Organizational factors and depression management in community-based primary care settings

Abstract Background Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework. Methods We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT) infrastructure, and external incentives) and process features (e.g., staff performance, degree of integrated depression care, and IT performance). Results The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment. Conclusions The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition, survey information can inform efforts of individual primary care practices in customizing intervention strategies to improve depression management.http://deepblue.lib.umich.edu/bitstream/2027.42/78269/1/1748-5908-4-84.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78269/2/1748-5908-4-84-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78269/3/1748-5908-4-84.pdfPeer Reviewe

AN ANALYSIS OF THE DEFENSE HEALTH AGENCY TRANSITION PLAN WITH REGARD TO THE IMPACT ON CONTRACTING OPERATIONS WITHIN THE MILITARY HEALTH SYSTEM

This analysis examines the Defense Health Agency’s (DHA) transition plan with regard to contracting operations within the Military Health System (MHS). First, the study addresses various Government Accountability Office (GAO) cases relating to healthcare reform. The documents establish a pattern of the government’s attempt to address needed change in the MHS. Next, the analysis provides an overview of contracting capabilities from each service component. The findings highlight the impact of these capabilities as a result of DHA’s authority, direction, and control (ADC) of the MTFs. Third, the analysis addresses the efficiencies in the acquisition process. The findings identify any gained efficiencies as described in DHA’s Quadruple Aim initiative. Additionally, the analysis addresses the Medical Q-Service contracting vehicle. The results highlight cost-savings using this strategic, contract vehicle and compare the data to market trends and government expenditures. The results of this study will lend a better understanding of the operational and strategic impact of the DHA transition plan. Last, the recommendations focus on optimizing existing operational capabilities and processes, and increasing contracting efficiencies. The goal is to improve the overall ability to conduct medical contracting operations effectively while reducing costs and maintaining a high level of medical capability.Major, United States ArmyMajor, United States ArmyApproved for public release. distribution is unlimite

Linking food web functioning and habitat diversity for an ecosystem based management: A Mediterranean lagoon case-study

We propose a modelling approach relating the functioning of a transitional ecosystem with the spatial extension of its habitats. A test case is presented for the lagoon of Venice, discussing the results in the context of the application of current EU directives. The effects on food web functioning due to changes related to manageable and unmanageable drivers were investigated. The modelling procedure involved the use of steady-state food web models and network analysis, respectively applied to estimate the fluxes of energy associated with trophic interactions, and to compute indices of food web functioning. On the long term (hundred years) temporal scale, the model indicated that the expected loss of salt marshes will produce further changes at the system level, with a lagoon showing a decrease in the energy processing efficiency. On the short term scale, simulation results indicated that fishery management accompanied by seagrass restoration measures would produce a slight transition towards a more healthy system, with higher energy cycling, and maintaining a good balance between processing efficiency and resilience. Scenarios presented suggest that the effectiveness of short term management strategies can be better evaluated when contextualized in the long term trends of evolution of a system. We also remark the need for further studying the relationship between habitat diversity and indicators of food web functioning

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

Implementing family involvement in the treatment of patients with psychosis: a systematic review of facilitating and hindering factors

This paper presents independent research and was partially funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) North Thames at Bart's Health NHS Trust

An integrated genomic approach for the study of mandibular prognathism in the European seabass (Dicentrarchus labrax)

Skeletal anomalies in farmed fish are a relevant issue affecting animal welfare and health and causing significant economic losses. Here, a high-density genetic map of European seabass for QTL mapping of jaw deformity was constructed and a genome-wide association study (GWAS) was carried out on a total of 298 juveniles, 148 of which belonged to four full-sib families. Out of 298 fish, 107 were affected by mandibular prognathism (MP). Three significant QTLs and two candidate SNPs associated with MP were identified. The two GWAS candidate markers were located on ChrX and Chr17, both in close proximity with the peaks of the two most significant QTLs. Notably, the SNP marker on Chr17 was positioned within the Sobp gene coding region, which plays a pivotal role in craniofacial development. The analysis of differentially expressed genes in jaw-deformed animals highlighted the "nervous system development" as a crucial pathway in MP. In particular, Zic2, a key gene for craniofacial morphogenesis in model species, was significantly down-regulated in MP-affected animals. Gene expression data revealed also a significant down-regulation of Sobp in deformed larvae. Our analyses, integrating transcriptomic and GWA methods, provide evidence for putative mechanisms underlying seabass jaw deformity

Stakeholder Approach to Better Understand Psychological Health Services in the Military

Ensuring the psychological well-being of service members and their families has emerged as one of the principal challenges of today‟s armed services. Given that the system of care of psychological health services in the United States Military cannot be divorced from the large healthcare delivery system, an enterprise perspective is needed to truly understand the dynamics of the system of care. This paper makes two key contributions: it identifies the key stakeholders of the military health enterprise with respect to psychological health, and analyzes the espoused senior leadership values over the last decade as seen in the stakeholder reports. This stakeholder analysis highlights the challenges faced in melding the constituent organizations into an enterprise, especially in the face of leadership turnover. The thematic analysis of senior leadership values shows an evolution of focus from managing execution of care to a more holistic emphasis on healthy lifestyles and psychological health

Evidence-Based Practice Guideline: Breastfeeding Support of the Active Duty Servicewoman

There is no policy on breastfeeding support of the active duty military servicewoman at the targeted military treatment facility, and no global policy serving active duty personnel applicable at the Department of Defense and Defense Health Agency (DoD/DHA) level to span across branches of the U.S. military. Nurses, as members of the most trusted profession, are often expected to know how to assist a mother in meeting her feeding goals. Creation of an evidence-based practice guideline (EBPG) for support of the active duty servicewoman in the military health system was the purpose of this project. The project was conceptualized within the framework of Pender’s health promotion model and supported by Rogers’s theory on the diffusion of innovations. Sources of evidence included consensus statements by professional organizations, peer-reviewed literature applicable to lactation support in general and within the military health system, and feedback from expert panelists in the fields of lactation and education with experience in the military health system. The need for the EBPG was supported through review of the literature and expert feedback. Simple descriptive statistics and analysis of qualitative feedback were reviewed supporting the applicability of the EBPG. The guideline should better prepare health care providers, including nurses on the front lines of care, to support active duty servicewomen in their feeding goals. Adoption of the EBPG by the DoD/DHA would allow the organization to lead the charge in positive social change by providing a policy that treats all branches of the U.S. military equally and incentivizes family health and retention of valuable federal employees who lay their lives on the line in defense of the nation

Assessing the governance of the health policy-making process using a new governance tool: The case of Lebanon

Background: In the international agenda, it has become common to assert that the assessment of health system governance using a practical tool is crucial. This approach can help us better understand how health systems are being steered as well as to identify gaps in the decision-making process and their causes. The authors developed a new assessment tool, the Health Policymaking Governance Guidance Tool (HP-GGT), that was designed to be conceptually sound and practical. This tool enables policy-makers and stakeholders to systematically review and assess health system governance at policy-making level. This article presents first use of the HP-GGT in Lebanon, together with generated results, recommendations, and discusses how these results improve governance practices when initiating new health policy formulation processes.Methods: The HP-GGT, which is a multidimensional structured tool, was used retrospectively to assess and review the process used to develop a new mental health strategy; this process was compared against consensus-based good governance principles, focusing on participation, transparency, accountability, information and responsiveness. The assessment was conducted through face-to-face interviews with 11 key informants who were involved in the development of the strategy.Results: The HP-GGT enabled policy-makers to reflect on their governance practices when developing a mental health strategy and was able to identify key areas of strengths and weaknesses using good governance practice checklists given by the questions. The insights generated from the assessment equipped the national policy-makers with a better understanding of the practice and meaning of policy-making governance. Identifying weaknesses to be addressed in future attempts to develop other national health policies helped in this regard. Using the tool also increased awareness of alternative good practices among policy-makers and stakeholders.Conclusions: Assessing a health policy formulation process from a governance perspective is essential for improved policy-making. The HP-GGT was able to provide a general overview and an in-depth assessment of a policy formulation process related to governance issues according to international good practices that should be applied while formulating health policies in any field. The HP-GGT was found to be a practical tool that was useful for policy-makers when used in Lebanon and awaits applications in other low- and middle-income countries to further show its validity and utility

Role of the Physical Environment on Team-Based Primary Care in the Military Health System

Primary care in the United States has shifted from a physician-centered care approach to a multidisciplinary, team-based care approach. This shift has resulted in many day-to-day changes in the care delivery process including how clinical staff collaborate; interact with patients; and use space, equipment, and various technologies. Team-based approaches, such as the Patient-Centered Medical Home (PCMH) model, are demonstrating improvements in patient health outcomes. The U.S. Military Health System, one of the largest healthcare organizations in the world, has adopted the PCMH model for primary care clinics. To support this new care model, a team-based clinical module is emerging as a spatial concept that colocates the resources staff need for delivering care. Several different design configurations of team-based clinical modules exist in MHS clinics despite the organization’s emphasis on clinic standardization. The purpose of this dissertation is to understand staff perceptions concerning the environmental factors that best support team-based care in the MHS. Using a qualitative approach and a case study research strategy along with ethnographic data collection techniques, this study investigates how six team-based clinical module configurations in three different clinics influence the delivery of team-based care. Data collection included 58 semi-structured interviews with primary care providers, registered nurses, licensed practical nurses, and specialty care providers. Additionally, 11 hours of observations in team rooms provided insight on how the staff use space. Findings were translated into a set of design recommendations for planning team-based clinical modules aimed at improving staff workflow, functionality, and workspaces to facilitate both team collaboration and focused work. This study provides initial evidence that can directly support the MHS in updating design guidance criteria to support team-based primary care