Integrated health and social care evaluation framework for mental health and drug addiction care

Abstract Background Guiding the decision-making process in mental health investments is advisable. The objective of the study is to develop a framework for evaluating the quality of integrated health and social care in Mental Health and Drug Addiction (MH&DA) Methods A literature review helped to establish a definition of integrated care specific to MH&DA and to identify potential indicators for its evaluation. The quality of integrated care was assessed through focus groups (FGs) and interviews (INs) with three different profiles: professionals (2FGs & 2 INs), patients (3 FGs & 2 INs) and families/carers (2FGs & 2 INs). Additional indicators were also obtained from them. Results Out of 2,226 publications identified, 87 (4%) were reviewed in full. According to the literature, integrated care in MH&DA is based on four main components: case management, comprehensive assessment, individualised care plan and care coordination among different providers. Based on these components, an operational definition of integrated care was developed and validated in the FGs and INs. Positive aspects identified were a respectful approach and positive experiences of coordination between social and community network. Regarding indicators about 400 were identified, after screening were reduced to 60: 25% corresponded to accessibility, 20% person-centred care, 16% each to care coordination and to effectiveness. In general, the main threats to the quality of care, identified in FGs and INs, matched the dimensions with the highest proportion of indicators (i.e., limited care resources, poor coordination and communication among professionals and services, and barriers in accessing specialized treatment). Conclusions According to literature, integrated care in MH&DA seems to be mainly evaluated in terms of accessibility and person-centred care. In a following phase, a large group of experts will be key to select the most relevant dimensions and indicators for the evaluation in a Delphi study. Key messages A quality integration of Health and Social Care is paramount for people with mental disorders and/or drug addictions. A framework for assessing the quality of integrated Health and Social Care in Mental Health and Addictions would help guide necessary investments in mental health.


Background:
With the refugee movement in 2015, also forced migrated female and male medical professionals have arrived in Germany.The effect of occupation on the subjective health status of these physicians working in the German health care system was investigated on the basis of Antonovsky's sense of coherence (SOC) and the occupational science models of Siegrist and Karasek&Theorell.Methods: Using a semi-structured interview guide, nine forced migrated physicians were interviewed before and nine forced migrated physicians were interviewed during their professional medical activity.Both interview groups had an Arabic cultural background.The transcribed interviews were analyzed according to Kuckartz's content structuring qualitative content analysis using the MAXQDA 2020 software tool.

Results:
The SOC of migrated physicians is favorably influenced by meaningful occupational activity and the newly gained manageability of life.Positive influences are seen in professional appreciation and collegial support at all hierarchical levels.Negative effects are perceived in experiences of discrimination, insecurity and experienced injustice in the recognition of foreign qualifications.Physical stress results from occupational overload, unfamiliar work and time pressure.

Conclusions:
The salutogenic effect of the work, the recognition in the profession and the collegial support are essential contributions to the promotion of especially mental health among forced migrated doctors.This speaks in favor of rapid and stringent integration into professional life.However, organizational barriers inherent in the German health care system should not be disregarded, which is why both legal and structural improvements should be made to the existing integration procedure before and during professional activity.

Key messages:
Expediting the integration of migrant doctors back into their professions is of salutogenic importance.Therefore, coordinated and corrective measures should be taken to this end by those responsible for this process.
Abstract citation ID: ckac130.115Integrated health and social care evaluation framework for mental health and drug addiction care

Conclusions:
According to literature, integrated care in MH&DA seems to be mainly evaluated in terms of accessibility and personcentred care.In a following phase, a large group of experts will be key to select the most relevant dimensions and indicators

Introduction:
Professionals caring for persons with dementia (PwD) have to meet demands from various sides.Considering today's high standards put on institutional care with respect to ''person centred care'' and the skills related to specific needs of PwD, caring for care staff is one of the major challenges.

Objectives:
The aim of this study was to investigate the caregiver burden in professional dementia care and its work related differences.

Methods:
The study was carried out from September 2021 to February 2022 among 105 professionals working in different settings for PwD in Slovakia including home care and day care centres.
The Professional Care Team Burden scale (PCTB) and the Zarit Burden Interview (ZBI-12) were chosen to measure caregiver burden.Length of work in the organisation (< 3, 3 to 6, > 6 years), job position (domiciliary and other care worker), and current dementia care intensity ( 8, 9 to 39, > 40 hours/ week) were also measured.Independent samples T-tests and ANOVA were used to analyse the differences (IBM SPSS 27).
Results: 87.6% of professionals were women (mean age 48.6AE9.8years).52.5% worked more than 6 years in the organisation, 53.3% were in the job position of domiciliary care workers, and for 52.1% the current dementia care intensity was 9 to 39 hours/week.Caregiver burden mean scores achieved were 26.7AE4.0(PCTB) and 9.7AE6.2(ZBI-12).The significant difference was found in the PCTB by job position with the higher burden in domiciliary care workers (mean score 26.0 + 4.2, p < 0.05).No significant differences were observed in the PCTB and the ZBI-12 by the length of work in the organisation and current dementia care intensity.

Conclusions:
Specific scales for assessing professionals' caregiver burden are useful to uncover areas for intervention.Structuring the interventions by taking the care staff subjective feelings of burden into account is important for future improvements in institutional care.(Grant support: VEGA no.1/0372/20).

Key messages:
Caring for professionals is one of the major challenges to improve health and social services for persons with dementia.
Structuring the tailored interventions should take the caregiver burden into account.
Methods:A literature review helped to establish a definition of integrated care specific to MH&DA and to identify potential indicators for its evaluation.The quality of integrated care was assessed through focus groups (FGs) and interviews(INs)with three different profiles: professionals (2FGs & 2 INs), patients (3 FGs & 2 INs) and families/carers (2FGs & 2 INs).Additional indicators were also obtained from them.
6Consorci Sanitari de Barcelona, Barcelona, Spain 7 Fundacio ´n Avedis Donabedian, Barcelona, Spain 8 King's College, London, UK 9 Universidad de Leo ´n, Leo ´n, Spain Contact: mgbarbag@aspb.catBackground:Guiding the decision-making process in mental health investments is advisable.The objective of the study is to develop a framework for evaluating the quality of integrated health and social care in Mental Health and Drug Addiction (MH&DA)