Abstract
This article discusses mental health care reforms in Belgium from an interorganisational perspective. In 2007 a three year experiential government programme was launched seeking for ...alternative organisation models in mental health care, labeled as ‘care circuits’ and ‘networks’. The target population is ‘persons with chronic and complex mental disorders’. This article reports some of the observations based of an ongoing evaluation process. The research evaluates the plan and implementation processes of these collaboration and networking models (the TP). The qualitative approach aims at developing, testing and refining insights in the dynamics of developing collaboration and networks by exploring the complex and dynamic interaction among context, mechanism, and outcome. The article uses insights form health care innovation literature, interorganisational network theories and literature on organisational fields. Health care innovations take place in a complex multi-agent environment. The implementation (adopting and sustaining) of health services innovations is influenced both by ‘external’ and ‘internal’ processes and barriers. The public sector context of mental health care includes ‘external’ influences by multiple stakeholder through values, power plays, regulations and normative frameworks. The development of interprofessional collaboration and interorganisational networks develops thus in an organisational field. An organisational field is complex, heterogeneous, multi-layered and dynamic. Organisations and actors in the field act on the basis of their interests and respond strategically to institutional pressures. Fields also shape the discourse, norms and structures in ways that match their individual interests and objectives. We found plenty of indications in the mental health reform programme. But the research also urges to develop that further insights into the question whether and under what conditions networks and collaborations between different types of organisations actually are effective. The issue of network governance should be elaborated upon.
Objective This literature review focuses on information and communication needs of parents of children admitted to the NICU and on their use of information sources in the illness trajectories at ...NICU. Methods Literature search in 4 electronic databases (Ovid Medline, PsycINFO, CINAHL and Sociological Abstracts), covering 1990-March 2008. Results The seventy-eight included articles revealed that NICU parents have high information needs. The illness trajectory mediates parental information needs and induces a changing pattern in information use and information needs. Most attention is paid to the prenatal and acute phases, while information behaviour in sudden events and later phases receives limited attention. Conclusions In-depth studies on information needs and corresponding use of information sources are lacking. More longitudinal studies are needed, taking the illness trajectory into account and investigating the determinants and outcomes of the information and communication needs of NICU parents. Practice implications Healthcare professionals should adapt their information provision along the illness trajectory. The development of guidelines of information provision during the illness trajectory at NICU would support all professionals. Copyright Elsevier B.V.
Abstract Objective This literature review focuses on information and communication needs of parents of children admitted to the NICU and on their use of information sources in the illness ...trajectories at NICU. Methods Literature search in 4 electronic databases (Ovid Medline, PsycINFO, CINAHL and Sociological Abstracts), covering 1990–March 2008. Results The seventy-eight included articles revealed that NICU parents have high information needs. The illness trajectory mediates parental information needs and induces a changing pattern in information use and information needs. Most attention is paid to the prenatal and acute phases, while information behaviour in sudden events and later phases receives limited attention. Conclusions In-depth studies on information needs and corresponding use of information sources are lacking. More longitudinal studies are needed, taking the illness trajectory into account and investigating the determinants and outcomes of the information and communication needs of NICU parents. Practice implications Healthcare professionals should adapt their information provision along the illness trajectory. The development of guidelines of information provision during the illness trajectory at NICU would support all professionals.
The pragmatism in health care has made health technology assessment (HTA) restrict its scope to a particular set of problems, c.q. methods. The “multidisciplinary and comprehensive nature” of HTA, as ...the concept is presented in certain definitions, is lacking. Health care is also dominated by a positivistic-rationalistic approach of evaluation. In contrast, social studies of evaluations learn that a major difference has to be made between scientific research on (potential) impact of a technology and valuing these effects. In this contribution, we will discuss how the positivistic scientific bias of current HTA practice can be made up with other research traditions. More specifically, we focus on the question of how social scientists and particularly how qualitative research can contribute to HTA, complementary to positivistic studies of evidence and efficacy.
Outcome after first stroke varies significantly across Europe. This study was designed to compare motor and functional recovery after stroke between four European rehabilitation centers.
Consecutive ...stroke patients (532 patients) were recruited. They were assessed on admission and at 2, 4, and 6 months after stroke with the Barthel Index, Rivermead Motor Assessment of Gross Function, Rivermead Motor Assessment of Leg/Trunk, Rivermead Motor Assessment of Arm, and Nottingham Extended Activities of Daily Living (except on admission). Data were analyzed using random effects ordinal logistic models adjusting for case-mix and multiple testing.
Patients in the UK center were more likely to stay in lower Rivermead Motor Assessment of Gross Function classes compared with patients in the German center (DeltaOR, 2.4; 95% CI, 1.3 to 4.3). In the Swiss center, patients were less likely to stay in lower Nottingham Extended Activities of Daily Living classes compared with patients in the UK center (DeltaOR, 0.7; 95% CI, 0.5 to 0.9). The latter were less likely to stay in lower Barthel Index classes compared with the patients in the German center (DeltaOR, 0.6; 95%CI, 0.4 to 0.8). Recovery patterns of Rivermead Motor Assessment of Leg/Trunk and Rivermead Motor Assessment of Arm were not significantly different between centers.
Gross motor and functional recovery were better in the German and Swiss centers compared with the UK center, respectively. Personal self-care recovery was better in the UK compared with the German center. Previous studies in the same centers indicated that German and Swiss patients received more therapy per day. This was not the result of more staff but of a more efficient use of human resources. This study indicates potential for improving rehabilitation outcomes in the UK and Belgian centers.
Physiotherapy (PT) and occupational therapy (OT) are key components of stroke rehabilitation. Little is known about their content. This study aimed to define and compare the content of PT and OT for ...stroke patients between 4 European rehabilitation centers.
In each center, 15 individual PT and 15 OT sessions of patients fitting predetermined criteria were videotaped. The content was recorded using a list comprising 12 therapeutic categories. A generalized estimating equation model was fitted to the relative frequency of each category resulting in odds ratios.
Comparison of PT and OT between centers revealed significant differences for only 2 of the 12 categories: ambulatory exercises and selective movements. Comparison of the 2 therapeutic disciplines on the pooled data of the 4 centers revealed that ambulatory exercises, transfers, exercises, and balance in standing and lying occurred significantly more often in PT sessions. Activities of daily living, domestic activities, leisure activities, and sensory, perceptual training, and cognition occurred significantly more often in OT sessions.
This study revealed that the content of each therapeutic discipline was consistent between the 4 centers. PT and OT proved to be distinct professions with clear demarcation of roles.
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