Assessing Patient Participation in Health Policy DecisionMaking in Cyprus

Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients’ involvement in health policy decision-making processes and to increase its impact are greatly needed in Cypru

Cost effectiveness review of text messaging, smartphone application, and website interventions targeting T2DM or hypertension

Digital health interventions have been shown to be clinically-effective for type 2 diabetes mellitus (T2DM) and hypertension prevention and treatment. This study synthesizes and compares the cost-effectiveness of text-messaging, smartphone application, and websites by searching CINAHL, Cochrane Central, Embase, Medline and PsycInfo for full economic or cost-minimisation studies of digital health interventions in adults with or at risk of T2DM and/or hypertension. Costs and health effects are synthesised narratively. Study quality appraisal using the Consensus on Health Economic Criteria (CHEC) list results in recommendations for future health economic evaluations of digital health interventions. Of 3056 records identified, 14 studies are included (7 studies applied text-messaging, 4 employed smartphone applications, and 5 used websites). Ten studies are cost-utility analyses: incremental cost-utility ratios (ICUR) vary from dominant to €75,233/quality-adjusted life year (QALY), with a median of €3840/QALY (interquartile range €16,179). One study finds no QALY difference. None of the three digital health intervention modes is associated with substantially better cost-effectiveness. Interventions are consistently cost-effective in populations with (pre)T2DM but not in populations with hypertension. Mean quality score is 63.0% (standard deviation 13.7%). Substandard application of time horizon, sensitivity analysis, and subgroup analysis next to transparency concerns (regarding competing alternatives, perspective, and costing) downgrades quality of evidence. In conclusion, smartphone application, text-messaging, and website-based interventions are cost-effective without substantial differences between the different delivery modes. Future health economic studies should increase transparency, conduct sufficient sensitivity analyses, and appraise the ICUR more critically in light of a reasoned willingness-to-pay threshold

Design, implementation and evaluation of a secondary prevention intervention to pediatricians in order to improve identification and management of maternal depression

Aim & objectives: Maternal depression is a common mood disorder that occurs in women, especially during child-bearing years with prevalence rates ranging from 10-20%. It affects both mother and child’s health and development. Although research evidence suggests the integration of mental health services into primary care, too little has yet been done. As a consequence, mothers demonstrating depressive symptoms do not have access to appropriate and adequate treatment. The role of the pediatrician in the early detection and management of maternal depression is well established. The aim of the present study was to implement an intervention for the secondary prevention of maternal depression in the pediatric primary care setting, Methods: The study was carried out in two phases: a) a qualitative exploration to assess pediatricians’ needs and perceptions regarding the detection and management of maternal depression, as well as, the pathways to treatment of mothers experiencing depressive symptoms and b) a randomized controlled trial to evaluate a theory-based intervention to pediatricians. The intervention was according to the Transtheoretical Model of Change and the Normalization Process Theory. For the purpose of the study, a random and representative sample of 377 pediatricians was selected. They were randomly assigned to intervention and control groups. Pediatricians in the intervention group participated in a web-based intervention. Evaluation measurements were carried out at baseline and post intervention, as well as, at 6 and 12 months. The following tools were employed to assess the impact of the intervention: i) Stage of Change Scale, ii) Processes of Change Scale, iii) Decisional Balance Scale, iv) Self-Efficacy Scale and v) the NoMad tool. To assess patient outcomes the PHQ-9 & SF-12 were used for depressive symptoms and quality of life related to health, respectively. Statistical analysis was performed using the SPSS 19 software and Pearson’s χ2 test, Student’s t-test, Analysis of Variance (ANOVA) and Multiple Logistic Regression Analysis. Results: The findings revealed that there were no statistical differences between the two groups prior to the intervention. Post and follow-up measurements indicated that differences at a statistical significance level between intervention and control groups. Pediatricians in the intervention group demonstrated higher scores in stages of change, processes of change, decisional balance and self-efficacy scales, as well as, screening rates and mothers identified with depressive symptoms. A strong and positive correlation was found between the processes of change scale and the NoMad instrument, indicating that the relationship between the pediatricians’ stage of change is directly proportional to the integration of detection and management practices in the pediatric setting. A proportion of 11% (1,102) of mothers was found to experience moderately severe and severe depression. A 20% of them evaluated for patient outcomes. Significant differences were found at 6 and 12 months follow-up measurements after referral. The severity of depressive symptoms was dramatically decreased while the quality of life related to health was significantly increased. Conclusion: The present study provides evidence for the benefits of integrating of mental health services into primary care. The pragmatic trial revealed that the intervention to pediatricians was effective and efficient for the secondary prevention of maternal depression. This suggests that the integration of maternal mental health into pediatric primary care may constitute an effective strategy to facilitate access to treatment for mothers suffering depressive symptoms and is recommended for countries of weak primary healthcare systems and limited resources.Σκοπός και στόχοι: Η κατάθλιψη που εμφανίζεται σε μητέρες με παιδιά ηλικίας 0-5 ετών έχει πολλαπλές επιπτώσεις τόσο στην υγεία της μητέρας, όσο και στην υγεία και την ανάπτυξη του παιδιού. Παρ’ όλο που τα σύγχρονα ερευνητικά δεδομένα συγκλίνουν στην ανάγκη ενσωμάτωσης μέρους των υπηρεσιών ψυχικής υγείας στην Πρωτοβάθμια Φροντίδα Υγείας (ΠΦΥ), ελάχιστα έχουν γίνει προς αυτήν την κατεύθυνση. Ο ρόλος του παιδιάτρου στην έγκαιρη ανίχνευση και παραπομπή αυτών των περιπτώσεων, αναδεικνύεται καθοριστικός. Στόχος της παρούσας εργασίας είναι η δευτερογενής πρόληψη της κατάθλιψης σε μητέρες παιδιών ηλικίας 0-5 ετών, μέσω της εφαρμογής μιας παρέμβασης στο παιδιατρικό πλαίσιο της ΠΦΥ. Μέθοδος: Η έρευνα πραγματοποιήθηκε σε δύο φάσεις: α) έγινε ποιοτική διερεύνηση τόσο των αναγκών των παιδιάτρων ως προς την εφαρμογή πρακτικών διαχείρισης της κατάθλιψης, όσο και των μητέρων σε σχέση με τους παράγοντες που επηρεάζουν την αναζήτηση βοήθειας (τα αποτελέσματα χρησιμοποιήθηκαν στην ανάπτυξη του θεωρητικού πλαισίου της παρέμβασης και το περιεχόμενό της) και β) ποσοτική έρευνα, η οποία περιελάμβανε τυχαιοποιημένη ελεγχόμενη μελέτη για την αξιολόγηση της παρέμβασης. Η παρέμβαση βασίστηκε στο Διαθεωρητικό Μοντέλο Αλλαγής και τη Θεωρία Κανονικοποίησης της Διαδικασίας. Για το σκοπό της έρευνας, επιλέχθηκε τυχαίο και αντιπροσωπευτικό δείγμα 377 παιδιάτρων από όλη την ελληνική επικράτεια, οι οποίοι εκχωρήθηκαν τυχαία στις ομάδες παρέμβασης και ελέγχου. Η ομάδα παρέμβασης συμμετείχε σε ένα πολυδιάστατο εκπαιδευτικό πρόγραμμα μέσω διαδικτύου, ενώ η ομάδα ελέγχου δεν έλαβε καμία παρέμβαση. Μετρήσεις πραγματοποιήθηκαν αμέσως μετά την παρέμβαση, 6 και 12 μήνες μετά. Για την αξιολόγηση της παρέμβασης χρησιμοποιήθηκαν τα ακόλουθα εργαλεία: i) ερωτηματολόγιο δημογραφικών στοιχείων, ii) Γενικές ερωτήσεις στάσεων, iii) κλίμακα σταδίου αλλαγής, iv) κλίμακα διαδικασιών αλλαγής, v) κλίμακα αυτοαποτελεσματικότητας, vi) κλίμακα ισοζυγίου απόφασης, αλλά και το ερωτηματολόγιο κανονικοποίησης της διαδικασίας. Για την αξιολόγηση των αποτελεσμάτων στην ψυχική υγεία και την ποιότητα ζωής της μητέρας χρησιμοποιήθηκαν: α) το εργαλείο ανίχνευσης καταθλιπτικών συμπτωμάτων PHQ-9 και το ερωτηματολόγιο για την Ποιότητα Ζωής που Σχετίζεται με την Υγεία (ΠΖΣΥ) SF-12. Για τη στατιστική ανάλυση χρησιμοποιήθηκε το Pearson’s χ2 test, το Student’s t-test, η ανάλυση διασποράς (ANOVA) και η πολλαπλή λογαριθμιστική παλινδρόμηση. Η ανάλυση έγινε με το στατιστικό πρόγραμμα SPSS 19.0. Αποτελέσματα: από τα ευρήματα φάνηκε ότι οι δύο ομάδες δεν είχαν στατιστικά σημαντικές διαφορές πριν από την παρέμβαση. Μετά την παρέμβαση, οι παιδίατροι της ομάδας παρέμβασης παρουσίασαν υψηλότερες επιδόσεις στο στάδιο και τις διαδικασίες αλλαγής, την αυτό-αποτελεσματικότητα και το ισοζύγιο απόφασης, ενώ αυξήθηκαν και τα ποσοστά των μητέρων που ανιχνεύθηκαν σε κάθε μέτρηση (αμέσως μετά την παρέμβαση, 6 μήνες, 12 μήνες). Ισχυρή θετική συσχέτιση παρουσίασε και το ερωτηματολόγιο κανονικοποίησης της διαδικασίας με την κλίμακα διαδικασιών αλλαγής – όσο δηλαδή οι παιδίατροι προχωρούσαν σε επόμενο στάδιο, αυξανόταν η ενσωμάτωση των πρακτικών διαχείρισης της κατάθλιψης στο πλαίσιο της καθημερινής τους κλινικής πρακτικής. Από τις μητέρες στις οποίες χορηγήθηκε το εργαλείο ανίχνευσης της κατάθλιψης, βρέθηκε να πάσχει από μέτρια σοβαρή και σοβαρή κατάθλιψη ποσοστό 11% (1102 μητέρες). Από αυτές επιλέχθηκε τυχαία ποσοστό 20% για να συμπληρώσει το PHQ-9 & το SF-12. Τα σκορ των μητέρων αμέσως μετά την παραπομπή και μετά από 6 και 12 μήνες, παρουσίασαν στατιστικά σημαντικές διαφορές τόσο ως προς τη σοβαρότητα της καταθλιπτικής συμπτωματολογίας, όσο και ως προς την ΠΖΣΥ. Τα επίπεδα κατάθλιψης μειώθηκαν δραστικά και η ΠΖΣΥ των μητέρων, μειώθηκε αισθητά στις μετρήσεις παρακολούθησης.Συμπέρασμα: Η παρέμβαση ήταν επιτυχημένη, καταδεικνύοντας ότι το παιδιατρικό πλαίσιο της ΠΦΥ είναι πλεονεκτικό πεδίο για τη δευτερογενή πρόληψη της κατάθλιψης σε μητέρες με μικρά παιδιά και αποτελεί ένα ενδεικτικό παράδειγμα, του πως είναι δυνατόν να ενσωματωθεί ένα μέρος των υπηρεσιών ψυχικής υγείας στην ΠΦΥ, δαπανώντας ελάχιστους πόρους και αυξάνοντας την πρόσβαση των μητέρων που αντιμετωπίζουν προβλήματα κατάθλιψης στη θεραπεία

Psychiatrists role in primary health care in Greece: findings from a quantitative study

Abstract Background Although the need for integration of mental health services into primary care is well established little has been done. The outbreak of the recession found the Greek mental health system in transition. As a response to the crisis, governments implemented horizontal budget cuts instead of health reforms. This resulted in an unfavorable situation for mental health which was set once again on the sidelines of the health policy agenda. Previous studies suggest that the most prevalent disorders in the years of financial crisis in Greece are depression and anxiety while a general increase of the psychiatric morbidity is observed does not follow the population’ needs. Methods The present descriptive study was carried out between March and June of 2015. A convenience sample of 174 psychiatrists and psychiatry residents who met the inclusion criteria were finally selected to participate. Data were collected by using a 40-items questionnaire consisted of three sections: (a) nine questions about demographics, (b) nine questions pertaining to general aspects of administrative regulations related to primary care, (c) 22 questions about psychiatrists attitudes and perceptions towards their role in primary care. Quantitative variables are expressed as mean values, while qualitative variables as absolute and relative frequencies. Results The vast majority of participants perceives the public primary care services and mental health services in their community as inadequate and considers psychiatrists’ participation in primary care as important in order to improve the detection and management rates of people demonstrating mental health symptoms. They also believe that: (a) primary care practitioners’ usually fail to detect the mental health conditions of patients; (b) their participation in primary care will decrease the social stigmatization for mental health conditions; (c) patients receiving pharmaceutical treatment for mental health problems by GPs and other primary care professionals usually fail to comply. Conclusions Respondents in the present study are receptive to participate in primary care. They believe that their inclusion to primary care will result to decreased social stigmatization for mental health problems, increased patient’ access and improved detection and management rates for common mental health conditions

A Theory-Based Intervention in Health Visiting Students in Order to Reduce Mental Illness Stigma: A Quasi-Experimental Study

Background: Stigma of mental illness is an important barrier to treatment and recovery of mental illness. Schizophrenia represents the most common mental disorder for the public and it is connected with the highest stigma due to misconceptions of dangerousness. Stigmatizing attitudes have been found not only among general population but also in health care providers. Objectives: A randomized trial was conducted in order to evaluate a short duration theory–based intervention programme to reduce potential stigma of mental illness, specifically schizophrenia, in a sample of Health Visiting students. The intervention involved education combined with video based contact with people with mental illness; this specific intervention scheme has proved to be the most effective intervention strategy and has been proposed as a good practice for stigma reduction. Methods: In 2015, fifty seven Health Visiting students of the Athens Technological Education Institute who accepted to participate in the research were randomly assigned in two groups: an intervention group which received education and video-based contact with people with experience of mental illness and a control group which received education but no contact. The Mental Health Knowledge Scale (MAKS), the Attitudes to Severe Mental Illness (ASMI) Scale and the Social Distance Scale (SDS) were used to evaluate students’ knowledge, attitudes and desired social distance from people with schizophrenia respectively, at three points of time (pre, mid, post). Results: Although no cut-off points exist for any of the scales, health visiting students were found to hold relatively positive attitudes towards mental illness. As expected, stigma-related mental health knowledge increased in both groups after the intervention. The intervention group also improved their scores on the factor “Optimism” of the ASMI scale and decreased their stigma scores on the factor “Close Relations” of the SCD scale. Conclusions: Our results indicate that stigma-related mental health knowledge can b&nbsp; increased with a short duration intervention, whilst negative attitudes and increased desired social distance from people with mental illness are more resistant to change. Further research is needed to explore the specific&nbsp; omponents</p

Assessing Patient Participation in Health Policy Decision-Making in Cyprus

Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients’ involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus