Abstract:
BACKGROUND:Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. METHOD:We describe a model for integrating complex specialty care with generalist/primary care, using as an illustration the integration of mental health into hospital-based HIV treatment services in Ethiopia. Generalists and specialists collaboratively developed mental health treatments to fit the knowledge, skills and resources of the generalists. The model recognizes commonalities between mental health and general medical care, focusing on practical interventions acceptable to patients. It was developed through a process of literature review, interviews, observing clinical practice, pilot trainings and expert consultation. Preliminary evaluation results were obtained by debriefing generalist trainees after their return to their clinical sites. RESULTS:In planning interviews, generalists reported discomfort making mental health diagnoses but recognition of symptom groups including low mood, anxiety, thought problems, poor child behaviour, seizures and substance use. Diagnostic and treatment algorithms were developed for these groups and tailored to the setting by including possible medical causes and burdens of living with HIV. First-line treatment included modalities familiar to generalists: empathetic patient-provider interactions, psychoeducation, cognitive reframing, referral to community supports and elements of symptom-specific evidence-informed counselling. Training introduced basic skills, with evolving expertise supported by job aides and ongoing support from mental health nurses cross-trained in HIV testing. Feedback from trainees suggested the programme fit well with generalists' settings and clinical goals. CONCLUSIONS:An integration model based on collaboratively developing processes that fit the generalist setting shows promise as a method for incorporating complex, multi-faceted interventions into general medical settings. Formal evaluations will be needed to compare the quality of care provided with more traditional approaches and to determine the resources required to sustain quality over time.
journal_name
Health Policy Planjournal_title
Health policy and planningauthors
Wissow LS,Tegegn T,Asheber K,McNabb M,Weldegebreal T,Jerene D,Ruff Adoi
10.1093/heapol/czu058subject
Has Abstractpub_date
2015-07-01 00:00:00pages
791-803issue
6eissn
0268-1080issn
1460-2237pii
czu058journal_volume
30pub_type
杂志文章abstract::Decentralization of the health care system in China has led to an increasing need for income generation at all operational levels, both for curative services and for public health programmes. In general, people have accepted the costs of curative services, although the impact of charges on health-seeking behaviour has...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/16.3.292
更新日期:2001-09-01 00:00:00
abstract::In Chile, workers are mandated to choose either public or private health insurance coverage. Although private insurance premiums depend on health risk, public insurance premiums are solely linked to income. This structure implies that individuals with higher health risks may tend to avoid private insurance, leaving th...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt017
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND:Attention to global health security governance is more important now than ever before. Scientists predict that a possible influenza pandemic could affect 1.5 billion people, cause up to 150 million deaths and leave US$3 trillion in economic damages. A public health emergency in one country is now only hours ...
journal_title:Health policy and planning
pub_type: 历史文章,杂志文章
doi:10.1093/heapol/czq037
更新日期:2010-11-01 00:00:00
abstract::'One World, One Health' has become a key rallying theme for the integration of public health and animal health priorities, particularly in the governance of pandemic-scale zoonotic infectious disease threats. However, the policy challenges of integrating public health and animal health priorities in the context of tra...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czu001
更新日期:2015-03-01 00:00:00
abstract::In 1991, Zimbabwe introduced cost recovery measures as part of its programme of economic reforms, following a course taken by many developing countries. The system of user fees in public health care, aimed to 'protect and support the vulnerable groups' by exemption or incremental fees based on 4 income brackets. Drugs...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/10.3.319
更新日期:1995-09-01 00:00:00
abstract::In most settings, a 'public' health service refers to a service which belongs to the state. The term 'private' is used when health care is delivered by individuals and/or institutions not administered by the state. In this paper it is argued that such a distinction, which is based on the institutional or administrativ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/12.3.193
更新日期:1997-09-01 00:00:00
abstract::This paper investigates the key factors associated with the demand for Urban Resident Basic Medical Insurance (URBMI), which was established in 2007 and aims to cover all Chinese urban residents. Two waves of longitudinal household survey data are used, and a three-level random-intercept logit model is used for the an...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czs014
更新日期:2012-12-01 00:00:00
abstract:INTRODUCTION:Lack of information on the warning signs of complications during pregnancy, parturition and postpartum hampers women's ability to partake fully in safe motherhood initiatives. We assessed the extent to which women in 19 countries of sub-Saharan Africa recall receiving information about pregnancy complicati...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czp017
更新日期:2009-09-01 00:00:00
abstract::Similar to many other countries, Chile is facing the challenges of rapid ageing and the increase in long-term care (LTC) needs for this population. Implementation of LTC systems has been the response to these challenges in other countries, however, Chile still lacks a strategy for addressing LTC needs. This article ad...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czy083
更新日期:2018-11-01 00:00:00
abstract::In countries with large gender disparities in health status, can investments in local communities mitigate the gender bias observed in intra-household resource allocations? This paper explores the evidence for gender differences in the impact of community prices and infrastructure on child nutritional outcomes. Standa...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czl007
更新日期:2006-05-01 00:00:00
abstract::Stroke is a major global health problem. It is a major cause of mortality, morbidity and disability in developed and increasingly in less developed countries. Worldwide, it is the leading cause of healthy years lost in late adulthood, and evidence indicates that the burden of stroke, particularly in terms of morbidity...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/10.1.1
更新日期:1995-03-01 00:00:00
abstract::The connection between HIV and sexual and reproductive health and rights (SRHR) is widely recognised along with the benefits of linking them at the legal/policy, health systems, and service delivery levels. However, despite increased rhetoric about the need for this three-tiered approach, integrated service delivery h...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czw119
更新日期:2017-11-01 00:00:00
abstract::Like many other developing countries, Burkina Faso has been exploring how community resources can be tapped to co-finance health services. Although revenue generation is important for the viability of health services, effects on utilization and on equity of access to health care must also be considered. The authors pr...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/9.2.185
更新日期:1994-06-01 00:00:00
abstract::Generic prescribing and generic substitution are mechanisms for reducing the cost of drugs. The purpose of this study was to assess the extent to which generic prescribing by private medical practitioners and generic substitution by private pharmacists is practised in South Africa and to estimate the potential savings...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/11.2.198
更新日期:1996-06-01 00:00:00
abstract::Hypertension and diabetes are highly prevalent in China and pose significant health and economic burdens, but large gaps in care remain for people with such conditions. In this article, drawing on administrative insurance claim data from China's Urban Employee Basic Medical Insurance (UEBMI), we use an interrupted tim...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa087
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:Health-care financing should be equitable. In many developing countries such as Kenya, changes to health-care financing systems are being implemented as a means of providing equitable access to health care with the aim of attaining universal coverage. Vertical equity means that people of dissimilar ability t...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt073
更新日期:2014-10-01 00:00:00
abstract::Many countries have expanded insurance programmes in an effort to achieve universal health coverage (UHC). We assess a complementary path toward financial risk protection: increased access to technologies that improve health and reduce the risk of large health expenditures. Malawi has provided free HIV treatment since...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa023
更新日期:2020-07-01 00:00:00
abstract::There is some evidence that female sex workers (FSWs) receive greater earnings for providing unprotected sex. In 2003, the landscape of the fight against HIV/AIDS dramatically changed in India with the introduction of Avahan, the largest HIV prevention programme implemented globally. Using a unique, cross-sectional bi...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czz100
更新日期:2019-12-01 00:00:00
abstract::Given the demonstrated efficacy of vitamin A supplements in reducing childhood mortality, health officials now have to decide whether it would be efficient to target the supplements to high risk children. Decisions about targeting are complex because they depend on a number of factors; the degree of clustering of prev...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/12.1.29
更新日期:1997-03-01 00:00:00
abstract::Subsequent to recommendations from the 1994 United Nations International Conference on Population and Development, and given recent findings outlining the links between control of sexually transmitted infections (STIs) and a reduction in HIV incidence, many countries are now seeking to establish STI control programmes...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/13.2.121
更新日期:1998-06-01 00:00:00
abstract:BACKGROUND:One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis. METHODS:The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing funct...
journal_title:Health policy and planning
pub_type: 杂志文章,随机对照试验
doi:10.1093/heapol/czv078
更新日期:2016-05-01 00:00:00
abstract::In low- and middle-income countries (LMICs), making the best use of scarce resources is essential to achieving universal health coverage. The design of health benefits packages creates the opportunity to select interventions on the basis of explicit objectives. Distributional cost-effectiveness analysis (DCEA) provide...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa015
更新日期:2020-07-01 00:00:00
abstract::The use of community health workers (CHWs) has been explored as a viable option to provide home health education, counselling and basic health care, notwithstanding their challenges in training and retention. In this manuscript, we review the evidence and discuss how the digitalization affects the CHWs programmes for ...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czy099
更新日期:2019-02-01 00:00:00
abstract::When seeking to ensure financial sustainability of a health programme, existence of a line item in the Ministry of Health (MOH) budget is often seen as an essential, first step. We used immunization as a reference point for cross-country comparison of budgeting methods in Sub-Saharan African countries. Study objective...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa040
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Lebanon, characterized by a free-market health care system, has one of the highest reported per capita rates of cardiac catheterization facilities and coronary angiographies in the world. The aim of this study is to evaluate the appropriateness of performance of coronary angiography procedures in Lebanon. M...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czn005
更新日期:2008-05-01 00:00:00
abstract::Poor mental health is a pressing global health problem, with high prevalence among poor populations from low-income countries. Existing studies of conditional cash transfer (CCT) effects on mental health have found positive effects. However, there is a gap in the literature on population-wide effects of cash transfers...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa079
更新日期:2020-11-20 00:00:00
abstract::Formalized task shifting structures have been used to rapidly scale up antiretroviral service delivery to underserved populations in several countries, and may be a promising mechanism for accomplishing universal health coverage. However, studies evaluating the quality of service delivery through task shifting have la...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czu072
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Many clients of HIV care and treatment services have unmet contraceptive needs. Integrating family planning (FP) services into HIV services is an increasingly utilized strategy for meeting those unmet needs. However, numerous models for services integration are potentially applicable for clients with diverse...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt043
更新日期:2014-08-01 00:00:00
abstract::In 2006, in response to the high maternal mortality, driven largely by unsafe abortions, the government of Ghana, in partnership with other organizations, launched the reducing maternal mortality and morbidity (R3M) programme in seven districts in Greater Accra, Ashanti and Eastern, to improve comprehensive abortion c...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czu105
更新日期:2015-10-01 00:00:00
abstract::During the last 20 years Lao People's Democratic Republic has successfully developed and adopted some 30 health policies, strategies, decrees and laws in the field of health. Still, the implementation process remains arduous. This article aims at discussing challenges of health policy development and effective impleme...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czu017
更新日期:2015-05-01 00:00:00