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Introduction: In Haiti, the delegation of tasks to Multi-skilled Community Health Workers (locally called ASCP) is a strategy implemented by the Ministry of Public Health and Population to improve universal health coverage. Purpose of research: To contribute to the successful implementation of this strategy, this article reports on a case study of its implementation in the northern health department of Haiti. More specifically, this article provides information on the contextual factors that facilitate or hinder the implementation of task delegation to ASCP. Results: The results obtained show notable progress in the implementation of task delegation to ASCP in the northern health department of Haiti. These mainly concern the following activities: selection, training, and deployment of ASCPs, endowment of work materials, supervision, collection and analysis of data on the results obtained. In September 2019, 215 ASCPs were active in the department. This corresponds to 44.3% of the 485 ASCPs planned to cover the department's needs. Several contextual factors hindering or facilitating the implementation of this intervention were also identified with 35 resource persons during semi-structured interviews. These relate to the planning and monitoring of the implementation of the intervention (cited by 12 out of 35 people), the institutional context (10/35), and political (17/35), structural (30/35) and environmental factors (7/35). Conclusions: This study highlights several contextual factors that need to be considered to ensure the successful implementation of the delegation of tasks to ASCP in Haiti and possibly in other contexts.
Introduction: En Haïti, la délégation des tâches aux Agents de Santé Communautaire Polyvalents (ASCP) est une stratégie mise en Åuvre par le Ministère de la Santé Publique et de la Population en vue d'améliorer la couverture sanitaire universelle. But de l'étude: Afin de contribuer à la mise en Åuvre réussie de cette stratégie, cet article rend compte d'une étude de cas portant sur son implantation dans le département sanitaire du nord d'Haïti. Plus spécifiquement, cet article renseigne sur les facteurs contextuels qui influencent la mise en Åuvre de la délégation de tâches aux ASCP. Résultats: D'une manière générale, les résultats obtenus montrent des avancées notables dans la sélection, formation, dotation en matériels de travail, supervision et déploiement des ASCP. En septembre 2019, 215 ASCP étaient en activité dans le département sanitaire du nord d'Haïti, ce qui correspond à 44,3 % des 485 ASCP prévus pour couvrir les besoins du département. Plusieurs facteurs contextuels entravant ou facilitant la mise en Åuvre de cette intervention ont été également identifiés auprès de 35 personnes-ressources lors d'entrevues semi-dirigées. Ceux-ci ont trait à la planification et au suivi de l'implantation de l'intervention (cités par 12 personnes sur 35), à l'environnement institutionnel (10/35) et à des facteurs d'ordre politique (17/35), structurel (30/35) et environnemental (7/35). Conclusions: Cette étude met en lumière plusieurs facteurs contextuels qu'il convient de prendre en compte pour assurer le succès de l'implantation de la délégation de tâches aux ASCP en Haïti et, éventuellement, dans d'autres contextes.
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Agentes Comunitários de Saúde , Humanos , HaitiRESUMO
OBJECTIVE: A core function of the public health nutrition workforce is advocacy. Little is known of the nutritionists' role in policymaking from a policy process theory perspective. The current study analyses the nutritionists' role in advocating for a six-year governmental plan on obesity prevention in Quebec, Canada. DESIGN: We conducted qualitative research using Quebec's obesity policy as a case study to understand the role of nutritionists in advocating for obesity prevention policies. A conceptual framework combining the Advocacy Coalition Framework with a political analysis model based on the Theory of the Strategic Actor was developed to analyse the beliefs, interests and strategies of policy actors including nutritionists. Data sources comprised semi-structured open-ended interviews with key policy actors (n 25), including eight nutritionists (32 %) and policy-related documents (n 267). Data analysis involved thematic coding and analysis using NVivo 11 Pro. SETTING: Quebec, Canada. PARTICIPANTS: Key policy actors including nutritionists. RESULTS: Nutritionists formed the core of the dominant public health coalition. They advocated for an inter-sectoral governmental plan to prevent obesity through enabling environments. Their advocacy, developed through an iterative process, comprised creating a think tank and reinforcing partnerships with key policy actors, conducting research and developing evidence, communicating policy positions and advocacy materials, participating in deliberative forums and negotiating an agreement with other coalitions in the policy subsystem. CONCLUSIONS: Nutritionists' advocacy influenced agenda setting and policy formulation. This research may contribute to empowering the public health nutrition workforce and strengthening its advocacy practices. It informs practitioners and researchers concerned with obesity policy and workforce development.
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Disproportionate use of emergency departments (EDs) by patients with mental disorders suggests the need to evaluate factors associated with ED use. Based on the Andersen Behavioral model, this mixed-method study identified the contributions of predisposing, enabling and needs factors in ED use among 328 patients with mental disorders. We hypothesised that ED use for mental health (MH) reasons would be most strongly associated with need factors. The study was conducted in four EDs located in different territories of Quebec (Canada). ED teams assisted with patient recruitment. Participants completed a questionnaire including a qualitative component on reasons for using the ED and assessments of ED and MH services. Data were organised according to the Andersen model, and analysed thematically. ED users were generally single, with low socioeconomic status and inadequate knowledge of MH services (predisposing factors). Most had a regular source of care which facilitated ED referrals (enabling factors); although inadequate access to outpatient care contributed to ED use. Needs factors were the primary motivators in ED use among patients with mental disorders, especially self-rated importance of problems, and MH diagnoses including suicidal ideation/attempts, depression, anxiety, and substance use disorders. Results confirmed our hypothesis that ED visits were more strongly related to needs factors. The mixed methodology reinforced the importance of predisposing and enabling factors in ED use, particularly in more complex cases. Various strategies (e.g. shared care, recruitment of addiction liaison nurses for SUD screening) are suggested for improving access to other resources and reducing non-urgent ED use.
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Serviço Hospitalar de Emergência/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Quebeque , Fatores SocioeconômicosRESUMO
This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users.
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Serviço Hospitalar de Emergência/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços Comunitários de Saúde Mental/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Serviços de Emergência Psiquiátrica/organização & administração , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Capacitação em Serviço/organização & administração , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente , Pesquisa Qualitativa , Quebeque , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
BACKGROUND: This study evaluates implementation of the Quebec Mental Health (MH) Reform (2005-2015) which aimed to improve accessibility, quality and continuity of care by developing primary care and optimizing integrated service networks. Implementation of MH primary care teams, clinical strategies for consolidating primary care, integration strategies to improve collaboration between primary care and specialized services, and facilitators and barriers related to these measures were examined. METHODS: Eleven Quebec MH service networks provided the study setting. Networks were identified in consultation with 20 key MH decision makers and selected based on variation in services offered, integration strategies, best practices, and geographic criteria. Data collection included: primary documents, structured questionnaires completed by 25 managers from MH primary care teams and 16 respondent-psychiatrists working in shared-care, and semi-structured interviews with 102 network stakeholders involved in the reform. The study employed a mixed method approach, triangulating the three data sources across networks. RESULTS: While implementation was not fully achieved in most networks, the Quebec reform succeeded in improving primary care services with the creation of adult primary care teams, and one-stop services which increased access to care, mainly for clients with common MH disorders. In terms of clinical strategies implemented, the functions provided by respondent-psychiatrists had a greater impact on the MH primary care teams than on general practitioners (GPs) in medical clinics; whereas the implementation of best practices were indirect outcomes of another reform developed simultaneously by the Quebec substance use disorders program. The main integration strategies used for increasing continuity of care and collaboration between primary care and specialized services were those involving fewer formal procedures such as referrals between teams and organizations. The lack of operational mechanisms and protocols governing new services and structures were important barriers to primary care consolidation and service integration, as was the lack of interest and involvement of most GPs in MH. CONCLUSIONS: Successful and sustained healthcare reform requires attention to process and outcomes as well as structural change or service reorganization. Six recommendations for more successful implementation of the Quebec MH Reform are provided, with implications for healthcare reform internationally.
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Reforma dos Serviços de Saúde , Implementação de Plano de Saúde/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Adulto , Comportamento Cooperativo , Feminino , Medicina Geral/organização & administração , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Quebeque/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: The objectives of this research are: 1) to provide a conceptual framework for analyzing mental health policies; 2) to compare mental health policies across a sample of OECD jurisdictions; 3) to describe configurations of mental health policies; 4) to identify practical implications for the Province of Quebec. DESIGN: This research is a comparative synthetic study of mental health policies. SAMPLING: The web sites of the Ministries of health of the thirty-four OECD countries and ten Canadian Provinces were searched for mental health policies proposed within the last fifteen years. Twenty one such policies (with an English or French version) were retrieved, covering thirteen OECD countries, six Canadian Provinces and the WHO. ANALYSIS: Content analysis was performed based on the categories (differentiation, integration, governance) and sub-categories of the aforementioned conceptual framework. Eight policies that together cover the variations encountered between all policies were used to identify typical configurations. RESULTS: A conceptual framework derived from Parsons' Theory of Social Action posits that social action systems must exhibit a level of internal differentiation that corresponds to the heterogeneity of their external environment and also a level of integration that allows them to remain coherent despite the complexity of their environment. Governance mechanisms help them maintain an equilibrium between differentiation and integration.In terms of differentiation, mental health policies exhibit much variation between the needs and the groups that are prioritized (age, gender, ethnicity, culture, etc.), the types of interventions that are proposed (promotion, prevention, treatment, rehabilitation, etc.), the systemic levels at which interventions take place (society, government as a whole, health care system, organizations, programs, individuals), and the level of specification and scientific basis of proposed interventions. In terms of integration, policies promote various mechanisms belonging to four general categories of increasing effectiveness from hierarchical separation of mandates, to exchange of information, to collaborative planning, and to complete structural integration and co-localisation of certain components (ex. dependence and mental health services). In terms of governance, policies present program theories of varying explicitness and scientific bases, and with different emphases on structures, processes or outcomes. Management models also vary in terms of precision, accountability, financing mechanisms, information systems, and the importance of clinical governance and quality improvement.Five configurations of mental health policies are identified (the public health, the professional, the structural technocratic, the functional technocratic, and the political), each comprising typical combinations of the preceding ingredients. CONCLUSION: The current Quebec mental health policy belongs to the structural technocratic configuration. It specifies fragmented mental health structures with mild integration mechanisms. In the future, it should consider improving its public health aspects (inter-sector work on the determinants of mental health), professional aspects (emphasis on scientific evidence, clinical governance and quality), and functional aspects (integrated specialized community mental health and addiction services). But political factors may prevent it from doing so.
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Política de Saúde , Austrália , Europa (Continente) , Planejamento em Saúde , Humanos , Serviços de Saúde Mental/organização & administração , América do NorteRESUMO
Emergency department (ED) overcrowding is a growing problem worldwide. High ED users have been historically targeted to reduce ED overcrowding and associated high costs. Patients with psychiatric disorders, including substance-related disorders (SRDs), are among the largest contributors to high ED use. Since EDs are meant for urgent cases, they are not an appropriate setting for treating recurrent patients or replacing outpatient care. Identifying ED user profiles in terms of perceived barriers to care, service use, and sociodemographic and clinical characteristics is crucial to reduce ED use and unmet needs. Data were extracted from medical records and a survey was conducted among 299 ED patients from 2021 to 2022 in large Quebec networks. Cluster algorithms and comparison tests identified three profiles. Profile 1 had the most patients without barriers to care, with case managers, and received the best primary care. Profile 2 reported moderate barriers to care and low primary care use, best quality of life, and more serious psychiatric disorders. Profile 3 had the most barriers to care, high ED users, and lower service satisfaction and perceived mental/health conditions. Our findings and recommendations inform decision-makers on evidence-based strategies to address the unmet needs of these vulnerable populations.
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Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Humanos , Qualidade de Vida , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Serviço Hospitalar de Emergência , Assistência AmbulatorialRESUMO
Objectives Hospital emergency departments (ED) are often overcrowded, and patients using ED for mental health (MH) reasons contribute in great part to this situation. In Quebec, in 2014-15, 17% of ED users with mental disorders had visited ED at least 4 times for various reasons. These patients' frequent ED use usually reflects the inadequacy of the services provided to them. A better understanding of the underlying reasons behind this frequent ED use would enable stakeholders to formulate recommendations that would help improve services, making them more suited to the needs of these patients. The aim of this study was to identify the factors that encourage or limit the use of ED by frequent ED users, the term "frequent ED users" being defined as patients who use ED at least 3 times over a one-year period. Methodology Between April and September 2021, 20 ED professionals were interviewed concerning factors they perceived as encouraging or limiting ED use among frequent ED users. Participants worked in a psychiatric ED or in other hospital services (e.g., assessment-liaison module), or were partners of the ED within the territory (e.g., crisis centers). Study data were analyzed using a content analysis method carried out in various stages (e.g., data transcription, content coding), and guided by a conceptual framework comprised of 4 categories of factors that encourage or limit frequent use for MH reasons. These factors were related to the healthcare system, patient profiles, health professionals, and the MH network's organizational characteristics. Results More encouraging factors than limiting ones were identified as pertains to ED use. Most factors were associated with the healthcare system (and particularly with the unavailability of MH services), and with patient profiles, more specifically those with complex mental disorders compounded by psychosocial problems. Organizational characteristics, in particular the deployment of innovations in the ED or in partnership with it, although not widely deployed overall, tended to limit ED use. Conclusion This study highlights the importance of developing more innovations in the ED and in conjunction with other hospital and community services to better meet the needs of frequent ED users, and thus reduce their use of these services. ED should optimize their role in the screening, brief treatment, referral, and quality monitoring of services for patients, particularly those not adequately served by outpatient MH services.
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Transtornos Mentais , Serviços de Saúde Mental , Humanos , Saúde Mental , Transtornos Mentais/terapia , Quebeque , Serviço Hospitalar de EmergênciaRESUMO
BACKGROUND: Primary care improvement is the cornerstone of current reforms. Mental disorders (MDs) are a leading cause of morbidity worldwide and widespread in industrialised countries. MDs are treated mainly in primary care by general practitioners (GPs), even though the latter ability to detect, diagnose, and treat patients with MDs is often considered unsatisfactory. This article examines GPs' management of MDs in an effort to acquire more information regarding means by which GPs deal with MD cases, impact of such cases on their practices, factors that enable or hinder MD management, and patient-management strategies. METHODS: This study employs a mixed-method approach with emphasis on qualitative investigation. Based on a previous survey of 398 GPs in Quebec, Canada, 60 GPs representing a variety of practice settings were selected for further study. A 10-minute-long questionnaire comprising 27 items was administered, and 70-minute-long interviews were conducted. Quantitative (SPSS) and qualitative (NVivo) analyses were performed. RESULTS: At least 20% of GP visits were MD-related. GPs were comfortable managing common MDs, but not serious MDs. GPs' based their treatment of MDs on pharmacotherapy, support therapy, and psycho-education. They used clinical intuition with few clinical tools, and closely followed their patients with MDs. Practice features (salary or hourly fees payment; psycho-social teams on-site; strong informal networks), and GPs' individual characteristics (continuing medical education; exposure and interest in MDs; traits like empathy) favoured MD management. Collaboration with psychologists and psychiatrists was considered key to good MD management. Limited access to specialists, system fragmentation, and underdeveloped group practice and shared-care models were impediments. MD management was seen as burdensome because it required more time, flexibility, and emotional investment. Strategies exist to reduce the burden (one-problem-per-visit rule; longer time slots). GPs found MD practice rewarding as patients were seen as grateful and more complying with medical recommendations compared to other patients, generally leading to positive outcomes. CONCLUSIONS: To improve MD management, this study highlights the importance of extending multidisciplinary GP practice settings with salary or hourly fee payment; access to psychotherapeutic and psychiatric expertise; and case-discussion training involving local networks of GPs and MD specialists that encourage both knowledge transfer and shared care.
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Competência Clínica/normas , Clínicos Gerais , Transtornos Mentais/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Padrões de Prática Médica , Adulto , Idoso , Competência Clínica/estatística & dados numéricos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Gerenciamento Clínico , Planos de Pagamento por Serviço Prestado/economia , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Feminino , Prática de Grupo/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Renda/estatística & dados numéricos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Educação de Pacientes como Assunto/métodos , Prevalência , Prática Privada/estatística & dados numéricos , Quebeque/epidemiologia , Serviços de Saúde Rural/economia , Fatores Socioeconômicos , Inquéritos e Questionários , Serviços Urbanos de Saúde/economiaRESUMO
OBJECTIVE: To document the management of mental health problems (MHPs) by general practitioners. DESIGN: A mixed-method study consisting of a self-administered questionnaire and qualitative interviews. An analysis was also performed of Régie de l'assurance maladie du Québec administrative data on medical procedures. SETTING: Quebec. PARTICIPANTS: Overall, 1415 general practitioners from different practice settings were invited to complete a questionnaire; 970 general practitioners were contacted. A subgroup of 60 general practitioners were contacted to participate in interviews. MAIN OUTCOME MEASURES: The annual frequency of consultations over MHPs, either common (CMHPs) or serious (SMHPs), clinical practices, collaborative practices, factors that either support or interfere with the management of MHPs, and recommendations for improving the health care system. RESULTS: The response rate was 41% (n = 398 general practitioners) for the survey and 63% (n = 60) for the interviews. Approximately 25% of visits to general practitioners are related to MHPs. Nearly all general practitioners manage CMHPs and believed themselves competent to do so; however, the reverse is true for the management of SMHPs. Nearly 20% of patients with CMHPs are referred (mainly to psychosocial professionals), whereas nearly 75% of patients with SMHPs are referred (mostly to psychiatrists and emergency departments). More than 50% of general practitioners say that they do not have any contact with resources in the mental health field. Numerous factors influence the management of MHPs: patients' profiles (the complexity of the MHP, concomitant disorders); individual characteristics of the general practitioner (informal network, training); the professional culture (working in isolation, formal clinical mechanisms); the institutional setting (multidisciplinarity, staff or consultant); organization of services (resources, formal coordination); and environment (policies). CONCLUSION: The key role played by general practitioners and their support of the management of MHPs were evident, especially for CMHPs. For more optimal management of primary mental health care, multicomponent strategies, such as shared care, should be used more often.
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Medicina Geral/organização & administração , Transtornos Mentais , Serviços de Saúde Mental/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Idoso , Competência Clínica , Feminino , Medicina Geral/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Humanos , Relações Interprofissionais , Entrevistas como Assunto , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Melhoria de Qualidade , Quebeque/epidemiologia , Inquéritos e QuestionáriosRESUMO
Mental health services are in the midst of change in different countries. In Quebec (Canada), the government has adopted a Mental Health Action Plan (2005-2010). In this context, 2 psychiatric institutions have developed and implemented a mental health services organization model based on diagnosis-related mental health programs and support for frontline services. This article presents the impact on health care providers of implementation of diagnosis-related mental health programs in the context of transformation of mental health services.
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Grupos Diagnósticos Relacionados , Pessoal de Saúde , Serviços de Saúde Mental/organização & administração , Adulto , Pessoal de Saúde/psicologia , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Modelos Organizacionais , Estudos de Casos Organizacionais , Quebeque , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Quality improvement in Healthcare is the new fashion actually. Rich countries and developing countries alike are trying to implement quality improvement initiatives to improve their performance and the quality of care. There is evidence in the scientific literature that the existence of a "champion" can play an important role in the successful implementation of quality improvement strategies. Most of the time, people get stuck at the implementation level: they know what to do but they fail to execute it in the organizational setting. That's where a champion can be useful to facilitate the success of the change. There is a paucity of research on the link between the champion and the implementation of quality improvement programs. The aim of the study was to investigate the perceptions of stakeholders about the characteristics and qualities of the champion that could facilitate the successful implementation of quality improvement programs in health care settings in Haiti. METHODS: Twenty semi-structured individual interviews and one small group discussion (n = 4) with providers, administrators, directors, and NGO representatives were conducted during a six months period. The total sample size was twenty-four (n = 24). The methods were informed by grounded theory and the data were analyzed using the constant comparative method and thematic content analysis approach. RESULTS: The analysis resulted in eleven themes describing the characteristics and qualities of a successful champion: Communication and persuasion, proactivity, humility, horizontal and collective leadership style, sense of responsibility and accountability, go-ahead type, empathy, dedication and motivation, ability to inspire and motivate people, have a vision, and encourage learning. CONCLUSIONS: It is important to support and encourage champions in the health care systems in developing countries to master and exhibit those qualities and characteristics in order to lead a team for the successful implementation of quality improvement initiatives in the health facilities. More research is needed to understand how to better articulate those qualities in the context of the Haitian health care system.
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Analyses of the present data are reported in the article "What are the characteristics of the champion that influence the implementation of quality improvement programs?" [5]. Data were collected from April to September 2019 using a qualitative data collection tool, an interview guide (see Appendix 1). A total of 21 staff were interviewed from three different health facilities in the Northern Department of Haiti. They gave their perceptions about the qualities and the characteristics of the champions involved in the planning and implementation of quality improvement initiatives in the health facilities in order to introduce change for a better quality of care. This data article provides an overview of the content of those interviews in terms of the characteristics of the champions. In addition, instructions are included about the output of Atlas ti software. You could reuse those data to get a better understanding of the quality and the characteristics of the champions that play a critical role in the implementation of quality improvement programs. The dataset includes the following: - Raw data: interviews transcripts - The Atlas ti software outputs: codes and quotations - The codebook.
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Background: Few studies have investigated satisfaction with emergency departments (EDs) among patients with mental health (MH) issues. This study evaluated the use of and satisfaction with EDs and other MH services among 328 patients with MH disorders, as well as specific characteristics of patient satisfaction and dissatisfaction. Methods: A mixed-methods study was conducted in four EDs located in different administrative healthcare regions of Quebec (Canada). Results: Patients were highly satisfied with staff attitudes in EDs and other MH services (i.e., hospital in-patient services, outpatient services, community organizations). Major sources of dissatisfaction were the information received in EDs concerning community services and the physical environment or climate in EDs and other MH services. Conclusion: Dissatisfaction with services may be reduced by extending hours of operation in MH services; promoting collaboration between psychiatrists, family physicians and other primary care providers; further integrating EDs with other healthcare services; and improving the characteristically austere and restrictive atmosphere in EDs.
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Serviço Hospitalar de Emergência , Transtornos Mentais/terapia , Serviços de Saúde Mental , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Quebeque , Adulto JovemRESUMO
The purpose of this study was to investigate the relationships between dimensions of the psychosocial work environment and health professionals' use of evidence in their practice. A correlational descriptive design was developed. Health professionals working in mental health units at 2 hospitals were asked to complete a questionnaire about their perceptions of the psychosocial work environment and their use of evidence. Correlations and regression analyses were performed. Use of evidence was found to be correlated with social support and decision latitude. Results of multiple regression analyses found perceived social support (beta = .27, p < .01) and perceived decision latitude (beta = .25,p < .01) to be significant predictors of the use of evidence. The authors conclude that good social support and decision latitude among interprofessional groups may promote use of evidence by health professions in their practice.
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Atitude do Pessoal de Saúde , Difusão de Inovações , Prática Clínica Baseada em Evidências , Ambiente de Instituições de Saúde/organização & administração , Recursos Humanos em Hospital , Local de Trabalho , Adulto , Idoso , Análise de Variância , Canadá , Distribuição de Qui-Quadrado , Tomada de Decisões Gerenciais , Prática Clínica Baseada em Evidências/educação , Prática Clínica Baseada em Evidências/organização & administração , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pesquisa Metodológica em Enfermagem , Saúde Ocupacional , Cultura Organizacional , Recursos Humanos em Hospital/educação , Recursos Humanos em Hospital/psicologia , Autonomia Profissional , Enfermagem Psiquiátrica/educação , Enfermagem Psiquiátrica/organização & administração , Psiquiatria/educação , Psiquiatria/organização & administração , Análise de Regressão , Recompensa , Apoio Social , Inquéritos e Questionários , Carga de Trabalho/psicologia , Local de Trabalho/organização & administração , Local de Trabalho/psicologiaRESUMO
Recent mental health (MH) reforms have had a sharp impact on practices among MH professionals. A deeper understanding of factors contributing to their job satisfaction, in this context, may help improve quality and continuity of care. The purpose of this study was to identify variables associated with job satisfaction for 315 MH professionals in Quebec (Canada) after implementation of wide-ranging MH reforms. Job satisfaction was measured with the Job Satisfaction Survey. Independent variables were conceptualized within five domains: 1) Professional Characteristics, 2) Team Attributes, 3) Team Processes, 4) Team Emergent States, and 5) Organizational Culture. Univariate, bivariate and multivariate analyses were performed. Job satisfaction was significantly associated with absence of team conflict, stronger team support, better team collaboration, greater member involvement in the decision-making process (Team Processes), Affective commitment toward the team (Team Emergent States), as well as lack of a market/rational culture (Organizational Culture). Job satisfaction was strongly related to team processes and, to a lesser extent, team emergent states.
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Pessoal de Saúde/psicologia , Satisfação no Emprego , Saúde Mental , Feminino , Humanos , Modelos Lineares , Masculino , Análise Multinível , Padrões de Referência , Inquéritos e QuestionáriosRESUMO
Objectives This study aimed to: 1) assess implementation of the 2005-2015 Quebec mental health (MH) reform, and its enabling and hindering factors as well as MH team performance, in 11 local health service networks; then, for a subset of 4 networks: 2) identify processes influencing service quality in MH teams, and 3) analyze effects of team structures and processes on outcomes for service users.Methods The networks were selected in consultation with 20 MH decision makers. Data sources included: 1) documentation on population, organization and service characteristics, integration strategies, and network challenges; 2) individual and group interviews with 102 regional managers, MH professionals and managers from primary care or specialized MH teams, community organization directors, respondent psychiatrists and general practitioners (GPs); and 3) questionnaires completed by 16 respondent psychiatrists, 90 managers, 315 MH professionals from primary care or specialized teams, and 327 service users.Results Objectives of the MH reform were only partially achieved across the 11 health service networks, given the limited availability of practice guidelines related to implementing new structures and services, and reluctance among MH professionals (mainly GPs) to adopt them. As well, most primary care teams lacked GPs or psychiatrists. Implementation was more successful in large networks with specialized services located in general hospitals. The use of clinical tools and approaches, and frequent interactions with other teams or organizations enhanced team performance. Several team process variables including autonomy, involvement in decision-making, and knowledge sharing were strongly associated with the performance of MH professionals and higher quality services. While geographic variables (e.g. frequency of interactions with GPs) had more influence on performance in specialized services, individual variables (e.g. lower seniority in the team) and organizational variables (e.g. lower proportion of service users with personality disorders) influenced performance in primary care teams. Work satisfaction was more strongly associated with team process variables (e.g. fewer conflicts, higher team support, greater collaboration) and recovery-oriented services with organizational variables (e.g. primary care team). Some types of organizational culture were strongly associated with team performance (clan and hierarchical cultures), and work satisfaction (market culture). Concerning effects of team structure and processes on service user outcomes, higher quality of life and recovery scores were strongly associated with continuity and diversity of services. Finally, high seriousness of needs among service users represented a major obstacle for MH services attempting to address their quality of life issues and recovery.Conclusion This study suggests various measures that may improve MH service quality: promotion of more results-oriented organizational cultures, and greater collaboration, professional training on evidence-based practices, greater support for professionals, increasing their autonomy and involvement in decision-making, and more formalized integration strategies. Diversified and continuous biopsychosocial support was also recommended for improving quality of life and recovery among service users.
RESUMO
Effective mental health care requires a high performing, interprofessional team. Among 79 mental health teams in Quebec (Canada), this exploratory study aims to 1) determine the association between work role performance and a wide range of variables related to team effectiveness according to the literature, and to 2) using structural equation modelling, assess the covariance between each of these variables as well as the correlation with other exogenous variables. Work role performance was measured with an adapted version of a work role questionnaire. Various independent variables including team manager characteristics, user characteristics, team profiles, clinical activities, organizational culture, network integration strategies and frequency/satisfaction of interactions with other teams or services were analyzed under the structural equation model. The later provided a good fit with the data. Frequent use of standardized procedures and evaluation tools (e.g. screening and assessment tools for mental health disorders) and team manager seniority exerted the most direct effect on work role performance. While network integration strategies had little effect on work role performance, there was a high covariance between this variable and those directly affecting work role performance among mental health teams. The results suggest that the mental healthcare system should apply standardized procedures and evaluation tools and, to a lesser extent, clinical approaches to improve work role performance in mental health teams. Overall, a more systematic implementation of network integration strategies may contribute to improved work role performance in mental health care.
Assuntos
Comportamento Cooperativo , Pessoal de Saúde , Transtornos Mentais/terapia , Saúde Mental , Desempenho Profissional , Reforma dos Serviços de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Cultura Organizacional , Equipe de Assistência ao Paciente , Quebeque , Inquéritos e Questionários , Recursos HumanosRESUMO
INTRODUCTION: This study evaluates implementation of the Quebec Mental Health Reform (2005-2015), which promoted the development of integrated service networks, in 11 local service networks organized into four territorial groups according to socio-demographic characteristics and mental health services offered. METHODS: Data were collected from documents concerning networks; structured questionnaires completed by 90 managers and by 16 respondent-psychiatrists; and semi-structured interviews with 102 network stakeholders. Factors associated with implementation and integration were organized according to: 1) reform characteristics; 2) implementation context; 3) organizational characteristics; and 4) integration strategies. RESULTS: While local networks were in a process of development and expansion, none were fully integrated at the time of the study. Facilitators and barriers to implementation and integration were primarily associated with organizational characteristics. Integration was best achieved in larger networks including a general hospital with a psychiatric department, followed by networks with a psychiatric hospital. Formalized integration strategies such as service agreements, liaison officers, and joint training reduced some barriers to implementation in networks experiencing less favourable conditions. CONCLUSION: Strategies for the implementation of healthcare reform and integrated service networks should include sustained support and training in best-practices, adequate performance indicators and resources, formalized integration strategies to improve network coordination and suitable initiatives to promote staff retention.
RESUMO
In the Province of Quebec (Canada), adolescents involved with the child welfare and juvenile justice systems committed at least one third of all completed suicides in their age group in 1995 and 1996. Their risk of suicide, standardized for age and sex, was five times that of the general adolescent population, and female juvenile delinquents had the highest relative risk of suicide (36.1). Cumulated risk factors may explain those results. Since 40% of those suicides did occur when subjects were still actively involved with the child welfare and juvenile justice systems, those agencies should revise their suicide prevention strategies.