Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries

This research was financially supported by DG-Sanco (contract: 800197; 2007-2010). The authors would like to thank all of the professionals and services who participated in the PROMO assessment of services. A PhD grant from Fundação para a Ciência e Tecnologia–Portugal (SFRH/BD/66388/2009) to the first author is acknowledged

An automated tool for a uniform decentralized quality control and data analysis in multicenter studies with health care registry data

ABSTRACT Objectives The EU FP7 funded project CEPHOS-LINK investigates hospital re-admissions of patients with a psychiatric disorder in 6 European countries by using linked health care registry data. In addition to the problems of different healthcare, payment and data collection systems, coordinating quality control, data analysis, and statistical modeling of sensitive data with six partners is challenging. For this purpose we have designed a secure online data analysis tool to diminish the time necessary to get results and incremental adaptions of reports as well as decreasing the chance and effects of misunderstandings between national and linguistic boundaries. Approach A comprehensive study protocol clearly defining variables to be obtained and methods to be applied has been put together. The protocol is based on a thorough investigation of the different healthcare systems and related registries. It became clear that nonetheless misconceptions occur and the incremental improvements consumed vast amounts of available resources. Therefore a system which automatically creates the required reports including all tables, graphics and statistical models including data preparation based on a defined data structure has been developed. The report system is based on the statistical environment R and the document markup language LaTeX, tightly integrated with R's package “knitr”.As this highly flexible solution is not straight forward to apply and implies various technical dependencies, a secure online platform hiding all technical details from the users has been developed. Utilizing state of the art software containers based on Linux and docker, a customized VPN solution, authentication and SSL encryption were put together. The web application itself is developed with R's “shiny” package and allows users to simply upload a dataset in the predefined format, interactively explore the contents, apply filters and generate the customizable, standardized report. Additionally, an offline version of the application is available for all major (desktop) operating systems. Results The new platform advances data analysis and reporting in a situation where several partners are involved in analyzing local datasets, as is the case of the CEPHOS-LINK project. Integrating new features, graphics and research topics can be managed centrally while users can update their results and reports in nearly no time. Conclusion The additional effort spent on developing a customized platform for quality control, data analysis and reporting has been worth the effort. Benefits include quick detection of implausible results, unifying the layout and graphics often depending on the software utilized and an established common data structure

Good practice in health care for migrants: views and experiences of care professionals in 16 European countries

Background: Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care. Methods: Structures interviews with open questions and case vignettes were conducted with health care professional working in areas with high proportion of migrant population in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients. i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis. Results: Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrant positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services. Conclusion: Health care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information

Experiences with treating immigrants: a qualitative study in mental health services across 16 European countries

While there has been systematic research on the experiences of immigrant patients in mental health services within certain European countries, little research has explored the experiences of mental health professionals in the delivery of services to immigrants across Europe. This study sought to explore professionals’ experiences of delivering care to immigrants in districts densely populated with immigrants across Europe. Forty-eight semi-structured interviews were conducted with mental health care professionals working in 16 European countries. Professionals in each country were recruited from three areas with the highest proportion of immigrants. For the purpose of this study, immigrants were defined as first-generation immigrants born outside the country of current residence, including regular immigrants, irregular immigrants, asylum seekers, refugees and victims of human trafficking. Interviews were transcribed and analysed using thematic analysis. The interviews highlighted specific challenges to treating immigrants in mental health services across all 16 countries including complications with diagnosis, difficulty in developing trust and increased risk of marginalisation. Although mental health service delivery varies between and within European countries, consistent challenges exist in the experiences of mental health professionals delivering services in communities with high proportions of immigrants. Improvements to practice should include training in reaching appropriate diagnoses, a focus on building trusting relationships and measures to counter marginalisation

Health care for immigrants in Europe : Is there still consensus among country experts about principles of good practice? A Delphi study

Background: European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. Methods: A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. Results: The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e. g. on the need for prioritising cultural differences, and between countries, e. g. on the need for more consistent governance of health care services for immigrants. Conclusions: Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate

Health care for immigrants in Europe: Is there still consensus among country experts about principles of good practice? A Delphi study

Background: European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. Methods: A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. Results: The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e. g. on the need for prioritising cultural differences, and between countries, e. g. on the need for more consistent governance of health care services for immigrants. Conclusions: Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate