Characteristics and activities of acute psychiatric in-patient facilities: national survey in Italy

2007 ◽  
Vol 191 (2) ◽  
pp. 170-177 ◽  
Author(s):  
Giovanni De Girolamo ◽  
Angelo Barbato ◽  
Renata Bracco ◽  
Andrea Gaddini ◽  
Rossella Miglio ◽  
...  
Keyword(s):  
Patient Care ◽  
Full Range ◽  
Great Variability ◽  
Structured Interviews ◽  
Community Based ◽  
Public And Private ◽  
Psychiatric Admissions ◽  
Italian Regions ◽  
Hospital Days ◽  
Community Based Services

BackgroundLegislation in 1978 led to the gradual replacement of mental hospitals in Italy with a full range of community-based services, including facilities for acute in-patient care.AimsTo survey the main characteristics of Italian public and private in-patient facilities for acute psychiatric disorders.MethodStructured interviews were conducted with each facility's head psychiatrist in all Italian regions, with the exception of Sicily.ResultsOverall, Italy (except Sicily) has atotal of 4108 public in-patient beds in 319 facilities, with 0.78 beds for every 10 000 inhabitants, and 4862 beds in 54 private in-patient facilities, with 0.94 beds per 10 000 inhabitants. In 2001 the rates of psychiatric admissions and admitted patients per 10 000 inhabitants were 26.7 and 17.8 respectively. In the same year the percentage of involuntary admissions was 12.9%, for atotal of 114 570 hospital days. Many in-patient facilities showed significant limitations in terms of architectural and logistic characteristics. Staffing showed a great variability among facilities.ConclusionsThe overall number of acute beds per 10 000 inhabitants is one of the lowest in Europe. The survey has provided evidence of two parallel systems of in-patient care, a public one and a private one, which are not fully interchangeable.

scholarly journals 22 GP perceptions of the adequacy of community-based care for patients with advanced heart failure in a uk region (NI): a qualitative study

2018 ◽  
Vol 8 (3) ◽  
pp. 368.1-368
Author(s):  
Lisa Graham-Wisener ◽  
Jingwen Jessica Chen ◽  
Kathryn Gamble ◽  
Kieran McGlade ◽  
Jennifer Doherty ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Association ◽  
Models Of Care ◽  
Advanced Heart Failure ◽  
Structured Interviews ◽  
Care Needs ◽  
Community Based ◽  
Medical Needs ◽  
Health And Social Care ◽  
Community Based Services

IntroductionAlthough there is recognition of the multi-dimensional needs of patients with advanced heart failure (HF) conventional models of care have traditionally been medically focused. It is unknown whether community-based systems and services have improved and adapted to better meet the emotional social functional and medical needs of patients with HF and their families.AimsTo assess the adequacy of community-based services available in Northern Ireland (NI) to meet the multidimensional needs of patients living with New York Heart Association Stage III and IV HF as experienced and perceived by general practitioners (GP).MethodsSemi-structured interviews were conducted with GPs. Interviews were transcribed independently coded and analysed using a six-step thematic analysis approach.Results20 semi-structured interviews were conducted. GPs reported managing patients in a ‘reactive rather than proactive’ way responding only to acute medical needs with hospital admission the default due to lack of community-based services. Care provided by HF specialists was highly regarded but ‘access and coordination’ were lacking. Conversations regarding current and future care needs were considered important but challenging due to time constraints and prognostic uncertainty. GPs expressed that ‘specialist palliative care (SPC) is only a credible option in end stages’ related to limited understanding of the scope of SPC and concern that SPC services are cancer-focused.ConclusionsDespite recent evidence for the effectiveness of integrated SPC in improving quality of life for patients with HF health and social care services within NI have not yet adapted to assess and meet these needs.

scholarly journals PHYSICAL ACTIVITY PREFERENCES OF OLDER ADULT MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER CLIENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S500-S500
Author(s):  
Victoria S Davila ◽  
Lauren Pietzak ◽  
Danielle Rossi ◽  
Karen Phipps ◽  
Margaret Danilovich
Keyword(s):  
Physical Activity ◽  
Older Adult ◽  
Health Belief ◽  
Care Program ◽  
Structured Interview ◽  
Structured Interviews ◽  
Community Based ◽  
Individual Level ◽  
Personalized Approach ◽  
Community Based Services

Abstract Despite the known effectiveness, physical activity (PA) is not currently offered to older adult clients receiving Medicaid Home and Community Based Services (HCBS). To optimize PA implementation within Medicaid HCBS, understanding client preferences for PA programming is needed. Thus, the objective of this exploratory qualitative study was to identify the PA preferences of HCBS clients including mode, duration, implementation strategy, and frequency, as well as barriers and motivators to PA. We recruited participants from the Illinois’ Department on Aging Community Care Program. We conducted semi-structured interviews in participants’ homes which were audio recorded, transcribed, and analyzed using Dedoose (version 7.0.23). We derived semi-structured interview questions from the Health Belief, Social Cognitive, and Health Action Process Approach framework. We used a structured coding approach using conventional content analysis to derive codes from the text, then applied these codes to each interview and examined the frequency to determine themes. The most frequently referenced theme was barriers to PA, primarily co-morbidities. The primary motivator was social support by a peer or instructor. The preferred PA program components were walking 2-3 days per week with duration varying from 20 minutes to 2 hours. Clients also preferred individualized PA instruction versus a passive strategy such as pamphlets or videotapes. Our findings show that individual-level factors most significantly influence PA participation and should be addressed among Medicaid HCBS clients. We recommend Medicaid HCBS consider a personalized approach of PA implementation with their clients.

scholarly journals HEALTH INTERVIEWING IMPROVES THE MEDICAID HOME AND COMMUNITY-BASED SERVICES HOME CARE AIDE-CLIENT RELATIONSHIP

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S134-S135
Author(s):  
Margaret Danilovich ◽  
Rebecca E Johnson ◽  
Laura Diaz ◽  
Lara Boyken
Keyword(s):  
Home Care ◽  
Willingness To Communicate ◽  
Retention Rates ◽  
Structured Interviews ◽  
Community Based ◽  
Care Services ◽  
Client Care ◽  
Health Interview ◽  
Food And Drink ◽  
Community Based Services

Abstract We investigated the feasibility of a Medicaid Home and Community-based Services home care aide (HCA) led health interview with clients (n=21) during usual care services provided by a single provider. We provided interview training in English and Spanish and HCAs (n=21) conducted five interviews using a card sort methodology to elicit client care preferences. The interviews consisted of five topics relative to care: 1) food and drink, 2) physical activity and mobility, 3) self-care, 4) home environment, and 5) how I spend my time. HCAs audio-recorded interviews and photographed card sorts for analysis. We conducted semi-structured interviews by telephone with clients and focus groups with HCAs, to evaluate the health interviewing experience. We transcribed interview recordings and evaluated fidelity to the health interview script. We administered the Your Health Orientation, Willingness to Communicate, and PROMIS-global health to clients and the Active Empathetic Listening Scale to HCAs. We used t-tests to investigate changes in survey outcomes pre and post interviews. Results show it is feasible to train English and Spanish speaking HCAs in a simple, health interviewing technique to elicit care preferences from clients. Doing so contributes new knowledge on client preferences. Clients desire HCAs who provide empathy, compassion, and motivation, and HCAs observed that interviewing clients helped them to better understand their care recipient’s needs. Future work should determine how embedding health communications training as part of orientation to client care, would influence HCA retention rates, as well as modify client health outcomes.

Maternal and child health nurses’ experiences of implementing two community-based breastfeeding interventions in Victoria, Australia: A mixed methods process evaluation

2019 ◽  
Vol 16 (1) ◽  
pp. 4-14 ◽  
Author(s):  
Rhian L Cramer ◽  
Helen L McLachlan ◽  
Touran Shafiei ◽  
Lisa H Amir ◽  
Meabh Cullinane ◽  
...  
Keyword(s):  
Child Health ◽  
Maternal And Child Health ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Breastfeeding Initiation ◽  
Structured Interviews ◽  
Breastfeeding Support ◽  
Community Based ◽  
Significant Drop ◽  
And Child Health

Despite high rates of breastfeeding initiation in Australia, there is a significant drop in breastfeeding rates in the early postpartum period, and Australian government breastfeeding targets are not being met. The Supporting breastfeeding In Local Communities (SILC) trial was a three-arm cluster randomised trial implemented in 10 Victorian local government areas (LGAs). It aimed to determine whether early home-based breastfeeding support by a maternal and child health nurse (MCH nurse) with or without access to a community-based breastfeeding drop-in centre increased the proportion of infants receiving ‘any’ breast milk at four months. Focus groups, a written questionnaire and semi-structured interviews were undertaken to explore the interventions from the perspective of the SILC-MCH nurses (n=13) and coordinators (n=6), who established and implemented the interventions. Inductive thematic analysis was used to identify themes, then findings further examined using Diffusion of Innovations Theory as a framework. SILC-MCH nurses and coordinators reported high levels of satisfaction, valuing the opportunity to improve breastfeeding in our community; and having focused breastfeeding time with women in their own homes. They felt the SILC interventions offered benefits to women, nurses and the MCH service. Implementing new interventions into existing, complex community health services presented unforeseen challenges, which were different in each LGA and were in part due to the complexity of the individual LGAs and not the interventions themselves. These findings will help inform the planning and development of future programs aimed at improving breastfeeding and other interventions in MCH.

Experiences in physical activity promotion in health care settings for primary prevention in the UK

2014 ◽  
Vol 62 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Controlled Trial ◽  
Full Range ◽  
Tertiary Care ◽  
Physical Activity Promotion ◽  
Community Based ◽  
Activity Promotion ◽  
Randomised Controlled

In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial. With notable exceptions where individuals have a personal interest or commitment, the majority of health professionals tend to limit themselves to peremptory non-specific advice at best, or frequently don’t broach the subject at all. There are a number of reasons for this including increasing time pressures, a general lack of knowledge, limited evidence and concerns about litigation in the event of an adverse exercise induced event. However in the 1990s there was a surge of interest in the emerging “Exercise on Prescription” model where patients could be referred to community based exercise instructors for a structured “prescription” of exercise in community leisure centres. Despite the continuing popularity of the model there remain problems particularly in getting the active support of health professionals who generally cite the same barriers as previously identified. In an attempt to overcome some of these problems Wales established a national exercise referral scheme with an associated randomised controlled trial. The scheme evaluated well and had subsequently evolved with new developments including integration with secondary and tertiary care pathways, accredited training for exercise instructors and exit routes into alternative community based exercise opportunities.

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