1
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Wang SS, Eapen V, Lin PI. The relationship between mental health reforms and general population suicide rates in Australia over the past three and a half decades: 1987-2021. Psychiatry Res 2024; 335:115884. [PMID: 38569443 DOI: 10.1016/j.psychres.2024.115884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
Nearly 3,000 Australians tragically end their lives by suicide each year, underscoring a major national public health challenge with substantial socio-economic ramifications. Australia's National Mental Health Plans (NMHPs) aim to improve mental health and reduce suicide rates. This study investigates their effectiveness by analyzing how age-standardized suicide rates across Australian jurisdictions have fluctuated alongside the implementation of five NMHPs from 1987 to 2021. Findings reveal mixed impacts, with some plans linked to decreases and others associated with increases in suicide rates across different periods and regions. Notably, the recent decline in 2020 requires careful consideration amidst COVID-19 pandemic influences. These insights not only provide valuable evidence for shaping future mental health policies and initiatives but also for future health services research.
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Affiliation(s)
| | - Valsamma Eapen
- School of Medicine, University of New South Wales, Sydney, Australia; Academic Unit of Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, Australia
| | - Ping-I Lin
- School of Medicine, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; School of Medicine, Western Sydney University, Penrith, Australia.
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2
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Aliev AA, Tomaskova H, Winkler P, Yon Y, Kagstrom A, Guerrero Z, Lazeri L, Reinap M, Redlich C, Tijerino Inestroza AM, Maurer J. Methods and tools to assess implementation of mental health policies and plans: A systematic review. Glob Ment Health (Camb) 2023; 10:e12. [PMID: 37854405 PMCID: PMC10579679 DOI: 10.1017/gmh.2023.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/17/2023] [Accepted: 02/07/2023] [Indexed: 03/19/2023] Open
Abstract
Mental health policies and plans (MHPPs) are important policy instruments and powerful tools to facilitate development of mental health systems and services across the world. We aimed to map and analyse methods and tools used to assess the extent, process and impact of implementing MHPPs. We systematically searched peer-reviewed and grey literature across seven scientific databases. We extracted and analysed the data on a) the characteristics of included studies (e.g., policy areas, region of origin, income setting) and b) the methodology and evaluation tools applied to assess the extent and process of implementation. We included 48 studies in the analyses. Twenty-six of these studies employed only qualitative methods (e.g., semi-structured interviews, focus group discussions, desk review, stakeholder consultations); 12 studies used quantitative methods (e.g., trend analysis, survey) and 10 used mixed-methods approaches. Generally, methods and tools used for assessment were described poorly with less than half of the studies providing partial or full details about them. Only three studies provided assessment of full policies. There is a lack of rigorous research to assess implementation MHPPs. Assessments of the implementation of entire MHPPs are almost non-existent. Strategies to assess the implementation of MHPPs should be an integral part of MHPPs.
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Affiliation(s)
- Akmal Alikhan Aliev
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Hana Tomaskova
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
- Department of Psychology, Charles University, Prague, Czechia
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Yongjie Yon
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Anna Kagstrom
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Zoe Guerrero
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Ledia Lazeri
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Marge Reinap
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Cassie Redlich
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Jason Maurer
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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3
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Pearce T, Maple M, Wayland S, McKay K, Shakeshaft A, Woodward A. Evidence of co-creation practices in suicide prevention in government policy: a directed and summative content analysis. BMC Public Health 2022; 22:1929. [PMID: 36253848 PMCID: PMC9578215 DOI: 10.1186/s12889-022-14313-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background In Australia, the collaborative involvement of stakeholders, especially those with lived experience in mental health and suicide prevention, has become important to government policy and practice at Federal and State levels. However, little is known about how governments translate this intention into frameworks of co-creation for policy, funding programs, service improvement, and research and evaluation. We investigated the extent to which publicly available government policies refer to collaborative practice using an established translation model. Methods An exploratory directed and summative content analysis approach was used to analyse the contents of Federal (also known as Commonwealth), State and Territories policy documents on mental health and suicide prevention published in Australia between 2010 and 2021. The data was extracted, compared to an existing translation model, and summated to demonstrate the evidence of co-creation-related concepts between government and stakeholders. Results 40 policy documents (nine at the Federal and 31 at the State and Territory level) were identified and included in the analysis. Only 63% of policy documents contained references to the concept of co-design. Six of the State policies contained references to the concept of co-production. Across all policy documents, there were no references to other concepts in the model adopted for this study, such as co-creation, co-ideation, co-implementation, and co-evaluation. Conclusion Although the government at Federal, State and Territory levels appear to support collaborative practice through partnership and co-design, this study suggests a narrow approach to the theoretical model for co-creation at a policy level. Implications for both research and practice are discussed.
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Affiliation(s)
- Tania Pearce
- School of Health, University of New England, 2351, Armidale, NSW, Australia.
| | - Myfanwy Maple
- School of Health, University of New England, 2351, Armidale, NSW, Australia
| | - Sarah Wayland
- School of Health, University of New England, 2351, Armidale, NSW, Australia
| | - Kathy McKay
- Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK.,Tavistock and Portman NHS Foundation Trust, London, UK
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick Campus, 22-32 King Street, 2031, Randwick, NSW, Australia
| | - Alan Woodward
- Centre for Mental Health, School of Population and Global Health, University of Melbourne, VIC, 3010, Melbourne, Australia
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4
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Bullock HL, Lavis JN, Wilson MG, Mulvale G, Miatello A. Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis. Implement Sci 2021. [PMID: 33588878 DOI: 10.1186/s13012‐021‐01082‐7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers, and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts. METHODS We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: How is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as gray literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature. RESULTS A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as (1) the context, (2) a focusing lens, (3) the innovation itself, (4) a lever of influence, (5) an enabler/facilitator or barrier, or (6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. CONCLUSIONS This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers, and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.
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Affiliation(s)
- Heather L Bullock
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.
| | - John N Lavis
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Michael G Wilson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Gillian Mulvale
- DeGroote School of Business, McMaster University, Burlington, Canada
| | - Ashleigh Miatello
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada
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5
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Bullock HL, Lavis JN, Wilson MG, Mulvale G, Miatello A. Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis. Implement Sci 2021; 16:18. [PMID: 33588878 PMCID: PMC7885555 DOI: 10.1186/s13012-021-01082-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers, and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts. METHODS We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: How is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as gray literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature. RESULTS A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as (1) the context, (2) a focusing lens, (3) the innovation itself, (4) a lever of influence, (5) an enabler/facilitator or barrier, or (6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. CONCLUSIONS This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers, and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.
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Affiliation(s)
- Heather L Bullock
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.
| | - John N Lavis
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Michael G Wilson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Gillian Mulvale
- DeGroote School of Business, McMaster University, Burlington, Canada
| | - Ashleigh Miatello
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada
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6
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Khalife J, Ammar W, Emmelin M, El-Jardali F, Ekman B. Hospital performance and payment: impact of integrating pay-for-performance on healthcare effectiveness in Lebanon. Wellcome Open Res 2020; 5:95. [PMID: 33437874 PMCID: PMC7780336 DOI: 10.12688/wellcomeopenres.15810.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 11/25/2022] Open
Abstract
Background: In 2014 the Lebanese Ministry of Public Health integrated pay-for-performance into setting hospital reimbursement tiers, to provide hospitalization service coverage for the majority of the Lebanese population. This policy was intended to improve effectiveness by decreasing unnecessary hospitalizations, and improve fairness by including risk-adjustment in setting hospital performance scores. Methods: We applied a systematic approach to assess the impact of the new policy on hospital performance. The main impact measure was a national casemix index, calculated across 2011-2016 using medical discharge and surgical procedure codes. A single-group interrupted time series analysis model with Newey ordinary least squares regression was estimated, including adjustment for seasonality, and stratified by case type. Code-level analysis was used to attribute and explain changes in casemix index due to specific diagnoses and procedures. Results: Our final model included 1,353,025 cases across 146 hospitals with a post-intervention lag-time of two months and seasonality adjustment. Among medical cases the intervention resulted in a positive casemix index trend of 0.11% per month (coefficient 0.002, CI 0.001-0.003), and a level increase of 2.25% (coefficient 0.022, CI 0.005-0.039). Trend changes were attributed to decreased cases of diarrhea and gastroenteritis, abdominal and pelvic pain, essential hypertension and fever of unknown origin. A shift from medium to short-stay cases for specific diagnoses was also detected. Level changes were attributed to improved coding practices, particularly for breast cancer, leukemia and chemotherapy. No impact on surgical casemix index was found. Conclusions: The 2014 policy resulted in increased healthcare effectiveness, by increasing the casemix index of hospitals contracted by the Ministry. This increase was mainly attributed to decreased unnecessary hospitalizations and was accompanied by improved medical discharge coding practices. Integration of pay-for-performance within a healthcare system may contribute to improving effectiveness. Effective hospital regulation can be achieved through systematic collection and analysis of routine data.
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Affiliation(s)
- Jade Khalife
- Faculty of Medicine at Lund University, Lund, Sweden
- Ministry of Public Health, Beirut, Lebanon
| | - Walid Ammar
- Ministry of Public Health, Beirut, Lebanon
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maria Emmelin
- Faculty of Medicine at Lund University, Lund, Sweden
| | - Fadi El-Jardali
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Bjorn Ekman
- Faculty of Medicine at Lund University, Lund, Sweden
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7
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Croker H, Russell SJ, Gireesh A, Bonham A, Hawkes C, Bedford H, Michie S, Viner RM. Obesity prevention in the early years: A mapping study of national policies in England from a behavioural science perspective. PLoS One 2020; 15:e0239402. [PMID: 32997681 PMCID: PMC7526925 DOI: 10.1371/journal.pone.0239402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/05/2020] [Indexed: 01/10/2023] Open
Abstract
Background Evidence indicates that early life is critical for determining future obesity risk. A sharper policy focus on pregnancy and early childhood could help improve obesity prevention efforts. This study aimed to systematically identify and categorise policy levers used in England with potential to influence early life course (pregnancy, 0–5 years) and identify how these interface with energy balance behaviours. The objective is to identify gaps and where further policy actions could most effectively focus. Methods A behavioural science approach was taken using the Capability-Opportunity-Motivation-Behaviour (COM-B) model and Behaviour Change Wheel (BCW) framework. The key determinants of energy balance in the early years were identified from the Foresight Systems Map. Policy actions were scoped systematically from available literature, including any health or non-health policies which could impact on energy balance behaviours. Foresight variables and policy actions were considered in terms of COM-B and the BCW to determine approaches likely to be effective for obesity prevention and treatment. Existing policies were overlaid across the map of key risk factors to identify gaps in obesity prevention and treatment provision. Results A wide range of policy actions were identified (n = 115) to address obesity-relevant risk factors. These were most commonly educational or guidelines relating to environmental restructuring (i.e. changing the physical or social context). Scope for strengthening policies relating to the food system (e.g. the market price of food) and psychological factors contributing to obesity were identified. Policies acted via all aspects of the COM-B model, but there was scope for improving policies to increase capability through skills acquisition and both reflective and automatic motivation. Conclusions There is substantial policy activity to address early years obesity but much is focused on education. Scope exists to strengthen actions relating to upstream policies which act on food systems and those targeting psychological factors contributing to obesity risk.
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Affiliation(s)
- Helen Croker
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- * E-mail:
| | - Simon J. Russell
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Aswathikutty Gireesh
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Aida Bonham
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Corinna Hawkes
- School of Health Sciences, Division of Health Services Research & Management City, University of London, Northampton Square, London, United Kingdom
| | - Helen Bedford
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Susan Michie
- UCL Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Russell M. Viner
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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8
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Khalife J, Ammar W, Emmelin M, El-Jardali F, Ekman B. Hospital performance and payment: impact of integrating pay-for-performance on healthcare effectiveness in Lebanon. Wellcome Open Res 2020; 5:95. [PMID: 33437874 PMCID: PMC7780336 DOI: 10.12688/wellcomeopenres.15810.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 09/20/2023] Open
Abstract
Background: In 2014 the Lebanese Ministry of Public Health integrated pay-for-performance into setting hospital reimbursement tiers, to provide hospitalization service coverage for the majority of the Lebanese population. This policy was intended to improve effectiveness by decreasing unnecessary hospitalizations, and improve fairness by including risk-adjustment in setting hospital performance scores. Methods: We applied a systematic approach to assess the impact of the new policy on hospital performance. The main impact measure was a national casemix index, calculated across 2011-2016 using medical discharge and surgical procedure codes. A single-group interrupted time series analysis model with Newey ordinary least squares regression was estimated, including adjustment for seasonality, and stratified by case type. Code-level analysis was used to attribute and explain changes in casemix index due to specific diagnoses and procedures. Results: Our final model included 1,353,025 cases across 146 hospitals with a post-intervention lag-time of two months and seasonality adjustment. Among medical cases the intervention resulted in a positive casemix index trend of 0.11% per month (coefficient 0.002, CI 0.001-0.003), and a level increase of 2.25% (coefficient 0.022, CI 0.005-0.039). Trend changes were attributed to decreased cases of diarrhea and gastroenteritis, abdominal and pelvic pain, essential hypertension and fever of unknown origin. A shift from medium to short-stay cases for specific diagnoses was also detected. Level changes were attributed to improved coding practices, particularly for breast cancer, leukemia and chemotherapy. No impact on surgical casemix index was found. Conclusions: The 2014 policy resulted in increased healthcare effectiveness, by increasing the casemix index of hospitals contracted by the Ministry. This increase was mainly attributed to decreased unnecessary hospitalizations and was accompanied by improved medical discharge coding practices. Integration of pay-for-performance within a healthcare system may contribute to improving effectiveness. Effective hospital regulation can be achieved through systematic collection and analysis of routine data.
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Affiliation(s)
- Jade Khalife
- Faculty of Medicine at Lund University, Lund, Sweden
- Ministry of Public Health, Beirut, Lebanon
| | - Walid Ammar
- Ministry of Public Health, Beirut, Lebanon
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maria Emmelin
- Faculty of Medicine at Lund University, Lund, Sweden
| | - Fadi El-Jardali
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Bjorn Ekman
- Faculty of Medicine at Lund University, Lund, Sweden
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9
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So M, McCord RF, Kaminski JW. Policy Levers to Promote Access to and Utilization of Children's Mental Health Services: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:334-351. [PMID: 30604005 DOI: 10.1007/s10488-018-00916-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Policies have potential to help families obtain behavioral healthcare for their children, but little is known about evidence for specific policy approaches. We reviewed evaluations of select policy levers to promote accessibility, affordability, acceptability, availability, or utilization of children's mental and behavioral health services. Twenty articles met inclusion criteria. Location-based policy levers (school-based services and integrated care models) were associated with higher utilization and acceptability, with mixed evidence on accessibility. Studies of insurance-based levers (mental health parity and public insurance) provided some evidence for affordability outcomes. We found no eligible studies of workforce development or telehealth policy levers, or of availability outcomes.
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Affiliation(s)
- Marvin So
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway MS-E88, Atlanta, 30341, GA, USA. .,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Russell F McCord
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway MS-E88, Atlanta, 30341, GA, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jennifer W Kaminski
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway MS-E88, Atlanta, 30341, GA, USA
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10
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Esdaile E, Thow AM, Gill T, Sacks G, Golley R, Love P, Wen LM, Rissel C. National policies to prevent obesity in early childhood: Using policy mapping to compare policy lessons for Australia with six developed countries. Obes Rev 2019; 20:1542-1556. [PMID: 31408577 DOI: 10.1111/obr.12925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/30/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022]
Abstract
Interventions for obesity prevention in early childhood (first 5 years of life) are likely to have a significant preventive health impact. This mapping review identified recommended policy options for the Australian Federal Government (AFG) by comparing countries with similar population, income, and language to Australia. Policies were mapped in six countries using two matrices. The first matrix examined policy context, describing obesity prevention governance. The second matrix examined policy content, compared with global recommendations. Policies were grouped into downstream (healthcare), midstream (lifestyle and settings), and upstream (determinants of health, including food and built environments). Results identified variance in obesity governance across the six countries including policy coherence, leadership, institutional drivers, and overlapping responsibility across different levels of government. While countries tended to have more downstream or midstream policies, upstream policies were more likely when countries had invested in system-wide approaches to obesity such as developing a national obesity strategy, having separate food/nutrition and physical activity plans, and a dedicated preventive health agency. This study recommends a range of initiatives for the AFG to strengthen policies for the prevention of obesity in early childhood, including prioritising the development of a national food/nutrition strategy.
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Affiliation(s)
- Emma Esdaile
- Charles Perkins Centre, Prevention Research Collaboration, Faculty of Health and Medicine, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia
| | - Anne Marie Thow
- Menzies Centre, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Tim Gill
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,Boden Institute, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Geelong, Victoria, Australia
| | - Rebecca Golley
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Penelope Love
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Li Ming Wen
- Charles Perkins Centre, Prevention Research Collaboration, Faculty of Health and Medicine, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,Health Promotion Unit, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Chris Rissel
- Charles Perkins Centre, Prevention Research Collaboration, Faculty of Health and Medicine, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,Office of Preventive Health, New South Wales Ministry of Health, Sydney, New South Wales, Australia
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11
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Meurk C, Harris M, Wright E, Reavley N, Scheurer R, Bassilios B, Salom C, Pirkis J. Systems levers for commissioning primary mental healthcare: a rapid review. Aust J Prim Health 2019; 24:29-53. [PMID: 29338836 DOI: 10.1071/py17030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/23/2017] [Indexed: 11/23/2022]
Abstract
Primary Health Networks (PHNs) are a new institution for health systems management in the Australian healthcare system. PHNs will play a key role in mental health reform through planning and commissioning primary mental health services at a regional level, specifically adopting a stepped care approach. Selected PHNs are also trialling a healthcare homes approach. Little is known about the systems levers that could be applied by PHNs to achieve these aims. A rapid review of academic and grey literature published between 2006 and 2016 was undertaken to describe the use of systems levers in commissioning primary care services. Fifty-six documents met the inclusion criteria, including twelve specific to primary mental healthcare. Twenty-six levers were identified. Referral management, contracts and tendering processes, and health information systems were identified as useful levers for implementing stepped care approaches. Location, enrolment, capitation and health information systems were identified as useful in implementing a healthcare homes approach. Other levers were relevant to overall health system functioning. Further work is needed to develop a robust evidence-base for systems levers. PHNs can facilitate this by documenting and evaluating the levers that they deploy, and making their findings available to researchers and other commissioning bodies.
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Affiliation(s)
- Carla Meurk
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Meredith Harris
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Eryn Wright
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Nicola Reavley
- The University of Melbourne, Melbourne School of Population and Global Health, Vic. 3010, Australia
| | - Roman Scheurer
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Bridget Bassilios
- The University of Melbourne, Melbourne School of Population and Global Health, Vic. 3010, Australia
| | - Caroline Salom
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, Qld 4108, Australia
| | - Jane Pirkis
- The University of Melbourne, Melbourne School of Population and Global Health, Vic. 3010, Australia
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Zhou W, Yu Y, Yang M, Chen L, Xiao S. Policy development and challenges of global mental health: a systematic review of published studies of national-level mental health policies. BMC Psychiatry 2018; 18:138. [PMID: 29776356 PMCID: PMC5960139 DOI: 10.1186/s12888-018-1711-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 05/01/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mental health policy can be an essential and powerful tool to improve a population's mental health. However, around one third of countries do not possess a mental health policy, and there are large disparities in population coverage rates between high- and low-income countries. The goal of this study is to identify the transition and implementation challenges of mental health policies in both high-income countries (HICs) as well as middle- and low-income countries (MLICs). METHODS PubMed, Cochrane Library and Campbell Library were searched from inception to 31 December 2017, for studies on implemented mental health policies at the national level. Abstracts and the main texts of papers were double screened, and extracted data were analysed through thematic synthesis. RESULTS A total of 93 papers were included in this study, covering 24 HICs, 28 MLICs and 5 regions. Studies on mental health policies, especially those of MLICs, kept increasing, but MLICs were still underrepresented in terms of publication quantity and study frequency. Based on the included studies, nine policy domains were summarized: service organizing, service provision, service quality, human resources, legislation and human rights, advocacy, administration, surveillance and research, and financing and budgeting. HICs incrementally enriched their policy content in all domains over centuries of development; following HICs' experience, mental health policies in MLICs have boomed since the 1990s and quickly extended to all domains. Implementation problems in HICs were mainly related to service organizing and service provision; for MLICs, more severe implementation problems converged on financing and budgeting, administration and human resources. CONCLUSIONS Mental health policy developments in both HICs and MLICs present a process of diversification and enrichment. In terms of implementation, MLICs are faced with more and greater challenges than HICs, especially in funding, human resources and administration. Therefore, future efforts should not only be made on helping MLICs developing mental health policies, but also on promoting policy implementation under MLICs' local context.
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Affiliation(s)
- Wei Zhou
- 0000 0001 0379 7164grid.216417.7Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China ,0000 0001 0379 7164grid.216417.7Hospital Administration Institute, Xinagya Hospital, Central South University, Changsha, China
| | - Yu Yu
- 0000 0001 0379 7164grid.216417.7Evaluation Department, Xiangya Hospital, Central South University, Changsha, China
| | - Mei Yang
- grid.452897.5Department of Addiction Medicine, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Lizhang Chen
- 0000 0001 0379 7164grid.216417.7Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, China.
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13
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Grace FC, Meurk CS, Head BW, Hall WD, Harris MG, Whiteford HA. An analysis of policy success and failure in formal evaluations of Australia's national mental health strategy (1992-2012). BMC Health Serv Res 2017; 17:374. [PMID: 28558763 PMCID: PMC5450180 DOI: 10.1186/s12913-017-2309-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 05/15/2017] [Indexed: 11/21/2022] Open
Abstract
Background Heightened fiscal constraints, increases in the chronic disease burden and in consumer expectations are among several factors contributing to the global interest in evidence-informed health policy. The present article builds on previous work that explored how the Australian Federal Government applied five instruments of policy, or policy levers, to implement a series of reforms under the Australian National Mental Health Strategy (NMHS). The present article draws on theoretical insights from political science to analyse the relative successes and failures of these levers, as portrayed in formal government evaluations of the NMHS. Methods Documentary analysis of six evaluation documents corresponding to three National Mental Health Plans was undertaken. Both the content and approach of these government-funded, independently conducted evaluations were appraised. Results An overall improvement was apparent in the development and application of policy levers over time. However, this finding should be interpreted with caution due to variations in evaluation approach according to Plan and policy lever. Tabulated summaries of the success and failure of each policy initiative, ordered by lever type, are provided to establish a resource that could be consulted for future policy-making. Conclusions This analysis highlights the complexities of health service reform and underscores the limitations of narrowly focused empirical approaches. A theoretical framework is provided that could inform the evaluation and targeted selection of appropriate policy levers in mental health.
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Affiliation(s)
- Francesca C Grace
- NSW Ministry of Health, 73 Miller St, North Sydney, NSW, 2060, Australia.
| | - Carla S Meurk
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, QLD, 4108, Australia
| | - Brian W Head
- School of Political Science, The University of Queensland, Campbell Rd, St Lucia, QLD, 4072, Australia
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, CYSAR K Floor Mental Health Centre, Royal Brisbane & Women's Hospital Campus, Herston, QLD, 4029, Australia
| | - Meredith G Harris
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, QLD, 4108, Australia
| | - Harvey A Whiteford
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, QLD, 4108, Australia
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