Barriers to mental health care utilization among internally displaced persons in the republic of Georgia: a rapid appraisal study.

BACKGROUND: There is a paucity of evidence on access to services for mental health and psychosocial support for conflict-affected populations in low- and middle-income countries. In the Republic of Georgia, rates of utilization of mental health services among internally displaced people with mental disorders are low. We set out to identify the health system barriers leading to this treatment gap. METHODS: We used rapid appraisal methods (collection and triangulation of multiple data sources) to investigate barriers to accessing mental health care services among adult IDPs in Georgia. Data collection included review of existing policy documents and other published data, as well as semi-structured interviews with 29 key informants including policy makers, NGO staff, health professionals and patients. RESULTS: The following factors emerged as important barriers affecting access to mental health care services among IDPs in Georgia: inadequate insurance coverage of mental disorders and poor identification and referral systems, underfunding, shortage of human resources, poor information systems, patient out-of-pocket payments and stigmatization. CONCLUSION: While rapid appraisal methods cannot control for potential biases or achieve representativeness, triangulation supports internal validity and reliability of the data collected, allowing data to be used to inform health care interventions. The appropriateness and potential effectiveness of policy interventions such as insurance coverage of a wider range of mental disorders, integration of services for these at the primary health care level, and community-based approaches in this context should be explored

Health service utilization for mental, behavioural and emotional problems among conflict-affected population in Georgia: a cross-sectional study.

BACKGROUND: There is large gap in mental illness treatment globally and potentially especially so in war-affected populations. The study aim was to examine health care utilization patterns for mental, behavioural and emotional problems among the war-affected adult population in the Republic of Georgia. METHODS: A cross-sectional household survey was conducted among 3600 adults affected by 1990s and 2008 armed conflicts in Georgia. Service use was measured for the last 12 months for any mental, emotional or behavioural problems. TSQ, PHQ-9 and GAD-7 were used to measure current symptoms of PTSD, depression and anxiety. Descriptive and regression analyses were used. RESULTS: Respondents were predominantly female (65.0%), 35.8% were unemployed, and 56.0% covered by the government insurance scheme. From the total sample, 30.5% had symptoms of at least one current mental disorder. Among them, 39.0% sought care for mental problems, while 33.1% expressed facing barriers to accessing care and so did not seek care. General practitioners (29%) and neurologists (26%) were consulted by the majority of those with a current mental disorder who accessed services, while use of psychiatric services was far more limited. Pharmacotherapy was the predominant type of care (90%). Female gender (OR 1.50, 95% CI: 1.25, 1.80), middle-age (OR 1.83, 95% CI: 1.48, 2.26) and older-age (OR 1.62, 95% CI: 1.19, 2.21), possession of the state insurance coverage (OR 1.55, 95% CI: 1.30, 1.86), current PTSD symptoms (OR 1.56, 95% CI: 1.29, 1.90) and depression (OR 2.12, 95% CI: 1.70, 2.65) were associated with higher rates of health service utilization, while employed were less likely to use services (OR 0.71, 95% CI: 0.55, 0.89). CONCLUSIONS: Reducing financial access barriers and increasing awareness and access to local care required to help reduce the burden of mental disorders among conflict-affected persons in Georgia

How do participatory methods shape policy? Applying a realist approach to the formulation of a new tuberculosis policy in Georgia

From PubMed via Jisc Publications RouterThis paper presents the iterative process of participatory multistakeholder engagement that informed the development of a new national tuberculosis (TB) policy in Georgia, and the lessons learnt. Guided by realist evaluation methods, a multistakeholder dialogue was organised to elicit stakeholders' assumptions on challenges and possible solutions for better TB control. Two participatory workshops were conducted with key actors, interspersed by reflection meetings within the research team and discussions with policymakers. Using concept mapping and causal mapping techniques, and drawing causal loop diagrams, we visualised how actors understood TB service provision challenges and the potential means by which a results-based financing (RBF) policy could address these. The study was conducted in Tbilisi, Georgia. A total of 64 key actors from the Ministry of Labour, Health and Social Affairs, staff of the Global Fund to Fight AIDS, TB and Malaria Georgia Project, the National Centre for Disease Control and Public Health, the National TB programme, TB service providers and members of the research team were involved in the workshops. Findings showed that beyond provider incentives, additional policy components were necessary. These included broadening the incentive package to include institutional and organisational incentives, retraining service providers, clear redistribution of roles to support an integrated care model, and refinement of monitoring tools. Health system elements, such as effective referral systems and health information systems were highlighted as necessary for service improvement. Developing policies that address complex issues requires methods that facilitate linkages between multiple stakeholders and between theory and practice. Such participatory approaches can be informed by realist evaluation principles and visually facilitated by causal loop diagrams. This approach allowed us leverage stakeholders' knowledge and expertise on TB service delivery and RBF to codesign a new policy. [Abstract copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.]11pubpub

Addressing challenges in tuberculosis adherence via performance-based payments for integrated case management: protocol for a cluster randomized controlled trial in Georgia.

From Europe PMC via Jisc Publications RouterHistory: ppub 2019-08-01, epub 2019-08-28Publication status: PublishedFunder: Department of Interational Development; Grant(s): MR/P015018/1Funder: Medical Research Council; Grant(s): MR/P015018/1Funder: Welcome Trust; Grant(s): MR/P015018/1Funder: Economic and Social Research Council; Grant(s): MR/P015018/1BACKGROUND:Tuberculosis is one of the greatest global health concerns and disease management is challenging particularly in low- and middle-income countries. Despite improvements in addressing this epidemic in Georgia, tuberculosis remains a significant public health concern due to sub-optimal patient management. Low remuneration for specialists, limited private-sector interest in provision of infectious disease care and incomplete integration in primary care are at the core of this problem. METHODS:This protocol sets out the methods of a two-arm cluster randomized control trial which aims to generate evidence on the effectiveness of a performance-based financing and integrated care intervention on tuberculosis loss to follow-up and treatment adherence. The trial will be implemented in health facilities (clusters) under-performing in tuberculosis management. Eligible and consenting facilities will be randomly assigned to either intervention or control (standard care). Health providers within intervention sites will form a case management team and be trained in the delivery of integrated tuberculosis care; performance-related payments based on monthly records of patients adhering to treatment and quality of care assessments will be disbursed to health providers in these facilities. The primary outcomes include loss to follow-up among adult pulmonary drug-sensitive and drug-resistant tuberculosis patients. Secondary outcomes are adherence to treatment among drug-sensitive and drug-resistant tuberculosis patients and treatment success among drug-sensitive tuberculosis patients. Data on socio-demographic characteristics, tuberculosis diagnosis and treatment regimen will also be collected. The required sample size to detect a 6% reduction in loss to follow-up among drug-sensitive tuberculosis patients and a 20% reduction in loss to follow-up among drug-resistant tuberculosis patients is 948 and 136 patients, respectively. DISCUSSION:The trial contributes to a limited body of rigorous evidence and literature on the effectiveness of supply-side performance-based financing interventions on tuberculosis patient outcomes. Realist and health economic evaluations will be conducted in parallel with the trial, and associated composite findings will serve as a resource for the Georgian and wider regional Ministries of Health in relation to future tuberculosis and wider health policies. The trial and complementing evaluations are part of Results4TB, a multidisciplinary collaboration engaging researchers and Georgian policy and practice stakeholders in the design and evaluation of a context-sensitive tuberculosis management intervention. TRIAL REGISTRATION:ISRCTN, ISRCTN14667607 . Registered on 14 January 2019

A transdiagnostic psychosocial prevention-intervention service for young people in the Republic of Georgia: early results of the effectiveness study.

Background: The decade between the ages of 14 and 25 is a particularly vulnerable period for the development of mental health problems, especially of common mental disorders. Mental health and psychosocial prevention and support services for young people in the Republic of Georgia have been extremely limited, leaving a wide treatment and care gap. Club Synergy was designed as an innovative, pragmatic solution that is responsive to the needs of young people and incorporates all necessary levels of care required (prevention, early identification & intervention, and treatment) into a single, trauma-informed service that uses a transdiagnostic approach. This paper presents preliminary findings from the pilot phase of establishing and running the service. Aim: To examine the characteristics of young people presenting to Club Synergy and the effectiveness of contact with the service. Methods: Quantitative evaluation of a consecutive series of young people seen by Club Synergy between November 2019 and July 2020. Demographic information was analysed using descriptive statistics. Pre-post outcomes for anxiety (GAD-7), depression (PHQ-9) and health-related quality of life (EQ-5D-5L) were analysed using the Wilcoxon signed-rank test. Results: Hundred and seventy-four young people were included. The majority (68.9%) self-referred, with referral from The Ministry of Justice due to conflict with law (23%) accounting for most of the other young people seen. Emotional disturbance (73.6%), anxiety (60.3%), problems in interpersonal relationships (57.5%) and low mood (49.4%) were the commonest presenting symptoms. Seventy-three per cent reported 4 or more adverse childhood experiences. After engaging in transdiagnostic modules, median baseline scores for depression and anxiety reduced by 40% and 45%, respectively, and self-rated health improved by 14%. Conclusions: Preliminary analysis indicates that Club Synergy's trauma-informed model of care, based on a transdiagnostic approach, has the potential to provide an effective service to young people in Georgia at risk of developing and with mental health problems. HIGHLIGHTS: This pragmatic study of a newly established mental health service for young people in Georgia suggests that a trauma-informed approach, using transdiagnostic modules, has the potential to effectively prevent and treat common mental health presentations

Economic and financial barriers to delivering mental health services in Georgia: Informing policy and acting on evidence

<p>Dataset includes qualitative data for the manuscript entitled "Economic and financial barriers to delivering mental health services in Georgia: Informing policy and acting on evidence".</p

Additional file 4: of Barriers to mental health care utilization among internally displaced persons in the republic of Georgia: a rapid appraisal study

Mental disorders covered by SMPH outpatient care. (DOCX 12 kb

Additional file 1: of Barriers to delivering mental health services in Georgia with an economic and financial focus: informing policy and acting on evidence

Survey guide developed by the research team as a basic document for different type of interview and focus group discussion guides preparation. (DOCX 30 kb

Additional file 2: of Barriers to mental health care utilization among internally displaced persons in the republic of Georgia: a rapid appraisal study

Topic guide for health professionals. (DOCX 14 kb

Additional file 1: of Barriers to mental health care utilization among internally displaced persons in the republic of Georgia: a rapid appraisal study

Topic guide for key informant interviews. (DOCX 13 kb