Mapping variability in allocation of Long-Term Care funds across payer agencies in OECD countries

Introduction: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). Objectives: This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. Methods: Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. Results: 11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations. Discussion and conclusions: A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions

Co morbidity of post-traumatic-stress disorders and substance use disorder

Background: The phenomenon of substance use, abuse and dependence is a serious problem with psychological, social, physical and economic impact. The co existence of two disorders, known as co morbidity or dual diagnosis and the relationship between a psychiatric disorder and substance dependence is complicated and many scientists support that psychopathology often forms the ground for the development of dependence. The aim of the study was to explore substance use in individuals with Post Traumatic Stress Disorder (PTSD) and investigate whether the severity of PTSD is related to Substance Use Disorder (SUD) as well as the severity of drug addiction. Method and material: A cross sectional, correlational study with the use of 3 research instruments: The Treatment Demand Indicator (T.D.I.), the Addiction Severity Index (ASI) for measuring the severity of substance dependence and the Post Traumatic Stress Diagnostic Scale P.D.S. for the diagnosis of PTSD. The sample consists of 33 individuals, chosen by the members of a therapeutic program for drug dependence which combines inpatient and outpatient therapeutic interventions. The statistical analyses was performed by using the statistical program SPSS. Results: The results showed that a percentage of 40.6% of drug depended people reported symptoms of PTSD and were diagnosed with PTSD. From those, the level of impaired functioning showed that (23%) had a medium problem and the other (77%) had a serious impaired functioning level. A significant positive relationship between PTSD and severity of drug problems was found. The results showed that there was a statistically positive significant correlation between the PTSD symptom severity and the level of dependency from drugs (r=0.678, p-value=0.011). This finding shows that the higher the level of dependency, the higher the PTSD symptom severity index. Also the results showed that there was a significant correlation suggesting that those suffering from PTSD presented a bigger problem with drugs (Χ2=18.945, p-value<0.001). Therefore, those participants who had an acute problem in the level of severity of drug abuse were also suffering from PTSD (78%) and those who had a medium problem were not suffering from PTSD (90%). Conclusions: More investigation is needed to determine the relationship between the two disorders (PTSD and SUD) in order to find out which one precedes the other. In addition, it is important to investigate how one disorder affects the development of the other and how they affect, if they do, the therapeutic progress and development of the perso

Challenges in mental health nursing: working in institutional or community settings?

Abstract Professional environments likely affect patient safety, quality of care provided, and nurses' satisfaction and retention. The aim of this study was to explore mental health nurses' perceptions of their professional practice environment and examine differences in perceptions between nurses working at institutions and those practising in community care. The methodology used was descriptive and comparative. The sample consisted of 248 mental health nurses working within the public sector (76% response rate) drawn from a psychiatric hospital (n = 163) and community settings (n = 85). We administered the Revised Professional Practice Environment (RPPE) questionnaire. Comparisons of the two groups were made using eight subscales of the RPPE. The results indicated that mental health nurses' ratings of their practice environment were slightly positive (M = 2.69; range = 1-4). Nurses working in a psychiatric hospital perceived the professional practice environment more negatively (M = 2.66) than their colleagues in community care (M = 2.73). A t-test comparison revealed statistically significant differences between the two groups within subcategories of work motivation (P = 0.04) and leadership and autonomy (P = 0.03). Nurses working in the community gave higher ratings in comparison with their colleagues working in institutional settings. In conclusions, an in-depth analysis of differences in practice environments is required to define causes of these differences and how they might influence nurses' abilities to provide quality care

Exploration of empathy in Cyprus nursing and health care students: A mixed method study

Developing professionals who are perceptive to the needs of patients and can respond by expressing empatheticbehavior is one of the aims of health care education. The aim of this study was to explore the level of empathy inhealth care students through a mixed method. The quantitative approach included the use of the Jefferson Scaleof Empathy and the qualitative a focus group approach to further deepen into the descriptive results. 869 healthcare students (RR=81%) participated in the study and the level of empathy ranged from 42 to 139 with a meanscore of 100.6 (20-140 scale). Significant statistical differences were found between the disciplines (F=8.6, p-value < 0.001) and gender (p-value < 0.001) with nursing students and women scoring the higher levels. Twofocus groups of ten participants each were conducted with 3rdand 4thyear nursing students. Four themes werederived from the analysis of these data a) empathy as an imperative component of care b) contact with theclinical reality c) the influence of family and choice of studies d) gender stereotypes. There is a lack of mixedmethodologies in the empathy research and this study provided the opportunity of a better understanding of thehealth care students’views

Public engagement in setting healthcare priorities: a ranking exercise in Cyprus

Abstract Background In countries such as Cyprus the financial crisis and the recession have severely affected the funding and priority setting of the health care system. There is evidence highlighting the importance of population’ preferences in designing priorities for health care settings. Although public preferences have been thorough analysed in many countries, there is a research gap in terms of simultaneously investigating the relative importance and the weight of differing and competing criteria for determining healthcare priority settings. The main objective of the study was tο investigate public preferences for the relative utility and weight of differing and competing criteria for health care priority setting in Cyprus. Methods The ‘conjoint analysis’ technique was applied to develop a ranking exercise. The aim of the study was to identify the preferences of the participants for alternative options. Participants were asked to grade in a priority order 16 hypothetical case scenarios of patients with different disease and of diverse socio-economic characteristics awaiting treatment. The sample was purposive and consisted of 100 Cypriots, selected from public locations all over the country. Results It was revealed that the “severity of the disease” and the “age of the patient” were the key prioritization criteria. Participants assigned the smallest relative value to the criterion “healthy lifestyle”. More precisely, participants older than 35 years old assigned higher relative importance to “age”, while younger participants to the “severity of the disease”. The “healthy lifestyle” criterion was assigned to the lowest relative importance to by all participants. Conclusion In Cyprus, public participation in health care priority setting is almost inexistent. Nonetheless, it seems that the public’s participation in this process could lead to a wider acceptance of the healthcare system especially as a result of the financial crisis and the upcoming reforms implemented such as the establishment of the General System of Health Insurance