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Article
Publication date: 3 July 2021

Emily Samuels and Nicola Moran

Physical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general…

Abstract

Purpose

Physical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general population. This paper aims to explore the experiences of individuals accessing primary health care following discharge from secure services, and the practitioners who support them.

Design/methodology/approach

Face-to-face qualitative interviews were conducted with service users (n = 4) and mental health practitioners (n = 4) within a forensic community mental health team in one NHS Trust in England in 2019. Data were analysed using the Interpretative Phenomenological Analysis.

Findings

Four super-ordinate themes emerged: perceived importance of physical health, agency, responsibility and relationships. Service users mostly saw themselves as passive recipients of health care and prioritised their mental health over their physical health. Close working relationships meant that mental health practitioners were often the first contact for service users with any health issue and thus felt a sense of responsibility for their physical health care. Service users who did access primary care reported that consistency of professional, feeling understood and listened to without judgement or stigma were important.

Practical implications

Interventions for service users that include practicalities and strategies to facilitate independence in physical health care, and collaborative working between primary care and forensic mental health services, are encouraged.

Originality/value

This study highlights some of the unique challenges in forensics around improving physical health outcomes for individuals with SMI.

Details

The Journal of Forensic Practice, vol. 23 no. 2
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 20 October 2010

Jeremy Gibson and Rory O'Connor

The objective of this paper was to systematically review published studies to determine if disability limits access to health care and to attempt to identify what body…

Abstract

The objective of this paper was to systematically review published studies to determine if disability limits access to health care and to attempt to identify what body functions, structures and activities and participation, as well as contextual factors (environmental and personal factors), interact with the health condition to limit this access. The AMED, CINAHL, EMBASE, Medline and psychINFO databases were searched for original study articles in English, dating from 1974 to 2008. Review articles and expert opinion were excluded. Each study had two independent reviews by either a general practitioner or specialist in rehabilitation medicine. Each study was critically appraised according to the National Service Framework for Long‐term Conditions (Department of Health, 2005a) methodology and recorded on standardised data extraction sheets. Studies of poor quality were excluded. Sixty studies were included. No randomised controlled trials were identified. Studies broadly fell into the following three main groups: database studies (n=27), quantitative surveys (n=20) and qualitative interviews (n=13). Disabled people are restricted in accessing health care and report less satisfaction with their medical care. Many of the identified studies were from the United States (US) and based on subjective reporting. More objective evidence is needed, especially in the UK, to clarify the true level of access to health care in people with disabilities. The complex, interdependent factors in providing health care to disabled people require complex solutions.

Details

Social Care and Neurodisability, vol. 1 no. 3
Type: Research Article
ISSN: 2042-0919

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Article
Publication date: 15 August 2011

Wendel Abel, Clayton Sewell, Eulalee Thompson and Teisha Brown

The aim of this paper is to review strategies implemented to improve access to mental health care in Jamaica.

Abstract

Purpose

The aim of this paper is to review strategies implemented to improve access to mental health care in Jamaica.

Design/methodology/approach

The paper is a review of peer‐reviewed articles, official documents, service data and the WHO AIMS data.

Findings

Despite limited resources, Jamaica was able to shift from institutional care to community care by implementing the appropriate policy framework, building on primary care services, providing mental health beds at the community level, the training of specialized community mental health nurses (mental health officers) and improving access to psychotropic drugs. As a result, the country has developed a more accessible mental health service; the number of patients treated in the community has doubled over the past decade and 67 percent of inpatients are now treated outside of the mental hospital and there has been a reduction in the population of the mental hospital.

Originality/value

The paper illustrates the approach that serves as a model for mental health services in resource‐limited countries.

Details

Ethnicity and Inequalities in Health and Social Care, vol. 4 no. 3
Type: Research Article
ISSN: 1757-0980

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Article
Publication date: 1 April 2008

Andrew Nocon, Liz Sayce and Zenobia Nadirshaw

It is well documented that the health of people with learning disabilities is worse in many ways than that of the rest of the population, and their lives are shorter. The…

Abstract

It is well documented that the health of people with learning disabilities is worse in many ways than that of the rest of the population, and their lives are shorter. The article reports on the results of a wide and diverse research programme, including reviews of the relevant literature, consultation, area studies and an inquiry panel, designed to gather the most complete picture possible of these health inequalities and the aspects of health services that permit them. The areas covered are morbidity, access to services, diagnosis, health problems, health promotion, health checks and services for people from black and minority ethnic populations. Inequalities are found in all these areas, some arising from professional prejudice, some from inadequate responses to characteristics shown by learning‐disabled people and some from unidentified causes. The article concludes with a summary of the measures needed to rectify the situation.

Details

Tizard Learning Disability Review, vol. 13 no. 1
Type: Research Article
ISSN: 1359-5474

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Article
Publication date: 5 March 2020

Philippa Miskelly, Ngaire Kerse and Janine Wiles

Managing patients in advanced age is complex, especially when it comes to multi-morbidities and polypharmacy. The purpose of this qualitative study is to investigate…

Abstract

Purpose

Managing patients in advanced age is complex, especially when it comes to multi-morbidities and polypharmacy. The purpose of this qualitative study is to investigate challenges, opportunities and potential solutions from a primary healthcare provider perspective.

Design/methodology/approach

Fifty-seven participants joined in group discussions on challenges and opportunities of working with advanced age. Participants included general practitioners (GPs), practice nurses, students and administration staff working in ten general practices. A thematic analysis was developed, supported by NVivo software.

Findings

Poor lines of communication and fragmentation of services between differing levels of health care services available for older people were highlighted. This has implications for quality of care and equity of services. Participants also reported challenges in treatment and funding regimes.

Research limitations/implications

The small sample size and regional nature of the study, along with the semi-structured nature of the group discussions and rigorous thematic analysis, indicate that this qualitative data is transferable, dependable, confirmable and credible. Comparing the views of tertiary and community services would be useful.

Practical implications

A range of potential strategies and solutions to the current fragmented services was offered by GPs. For example, adequately funded and staffed community-based health hubs; IT platforms enabling timely flow of patient information between primary and tertiary health providers and creation of medical, nursing and allied health roles aimed at improving synergy between GP and tertiary services.

Originality/value

Obtaining the perspectives of general practice highlights the challenges and complexities of caring for those in advanced age brings. These insights have not been previously been explored in-depth within this setting in New Zealand.

Details

Quality in Ageing and Older Adults, vol. 21 no. 1
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 1 September 1997

Frederic Stansfield and Andrew Taylor

General medical practitioners (GPs) in the UK are working from increasingly sophisticated premises. UK Government consultations have highlighted that inadequate premises…

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Abstract

General medical practitioners (GPs) in the UK are working from increasingly sophisticated premises. UK Government consultations have highlighted that inadequate premises are currently a barrier to improvements in primary health care. Therefore the National Health Service (Primary Care) Act 1997 permits pilot schemes for primary health care which may encompass property improvements. Provision of quality buildings has implications for the willingness of patients to consult GPs, the range of services offered by family doctors and the cost‐effectiveness of primary health care delivery. The decentralized nature of primary health care raises issues about the evolution of building design knowledge to cater for technical and organizational innovations in health care. As primary health care facilities become more sophisticated, advances in construction management techniques need to be applied so that they are procured efficiently. Current real estate arrangements for the provision of primary health care facilities are causing concern. The capital investment involved is increasingly burdensome for GPs. Lack of Government finance is leading to pressures for the employment of private capital, with accompanying new opportunities for property managers.

Details

Property Management, vol. 15 no. 3
Type: Research Article
ISSN: 0263-7472

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Article
Publication date: 6 May 2021

Nibedita Shankar Ray-Bennett, Denise Marsha Jeanor Corsel, Nimisha Goswami and Maqbul Hossain Bhuiyan

The quality and availability of sexual and reproductive health care are key determinants to reducing maternal mortalities and morbidities in disaster settings; yet, these…

Abstract

Purpose

The quality and availability of sexual and reproductive health care are key determinants to reducing maternal mortalities and morbidities in disaster settings; yet, these services are often lacking in developing countries. Reducing maternal mortality and morbidity is currently the main targets of the UN’s Sustainable Development Goal (SDG) 3. The purpose of this study was to develop an intervention package called RHCC (Reproductive Health Kit 8; Capacity building; Community awareness), and to implement and evaluate it in three primary health-care (PHC) facilities in Belkuchi, Bangladesh, in order to improve the quality and availability of post-abortion care (PAC) during the 2017 floods.

Design/methodology/approach

This research used both quantitative and qualitative methods to develop, implement and assess the RHCC in three flood-prone PHC facilities in Belkuchi.

Findings

The RHCC was implemented during the floods of 2017. The findings pre- and post-intervention suggest it led to an increase in skilled management among health workers, an increase in the quality of care for clients and the availability of PAC at three PHC facilities during floods.

Originality/value

Due to its geographic location, Bangladesh is exposed to recurrent floods and cyclones. Evidence-based integrated intervention packages, such as the RHCC, can improve the quality and availability of reproductive health care during disasters at PHC level and, in doing so, can promote the UN’s agenda on “disaster resilient health system” to achieve the SDG 3, and the WHO’s campaign on universal health coverage.

Details

International Journal of Human Rights in Healthcare, vol. 14 no. 4
Type: Research Article
ISSN: 2056-4902

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Article
Publication date: 6 February 2020

Agnieszka Sobolewska, Amy-Louise Byrne, Clare Lynette Harvey, Eileen Willis, Adele Baldwin, Sandy McLellan and David Heard

The purpose of the paper is to explore how the national, state and organisational health policies in Australia support the implementation of person-centred care in…

Abstract

Purpose

The purpose of the paper is to explore how the national, state and organisational health policies in Australia support the implementation of person-centred care in managing chronic care conditions.

Design/methodology/approach

A qualitative content analysis was performed regarding the national, state and organisational Queensland Health policies using Elo and Kyngas' (2008) framework.

Findings

Although the person-centred care as an approach is well articulated in health policies, there is still no definitive measure or approach to embedding it into operational services. Complex funding structures and competing priorities of the governments and the health organisations carry the risk that person-centred care as an approach gets lost in translation. Three themes emerged: the patient versus the government; health care delivery versus the political agenda; and health care organisational processes versus the patient.

Research limitations/implications

Given that person-centred care is the recommended approach for responding to chronic health conditions, further empirical research is required to evaluate how programs designed to deliver person-centred care achieve that objective in practice.

Practical implications

This research highlights the complex environment in which the person-centred approach is implemented. Short-term programmes created specifically to focus on person-centred care require the right organisational infrastructure, support and direction. This review demonstrates the need for alignment of policies related to chronic disease management at the broader organisational level.

Originality/value

Given the introduction of the nurse navigator program to take up a person-centred care approach, the review of the recent policies was undertaken to understand how they support this initiative.

Details

Journal of Health Organization and Management, vol. 34 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 10 June 2021

Ibraheem Khaled Abu Siam and María Rubio Gómez

Access to health-care services for refugees are always impacted by many factors and strongly associated with population profile, nature of crisis and capacities of hosing…

Abstract

Purpose

Access to health-care services for refugees are always impacted by many factors and strongly associated with population profile, nature of crisis and capacities of hosing countries. Throughout refugee’s crisis, the Jordanian Government has adopted several healthcare access policies to meet the health needs of Syrian refugees while maintaining the stability of the health-care system. The adopted health-care provision policies ranged from enabling to restricting and from affordable to unaffordable. The purpose of this paper is to identify the influence of restricted level of access to essential health services among Syrian refugees in Jordan.

Design/methodology/approach

This paper used findings of a cross-sectional surveys conducted over urban Syrian refugees in Jordan in 2017 and 2018 over two different health-care access policies. The first were inclusive and affordable, whereas the other considered very restricting policy owing to high inflation in health-care cost. Access indicators from four main thematic areas were selected including maternal health, family planning, child health and monthly access of household. A comparison between both years’ access indicators was conducted to understand access barriers and its impact.

Findings

The comparison between findings of both surveys shows a sudden shift in health-care access and utilization behaviors with increased barriers level thus increased health vulnerabilities. Additionally, the finding during implementation of restricted access policy proves the tendency among some refugees groups to adopt negative adaptation strategies to reduce health-care cost. The participants shifted to use a fragmented health-care, reduced or delayed care seeking and use drugs irrationally weather by self-medication or reduce drug intake.

Originality/value

Understanding access barriers to health services and its negative short-term and long-term impact on refugees’ health status as well as the extended risks to the host communities will help states that hosting refugees building rational access policy to protect whole community and save public health gains during and post crisis. Additionally, it will support donors to better mobilize resources according to the needs while the humanitarian actors and service providers will better contribute to the public health stability during refugee’s crisis.

Details

International Journal of Human Rights in Healthcare, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2056-4902

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Article
Publication date: 25 October 2018

Maytham Alshadood, Scott Butler Harpin and Jini Puma

The purpose of this paper is to identify factors, within a framework for integration, associated with healthcare utilization (primary care use, dental care, and insurance…

Abstract

Purpose

The purpose of this paper is to identify factors, within a framework for integration, associated with healthcare utilization (primary care use, dental care, and insurance coverage) for Colorado refugees, by gender.

Design/methodology/approach

The Refugee Integration Survey and Evaluation project was a four-year longitudinal study of refugees that resettled in Colorado beginning in 2011. Refugees from Burma and Bhutan were used in this secondary data analysis. Various integration domains were explored as predictors, across gender groups, of the healthcare utilization outcome variables (physical exam in the past 12 months, dental exam in the past 12 months, and current healthcare coverage) using bivariate and multivariate logistic regression analyses.

Findings

In 2015, 73.1 percent of the sample reported accessing primary health care in the past year, and only 13.2 percent used dental care services. Nearly three-quarters reported having health insurance at the time of survey. In the adjusted models, there was a strong positive association between the outcome variable “physical exam” and the predictor variables “employment and economic self-sufficiency” (OR=0.70, p<0.001), “social bonding” (OR=3.73, p<0.001), and “safety and stability” (OR=2.23, p<0.001). Additionally, education and training predicted dental visit (OR=2.06, p<0.01). None of the integration domains were statistically significant predictors of dental visits in the adjusted models.

Originality/value

This study offers insights about facilitators and barriers to healthcare utilization uptake after resettling in a major US city. These findings can be used by agencies and governmental organizations to best tailor healthcare services and promotion of those services for this vulnerable population.

Details

International Journal of Migration, Health and Social Care, vol. 14 no. 4
Type: Research Article
ISSN: 1747-9894

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