they lacked training in the relevant skills. While the attitude of the majority was indifferent, cynical, and sometimes hostile, a minority, comprising mostly younger fundholders, was more enthusiastic about needs assessment. CONCLUSION: The motivation and attitude of the majority of GPs present a barrier to needs assessment in primary care. GPs will require more resources and training if they are to undertake this responsibility. Most GPs believe than incentives (financial or organisational) will be necessary. Primary care trusts and equivalent structures should be aware of these attitudes as they seek to establish plans based on estimates of population needs in defined locations.

Adult↗