Assessment of Relative Technical Efficiency of Small Mental Health Areas in Bizkaia (Basque Country, Spain)

Mental disorders cause an enormous burden to society. Considering the current economic context, an efficient use of scarce inputs, with an appropriate outcome production, is crucial. This situation defines a classical Relative Technical Efficiency (RTE) problem. A well-known methodology to assess RTE is the Data Envelopment Analysis, although it presents some limitations. These may be overcome through a hybrid strategy that integrates Monte-Carlo simulation and artificial intelligence. This study aims to (1) design of a Decision Support System for the assessment of RTE of Small Mental Health Areas based on DEA; and (2) analyse 19 mental health areas of the Bizkaian Healthcare System (Spain) to classify them and to identify potential management improvements. The results have showed higher global RTE in the output-oriented orientation than in the input-oriented one. This suggests that a decision strategy based on improving the input management, within the ranges of the expert-driven model of community healthcare, could be appropriate. A future research line will focus our attention on the validation process through the analysis of micromanagement interventions and their potential impacts in the real system

Impact of the workforce allocation on the technical performance of mental health services: the collective case of Helsinki-Uusimaa (Finland)

Background Long-term mental health (MH) policies in Finland aimed at investing in community care and promoting reforms have led to a reduction in the number of psychiatric hospital beds. However, most resources are still allocated to hospital and community residential services due to various social, economic and political factors. Despite previous research focussing on the number and cost of these services, no study has evaluated the emerging patterns of use, their technical performance and the relationship with the workforce structure. Objective The purpose of this study was to observe the patterns of use and their technical performance (efciency) of the main types of care of MH services in the Helsinki-Uusimaa region (Finland), and to analyse the potential rela‑ tionship between technical performance and the corresponding workforce structure. Methods The sample included acute hospital residential care, non-hospital residential care and outpatient care services. The analysis was conducted using regression analysis, Monte Carlo simulation, fuzzy inference and data envelopment analysis. Results The analysis showed a statistically signifcant linear relationship between the number of service users and the length of stay, number of beds in non-hospital residential care and number of contacts in outpatient care services. The three service types displayed a similar pattern of technical performance, with high relative technical efciency on average and a low probability of being efcient. The most efcient acute hospital and outpatient care services integrated multidisciplinary teams, while psychiatrists and nurses characterized non-hospital residential care. Conclusions The results indicated that the number of resources and utilization variables were linearly related to the number of users and that the relative technical efciency of the services was similar across all types. This suggests homogenous MH management with small variations based on workforce allocation. Therefore, the distribution of workforce capacity should be considered in the development of efective policies and interventions in the southern Finnish MH system

Standard comparison of local mental health care systems in eight European countries

Sistema de Salut Mental; Comparació d'atenció a la salut mentalMental Health System; Mental health care comparisonSistema de Salud Mental; Comparación de atención a la salud mentalAims: There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. Methods: A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (≥18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. Results: The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sør-Trøndelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. Conclusions: There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.The REFINEMENT project has received funding from the European Commission under the Seventh Framework Programme (7FP) and lies within the Specific Programme ‘Cooperation’ – Theme ‘Health’: HEALTH.2010.3.2–1: Financing systems’ effect on quality of health care. Duration: 1 January 2011 to 31 December 2013. 7FP. Project number: 261459

A comprehensive review of ecosystem research and context analysis in mental health care

The role of context is critical in health services research. In health care, “context” could be defined as all sources of evidence of the local system: geographic, social and demographic factors, other environmental factors, service availability and scope, capacity, use, costs and the historical development of the health care system. The analysis of context of care of “healthcare ecosystem research” is an emerging discipline that should play a critical role in implementation sciences [1] and in the analysis of complex interventions [2, 3]. “Contextual evidence” has recently been identified as a major source of knowledge in health systems research together with experimental, observational, expert and experiential knowledge [4]. In spite of its relevance, the need for context analysis in health services and delivery research has not been sufficiently recognised [1, 2, 4]. One of the most widely used instrument in context analysis providing data on service availability is ESMS/DESDE (Description and Evaluation of Services and Directories for Long Term Care. This piece of research aims 1) to analyse available methods of context analysis and healthcare ecosystem research for standard description of mental health (MH

Uso de la clasificación internacional DESDE-LTC como sistema de codificación y estandarización de servicios sociales y su aplicación en Atención Primaria de Salud

El sistema internacional de estandarización de servicios DESDE-LTC es una herramienta que procura facilitar la planificación, gestión y evaluación de los servicios sociosanitarios que se presentan en un ámbito territorial determinado. Objetivos: 1) Probar la usabilidad de DESDE–LTC para la clasificación de servicios sociosanitarios en el ámbito de los servicios sociales y la Atención Primaria de salud en Andalucía; 2) Desarrollar un algoritmo informático para la recolección de datos y su codificación automática; 3) Incorporar la información a los sistemas de información geográfica

Borderline Intellectual Functioning: Consensus and good practice guidelines

Objectives: To elaborate a conceptual framework and to establish consensus guidelines. Method: A mixed qualitative methodology, including frame analysis and nominal groups techniques, was used. The literature was extensively reviewed in evidence based medical databases, scientific publications, and the grey literature. This information was studied and a framing document was prepared. Results: Scientific publications covering BIF are scarce. The term that yields a bigger number of results is ‘‘Borderline Intelligence’’. The Working Group detected a number of areas in which consensus was needed and wrote a consensus document covering the conclusions of the experts and the framing document. Conclusions: It is a priority to reach an international consensus about the BIF construct and its operative criteria, as well as to develop specific tools for screening and diagnosis. It is also necessary to define criteria that enable its incidence and prevalence. To know what interventions are the most efficient, and what are the needs of this population, is vital to implement an integral model of care centred on the individual

Standard comparison of local mental health care systems in eight European countries

There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems’ Effect on the Quality of Mental Health Care in Europe) project.The REFINEMENT project has received funding from the European Commission under the Seventh Framework Programme (7FP) and lies within the Specific Programme ‘Cooperation’ – Theme ‘Health’: HEALTH.2010.3.2–1: Financing systems’ effect on quality of health care. Duration: 1 January 2011 to 31 December 2013. 7FP. Project number: 261459

Psychotherapeutic Interventions to Improve Psychological Adjustment in Type 1 Diabetes: A Systematic Review

Background: International clinical practice guidelines highlight the importance of improving the psychological and mental health care of patients with Type 1 diabetes mellitus (T1DM). Psychological interventions can promote adherence to the demands of diabetes self-care, promoting high quality of life and wellbeing. Methods: A systematic review was carried out to determine whether psychological treatments with a specific focus on emotional management have an impact on glycemic control and variables related to psychological adjustment. Comprehensive literature searches of PubMed Medline, Psycinfo, Cochrane Database, Web of Science, and Open Grey Repository databases were conducted, from inception to November 2019 and were last updated in December 2020. Finally, eight articles met inclusion criteria. Results: Results showed that the management of emotions was effective in improving the psychological adjustment of patients with T1DM when carried out by psychologists. However, the evidence regarding the improvement of glycemic control was not entirely clear. When comparing adolescent and adult populations, findings yielded slightly better results in adolescents. Conclusions: More rigorous studies are needed to establish what emotional interventions might increase glycemic control in this population

Atlas de adicciones de España

España no cuenta con un directorio nacional completo de servicios, sino que es necesario acudir a las diferentes administraciones autonómicas con competencias en la materia, y dentro de ellas a los diferentes sectores implicados. Junto a esta fragmentación, el estudio y comparación de la provisión y disponibilidad de servicios es dificultada por problemas de inconmensurabilidad (diferentes unidades) y variedad terminológica (diferentes nombres). El Atlas de Adicciones de España está financiado por Plan Nacional sobre Drogas (PNSD)y tiene por objetivo ser un primer paso para conocer la provisión de servicios de adicciones en las Comunidades y Ciudades Autónomas

Latent structure and measurement invariance of the Hospital Anxiety and Depression Scale in cancer outpatients

The aim of the present study was to compare competing psychometric models and analyze measurement invariance of the Hospital Anxiety and Depression Scale (HADS) in cancer outpatients. Method: The sample included 3,260 cancer outpatients. Latent structure of the HADS was analyzed using confirmatory factor analysis (CFA) with robust maximum likelihood estimation (MLR). Measurement invariance was tested for age, time of response, gender, and cancer type by comparing nested multigroup CFA models with parameter restrictions. Results: Except for the one-factor solutions, all models showed acceptable model fit and measurement invariance. The model with the best fit was the originally proposed two-factor model with exclusion of two items. The one-factor solutions showed inacceptable model fit and were not invariant for age and gender. Conclusions: The HADS has a robust two-factor structure in cancer outpatients. We recommend excluding item 7 and 10 when screening for anxiety and depression