Healthcare professionals' perspectives on mental health service provision : a pilot focus group study in six European countries

Background: The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it. Methods: Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners. Results: The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative 'chain of care'. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence. Conclusions: The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people's needs throughout their lives is an essential aspect of optimal care provision

Actualizing Health Care Reform for Urban Indians: An Action Plan From the Urban Indian Health Summit

Outlines strategies to ensure the benefits of healthcare reform for urban Indians, including securing resources, education, and advocacy for workforce development, targeted and technical assistance, clarification of definitions, and other needs

Barriers and Facilitators to Use of a Clinical Evidence Technology in the Management of Skin Problems in Primary Care: Insights from Mixed Methods

Objective: Few studies have examined the impact of a single clinical evidence technology (CET) on provider practice or patient outcomes from the provider’s perspective. A previous cluster-randomized controlled trial with patient-reported data tested the effectiveness of a CET (i.e., VisualDx) in improving skin problem outcomes but found no significant effect. The objectives of this follow-up study were to identify barriers and facilitators to the use of the CET from the perspective of primary care providers (PCPs) and to identify reasons why the CET did not affect outcomes in the trial. Methods: Using a convergent mixed methods design, PCPs completed a post-trial survey and participated in interviews about using the CET for the management of patients’ skin problems. Data from both methods were integrated. Results: PCPs found the CET somewhat easy to use but only occasionally useful. Less experienced PCPs used the CET more frequently. Data from interviews revealed barriers and facilitators at four steps of evidence-based practice: clinical question recognition, information acquisition, appraisal of relevance, and application with patients. Facilitators included uncertainty in dermatology, intention for use, convenience of access, diagnosis and treatment support, and patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulties, presence of irrelevant information, and lack of decision impact. Conclusion: PCPs found the CET useful for diagnosis, treatment support, and patient communication. However, the barriers of interface difficulties, irrelevant search results, and preferred use of other sources limited its positive impact on patient skin problem management

Colocating Health Services: A Way to Improve Coordination of Children's Health Care?

Based on a literature review and interviews, outlines the benefits, costs, and issues of pediatric practices' co-location with other providers and services. Examines strategies, structures, and levels of integration, as well as barriers to implementation

"Towards Optimum Availability of Public Sector Information"

The policy objective I wish to pursue with this paper, in terms of the coalition agreement, is to ensure that public sector information is as widely accessible and available to citizens as possible. First of all because citizens need that information in order to participate in the democratic process. Secondly, national welfare is likely to benefit from public sector information being made available in an openminded manner. Thinking in terms of the new knowledge-based economy implies that the societal value of this information will increase as more people use it

Diffusion theory and multi-disciplinary working in children’s services

Purpose The purpose of this paper is to explore how innovation in children’s services is adopted and developed by staff within new multi-disciplinary children’s safeguarding teams. It draws on diffusion of innovations (DOI) theory to help us better understand the mechanisms by which the successful implementation of multi-disciplinary working can be best achieved. Design/methodology/approach It is based on interviews with 61 frontline safeguarding staff, including social workers, substance misuse workers, mental health workers and domestic abuse workers. Thematic analysis identified the enablers and barriers to implementation. Findings DOI defines five innovation attributes as essential for rapid diffusion: relative advantage over current practice; compatibility with existing values and practices; complexity or simplicity of implementation; trialability or piloting of new ideas; and observability or seeing results swiftly. Staff identified multi-disciplinary team working and group supervision as advantageous, in line with social work values and improved their service to children and families. Motivational interviewing and new ways of case recordings were less readily accepted because of the complexity of practicing confidently and concerns about the risks of moving away from exhaustive case recording which workers felt provided professional accountability. Practical implications DOI is a useful reflective tool for senior managers to plan and review change programmes, and to identify any emerging barriers to successful implementation. Originality/value The paper provides insights into what children’s services staff value about multi-disciplinary working and why some aspects of innovation are adopted more readily than others, depending on the perception of diffusion attributes.

How can diagnostic assessment programs be implemented to enhance inter-professional collaborative care for cancer?

BackgroundInter-professional collaborative care (ICC) for cancer leads to multiple system, organizational, professional, and patient benefits, but is limited by numerous challenges. Empirical research on interventions that promote or enable ICC is sparse so guidance on how to achieve ICC is lacking. Research shows that ICC for diagnosis could be improved. Diagnostic assessment programs (DAPs) appear to be a promising model for enabling ICC. The purpose of this study was to explore how DAP structure and function enable ICC, and whether that may be associated with organizational and clinical outcomes.MethodsA case study approach will be used to explore ICC among eight DAPs that vary by type of cancer (lung, breast), academic status, and geographic region. To describe DAP function and outcomes, and gather information that will enable costing, recommendations expressed in DAP standards and clinical guidelines will be assessed through retrospective observational study. Data will be acquired from databases maintained by participating DAPs and the provincial cancer agency, and confirmed by and supplemented with review of medical records. We will conduct a pilot study to explore the feasibility of estimating the incremental cost-effectiveness ratio using person-level data from medical records and other sources. Interviews will be conducted with health professionals, staff, and referring physicians from each DAP to learn about barriers and facilitators of ICC. Qualitative methods based on a grounded approach will be used to guide sampling, data collection and analysis.DiscussionFindings may reveal opportunities for unique structures, interventions or tools that enable ICC that could be developed, implemented, and evaluated through future research. This information will serve as a formative needs assessment to identify the nature of ongoing or required improvements, which can be directly used by our decision maker collaborators, and as a framework by policy makers, cancer system managers, and DAP managers elsewhere to strategically plan for and implement diagnostic cancer services

Enforcement Actions under EU Law: The New Member States. EIPA Working Papers 2007

Through the infringement procedure, provided for by Article 226 of the Treaty establishing the European Community (TEC), the Commission can stimulate Member States to comply effectively with their obligations under Community law. In cases of non-compliance, the Commission may bring Member States before the Court of Justice of the EC (ECJ). Indeed, the Commission may use this possibility because it is the "guardian of the Treaty" and has to ensure the proper application of Community law, in line with Article 211 TEC. The White Paper on European Governance published by the Commission in 2001 emphasises that the primary responsibility for applying Community law lies with national administrations and courts in the Member States. Therefore, the primary objective of enforcement actions against Member States is to monitor their compliance and to respond to cases of non-compliance. However, through adequate exercise of its discretion and improved cooperation with Member States, the Commission aims to encourage them to comply voluntarily with Community law as quickly as possible. Furthermore, under the current Commission's strategic objectives for the period 2005-2009, prompt and adequate transposition and vigorous pursuit of infringements are considered critical to the credibility of European legislation and the effectiveness of policies. The infringement procedure is of crucial importance to the new Member States and of high relevance to the candidate countries that have applied for accession to the EU. On the one hand, they have to adopt the whole acquis upon accession with only few transitional periods granted in a limited number of areas. New Member States have already submitted a large number of transposition notifications to the Commission. On the other hand and despite their huge efforts, new Member States experience considerable difficulties in implementing directives and other EC legislative instruments. The process of implementation is a challenging stumbling block for all new Member States. This paper will focus on the recent and main trends in the application of enforcement actions against new Member States, not only taking an empirical angle (infringements by Member States and by sectors) but also involving analytical reasoning. This analysis serves to present the fundamentals and relevance of the infringement procedure in the framework of the enlarged European Union (the object of the first part of this paper) where administrations of the new Member States will have to adopt this new way of thinking and of implementing know-how (addressed in the second part) while acquiring a better understanding of the principal characteristics of the EC/EU's legal system (direct effect, supremacy, indirect effect, state liability) and of the EC's general principles of law. Therefore, the second part of the paper will also focus on justifications deemed acceptable by the ECJ and others that are considered inadmissible. New Member States have to adjust to the requirements of the acquis (possibilities of opting out are not included in the Accession Treaties) and this obligation applies to all independent state institutions (including the judiciary where reforms represent a prerequisite for accession by some candidate countries). Efficient further implementation of the acquis and adequate understanding of the infringement procedure will facilitate new Member States' (and candidate countries') integration in the EU and, eventually, make their accession a success