Multimorbidity in Mentally Ill People: The Need for a Person-centered Integrated Approach

2015 ◽  
Vol 5 (1) ◽  
pp. 28-33
Author(s):  
Helen Millar ◽  
Mohammed T Abou-Saleh
Keyword(s):  
Health Care ◽  
Low Income ◽  
Mentally Ill ◽  
Health Care Professionals ◽  
Metabolic Diseases ◽  
Medical Condition ◽  
Low Income Countries ◽  
Easy Access ◽  
Chronic Medical Condition ◽  
Model Of Care

 The need for person-centered integrated care is particularly compelling for people who experience multimorbidity. The concept of multimorbidity has attracted increasing interest in the past decade with the recognition of multiple burdens of disease and their escalating costs for the individual and the community. It is evident in clinical practice that multimorbidity has become the norm rather than the exception, occurring in an increasingly younger population particularly in areas of socioeconomic deprivation and in low income countries.  It is now well established that the mentally ill have a markedly reduced life expectancy due to predominantly cardiovascular and metabolic diseases. The combination of a chronic medical condition and a mental health problem presents specific complex challenges for the single disease model of care which continues to prevail as the current delivery system in which health care professionals are trained and operate. The growing evidence and experience for adopting an integrated collaborative person-centered approach demonstrates the need for a more effective model of care which is individualised, and focused on patient engagement to prevent disease and manage multiple conditions systematically. Given the limited resources in our current health care systems, this approach requires innovation and redesign of the system to provide comprehensive person-centered care encompassing early detection, co-ordinated multidisciplinary working across specialities as well as between primary and secondary care with easy access to basic healthy lifestyle care programs. 

Formal assessment of teamwork among cancer health care professionals in 3 large tertiary centers in Nigeria.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18126-e18126 ◽  
Author(s):  
Abiola Falilat Ibraheem ◽  
Olutosin Alaba Awolude ◽  
Myhammad-yaqub Murtazha Habeebu ◽  
Anthonia Chima Sowunmi ◽  
Popoola Abiodun Olaniyi ◽  
...  
Keyword(s):  
Health Care ◽  
Low Income ◽  
Health Care Professionals ◽  
Cancer Care ◽  
Developing World ◽  
Low Income Countries ◽  
Major Barrier ◽  
Optimal Outcomes ◽  
Quality Cancer Care ◽  
Key Stakeholders

e18126 Background: Cancer is fast becoming a common cause of death in developing world. Over the last decade, there have been strategies to bring quality cancer care to underserved patients around the world. In low-income countries, poor utilization of principles of teamwork is a major barrier to achieving quality services. The intent of this study is to assess teamwork as perceived by the health care workers caring for cancer patients Methods: We conducted a survey among health care professionals involved in cancer care in 3 tertiary centers in the southwestern part of Nigeria from July to November 2016. Respondents rated teamwork using the previously validated ÒSafety Attitudes QuestionnaireÓ. For this analysis we focused on the teamwork climate subscale. This subscale is scored on a scale of 0-100 with mean (SD) values,in US ambulatory population of 69.7 (17). We compared ratings by professionals using analysis of variance Results: Overall 373 professionals completed the survey: Physicians (47%), nurses (14%), pharmacists (6%) and others (33%). Some results are shown in table Conclusions: Cancer care is complex and depends on teamwork amongst health care professionals to achieve optimal outcomes. While overall teamwork scores was consistent with US ambulatory studies , there are important variations that provide targets for intervention. Physicians rated teamwork poorly both intra and inter professionally. Pharmacists rated inter professional teamwork with nurses particularly poorly. Further data on additional subscales of the instrument and by individual centers will be presented. Efforts to transform cancer care need to focus on building trust among the key stakeholders. This is true in developing world where there is a need to maximize the use of limited resources to improve patient outcomes. [Table: see text]

Why Supplemental Security Income Is Important for Children and Adolescents

PEDIATRICS ◽  
1995 ◽  
Vol 95 (4) ◽  
pp. 603-608
Author(s):  
Keyword(s):  
Health Care ◽  
Special Needs ◽  
Low Income ◽  
Health Care Services ◽  
Family Income ◽  
Medical Condition ◽  
Supplemental Security Income ◽  
Chronic Medical Condition ◽  
Social Security Administration ◽  
Care Needs

The Supplemental Security Income (SSI) program for children is an important part of the federal government's social benefits program for children with special needs. The SSI program is a nationwide program administered by the Social Security Administration (SSA) that does the following: • provides monthly cash payments based on family income, • qualifies the child for Medicaid health care services in many states, and • assures referral of SSI child beneficiaries into the state Title V Children With Special Health Care Needs program's system of care. The SSA considers a child to be disabled if: • the impairment-physical or mental, or chronic medical condition-is as severe as a condition that would keep an adult from working, • the condition is expected to last a long time or is life threatening, and • the child is unable to engage in the everyday activities that most children the same age can do. Congress implemented the children's component of the SSI program in 1974 in recognition that disabled children who live in low-income households are among the most disadvantaged of all Americans and therefore deserve special assistance. The cost of caring for a child with special needs is an especially heavy burden for families with limited resources. The intent of the SSI program is to reduce the additional deleterious environmental effects that a low family income can have on the growth and development of the disabled child and thereby help these children become self-supporting members of society. The SSI program provides cash benefits.

scholarly journals Staff Perspectives Toward Challenges in a Newly Established Cancer Center in Tanzania: A Qualitative Study

2019 ◽  
pp. 1-8
Author(s):  
Zainab Alwash ◽  
Oliver Henke ◽  
Furaha Serventi ◽  
Eva Johanna Kantelhardt
Keyword(s):  
Health Care ◽  
Low Income ◽  
Health Care Professionals ◽  
Qualitative Content Analysis ◽  
Low Income Countries ◽  
Health Concern ◽  
Cancer Center ◽  
Health Seeking ◽  
Training And Education ◽  
The Government

PURPOSE Cancer is a growing public health concern in low-income countries (LICs). From 14 million new patient cases identified worldwide each year, 8 million are diagnosed in LICs. The fatality rate is 75% in LICs compared with 46% in high-income countries. Causes are low literacy levels, lack of awareness and knowledge about cancer, and limited education of health care professionals that leads to late detection and diagnosis. In Tanzania, cancer incidence will double to 60,000 in 2030. The referral hospital of Northern Tanzania established a new cancer unit in December 2016 to meet these needs. However, there is limited knowledge about perceptions of health care professionals toward cancer care in LICs. This study aims to understand attitudes and perspectives of those professionals and the treatment-related challenges in a newly established center to assist future efforts in this field. METHODS A qualitative method approach using in-depth interviews was chosen to achieve inductive conceptualization. Analysis of data was performed according to qualitative content analysis. RESULTS Eleven interviews were conducted. Five main categories were found: training and education of staff, availability of financial support, challenges in management, interests in future developments, and job satisfaction. Subcategories elaborated in more detail within the main categories. CONCLUSION Limitations in staffing, training, and education were major concerns. The importance of sustainable funding and the needed cooperation of the government with international aid were identified as key points. The involvement of different stakeholders requires guidance by health care management. Health care professionals expressed their satisfaction with the possibilities of treating cancer and the rewarding feedback from patients. Misconceptions and poor knowledge by patients were mentioned as reasons for delayed health-seeking behavior. Screening and awareness programs were seen as useful interventions.

scholarly journals The Need for Expanding Pulmonary Rehabilitation Services

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1236
Author(s):  
Aroub Lahham ◽  
Anne E. Holland
Keyword(s):  
Health Care ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Low Income ◽  
Health Care Professionals ◽  
Pulmonary Rehabilitation ◽  
Health Care Systems ◽  
Low Income Countries ◽  
Related Factors ◽  
Care Systems

Pulmonary rehabilitation is a strongly recommended and effective treatment for people with chronic lung disease. However, access to pulmonary rehabilitation is poor. Globally, pulmonary rehabilitation is accessed by less than 3% of people with chronic lung disease. Barriers to referral, uptake and completion of pulmonary rehabilitation are well documented and linked with organizational, practitioner and patient-related factors. Enhancing the knowledge of health care professionals, family carers, and people with chronic lung disease about the program and its benefits produces modest increases in referral and uptake rates, but evidence of the sustainability of such approaches is limited. Additionally, initiatives focusing on addressing organizational barriers to access, such as expanding services and implementing alternative models to the conventional center-based setting, are not yet widely used in clinical practice. The COVID-19 pandemic has highlighted the urgent need for health care systems to deliver pulmonary rehabilitation programs remotely, safely, and efficiently. This paper will discuss the pressing need to address the issue of the low accessibility of pulmonary rehabilitation. It will also highlight the distinctive challenges to pulmonary rehabilitation delivery in rural and remote regions, as well as low-income countries.

Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians

2015 ◽  
Vol 30 (4) ◽  
Author(s):  
Alison C. Bested ◽  
Lynn M. Marshall
Keyword(s):  
Health Care ◽  
Chronic Fatigue Syndrome ◽  
Health Care Professionals ◽  
Medical Condition ◽  
Chronic Fatigue ◽  
Myalgic Encephalomyelitis ◽  
Chronic Medical Condition ◽  
Management Approach ◽  
Care Needs ◽  
Fatigue Syndrome

AbstractThis review was written from the viewpoint of the treating clinician to educate health care professionals and the public about Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). It includes: the clinical definition of ME/CFS with emphasis on how to diagnose ME/CFS; the etiology, pathophysiology, management approach, long-term prognosis and economic cost of ME/CFS. After reading this review, you will be better able to diagnose and treat your patients with ME/CFS using the tools and information provided. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, chronic medical condition characterized by symptom clusters that include: pathological fatigue and malaise that is worse after exertion, cognitive dysfunction, immune dysfunction, unrefreshing sleep, pain, autonomic dysfunction, neuroendocrine and immune symptoms. ME/CFS is common, often severely disabling and costly. The Institute of Medicine (IOM) reviewed the ME/CFS literature and estimates that between 836,000 and 2.5 million Americans have ME/CFS at a cost of between 17 and 24 billion dollars annually in the US. The IOM suggested a new name for ME/CFS and called it Systemic Exertion Intolerance Disease (SEID). SEID’s diagnostic criteria are less specific and do not exclude psychiatric disorders in the criteria. The 2010 Canadian Community Health Survey discovered that 29% of patients with ME/CFS had unmet health care needs and 20% had food insecurity – lack of access to sufficient healthy foods. ME/CFS can be severely disabling and cause patients to be bedridden. Yet most patients (80%) struggle to get a diagnosis because doctors have not been taught how to diagnose or treat ME/CFS in medical schools or in their post-graduate educational training. Consequently, the patients with ME/CFS suffer. They are not diagnosed with ME/CFS and are not treated accordingly. Instead of compassionate care from their doctors, they are often ridiculed by the very people from whom they seek help. The precise etiology of ME/CFS remains unknown, but recent advances and research discoveries are beginning to shed light on the enigma of this disease including the following contributors: infectious, genetic, immune, cognitive including sleep, metabolic and biochemical abnormalities. Management of patients with ME/CFS is supportive symptomatic treatment with a patient centered care approach that begins with the symptoms that are most troublesome for the patient. Pacing of activities with strategic rest periods is, in our opinion, the most important coping strategy patients can learn to better manage their illness and stop their post-exertional fatigue and malaise. Pacing allows patients to regain the ability to plan activities and begin to make slow incremental improvements in functionality.

scholarly journals Using Prospective Methods to Identify Fieldwork Locations Favourable to Understanding Divergences in Health Care Accessibility

2021 ◽  
Vol 10 (8) ◽  
pp. 506
Author(s):  
Jan Ketil Rød ◽  
Arne H. Eide ◽  
Thomas Halvorsen ◽  
Alister Munthali
Keyword(s):  
Health Care ◽  
Low Income ◽  
Access To Health Care ◽  
Health Care Services ◽  
Good Health ◽  
Low Income Countries ◽  
Care Services ◽  
Health Care Accessibility ◽  
Barriers To Health ◽  
Walking Time

Central to this article is the issue of choosing sites for where a fieldwork could provide a better understanding of divergences in health care accessibility. Access to health care is critical to good health, but inhabitants may experience barriers to health care limiting their ability to obtain the care they need. Most inhabitants of low-income countries need to walk long distances along meandering paths to get to health care services. Individuals in Malawi responded to a survey with a battery of questions on perceived difficulties in accessing health care services. Using both vertical and horizontal impedance, we modelled walking time between household locations for the individuals in our sample and the health care centres they were using. The digital elevation model and Tobler’s hiking function were used to represent vertical impedance, while OpenStreetMap integrated with land cover map were used to represent horizontal impedance. Combining measures of walking time and perceived accessibility in Malawi, we used spatial statistics and found spatial clusters with substantial discrepancies in health care accessibility, which represented fieldwork locations favourable for providing a better understanding of barriers to health access.

Can employment in a café change Clientele Attitude towards the staff when they are Persons with Mental Illness?

2021 ◽  
pp. 002076402199006
Author(s):  
Sailaxmi - Gandhi ◽  
Sangeetha Jayaraman ◽  
Thanapal Sivakumar ◽  
Annie P John ◽  
Anoop Joseph ◽  
...  
Keyword(s):  
Health Care ◽  
Mental Illness ◽  
Mentally Ill ◽  
Health Care Professionals ◽  
Negative Attitude ◽  
Chi Square ◽  
Community Needs ◽  
Descriptive Research ◽  
Study Results ◽  
Self Administered Questionnaire

Background: Clientele’s attitude toward Persons with Mental Illness (PwMI) changes over a period of time. The aim of this study was to explore and understand how and whether perception about PwMI changes when they are seen working like persons without mental illness among those availing services of ROSes café at NIMHANS, Bengaluru. Methods: The descriptive research design was adopted with purposive sampling. Community Attitude toward Mentally Ill (CAMI) a self -administered questionnaire of was administered to measure the clientele attitude towards staff with mental illness in ROSes Café (Recovery Oriented Services). A total of 256 subjects availing services from the ROSes café recruited in the study. Chi-square and Mann–Whitney U test was computed to see the association and differences on selected variables. Results: The present study results showed that subjects had a positive attitude seen in health care professionals in the domains of benevolence (BE) (28.68 ± 3.00) and community mental health ideology (CMHI) (31.53 ± 3.19), whereas non-health care professionals had showed negative attitude in the domain of authoritarianism (AU) (30.54 ± 3.42) and social restrictiveness (SR) (30.18 ± 3.05). Education, employment, marital, income, and working status were significantly associated with CAMI domains. Conclusion: PwMI also can work like people without mental illness when the opportunities are provided. The community needs to regard mental illness in the same manner as chronic physical illness diabetes mellitus and allow PwMI to live a life of dignity by creating and offering opportunities to earn livelihood which would help them recover with their illnesses.

scholarly journals Stigmatising attitudes towards the mentally ill: A survey in a Nigerian university teaching hospital

2010 ◽  
Vol 16 (2) ◽  
pp. 5 ◽  
Author(s):  
Dominic Ignatius Ukpong ◽  
Festus Abasiubong
Keyword(s):  
Mental Illness ◽  
Teaching Hospital ◽  
Low Income ◽  
Mentally Ill ◽  
Educational Programme ◽  
University Teaching ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Nigerian University

<p><strong>Background.</strong> The burden of mental illness is particularly severe for people living in low-income countries. Negative attitudes towards the mentally ill, stigma experiences and discrimination constitute part of this disease burden.</p><p><strong>Objective.</strong> The aim of this study was to investigate knowledge of possible causes of mental illness and attitudes towards the mentally ill in a Nigerian university teaching hospital population.</p><p><strong>Method.</strong> A cross-sectional descriptive study of a convenience sample of 208 participants from the University of Uyo Teaching Hospital, Uyo, Nigeria, using the Community Attitudes towards the Mentally Ill (CAMI) scale. Information was also obtained on beliefs about possible causes of mental illness. <strong></strong></p><p><strong>Results.</strong> The respondents held strongly negative views about the mentally ill, mostly being authoritarian and restrictive in their attitudes and placing emphasis on custodial care. Even though the respondents appeared to be knowledgeable about the possible role of psychosocial and genetic factors in the causation of mental illness, 52.0% of them believed that witches could be responsible, 44.2% thought mental illness could be due to possession by demons, and close to one-third (30%) felt that it could be a consequence of divine punishment.</p><p><strong>Conclusions.</strong> Stigma and discrimination against the mentally ill are widespread even in a population that is expected to be enlightened. The widespread belief in supernatural causation is likely to add to the difficulties of designing an effective anti-stigma psycho-educational programme. There is a need in Nigeria to develop strategies to change stigma attached to mental illness at both institutional and community levels.</p>

scholarly journals Results From Screening Immigrants of Low‐Income Countries: Data From a Public Primary Health Care

2014 ◽  
Vol 21 (2) ◽  
pp. 92-98 ◽  
Author(s):  
Olga Hladun ◽  
Albert Grau ◽  
Esther Esteban ◽  
Josep M. Jansà
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Low Income ◽  
Low Income Countries ◽  
Primary Health

scholarly journals Breast Cancer in Low- and Middle-Income Countries: An Emerging and Challenging Epidemic

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Arafat Tfayli ◽  
Sally Temraz ◽  
Rachel Abou Mrad ◽  
Ali Shamseddine
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Low Income ◽  
Therapeutic Interventions ◽  
Low Income Countries ◽  
Middle Income ◽  
Major Health ◽  
Middle Income Countries ◽  
Low And Middle Income

Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.

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