A qualitative exploration of the health system responses to the screening and management of comorbid mental illness and chronic physical illness in Jamaica.

BACKGROUND: People with comorbid mental illness (MI) and chronic physical illness (CPI) face a range of health and quality of life challenges. The appropriate screening and management of comorbid MI and CPI are crucial to improving outcomes for this population. Despite this, there is a dearth of research exploring the health system response to the screening and management of patients with these comorbidities in public primary care settings, in several jurisdictions including Jamaica. This study explored and described the attitudes, perspectives, experiences, and practices of policymakers, primary care physicians, psychiatrists, and mental health nurses regarding screening and management of comorbid MI and CPI. METHOD: Twenty-nine participants representing policymakers, primary care physicians, psychiatrists, and mental health nurses took part in semi-structured interviews. Data was collected over the period April to November 2020 and subject to thematic analysis. RESULTS: Three overarching themes emerged from the data related to: 1) Policies and Protocols; 2) Clinical Practice; and 3) Personnel. The interplay of these themes illustrated fragmentation and gaps between national policies and guidelines and clinical practice. The findings also identified factors related to personnel, including barriers that limit clinicians' abilities to adequately screen and manage this patient population. CONCLUSION: There is a need for the continued development and revision of policies and protocols that support integrated care for patients with comorbid MI and CPI in primary care settings in Jamaica. Additionally, programs and strategies to improve clinicans knowledge, skills and access to resources are necessary to help them offer improved quality of care around screening and management for this patient population.

2020 family medicine postgraduate examinations at The University of the West Indies: successes and challenges in the time of COVID-19 pandemic.

Little has been published regarding postgraduate assessments during the COVID-19 pandemic. There is an urgent need to graduate well-trained specialists including family physicians who play a key role in patient care. The successes and challenges encountered in mounting qualifying 2020 Family Medicine examinations during the COVID-19 pandemic at the University of the West Indies are described in this paper. Human resource, planning, use of technology and virtual environments are discussed, which enabled successful examinations at this multicampus regional site.

Risk Factors Associated with Frequent Alcohol Binge Drinking among Jamaicans: Does Gender Matter?

Objective: Alcohol is one of the most commonly consumed substances in Jamaica, despite the many health problems associated with excessive alcohol use. The aim of this study was to identify potential risk factors for alcohol binge drinking among Jamaicans, and determine if there were significant gender differences in the associations between identified risk factors and frequent binge drinking. Methods: Data collected from the 2016 National Household Survey Jamaica were analysed. Descriptive and inferential statistics were computed using SPSS. Binary logistic regression analysis was used to determine factors associated with frequent binge drinking. Results: The total number of respondents was 4623. Females were 2,535 (54.8%) compared to males 2088 (45.2%). In bivariate analysis, there was a significant association between age and frequent binge drinking among males (X2 = 11.11, p =0.004), but not among females (X2 = 2.03, p = 0.36). Similarly, there was a significant association between employment and frequent binge drinking for males but not for females (X2= 12.85, p= 0.002; X2= 2.49, p= 0.29 respectively). In multivariate analysis, age 12- 17 years was significantly, inversely associated with frequent binge drinking in the crude logit model but not in the adjusted logit model (crude odds ratio [COR] 0.21, 95%CI= 0.6- 0.66; adjusted odds ratio [AOR] = 0.51, 95%CI= 0.12- 2.13 respectively). Employment was significantly, positively associated with frequent binge drinking in the adjusted logit model (employed: AOR= 3.63, 95% CI= 1.05- 12.59) among males. Among females, age showed no significant association with frequent binge drinking. Only having primary/ lower education was significantly, positively associated with frequent binge drinking among females (AOR= 5.17, 95%CI= 1.36- 19.65). Conclusion: Risk factors for frequent binge drinking differed by gender; being employed was a risk factor for males while having primary (or lower) education was a risk factor for females.