Better care through an optimized mental health services continuum (Eastern Townships, Québec, Canada): A systematic and multisource literature review

INTRODUCTION

In 2014, the health authorities of the Eastern Townships (Québec, Canada) commissioned an evaluation of the mental health admission system for adults (GASMA) to identify the best GASMA organizational or structural elements and optimize the mental health services continuum.

METHODS

To develop better services, seven indicators (ie, accessibility to services, integration of levels of services, user satisfaction, guidance and management time, evaluation tools, professional composition, and interprofessional collaboration) were examined through four evaluation questions. A three-step systematic and multisource evaluation was realized. A systematic review of the scientific and gray literature was performed. This evaluation also included key informant opinions to contextualize results from this review.

RESULTS

Results from 91 scientific articles, 40 gray literature documents, and 10 interviews highlighted determinants and barriers associated with the examined indicators. From these results, 24 preliminary recommendations were formulated and discussed in a steering committee. These recommendations were then weighted and validated. This served to formulate three final recommendations.

CONCLUSION

To optimize the regional mental health services continuum, stakeholders should (1) implement a single-window access for adults with mental health needs, (2) develop alternative services based on users' needs, and (3) test the effectiveness of new methods, initiatives, and tools.

Older adults' attitudes toward depression screening in primary care settings and exploring a brief educational pamphlet

OBJECTIVES

This study aimed to assess older adults' (OAs') attitudes toward depression screening in primary care settings with a survey and explore the impact of an educational pamphlet on these attitudes.

METHODS

Older adults above age 55 (N = 140) were randomly stratified by sex to an intervention or control group. The study included a baseline assessment, posttest, the Geriatric Depression Scale-Short Form, a two-page pamphlet on health and mood, and a 10-question quiz.

RESULTS

On the basis of survey responses, most participants (93.6%) were willing to complete a depression screen at their doctor's office, and 92.1% perceived depression screening as valuable to their health care. Participants rated the Geriatric Depression Scale-Short Form positively. The survey also provided information on how screening could be conducted in primary care settings to maximize OAs' comfort. Participants preferred screening in the waiting room or examination room instead of the nurse's station. Those receiving the pamphlet became significantly more willing to be screened for depression than those who did not, F(1, 134) = 4.47, p = 0.04.

CONCLUSION

Most OAs appear receptive to completing a depression screen in primary care settings. Educating OAs about the value of depression screening and tailoring recognition systems to account for preferences may be an initial step in improving recognition rates. Copyright © 2017 John Wiley & Sons, Ltd.

Community Models of Care: A Scoping Review

Nurse preparation and role in community models of care for older adults is not well documented. The purpose of the current structured scoping literature review was to identify nurse-led or nurse-involved community models of care for older adults, articulate the nurse's role and preparation in the model, and identify Triple Aim policy implications. Literature from 2008 through 2014 yielded 34 models identified in 51 articles. Twenty-one of 34 models were evaluated and none clearly articulated the full impact of a nurse role. Policy implications include: (a) consensus on degree preparation for nurses working in communities with older adults; (b) clearly defined nurse-sensitive measurements that capture the role of nursing in ambulatory and community care; (c) nonrestrictive scopes of practice for gerontological nurses and adult-gerontological nurse practitioners to extend their role beyond clinic settings; and (d) extending beyond value-based payment, which currently is largely physician awarded, and including additional Medicare and Medicaid policy to support nurses, community-level practice, and reimbursement. [Journal of Gerontological Nursing, 42(12), 12-20.].