Barriers to mental health services utilisation in Portugal - results from the National Mental Health Survey.

BACKGROUND: The treatment gap for mental disorders remains a challenge worldwide. Identifying reasons for nontreatment may contribute to reducing this gap. AIMS: To evaluate sociodemographic and clinical factors associated with use and barriers to treatment in Portugal. METHOD: Data from the 2009 National Mental Health Survey were used. Participants reported 12-month treatment and reasons for nontreatment. Logistic regression models analysed the association between sociodemographic (education; employment; income; marital status) and clinical variables (mental disorder diagnosis; disability) with treatment and type of barriers (low perceived need; structural; attitudinal). RESULTS: The majority of participants with a mental disorder was not treated. Treatment was more common among participants with mood disorders (OR = 4.19; 95% CI: 2.72-6.46), and disability (OR = 2.43; 95% CI: 1.33-4.46), and less common among single participants (OR = 0.38; 95% CI: 0.20-0.70) and those with basic/secondary education (OR = 0.42; 95% CI: 0.24-0.73). Attitudinal barriers were more likely among participants with none/primary (OR = 2.90; 95% CI: 1.42-5.90) and basic/secondary education (OR = 1.70; 95% CI: 1.01-2.85), and less likely among those with substance use disorders (OR = 0.27; 95% CI: 0.10-0.70). Low perceived need was higher among single people (OR = 1.77; 95% CI: 1.01-3.08), and lower among those with anxiety (OR = 0.50; 95% CI: 0.28-0.90) and mood disorders (OR = 0.16; 95% CI: 0.09-0.30). Unemployed participants had higher odds of reporting structural barriers (OR = 3.76; 95% CI: 1.29-10.92). CONCLUSIONS: This study identifies factors associated with nontreatment, providing useful evidence to develop policies and effective interventions.

Clinical Use and Barriers of Thoracic Ultrasound: A Survey of Italian Pulmonologists.

INTRODUCTION: Thoracic ultrasound is accurate in the diagnosis of a wide range of respiratory diseases. Yet the extent of its use is unknown. Through a national survey, we aimed to explore the clinical use of thoracic ultrasound and the barriers to the diffusion of the technique in Italy. METHODS: Accademia di Ecografia Toracica (AdET) developed a self-administered survey which was sent by email to Italian pulmonologists via national scientific societies and networks. RESULTS: Of the 2010 physicians invited, 514 completed the survey (26% response rate). According to 99% of responders, thoracic ultrasound had a relevant clinical role. Seventy-nine percent of the responders used thoracic ultrasound at least once a month. The main settings were: 53% pulmonology ward, 15% outpatient clinic, 15% interventional pulmonology room, 10% internal medicine ward, 4% respiratory intensive care units, and 9% other. Thoracic ultrasound was primarily used: (1) with both diagnostic and interventional aims (72%), (2) as diagnostic imaging (17%), and (3) as guidance for interventional procedures (11%). The main clinical applications were: (1) diagnosis and management of pleural effusion, (2) pneumothorax, (3) pneumonia, (4) cardiac failure, and (5) acute dyspnea. Twenty-one percent of the responders do not use thoracic ultrasound. The main reported bar-riers were: (1) availability of an ultrasound system (52%), (2) lack of protected time and training (22%), and (3) use of the technique by other specialists (15%). CONCLUSION: Thoracic ultrasound is widely used by Italian pulmonologists and considered a clinically relevant tool. The availability of dedicated ultrasound systems seems to be a major limit of the use of the technique.

Patient-reported outcome use in oncology: a systematic review of the impact on patient-clinician communication.

PURPOSE: Patient-reported outcomes (PROs) are an increasingly popular tool to optimize care and bridge the gap between patient experience and clinician understanding. The aim of this review was to identify mechanisms through which PROs facilitate patient-clinician communication in the adult oncology population. METHODS: We conducted a systematic review of the published literature using the following data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, Cab Direct, and CDSR. Studies included in this review reported on the outcomes of PRO use, used PROs as an intervention and not as a study outcome measurement tool, included cancer patients or survivors as study participants, and analyzed patient-clinician communication. RESULTS: We identified 610 unique records, of which 43 publications met the inclusion and exclusion criteria. Synthesis of the reviewed studies provided evidence of the usefulness of PROs in facilitating patient-clinician communication on a variety of topics. We identified mechanisms though which PROs influenced patient-clinician communication to include increasing symptom awareness, prompting discussion, streamlining consultations, and facilitating inter-professional communication. Barriers to PRO use in communication improvement include technical problems impeding its administration and completion, compliance issues due to lack of incentive or forgetfulness, and use of PROs that do not appropriately assess issues relevant to the patient. Facilitators include increased education on PRO use, using PRO tools that patients find more acceptable, and providing patient data summaries in an easily accessible format for clinicians. CONCLUSIONS: Our review suggests that PROs facilitate patient-clinician communication through various mechanisms that could perhaps contribute to improvements in symptom management and survival. The impact of PROs on clinical outcomes, however, remains poorly studied.

Factors that affect powered wheelchair use for an adult population: a systematic review.

PURPOSE: The purpose of the review was to explore current factors affecting the use of a powered wheelchair for an adult person a with a disability. MATERIALS AND METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Information about the characteristics of the studies (type, setting) and perceived barriers and facilitators to powered wheelchair use were extracted using a data extraction sheet. Data synthesis was achieved using narrative synthesis. The quality of the included studies was assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (SQAC) and the CASP checklist (Critical Appraisal Skills Programme), Centre for Evidence-Based Medicine, SIGN (Scottish Intercollegiate Guidelines Network). RESULTS: Fifteen studies qualified for inclusion in the review. The narrative synthesis produced a conceptual map of reported factors affecting the usability of a powered wheelchair. CONCLUSIONS: This review demonstrates that powered wheelchair use is a multifaceted and multidisciplinary phenomenon that is dependent on numerous interconnected factors including individual adjustment, stakeholder cooperation, societal attitudes, functional performance, and environmental features. Based on the review findings, there are several applied learning outcomes and practical applications to the powered wheelchair prescription and provision.

The rejection, misuse or damage of a powered wheelchair can result in condition deterioration and loss of independence for the user.Adult powered wheelchair prescription, maintenance, and use is a multi-faceted process spanning social, individual, environmental, technical and functional, and organisational factors.Individuals in this stakeholder network should aim to account for these interdisciplinary factors when engaging with people who use powered wheelchairs.

Healthcare in the Modern Era: Launching a Telemedicine-Based OPD Consultation in Rural Pune (Process, Results, and Challenges).

Introduction Telemedicine serves as a means of overcoming geographical barriers and increasing access to specialist care. This study focuses on the impact of telemedicine on the early diagnosis and treatment of patients, as well as its effect on patient satisfaction. In addition, the study examines the obstacles and facilitators that influence the implementation of telemedicine. Objectives The primary objectives of this study are to assess the effectiveness of telemedicine in facilitating early diagnosis and treatment for patients in need of specialist consultations, to evaluate patient satisfaction with specialist care delivered through telemedicine, and to identify the factors that influence the successful implementation of telemedicine in rural healthcare centers. Methodology An exploratory feasibility study was carried out at two rural health training centers (RHTCs) over a one-year period, enrolling 400 patients requiring specialist consultations. The study involved establishing a telemedicine center, implementing teleconsultations, and collecting data through patient interviews and self-administered questionnaires. Results A majority of teleconsultations, over 79%, were deemed valuable by medical officers, resulting in improved management, better counseling, and earlier diagnoses. More than 76% of patients found telemedicine to be acceptable due to the reduction in travel time and cost. The most common health concerns among patients were diabetes, hypertension, and skin disorders. The study also revealed several challenges, including limited specialist personnel, waiting times, prescription limitations, and connectivity issues. Discussion Telemedicine has proven to be a valuable tool for rural healthcare delivery, providing patients with access to specialist consultations and improving patient outcomes. Both patients and medical officers reported positive experiences with telemedicine. The findings of this study align with existing literature, which highlights the benefits of telemedicine in managing chronic diseases and increasing patient satisfaction. However, it is crucial to address challenges, such as personnel limitations and connectivity issues, to optimize telemedicine's effectiveness. Conclusion Telemedicine offers great potential for enhancing access to specialist care and achieving universal healthcare in rural areas. Despite its limitations, telemedicine demonstrates promising outcomes and warrants further development and optimization to ensure its successful implementation in rural healthcare centers.

Frail Older People Ageing in Place in Italy: Use of Health Services and Relationship with General Practitioner.

Functional limitations, chronic diseases and frailty often occur in later life. These aspects become very challenging when older people age alone in place, thus needing support in the activities of daily living, and in this context, it is important they can access and use health services. The present study aimed to explore these issues in Italy. In 2019, 120 qualitative interviews were carried out within the "Inclusive Ageing in Place" (IN-AGE) project, involving frail older people living at home in three Italian regions (Lombardy, Marche, and Calabria). A content analysis and some quantifications of main statements are presented. Results showed that the majority of seniors report poor self-rated health (SRH), suffer from many chronic diseases, and mainly use the General Practitioner (GP) and Medical Specialists (MSs), even though long waiting list in the public sector and high costs in the private one act as barriers to access health services. Complaints regarding GPs mainly refer to the almost exclusive provision of prescriptions and the lack of home visits. Some regional peculiarities highlighted a better overall context in the north than in the south, especially with regards to the public health sector. These results can provide useful insights for policy makers, in order to deliver health services assuring frail, older people the continuity of assistance needed at home.

Factors to Overcoming Barriers Affecting Electronic Medical Record Usage by Physicians.

BACKGROUND: Hospitals are adopting electronic medical records (EMRs) in larger numbers; however, the barrier to derive its full utility is the low acceptance by physicians. AIMS AND OBJECTIVES: This study is done with an objective to identify the factors to overcome the barriers preventing the adoption of EMR by physicians. MATERIALS AND METHODS: This study is cross sectional in natures and a self-administered questionnaire is developed based on the Technology Acceptance Model. RESULTS: The four identified factors are positive attitude toward EMR, reliability, difficulty to use, and adaptability, these factors together, have explained 62.54 percent variance in the data set. CONCLUSION: The physician's acceptance for EMRs can be improved by focusing on the identified four factors, which are "positive attitude toward electronic medical records," reliability of electronic medical records," "difficulty level of use," and "adaptability of electronic medical records."

Older adults' attitudes and barriers toward the use of mobile phones.

BACKGROUND AND OBJECTIVES: The limitations caused by the process of aging and the prevalence of chronic diseases contribute to reduced performance in physical, psychological, and social areas of life in older people. The use of mobile phones as easily accessible portable tools with a high performance is associated with an increased health literacy, self-care, and independence in older people. The present study was conducted to determine older people's attitudes toward the use of mobile phones and the barriers to their use. MATERIALS AND METHODS: The present descriptive study was conducted on a sample population of 328 individuals older than 60 years presenting to health centers across cities in west Mazandaran, Iran. The data collection tools used included a mobile phone use checklist, a questionnaire on older people's attitude toward the use of mobile phones, and a questionnaire on the barriers to the use of mobile phones. The reliability and validity of these questionnaires were confirmed by the researchers. The data obtained were recorded and then analyzed using SPSS. The level of statistical significance was set at P≤0.05. RESULTS: According to the results, 80% of the older people had regular mobile phones and 20% had smartphones. In 95% of the male and 80% of the female participants, the greatest use of mobile phones pertained to making phone calls. A total of 5% of the male and 2% of the female participants used the Internet in their mobile phones. A total of 44% of the female and 42.80% of the male participants had poor attitudes (score from 0 to 40) toward mobile phone use. As for the different dimensions of the attitude toward mobile phone use, the highest score obtained by the female participants (71.66%) pertained to the psychoemotional dimension and the highest score in the male participants (72.85%) to the instrumental dimension. The results also revealed the lack of knowledge of English as the greatest barrier to mobile phone use in both sexes. There was a significant relationship between sex and the attitude toward mobile phone use in all the three dimensions examined, the sociocultural, psychoemotional, and instrumental. DISCUSSION AND CONCLUSION: The results of the study revealed that the majority of older people have negative attitudes toward the use of mobile phones as a teaching aid, although they used them for performing daily tasks. Promoting this age group's knowledge about the different mobile phone applications available to help them and increasing their ability to learn the use of these applications through the mass media, family members, and peer groups can help improve older people's attitudes toward the use of mobile phones and thus increase their use of these devices.