European Alliance Against Depression: Person centered care for depression and prevention of suicidal behaviour

2016 ◽  
Vol 6 (3) ◽  
pp. 174-179
Author(s):  
Ulrich Hegerl ◽  
Ella Arensman ◽  
Elisabeth Kohls
Keyword(s):  
Suicidal Behavior ◽  
Public Awareness ◽  
Primary Care Providers ◽  
Successful Implementation ◽  
Care Providers ◽  
Community Based ◽  
Care Givers ◽  
Community Based Programs ◽  
Intermediate Outcomes ◽  
Centered Care

Background: Depression is a prevalent and severe disorder and a major cause for attempted and completed suicides in Europe. Objectives: The community-based 4-level-intervention concept developed within the “European Alliance against Depression” (EAAD; www.eaad.net) combines two important objectives:  to improve the care and treatment of patients with depression and to prevent suicidal behavior. Methods: The EAAD community-based 4-level intervention comprises training and support of primary care providers (level 1), a professional public awareness  campaign (level 2), training of community facilitators (teachers, priests, geriatric care givers, pharmacists, journalists) (level 3), and support for self-help of persons suffering from depression and for their relatives (level 4). Results: Several studies evaluated different aspects of the 4-level community-based intervention concept over the past years and showed a significant reduction in suicidal behavior and various changes in intermediate outcomes (e.g. changes in attitude or knowledge in different populations). Systematic process evaluation was helpful to identify several predictable and unpredictable obstacles to a successful implementation of such community-based programs as well as synergistic and catalytic effects.Conclusions: The EAAD community-based interventionhas been shown to be effective concerning the prevention of suicidal behavior and is the most broadly implemented community-based intervention targeting depression and suicidal behavior world-wide. Via the EAAD and partners from currently 22 countries from in- and outside of Europe, the intervention concept and materials (available in many different languages) are offered to interested regions.  

Community-based 4-level approach: Background, implementation and evidence for efficacy

2016 ◽  
Vol 33 (S1) ◽  
pp. S31-S32 ◽  
Author(s):  
U. Hegerl ◽  
E. Arensman ◽  
C. van Audenhove ◽  
T. Baader ◽  
R. Gusmão ◽  
...  
Keyword(s):  
Suicidal Behavior ◽  
Process Analysis ◽  
Primary Care Providers ◽  
Successful Implementation ◽  
Care Providers ◽  
Community Based ◽  
Community Based Programs ◽  
Intermediate Outcomes ◽  
Level 3 ◽  
Competing Interest

The community-based 4-level-intervention concept developed within the “European Alliance against Depression” (http://www.eaad.net/) combines two important aims: to improve the care and treatment of patients with depression and to prevent suicidal behavior. It has been shown to be effective concerning the prevention of suicidal behavior [1–4] and is worldwide the most broadly implemented community-based intervention targeting depression and suicidal behavior. The 4-level intervention concept comprises training and support of primary care providers (level 1), a professional public relation campaign (level 2), training of community facilitators (teacher, priests, geriatric caregivers, pharmacists, journalists) (level 3), and support for self-help of patients with depression and for their relatives (level 4). In order to deepen the understanding of factors influencing the effectiveness of the intervention, a systematic implementation research and process analysis was performed within the EU-funded study “Optimizing Suicide Prevention Programs and Their Implementation in Europe” (http://www.ospi-europe.com/; 7th Framework Programme) [5]. These analyses were based on data from four intervention and four control regions from four European countries. In addition to intervention effects on suicidal behaviour, a variety of intermediate outcomes (e.g. changes in attitude or knowledge in different populations) were considered. Strong synergistic as well as catalytic effects were identified as a result of being active simultaneously at four different levels. Predictable and unpredictable obstacles to a successful implementation of such community-based programs will be discussed. Via the EAAD, the intervention concept and materials (available in eight different languages) are offered to interested region in and outside of Europe.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Practical lessons learnt from the worldwide implementation of 115 community-based interventions for suicidal prevention

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
U Hegerl
Keyword(s):  
Suicidal Behavior ◽  
Suicidal Behaviour ◽  
Intervention Program ◽  
Process Analysis ◽  
Implementation Process ◽  
Primary Care Providers ◽  
Systematic Research ◽  
Care Providers ◽  
Community Based Interventions ◽  
Community Based

Abstract Background Depression and other psychiatric disorders are the main cause for suicidal behaviour. The community based 4-level-intervention concept adapted by the “European Alliance against Depression” (www.EAAD.net) has been found to have preventive effects not only on depression but also on suicidal behavior in several but not all controlled studies. The 4-level intervention concept comprises training and support of primary care providers (level 1), a professional public relation campaign (level 2), training of community facilitators (teacher, priests, geriatric care givers, pharmacists, journalists) (level 3), and support for self-help of patients with depression and their relatives (level 4). Methods This 4-level intervention has in the meanwhile been implemented in more than 115 regions worldwide. A systematic assessment of the practical experiences, as well as a systematic process analysis and an implementation research were performed. Results Important findings of this research are: i) the relevance of a strong bottom-up element in the implementation process, ii) the synergistic and catalytic effects generated by becoming simultaneously active at the four different intervention levels, and iii) the crucial advantage of combining the partly overlapping topics of depression and prevention of suicidal behaviour. The latter approach is highly relevant having in mind the unclear risk-benefit-balance of anti-suicidal public campaigns, which are likely to result in a lowering of the threshold by normalization of suicidal behavior. More detailed information on these findings will be presented. Conclusions Systematic research on the on-going community based 4-level intervention program can add useful insights in suicide prevention strategies.

The Trans Primary Care Guide: A Community-Based Approach to Developing a Web-based, Illustrated Resource for Primary Health Care Providers (Preprint)

2018 ◽  
Author(s):  
Kelly Katharina Speck ◽  
Shelley L Wall
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Providers ◽  
Successful Implementation ◽  
Care Providers ◽  
Design And Development ◽  
Community Based ◽  
Web Based ◽  
Basic Care ◽  
Training Resources

BACKGROUND There is a large gap in educational and training resources on trans-sensitive care in health professional curricula. In-person continuing medical education training sessions are often limited by time, place, and instructor availability. Web-based technologies offer the potential to easily reach primary care providers across the province. However, existing online training resources are lengthy in content, lack visual communication strategies, and do not encompass the multitude of different transition options sought by trans individuals. OBJECTIVE This article describes a community-based, participatory approach to the design and development of a web-based, illustrated resource guide with non-sequential access to medical and basic care protocols and guidelines to improve primary care providers' knowledge and confidence in caring for trans clients. METHODS The design and development of the Trans Primary Care Guide was informed by a participatory design research strategy focused on iterative improvement of the resource through iterative review by an advisory committee, formative evaluations with trans participants and primary care providers, and usability testing. RESULTS A web-based, illustrated resource (Trans Primary Care Guide) was developed to educate primary care providers on the health care needs of trans and gender-diverse people. CONCLUSIONS Successful implementation of the web-based resource was in part due to the utilization of design strategies to help primary care providers contextualize trans-competencies, the community-academic partnership and due to the early engagement of trans participants to ensure that information is gender affirming and culturally specific to regional community needs. CLINICALTRIAL Not applicable.

scholarly journals Primary Care Providers’ Perceptions and Experiences of Family-Centered Care for Older Adults: A Qualitative Study of Community-Based Diabetes Management in China

2021 ◽  
Author(s):  
Jing Liao ◽  
Jiong Tu
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health Professionals ◽  
Diabetes Management ◽  
Primary Care Providers ◽  
Family Centered Care ◽  
Care Providers ◽  
Community Based ◽  
Centered Care ◽  
Family Centered

Abstract Background: Family-centered care, as a contemporary model of health service delivery, involves a mutually beneficial partnership between healthcare providers, patients and their families. Although evidence on the positive effects of family-centered care on older adults and their families is accumulating, less is known about the providers’ beliefs, attitudes and practices related to family-centeredness, especially regarding community-based primary healthcare services for the rapidly-ageing Chinese population. Methods: This study investigated Chinese primary care providers’ perceptions and experiences of family-centered care for older adults, using community-based diabetes management services as an example. Ten focus-group interviews involving 48 community health professionals were conducted. Major themes were identified using thematic analysis. Results: The interviews revealed that the providers acknowledged the importance of the family in older patients’ diabetes management, while their current scope of practice with the patients’ families was limited and informal. The barriers to implementing family-centered care were attributed to structural and environmental obstacles associated with the patients’ families and the community healthcare context and culture. To engage patients’ families more effectively, the providers suggested that family-centered values endorsed by their healthcare organizations and reinforced by policies, a trained interdisciplinary team of health professionals and community social workers, and also that the utilization of technology would be beneficial. Conclusions: Our study extends the evidence of family-centered care for older adults in Chinese community-based healthcare settings, contributing to the design of a tailored healthcare delivery model embodying ageing in place.

scholarly journals Primary care providers’ perceptions and experiences of family-centered care for older adults: a qualitative study of community-based diabetes management in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiong Tu ◽  
Jing Liao
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health Professionals ◽  
Diabetes Management ◽  
Primary Care Providers ◽  
Family Centered Care ◽  
Care Providers ◽  
Community Based ◽  
Centered Care ◽  
Family Centered

Abstract Background Family-centered care, as a contemporary model of health service delivery, involves a mutually beneficial partnership between healthcare providers, patients and their families. Although evidence on the positive effects of family-centered care on older adults and their families is accumulating, less is known about the providers’ beliefs, attitudes and practices related to family-centeredness, especially regarding community-based primary healthcare services for the rapidly-ageing Chinese population. Methods This study investigated Chinese primary care providers’ perceptions and experiences of family-centered care for older adults, using community-based diabetes management services as an example. Ten focus-group interviews involving 48 community health professionals were conducted. Major themes were identified using thematic analysis. Results The interviews revealed that the providers acknowledged the importance of the family in older patients’ diabetes management, while their current scope of practice with the patients’ families was limited and informal. The barriers to implementing family-centered care were attributed to structural and environmental obstacles associated with the patients’ families and the community healthcare context and culture. To engage patients’ families more effectively, the providers suggested that family-centered values endorsed by their healthcare organizations and reinforced by policies, a trained interdisciplinary team of health professionals and community social workers, and also that the utilization of technology would be beneficial. Conclusions Our study extends the evidence of family-centered care for older adults in Chinese community-based healthcare settings, contributing to the design of a tailored healthcare delivery model embodying ageing in place.

scholarly journals Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045997
Author(s):  
Abhijit Pakhare ◽  
Ankur Joshi ◽  
Rasha Anwar ◽  
Khushbu Dubey ◽  
Sanjeev Kumar ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Multivariate Analysis ◽  
Urban Slum ◽  
Primary Care Providers ◽  
Health Facilities ◽  
Care Providers ◽  
Community Based ◽  
Public Health Facilities ◽  
Care Facilities

ObjectivesHypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction.MethodsWe conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities.ResultsOf 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group.ConclusionsThis study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

General Pediatric Teaching Clinics and Managed Care

PEDIATRICS ◽  
1998 ◽  
Vol 101 (Supplement_3) ◽  
pp. 775-778
Author(s):  
J. Thomas Badgett
Keyword(s):  
Managed Care ◽  
Work Environment ◽  
Primary Care Providers ◽  
Resident Training ◽  
Successful Implementation ◽  
Negative Consequences ◽  
Care Providers ◽  
Care Environment ◽  
The World ◽  
Teaching Clinics

Academic general pediatric divisions can function as effective primary care providers in a managed care environment. Residents training in these programs are expected to be better equipped to enter a work environment that is increasingly structured in a managed care format. Positive and negative consequences of managed care in an academic setting are discussed. Recommendations for successful implementation of resident training in the world of managed care are shared.

Multilevel approaches in adult suicide prevention

2021 ◽  
pp. 665-670
Author(s):  
Ulrich Hegerl ◽  
Ines Heinz ◽  
Juliane Hug
Keyword(s):  
Suicide Prevention ◽  
Suicide Attempts ◽  
Synergistic Effects ◽  
Public Awareness ◽  
Risk Groups ◽  
Primary Care Providers ◽  
Community Based ◽  
The Media ◽  
Different Cultures ◽  
Multilevel Interventions

The next steps forward in suicide prevention are to learn (i) how to best combine single measures into a multilevel intervention in order to create additive and synergistic effects and (ii) how to implement them in the communities in different cultures and healthcare systems. A narrative review based on findings and experiences from existing community-based multilevel interventions which have provided some evidence for preventive effects on suicidal behaviour is presented. Most multilevel interventions combine training for primary care providers and gatekeepers, public awareness activities, restricting access to lethal means, engaging with the media, and support for high risk groups. However, effects on completed suicides and/or suicide attempts have only been reported for a few interventions. The best evaluated community-based intervention is the four-level programme offered by the European Alliance Against Depression (EAAD; implemented in over 115 regions in 15 countries by 2019).

scholarly journals Facilitating treatment of HCV in primary care in regional Australia: closing the access gap

2018 ◽  
Vol 10 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Lauren White ◽  
Ali Azzam ◽  
Lauren Burrage ◽  
Clare Orme ◽  
Barbara Kay ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Primary Care Providers ◽  
Treatment Recommendation ◽  
Care Providers ◽  
Hcv Treatment ◽  
Community Based

BackgroundAustralia has unrestricted access to direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment. In order to increase access to treatment, primary care providers are able to prescribe DAA after fibrosis assessment and specialist consultation. Transient elastography (TE) is recommended prior to commencement of HCV treatment; however, TE is rarely available outside secondary care centres in Australia and therefore a requirement for TE could represent a barrier to access to HCV treatment in primary care.ObjectivesIn order to bridge this access gap, we developed a community-based TE service across the Sunshine Coast and Wide Bay areas of Queensland.DesignRetrospective analysis of a prospectively recorded HCV treatment database.InterventionsA nurse-led service equipped with two mobile Fibroscan units assesses patients in eight locations across regional Queensland. Patients are referred into the service via primary care and undergo nurse-led TE at a location convenient to the patient. Patients are discussed at a weekly multidisciplinary team meeting and a treatment recommendation made to the referring GP. Treatment is initiated and monitored in primary care. Patients with cirrhosis are offered follow-up in secondary care.Results327 patients have undergone assessment and commenced treatment in primary care. Median age 48 years (IQR 38–56), 66% male. 57% genotype 1, 40% genotype 3; 82% treatment naïve; 10% had cirrhosis (liver stiffness >12.5 kPa). The majority were treated with sofosbuvir-based regimens. 26% treated with 8-week regimens. All patients had treatment prescribed and monitored in primary care. Telephone follow-up to confirm sustained virological response (SVR) was performed by clinic nurses. 147 patients remain on treatment. 180 patients have completed treatment. SVR data were not available for 19 patients (lost to follow-up). Intention-to-treat SVR rate was 85.5%. In patients with complete data SVR rate was 95.6%.ConclusionCommunity-based TE assessment facilitates access to HCV treatment in primary care with excellent SVR rates.

scholarly journals Redefining the Care Continuum to Create a Pipeline to Dementia Care for Minority Populations

2020 ◽  
Vol 11 ◽  
pp. 215013272092168
Author(s):  
Tina R. Sadarangani ◽  
Vanessa Salcedo ◽  
Joshua Chodosh ◽  
Simona Kwon ◽  
Chau Trinh-Shevrin ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Asian American ◽  
Minority Groups ◽  
Primary Care Providers ◽  
Dementia Care ◽  
Care Providers ◽  
Community Based ◽  
Community Based Organizations

Multiple studies show that racial and ethnic minorities with low socioeconomic status are diagnosed with Alzheimer’s disease and Alzheimer’s disease–related dementias (AD/ADRD) in more advanced disease stages, receive fewer formal services, and have worse health outcomes. For primary care providers confronting this challenge, community-based organizations can be key partners in supporting earlier identification of AD/ADRD and earlier entry into treatment, especially for minority groups. The New York University Center for the Study of Asian American Health, set out to culturally adapt and translate The Kickstart-Assess-Evaluate-Refer (KAER) framework created by the Gerontological Society of America to support earlier detection of dementia in Asian American communities and assist in this community-clinical coordinated care. We found that CBOs play a vital role in dementia care, and are often the first point of contact for concerns around cognitive impairment in ethnically diverse communities. A major strength of these centers is that they provide culturally appropriate group education that focuses on whole group quality of life, rather than singling out any individual. They also offer holistic family-centered care and staff have a deep understanding of cultural and social issues that affect care, including family dynamics. For primary care providers confronting the challenge of delivering evidence-based dementia care in the context of the busy primary care settings, community-based organizations can be key partners in supporting earlier identification of AD/ADRD and earlier entry into treatment, especially for minority groups.

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