The Impact of Policy Changes, Dedicated Funding and Implementation Support on Early Intervention Programs for Psychosis

Introduction Early intervention services for psychosis (EIS) are associated with improved clinical and economic outcomes. In Quebec, clinicians led the development of EIS from the late 1980s until 2017 when the provincial government announced EIS-specific funding, implementation support and provincial standards. This provides an interesting context to understand the impacts of policy commitments on EIS. Our primary objective was to describe the implementation of EIS three years after this increased political involvement. Methods This cross-sectional descriptive study was conducted in 2020 through a 161-question online survey, modeled after our team's earlier surveys, on the following themes: program characteristics, accessibility, program operations, clinical services, training/supervision, and quality assurance. Descriptive statistics were performed. When relevant, we compared data on programs founded before and after 2017. Results Twenty-eight of 33 existing EIS completed the survey. Between 2016 and 2020, the proportion of Quebec's population having access to EIS rose from 46% to 88%; >1,300 yearly admissions were reported by surveyed EIS, surpassing governments’ epidemiological estimates. Most programs set accessibility targets; adopted inclusive intake criteria and an open referral policy; engaged in education of referral sources. A wide range of biopsychosocial interventions and assertive outreach were offered by interdisciplinary teams. Administrative/organisational components were less widely implemented, such as clinical/administrative data collection, respecting recommended patient-to-case manager ratios and quality assurance. Conclusion Increased governmental implementation support including dedicated funding led to widespread implementation of good-quality, accessible EIS. Though some differences were found between programs founded before and after 2017, there was no overall discernible impact of year of implementation. Persisting challenges to collecting data may impede monitoring, data-informed decision-making, and quality improvement. Maintaining fidelity and meeting provincial standards may prove challenging as programs mature and adapt to their catchment area's specificities and as caseloads increase. Governmental incidence estimates may need recalculation considering recent epidemiological data.

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Older and Wiser? The Need to Reexamine the Impact of Health Professionals Age and Experience on Competency-Based Practices

SAGE Open Nursing ◽

10.1177/23779608211029067 ◽

2021 ◽

Vol 7 ◽

pp. 237796082110290

Author(s):

Jing Xu ◽

Kristen Hicks-Roof ◽

Chloe E. Bailey ◽

Hanadi Y. Hamadi

Keyword(s):

Health Professionals ◽

Online Survey ◽

Evidence Based Practice ◽

Core Competencies ◽

Healthcare Services ◽

Interdisciplinary Teams ◽

Evidence Based ◽

Health Providers ◽

Cross Sectional ◽

The Impact

Introduction Delivery of healthcare services makes up a complex system and it requires providers to be competent and to be able to integrate each of the institute of medicine’s (IOM) 5 core competencies into practice. However, healthcare providers are challenged with the task to be able to understand and apply the IOM core competencies into practice. Objective The purpose of the study was to examine the factors that influence health professional’s likelihood of accomplishing the IOM core competencies. Methods A cross-sectional study design was used to administer a validated online survey to health providers. This survey was distributed to physicians, nursing professionals, specialists, and allied healthcare professionals. The final sample included 3,940 participants who completed the survey. Results The study findings show that younger health professionals more consistently practice daily competencies than their older counterparts, especially in the use of evidence-based practice, informatics, and working in interdisciplinary teams. Less experienced health professionals more consistently applied quality improvement methods but less consistently used evidence-based practice compared to their more experienced counterparts. Conclusion There is a need to understand how health professionals’ age and experience impact their engagement with IOM’s core competencies. This study highlights the need for educational resources on the competencies to be tailored to health providers’ age and experience.

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Où en sommes-nous? An Overview of Successes and Challenges after 30 Years of Early Intervention Services for Psychosis in Quebec: Où en sommes-nous? Un aperçu des réussites et des problèmes après 30 ans de services d’intervention précoce pour la psychose au Québec

The Canadian Journal of Psychiatry ◽

10.1177/0706743719895193 ◽

2020 ◽

Vol 65 (8) ◽

pp. 536-547

Author(s):

Bastian Bertulies-Esposito ◽

Marie Nolin ◽

Srividya N. Iyer ◽

Ashok Malla ◽

Phil Tibbo ◽

...

Keyword(s):

Early Intervention ◽

Organizational Support ◽

Online Survey ◽

Essential Elements ◽

Provincial Government ◽

First Episode ◽

Cross Sectional ◽

Early Intervention Services ◽

Essential Components ◽

Intervention Services

Introduction: Over the last 30 years, early intervention services (EIS) for first-episode psychosis (FEP) were gradually implemented in the province of Quebec. Such implementation occurred without provincial standards/guidelines and policy commitment to EIS until 2017. Although the literature highlights essential elements for EIS, studies conducted elsewhere reveal that important EIS components are often missing. No thorough review of Quebec EIS practices has ever been conducted, a gap we sought to address. Methods: Adopting a cross-sectional descriptive study design, an online survey was distributed to 18 EIS that existed in Quebec in 2016 to collect data on clinical, administrative, training, and research variables. Survey responses were compared with existing EIS service delivery recommendations. Results: Half of Quebec’s population had access to EIS, with some regions having no programs. Most programs adhered to essential components of EIS. However, divergence from expert recommendations occurred with respect to variables such as open referral processes and patient–clinician ratio. Nonurban EIS encountered additional challenges related to their geography and lower population densities, which impacted their team size/composition and intensity of follow-up. Conclusions: Most Quebec EIS offer adequate services but lack resources and organizational support to adhere to some core components. Recently, the provincial government has created EIS guidelines, invested in the development of new programs and offered implementation support from the National Centre of Excellence in Mental Health. These changes, along with continued mentoring and networking of clinicians and researchers, can help all Quebec EIS to attain and maintain recommended quality standards.

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How COVID-19 has affected general practice consultations and income: general practitioner cross-sectional population survey evidence from Ireland

BMJ Open ◽

10.1136/bmjopen-2020-044685 ◽

2021 ◽

Vol 11 (4) ◽

pp. e044685

Author(s):

Robyn Homeniuk ◽

Claire Collins

Keyword(s):

General Practice ◽

General Practitioners ◽

Online Survey ◽

Quality Care ◽

Cross Sectional ◽

Practice Nurses ◽

Global Pandemic ◽

Before And After ◽

General Practices ◽

The Impact

ObjectivesHow general practice is delivered in many countries has drastically changed due to the COVID-19 pandemic. This study aimed to answer the question of how general practice has changed in Ireland in response to COVID-19.DesignThe Irish College of General Practitioners surveyed its membership before and after the global pandemic hit Ireland using a cross-sectional online survey instrument.SettingThis study focuses on primary care, specifically general practice, in Ireland.ParticipantsIn February 2020 before the global pandemic, 526 general practices across Ireland submitted responses to the survey; 538 general practices responded to the second survey during the pandemic in June 2020. This covers 32% and 33% of practices in Ireland, respectively.Main outcome measuresThe type of consultations by general practitioners (GPs) and practice nurses in both surveys is the main outcome measure reported in this paper. Other changes such as the perceived change in attendance by certain patient groups and practice income are also reported.ResultsFace-to-face consultations significantly (p<0.001) decreased from a median of 26 (IQR 21.3–30) to a median of 8 (IQR 6–13). GP telemedicine consultations increased (p<0.001) from a median of 2.4 (IQR 0–5.3) to a median of 11.3 (IQR 6–19). The majority of practices (80.0%) reported reduced practice profit. Respondents reported a decline in non-COVID-19-related consultations among certain patient cohorts—92.0% for children under 6 years old; 79.5% for patients over 70 years.ConclusionsIt is likely that the way general practice is delivered will not return to as it was before the COVID-19 pandemic and increased telemedicine can be expected. However, it is necessary to assess the impact of this shift on patient health and to assess healthcare provider and patient experience to ensure continued high-quality care and patient safety.

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COVID-19: Psychological Impact on Lockdown Population

Homœopathic Links ◽

10.1055/s-0041-1725980 ◽

2021 ◽

Vol 34 (01) ◽

pp. 026-033

Author(s):

Bhuvaneswari Rajachandrasekar ◽

K. C. Muraleedharan ◽

Neethu Raj ◽

Sakthivel Vaiyapuri ◽

Aneena MS

Keyword(s):

Mental Health ◽

Emotional Disturbance ◽

Online Survey ◽

Demographic Data ◽

Psychological Impact ◽

P Value ◽

Psychological Resilience ◽

Cross Sectional ◽

Wide Range ◽

The Impact

Abstract Background Coronavirus disease 2019 (COVID-19) pandemic continues to surge throughout the entire world. Most of the impacted countries implemented preventive measures and lockdown to control the spread of the disease. This restriction developed psychological resilience in a wide range of the population. The objective of this study is to explore the impact on the mental health of the individuals caused by the unforeseen lockdown. Methods A cross-sectional online survey form had been designed leveraging the Google form. In the introduction section, the purpose of study and the details of the investigators were elaborately explained. The survey response was voluntary and ensured the confidentiality of the responder. The online survey consent procedures were well documented and shared with the participants. The Google forms were circulated through various social media platforms for data capturing, and the data were analysed using statistical software SPSS 23.0. A chi-squared test was performed to determine the association between demographic data and emotional data during the COVID-19 pandemic lockdown. Result A total of 2,150 responses were received out of which two of them were discarded due to insufficient data so total 2,148 responses were taken for analysis. The prevalence rate of emotional disturbance is 56.8% and 43.2% in females and males respectively (p-value = 0.001). The participant age ranges between 18 and 98 years, the mean age of participants is 33.25 years and the standard deviation is 12.24. The emotional disturbance response data are significantly associated with marital status (p-value = 0.021), socioeconomic status (p-value < 0.001), occupation (p-value = 0.019), loved one who were affected with COVID-19 (p-value = 0.034), preventive medicines taken (p-value = 0.017), sleep disturbance (p-value < 0.001), need of psychological support (p-value = 0.001), difficulty in monthly bill settlement (p-value < 0.0001), anxiouness and worry all the time during COVID-19 (p-value < 0.0001). Conclusion The survey data discovered the significant association between lockdown during COVID-19 and the emotional disturbance of the general population. These findings required additional research to identify mental health further.

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Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study (Preprint)

10.2196/preprints.24776 ◽

2020 ◽

Author(s):

Khanh Ngoc Cong Duong ◽

Tien Nguyen Le Bao ◽

Phuong Thi Lan Nguyen ◽

Thanh Vo Van ◽

Toi Phung Lam ◽

...

Keyword(s):

Psychological Distress ◽

General Population ◽

Psychological Health ◽

Online Survey ◽

Survey Study ◽

Limited Information ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Event Scale ◽

The Impact

BACKGROUND The first nationwide lockdown due to the COVID-19 pandemic was implemented in Vietnam from April 1 to 15, 2020. Nevertheless, there has been limited information on the impact of COVID-19 on the psychological health of the public. OBJECTIVE This study aimed to estimate the prevalence of psychological issues and identify the factors associated with the psychological impact of COVID-19 during the first nationwide lockdown among the general population in Vietnam. METHODS We employed a cross-sectional study design with convenience sampling. A self-administered, online survey was used to collect data and assess psychological distress, depression, anxiety, and stress of participants from April 10 to 15, 2020. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were utilized to assess psychological distress, depression, anxiety, and stress of participants during social distancing due to COVID-19. Associations across factors were explored using regression analysis. RESULTS A total of 1385 respondents completed the survey. Of this, 35.9% (n=497) experienced psychological distress, as well as depression (n=325, 23.5%), anxiety (n=195, 14.1%), and stress (n=309, 22.3%). Respondents who evaluated their physical health as average had a higher IES-R score (beta coefficient [B]=9.16, 95% CI 6.43 to 11.89), as well as higher depression (B=5.85, 95% CI 4.49 to 7.21), anxiety (B=3.64, 95% CI 2.64 to 4.63), and stress (B=5.19, 95% CI 3.83 to 6.56) scores for DASS-21 than those who rated their health as good or very good. Those who self-reported their health as bad or very bad experienced more severe depression (B=9.57, 95% CI 4.54 to 14.59), anxiety (B=7.24, 95% CI 3.55 to 10.9), and stress (B=10.60, 95% CI 5.56 to 15.65). Unemployment was more likely to be associated with depression (B=3.34, 95% CI 1.68 to 5.01) and stress (B=2.34, 95% CI 0.84 to 3.85). Regarding worries about COVID-19, more than half (n=755, 54.5%) expressed concern for their children aged <18 years, which increased their IES-R score (B=7.81, 95% CI 4.98 to 10.64) and DASS-21 stress score (B=1.75, 95% CI 0.27 to 3.24). The majority of respondents (n=1335, 96.4%) were confident about their doctor’s expertise in terms of COVID-19 diagnosis and treatment, which was positively associated with less distress caused by the outbreak (B=–7.84, 95% CI –14.58 to –1.11). CONCLUSIONS The findings highlight the effect of COVID-19 on mental health during the nationwide lockdown among the general population in Vietnam. The study provides useful evidence for policy decision makers to develop and implement interventions to mitigate these impacts. CLINICALTRIAL

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Changes in Consumers’ Food Practices during the COVID-19 Lockdown, Implications for Diet Quality and the Food System: A Cross-Continental Comparison

Nutrients ◽

10.3390/nu13010020 ◽

2020 ◽

Vol 13 (1) ◽

pp. 20

Author(s):

Blain Murphy ◽

Tony Benson ◽

Amanda McCloat ◽

Elaine Mooney ◽

Chris Elliott ◽

...

Keyword(s):

Diet Quality ◽

Food Systems ◽

Online Survey ◽

Food System ◽

Vegetable Intake ◽

Saturated Fat ◽

Physical And Mental Health ◽

Cross Sectional ◽

Food Practices ◽

The Impact

COVID-19 has led to dramatic societal changes. Differing movement restrictions across countries have affected changes in consumers’ food practices, with a potentially detrimental impact on their health and food systems. To investigate this, this research explored changes in consumers’ food practices during the initial COVID-19 phase and assessed the impact of location on these changes. A sample of 2360 adults from three continents (Island of Ireland (IOI), Great Britain (GB), United States (USA), and New Zealand (NZ)) were recruited for a cross-sectional online survey (May–June 2020). Participants completed questions in relation to their cooking and food practices, diet quality, and COVID-19 food-related practices. Significant changes in consumers’ food practices during the pandemic were seen within and between regions, with fewer cooking practices changes found in the USA. Food practices, which may put added pressure on the food system, such as bulk buying, were seen across all regions. To prevent this, organisational food practices, including planning ahead, should be emphasized. Additionally, while positive cooking-related practices and increases in fruit and vegetable intake were found, an increase in saturated fat intake was also seen. With the additional pressure on individuals’ physical and mental health, the essentiality of maintaining a balanced diet should be promoted.

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How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the UK? A cross-sectional online survey

BMJ Open ◽

10.1136/bmjopen-2020-043397 ◽

2021 ◽

Vol 11 (5) ◽

pp. e043397

Author(s):

Austen El-Osta ◽

Aos Alaa ◽

Iman Webber ◽

Eva Riboli Sasco ◽

Emmanouil Bagkeris ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Social Isolation ◽

Online Survey ◽

Female Gender ◽

School Age Children ◽

School Age ◽

Cross Sectional ◽

The Uk ◽

The Impact

ObjectiveInvestigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age children.DesignCross-sectional online survey of parents of primary and secondary school-age children.SettingCommunity setting.Participants1214 parents of school-age children in the UK.MethodsAn online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA Three-Item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression models.Main outcome measuresSelf-reported measures of social isolation and loneliness using UCLATILS and DMOL.ResultsHalf of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely during the first 100 days of lockdown. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study space and disruption of sleep patterns during the lockdown.ConclusionsThe COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. The sustained adoption of two modifiable health-seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) wmay help reduce feelings of social isolation and loneliness during lockdown.

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The Impact of the COVID-19 Pandemic on Self-Reported Management of Chronic Conditions

Journal of Patient Experience ◽

10.1177/23743735211007693 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110076

Author(s):

Hyllore Imeri ◽

Erin Holmes ◽

Shane Desselle ◽

Meagen Rosenthal ◽

Marie Barnard

Keyword(s):

Locus Of Control ◽

Chronic Conditions ◽

Online Survey ◽

Health Locus Of Control ◽

Patient Activation ◽

Survey Study ◽

Chronic Obstructive ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

The Impact

Chronic conditions (CCs) management during the COVID-19 pandemic and the impact of the pandemic on patient activation (PA) and health locus of control (HLOC) remain unknown. This cross-sectional online survey study examined the role of COVID-19 pandemic-related worry or fear in PA and HLOC among patients with CCs. Individuals with CCs (n = 300) were recruited through MTurk Amazon. The questionnaire included sociodemographic questions, the Patient Activation Measure, and the Multidimensional Health Locus of Control–Form B. Out of the 300 participants, 9.7% were diagnosed with COVID-19, and 7.3% were hospitalized. Patients with cancer, chronic kidney disease, chronic obstructive pulmonary disease, drug abuse/substance abuse, and stroke reported significant difficulties in managing their CCs due to worry or fear because of COVID-19. More than half of the sample (45.7%) reported COVID-19-related worry or fear about managing their CCs, and these patients had lower PA and lower external HLOC compared to patients not affected by COVID-19-related worry or fear. Health professionals should provide more support for patients facing difficulties in managing their CCs during the COVID-19 pandemic.

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Impact of dementia education and training on health and social care staff knowledge, attitudes and confidence: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-039939 ◽

2021 ◽

Vol 11 (1) ◽

pp. e039939

Author(s):

Sahdia Parveen ◽

Sarah Jane Smith ◽

Cara Sass ◽

Jan R Oyebode ◽

Andrea Capstick ◽

...

Keyword(s):

Online Survey ◽

Social Care ◽

Education And Training ◽

Care Staff ◽

Cross Sectional ◽

Health And Social Care ◽

Training Content ◽

The Impact ◽

And Training ◽

Dementia Education

ObjectivesThe aim of this study was to establish the impact of dementia education and training on the knowledge, attitudes and confidence of health and social care staff. The study also aimed to identify the most effective features (content and pedagogical) of dementia education and training.DesignCross-sectional survey study. Data collection occurred in 2017.SettingsHealth and social care staff in the UK including acute care, mental health community care trusts, primary care and care homes.ParticipantsAll health and social care staff who had completed dementia education and training meeting the minimal standards as set by Health Education England, within the past 5 years were invited to participate in an online survey. A total of 668 health and social care staff provided informed consent and completed an online survey, and responses from 553 participants were included in this study. The majority of the respondents were of white British ethnicity (94.4%) and identified as women (88.4%).OutcomesKnowledge, attitude and confidence of health and social care staff.ResultsHierarchical multiple regression analysis was conducted. Staff characteristics, education and training content variables and pedagogical factors were found to account for 29% of variance in staff confidence (F=4.13, p<0.001), 22% of variance in attitude (knowledge) (F=3.80, p<001), 18% of the variance in staff knowledge (F=2.77, p<0.01) and 14% of variance in staff comfort (attitude) (F=2.11, p<0.01).ConclusionThe results suggest that dementia education and training has limited impact on health and social care staff learning outcomes. While training content variables were important when attempting to improve staff knowledge, more consideration should be given to pedagogical factors when training is aiming to improve staff attitude and confidence.

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A Cross-National Study of Dementia Stigma Among the General Public in Israel and Australia

Journal of Alzheimer s Disease ◽

10.3233/jad-210277 ◽

2021 ◽

pp. 1-8

Author(s):

Perla Werner ◽

Sarang Kim

Keyword(s):

General Public ◽

Cultural Context ◽

Online Survey ◽

Cross Sectional Study ◽

National Study ◽

Cross Sectional ◽

Subjective Knowledge ◽

Cultural Aspects ◽

The Impact ◽

Cross National

Background: Despite the increasing amount of research on dementia stigma, there is a dearth of cross-national studies conducted on this subject. This is surprising since the experience of stigma is closely associated to socio-cultural aspects. Objective: The present study intended to expand knowledge about the impact of culture on dementia stigma by comparing the level and correlates of stigmatic beliefs about dementia among the general public in Israel and Australia. Methods: A cross-sectional study using an online survey was conducted with two age-matched samples: 447 adults in Israel and 290 adults in Australia. Results: Overall, dementia stigma was moderate in both countries. However, the level of dementia stigma was significantly higher in Australia than in Israel. Lower levels of subjective knowledge and higher levels of ageism were associated with increased levels of stigmatic beliefs in both countries. Gender was a significant correlate of dementia stigma, with male participants reporting higher levels of public stigma than women, although this gender difference was mainly driven by the Australian sample. Conclusion: Our findings indicate that providing knowledge and decreasing ageist attitudes should be key considerations in dementia awareness and stigma reduction campaigns despite the cultural context. In addition, developing gender-specific messages should be considered as a way of improving the effects of such campaigns.

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