Academic literature on the topic 'Provision of health and support services not elsewhere classified'

The systematic integration of evidence-based tobacco treatment has yet to be broadly viewed as a standard-of-care. The Framework Convention on Tobacco Control recommends the provision of support for tobacco cessation. We argue that the provision of smoking cessation services in clinical settings is a fundamental clinical responsibility and permits the opportunity to more effectively assist with cessation. The role of clinicians in prioritising smoking cessation is essential in all settings. Clinical benefits of implementing cessation services in hospital settings have been recognised for three decades—but have not been consistently provided. The Ottawa Model for Smoking Cessation has used an ‘organisational change’ approach to its introduction and has served as the basis for the introduction of cessation programmes in hospital and primary care settings in Canada and elsewhere. The significance of smoking cessation dwarfs that of many preventive interventions in primary care. Compelling evidence attests to the importance of providing cessation services as part of cancer treatment, but implementation of such programmes has been slow. We recognise that the provision of such services must reflect the realities and resources of a particular health system. In low-income and middle-income countries, access to treatment facilities pose unique challenges. The integration of cessation programmes with tuberculosis control services may offer opportunities; and standardisation of peri-operative care to include smoking cessation may not require additional resources. Mobile phones afford unique opportunities for interactive cessation programming. Health system change is fundamental to improving the provision of cessation services; clinicians can be powerful advocates for such change.

Substitution among the providers of old-age care has usually meant a process whereby the state ‘takes over’ what families used to do, but during the 1980s and 1990s, both home help and institutional care were cut back substantially in Sweden as elsewhere. Comparable, nationally representative surveys in Sweden of the provision of care for older people living in the community enable analysis of the effects of these cutbacks on the sources and patterns of care. It emerges that increased inputs from families match the decline of public services, that is, a ‘reverse’ substitution has recently been taking place. Local studies, of older people who have been followed over time as the provision of home help has changed, support these conclusions. Of the increased informal care, most has been provided by daughters, but sons have also contributed. A problematic aspect of these shifting patterns of care is that an increasing number of family carers with increasingly heavy care commitments are now without formal or informal support, whereas in the recent past many could expect their responsibilities to be shared with the state. The evidence from this study also calls into question common metaphors and assumptions about the assumed interdependence between informal care and public services for older people, and challenges the so-called substitution thesis.

Purpose – The purpose of this paper is to describe specific features of a Victorian (Australia) state-wide hub and spoke model of speech pathology provision established for adults with complex communication needs (CCN). Two case studies highlighting successful examples of services developed to enhance community inclusion will be described and the challenges discussed. Design/methodology/approach – The route to community inclusion is described through a case study illustration of one communication accessible community site and one disability service study. The disability service research involved focus groups, survey and interview data and demonstrated the efficacy and sustainability of a support worker training model. Findings – Sustainable change in the community and in disability services can occur through partnerships, training, and long-term commitment. Support workers who can facilitate interactions for people who have cognitive and communicative disabilities are an essential component of building the capacity of communities to include people with CCN. Collaboration between community members, specialised supports and people with disabilities enhances active community participation. Originality/value – This innovative, state-wide model has the capacity to be replicated elsewhere. On-going speech pathology services are integral to support adults with CCN providing both short-term individualised services, sustainable staff training and community engagement.

Purpose This study aims to develop a framework for the management of medical records in support of health-care service delivery in the hospitals in the Limpopo province of South Africa. Design/methodology/approach The study was predominantly quantitative and has used the questionnaires, system analysis, document analysis and observation to collect data in 40 hospitals of Limpopo province. The sample of 49 per cent (306) records management officials were drawn out of 622 (100 per cent) total population. The response rate was 71 per cent (217) out of the entire sample. Findings The study discovered that a framework for management of medical records in the public hospitals is not in place because of several reasons and further demonstrates that public health-care institutions need an integrative framework for the proper management of medical records of all forms and in all media. Originality/value The study develops and suggests a framework to embed medical records management into the health-care service delivery workflow for effective records management and ease of access. It is hoped that such a framework will help hospitals in South Africa and elsewhere to improve their medical records management to support health-care service provision.

This paper describes the setting up of a pilot community neurocase management service for homeless adults with a brain injury. Whilst homelessness is a major problem in the UK and elsewhere, to date few brain injury or homelessness services have considered the complex medical, psychological and social factors affecting this population specifically. Investment of resources in service provision should be based upon evidence of the presenting needs and best practice in meeting these. This paper addresses the first of these two requirements, focusing on the initial cohort referred into our service. More detail about the interventions received and outcomes achieved, along with a discussion of the challenges encountered in providing the service will be provided in a follow-up paper. The need for psychologically-informed services to promote social inclusion is supported by our data which revealed concerning levels of community estrangement. Our data also confirm that homelessness often occurs in the context of multiple comorbidities which traverse conventional boundaries across medical, social care and criminal justice systems, meaning that collaborative working is essential. The argument for neuropsychological input in designing and delivering support alongside other services is clear.

There have been increasing calls for more gender-specific service provision to support young men’s (20-29 years) mental health and well-being. In Ireland, young men are the demographic group that are most likely to die by suicide but among the least likely to seek help. This study sought to investigate service providers’ perspectives on the factors that support or inhibit young men from engaging in services targeted at supporting their mental/emotional well-being. Qualitative methodologies (focus groups, n = 9; interviews, n = 7) were used for this study. Disconnection from family and community was identified as a key indicator of “at-risk” groups of young men who, more typically, had experienced significant disruption in their lives. The discord between demands and expectations facing young men on one hand, and insufficient life-management and coping skills on the other, left many young men vulnerable and bereft. The desire to save face and preserve one’s masculine identity was linked to young men’s reluctance to seek help when feeling down. There was a strong consensus that there could be no shortcuts to [re]connecting with young men. While sport, technology, and social media were cited as appropriate media in which to engage young men, the essence of sustained connection revolved around creating safety, trust, rapport, and meaningful relationships. The findings from this study have informed the development of a Train the Trainer program (“Connecting with Young Men”), which is currently being delivered to service providers in Ireland and which may have implications for service provision elsewhere.

Background/aims Chronic heart failure is a common condition with a poor prognosis, and its prevalence is increasing in the UK and elsewhere. Patients with heart failure require complex multidisciplinary care, with appropriate medicines optimisation, nursing support and management of comorbidities, ideally delivered via a multidisciplinary team integrated between the community and the hospital. This study aimed to investigate how heart failure care services are structured and delivered. Methods A survey of 100 health professionals in 79 heart failure centres was conducted by post or telephone using the same structured question format. Results There was widespread variability in the provision of key elements of heart failure nursing (specialist heart failure nurses, nurse prescriber, nurse consultant). A total of 15% of trusts had no local consultant with special interest in heart failure; 73% had no pharmacist; and 83% had no mental health specialist working in the heart failure healthcare team. Dedicated administrative support was absent in 24% of trusts. One-fifth (20%) did not offer exercise rehabilitation. A total of 68% reported insufficient resources available locally for individualised exercise rehabilitation, in accordance with guidelines from the National Institute for Health and Care Excellence. Conclusions The structure and provision of heart failure care is variable across the UK, and not always consistent with current guidelines. Reducing this variability across the UK is an urgent priority and will require increased resources, especially for specialist nurses embedded within the routine care of patients with chronic heart failure.

ObjectiveTo identify factors associated with accessing and utilisation of healthcare and provision of health services in slums.DesignA scoping review incorporating a conceptual framework for configuring reported factors.Data sourcesMEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library were searched from their inception to December 2021 using slum-related terms.Eligibility criteriaEmpirical studies of all designs reporting relevant factors in slums in low and middle-income countries.Data extraction and synthesisStudies were categorised and data were charted according to a preliminary conceptual framework refined by emerging findings. Results were tabulated and narratively summarised.ResultsOf the 15 469 records retrieved from all years, 4368 records dated between 2016 and 2021 were screened by two independent reviewers and 111 studies were included. The majority (63 studies, 57%) were conducted in Asia, predominantly in India. In total, 104 studies examined healthcare access and utilisation from slum residents’ perspective while only 10 studies explored provision of health services from providers/planners’ perspective (three studies included both). A multitude of factors are associated with accessing, using and providing healthcare in slums, including recent migration to slums; knowledge, perception and past experience of illness, healthcare needs and health services; financial constraint and competing priorities between health and making a living; lacking social support; unfavourable physical environment and locality; sociocultural expectations and stigma; lack of official recognition; and existing problems in the health system.ConclusionThe scoping review identified a significant body of recent literature reporting factors associated with accessing, utilisation and provision of healthcare services in slums. We classified the diverse factors under seven broad categories. The findings can inform a holistic approach to improving health services in slums by tackling barriers at different levels, taking into account local context and geospatial features of individual slums.Systematic review registration numberhttps://osf.io/694t2.

AbstractObjectives: Continuing deinstitutionalisation has led to growing concern about the availability and accessibility of services for people with learning disabilities transferring to community living. This study was undertaken in order to assess the configuration of services in terms of availability and uptake for people with learning disabilities who have left long-stay hospital care and to identify gaps or barriers to service provision within the unique integrated health and social services structure in Northern Ireland.Method: The ‘keyworkers’ of 195 people – most of whom were aged 40-59 years with a diagnosis of moderate intellectual impairment – were interviewed by a researcher one year after discharge using the Service Interview.Results: While a wide range of generic and specialist services was available, ‘packages’ of care consisted largely of public sector services (eg. GPs, chiropodists and social workers) and relied, to some extent, on the type of community accommodation. Although services appeared well co-ordinated in terms of care reviews and keyworker arrangements, 40% of people required more one-to-one support particularly in areas related to integration. However, services were perceived by care staff to be satisfactoryConclusions: The development of community care has been slower in Northern Ireland than elsewhere and a large proportion of resources remain tied up in hospital care. However, existing community-based services appear to be addressing individual needs. Some former patients, though, may have been subject to transinstitutionalisation in the sense that their choice of accommodation was restricted mainly to large private sector homes and work and daytime opportunities were insufficient to facilitate integration. Service planners and providers need to give further consideration to the likely effects of different forms of rehabilitation, reprovision and resettlement and to be aware that the pattern of service provision is likely to be different for the more dependent cohorts of people who leave hospital in the future.

The cascade model is a commonly applied framework to evaluate ecosystem services provision, highlighting their benefits to society and assigning non-monetary and monetary values to these services. Adapting this model, we present a methodology to establish the most suitable indicators for monitoring Payment for Ecosystem Services (PES) programs related to water resources in Brazil. Through a participatory process, a set of ecosystem functions indicators were assigned for each ecosystem service (ES) considered in the study. The indicators were then classified following these criteria: clarity, viability, sensitivity, and relevance. The indicators were organized by their final score according to each evaluated criterion. The results demonstrated that “clarity” and “relevance” criteria were those most important for the experts to choose an indicator. In general, we could also observe a preference for analytical and well-established indicators in the literature for all ES evaluated. The indicators list presented can support the PES program monitoring in Brazil. Additionally, the methodology developed can be easily applied in other areas and provide the definition of the most suitable indicators to monitor water-based PES in different Brazilian contexts. Keywords:cascade model, ecosystem functions, ecosystem service indicators, tropical areas.

AbstractDecriminalisation recognises sex work as work; it provides opportunities for promoting the health of sex workers and therefore goes a long way to addressing health and human rights inequities for this sector of the population. This chapter focuses on three scenarios (among many) where decriminalisation of sex work in New Zealand has been successful in promoting sex workers’ health, safety, and wellbeing and, in so doing, provides a blueprint for best practice in working with sex workers.Although services for sex workers are available in many countries, they tend to focus on street-based sex workers, who are perceived as the most vulnerable and thus most in need. A decriminalised context provides greater access to peer support (Harcourt 2010), which is much better positioned to address the complex needs of all sex workers. It also allows for sex workers to engage with others in the community for more effective policy as well as service provision (O’Neill and Pitcher, Sex work matters: exploring money, power and intimacy in the sex industry, Zed Books, London, 2010). In this chapter, we discuss: How access to police has been improved for sex workers who wish to report sexual assault How decriminalisation has enabled interagency collaboration when working with sex workers who have concerns about practices within certain brothels How new sex workers access information on safe practices in a decriminalised environment We use the research literature from New Zealand and elsewhere to expand on the real-life stories of the engagement between New Zealand Prostitutes Collective and sex workers, agencies, and individuals to illustrate the three scenarios.

Students with disabilities often do not receive supportive services if they have coexisting mental health disorders. Students classified with emotional or behavioral disorders for an individualized education plan may be supported by a functional behavior assessment and, in some cases, a behavior intervention plan, but mental health is not included as a related service. Without appropriate mental health services, students face poorer outcomes. Results from a survey of special education teachers and behavior support specialists along with a secondary analysis of existing data revealed that respondents did not receive any mental health training that would allow them to support students with mental health needs. Moreover, funding, legal issues, and policies were emerging themes that likely contributed to the lack of appropriate mental health support in public school systems.

The World Bank (WB) was established in 1944 for the purpose of issuing long-term loans to governments for reconstruction and economic development following the Second World War (1). Over the time perspectives on development have changed dramatically. In particular, the WB’s focus began to shift to investments in health, energy, telecommunication, transport and infrastructure to earn more profit. In the field of health, the WB has focused on three areas, especially in developing countries: health, nutrition, and population. WB now has a more sophisticated view of well-being, living standards, and poverty and is committing more than 1 billion USD annually for new health projects. (2). The WB’s roles include financing, provision of information, surveillance, technical assistance and training and policy advice (3). The WB has achieved some gains in the fight against poverty. Reducing poverty focuses in part encompassing policies to promote equality but inequalities are still increasing all over the World, especially in the developing countries (4). However, the WB has faced a lot of critiques related to health. Some critiques related to health sector polices and say the bank's conditions on borrowing countries emphasize privatization and public sector contraction. This involved reducing government expenditures (in some cases for health) which have deleterious health effects (2). Other critiques related to the way of raising funds called a user charge for using public sector health services and point to evidence showing that user charges result in a decline in the uptake of services, especially among the people who are most socioeconomically deprived. The bank is also criticized for introducing DALYs to global health assessments. Critics point out that the introduction of DALYs was not based on sound methodology and that the underlying assumptions for their usefulness are weak (2, 5). Finally, the WB is also accused of bribing or conniving top government officials in the developing countries where it projects (6). There is a need for strengthening across the WB in several areas. A critical area is for the WB to strengthen its ability to work on multi-stakeholder solutions through engagement with the public sector, private sector, and citizens, and support primarily the public sector for health services. Similarly, about half of low-income countries are classified as fragile and conflict-affected, posing particular challenges. Furthermore, progress in fighting against poverty and sharing prosperity is accompanied by rising inequality in many countries. So, the WB should increase its efforts to address these issues (4). Introducing evidence into policy making is also a key issue to be strengthened for the future (5). It is also needed to strengthen the monitoring and evaluation methods in the countries.

Overview Skin cancer prevention is a component of the new Cancer Plan 2022–27, which guides the work of the Cancer Institute NSW. To lessen the impact of skin cancer on the community, the Cancer Institute NSW works closely with the NSW Skin Cancer Prevention Advisory Committee, comprising governmental and non-governmental organisation representatives, to develop and implement the NSW Skin Cancer Prevention Strategy. Primary Health Networks and primary care providers are seen as important stakeholders in this work. To guide improvements in skin cancer prevention and inform the development of the next NSW Skin Cancer Prevention Strategy, an up-to-date review of the evidence on the effectiveness and feasibility of skin cancer prevention activities in primary care is required. A research team led by the Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, was contracted to undertake an Evidence Check review to address the questions below. Evidence Check questions This Evidence Check aimed to address the following questions: Question 1: What skin cancer primary prevention activities can be effectively administered in primary care settings? As part of this, identify the key components of such messages, strategies, programs or initiatives that have been effectively implemented and their feasibility in the NSW/Australian context. Question 2: What are the main barriers and enablers for primary care providers in delivering skin cancer primary prevention activities within their setting? Summary of methods The research team conducted a detailed analysis of the published and grey literature, based on a comprehensive search. We developed the search strategy in consultation with a medical librarian at the University of Sydney and the Cancer Institute NSW team, and implemented it across the databases Embase, MEDLINE, PsycInfo, Scopus, Cochrane Central and CINAHL. Results were exported and uploaded to Covidence for screening and further selection. The search strategy was designed according to the SPIDER tool for Qualitative and Mixed-Methods Evidence Synthesis, which is a systematic strategy for searching qualitative and mixed-methods research studies. The SPIDER tool facilitates rigour in research by defining key elements of non-quantitative research questions. We included peer-reviewed and grey literature that included skin cancer primary prevention strategies/ interventions/ techniques/ programs within primary care settings, e.g. involving general practitioners and primary care nurses. The literature was limited to publications since 2014, and for studies or programs conducted in Australia, the UK, New Zealand, Canada, Ireland, Western Europe and Scandinavia. We also included relevant systematic reviews and evidence syntheses based on a range of international evidence where also relevant to the Australian context. To address Question 1, about the effectiveness of skin cancer prevention activities in primary care settings, we summarised findings from the Evidence Check according to different skin cancer prevention activities. To address Question 2, about the barriers and enablers of skin cancer prevention activities in primary care settings, we summarised findings according to the Consolidated Framework for Implementation Research (CFIR). The CFIR is a framework for identifying important implementation considerations for novel interventions in healthcare settings and provides a practical guide for systematically assessing potential barriers and facilitators in preparation for implementing a new activity or program. We assessed study quality using the National Health and Medical Research Council (NHMRC) levels of evidence. Key findings We identified 25 peer-reviewed journal articles that met the eligibility criteria and we included these in the Evidence Check. Eight of the studies were conducted in Australia, six in the UK, and the others elsewhere (mainly other European countries). In addition, the grey literature search identified four relevant guidelines, 12 education/training resources, two Cancer Care pathways, two position statements, three reports and five other resources that we included in the Evidence Check. Question 1 (related to effectiveness) We categorised the studies into different types of skin cancer prevention activities: behavioural counselling (n=3); risk assessment and delivering risk-tailored information (n=10); new technologies for early detection and accompanying prevention advice (n=4); and education and training programs for general practitioners (GPs) and primary care nurses regarding skin cancer prevention (n=3). There was good evidence that behavioural counselling interventions can result in a small improvement in sun protection behaviours among adults with fair skin types (defined as ivory or pale skin, light hair and eye colour, freckles, or those who sunburn easily), which would include the majority of Australians. It was found that clinicians play an important role in counselling patients about sun-protective behaviours, and recommended tailoring messages to the age and demographics of target groups (e.g. high-risk groups) to have maximal influence on behaviours. Several web-based melanoma risk prediction tools are now available in Australia, mainly designed for health professionals to identify patients’ risk of a new or subsequent primary melanoma and guide discussions with patients about primary prevention and early detection. Intervention studies have demonstrated that use of these melanoma risk prediction tools is feasible and acceptable to participants in primary care settings, and there is some evidence, including from Australian studies, that using these risk prediction tools to tailor primary prevention and early detection messages can improve sun-related behaviours. Some studies examined novel technologies, such as apps, to support early detection through skin examinations, including a very limited focus on the provision of preventive advice. These novel technologies are still largely in the research domain rather than recommended for routine use but provide a potential future opportunity to incorporate more primary prevention tailored advice. There are a number of online short courses available for primary healthcare professionals specifically focusing on skin cancer prevention. Most education and training programs for GPs and primary care nurses in the field of skin cancer focus on treatment and early detection, though some programs have specifically incorporated primary prevention education and training. A notable example is the Dermoscopy for Victorian General Practice Program, in which 93% of participating GPs reported that they had increased preventive information provided to high-risk patients and during skin examinations. Question 2 (related to barriers and enablers) Key enablers of performing skin cancer prevention activities in primary care settings included: • Easy access and availability of guidelines and point-of-care tools and resources • A fit with existing workflows and systems, so there is minimal disruption to flow of care • Easy-to-understand patient information • Using the waiting room for collection of risk assessment information on an electronic device such as an iPad/tablet where possible • Pairing with early detection activities • Sharing of successful programs across jurisdictions. Key barriers to performing skin cancer prevention activities in primary care settings included: • Unclear requirements and lack of confidence (self-efficacy) about prevention counselling • Limited availability of GP services especially in regional and remote areas • Competing demands, low priority, lack of time • Lack of incentives.