Project description:PurposeThe patient-centered medical home (PCMH) has emerged as an optimal primary care model for all youth; however, little is known about the extent to which adolescents in need of mental health (MH) treatment receive care consistent with the PCMH. This study assessed (1) 10-year trends in PCMH care among U.S. adolescents according to MH need and (2) variations in PCMH care and its subcomponents among adolescents with MH need, by individual and family characteristics.MethodsThis was a secondary analysis of Medical Expenditure Panel Survey data (2004-2013). The sample included adolescents aged 12-17 years with ≥1 office-based visits in the past year (N = 18,717). Questions assessing a usual source of care and care that is accessible, comprehensive, family-centered, and compassionate were used to define PCMH care. For adolescents with MH needs, multivariable logistic regression was used to describe the association between PCMH care and sample characteristics.ResultsFifty percent of adolescents experienced PCMH care, with little change between 2004 and 2013. Adolescents with MH need (N = 3,794) had significantly lower odds of experiencing PCMH care compared with those without MH need (odds ratio, .78; 95% confidence interval, .69-.87). Among adolescents with MH needs, being uninsured and living with a parent who did not graduate high school were negatively associated with PCMH care, whereas parental usual source of care was positively associated (odds ratio, 1.69; 95% confidence interval, 1.28-2.22).ConclusionsIncreasing care accessibility, integrating MH services into primary care settings, and targeting socioeconomically disadvantaged subgroups could improve rates of PCMH care among adolescents with MH needs.
Project description:BackgroundIntensive primary care (IPC) programs for patients with complex needs do not generate cost savings in most settings. Strengthening existing patient-centered medical homes (PCMH) to address the needs of these patients in primary care is a potential high-value alternative.ObjectivesExplore PCMH team functioning and characteristics that may impact their ability to perform IPC tasks; identify the IPC components that could be incorporated into PCMH teams' workflow; and identify additional resources, trainings, and staff needed to better manage patients with complex needs in primary care.MethodsWe interviewed 44 primary care leaders, PCMH team members (providers, nurses, social workers), and IPC program leaders at 5 VA IPC sites and analyzed a priori themes using a matrix analysis approach.ResultsHigher-functioning PCMH teams were described as already performing most IPC tasks, including panel management and care coordination. All sites reported that PCMH teams had the knowledge and skills to perform IPC tasks, but not with the same intensity as specialized IPC teams. Home visits/assessments and co-attending appointments were perceived as not feasible to perform. Key stakeholders identified 6 categories of supports and capabilities that PCMH teams would need to better manage complex patients, with care coordination/management and fully staffed teams as the most frequently mentioned. Many thought that PCMH teams could make better use of existing VA and non-VA resources, but might need training in identifying and using those resources.ConclusionsPCMH teams can potentially offer certain clinic-based services associated with IPC programs, but tasks that are time intensive or require physical absence from clinic might require collaboration with community service providers and better use of internal and external healthcare system resources. Future studies should explore the feasibility of PCMH adoption of IPC tasks and the impact on patient outcomes.
Project description:ObjectivesThis study aims to examine the association of work-related basic need satisfaction (W-BNS) with doctors' work engagement and explore the mediating role of work motivation and job satisfaction between the two variables.DesignThis was a cross-sectional study.SettingThe study was conducted in four public grade A tertiary hospitals in China.ParticipantsA total of 1000 doctors were invited to participate; 849 doctors completed questionnaires validly.Primary and secondary outcome measuresQuestionnaires were administered online and offline to collect data, consisting of six parts: social demographic characteristics, work-related characteristics, and scales related to W-BNS, work motivation, job satisfaction and work engagement. One-way analysis of variance, Pearson correlation analysis were performed using SPSS, and mediation analysis was carried out via PROCESS macro.ResultsOur research showed that W-BNS, work motivation, job satisfaction and work engagement were positively correlated. Work engagement was significantly predicted by W-BNS (β=0.15, p<0.001) through motivation at work (β=0.23, p<0.001) and job satisfaction (β=0.44, p<0.001), respectively. Compared with work motivation, the mediating effect of job satisfaction was stronger (95% CI -0.22 to -0.06).ConclusionThe findings suggest that job satisfaction and work motivation may be important pathways through which doctors' W-BNS may influence their work engagement. In order to maintain and promote doctors' work engagement, hospital administrators should consider strengthening the internal motivation of doctors and improving their job satisfaction.
Project description:BackgroundThis study aimed to identify work-related risk factors, including long working hours and night/shift work, for unmet health care need using data of a representative panel of Korean adults.MethodsAssociations between work-related factors and unmet health care need were analyzed using data of 3,440 participants (10,320 observations) from the 2011-2013 Korean Health Panel Study. A generalized estimating equation was used for the analysis of repeated measures.ResultsThe prevalence of unmet health care was 16.6%. After adjusting sex, age, socioeconomic status, work characteristics, and working more than 60 hours per week (odds ratio [OR]: 1.43, 95% confidence interval [CI]: 1.23-1.65) or 50-59 hours per week (OR: 1.26, 95% CI: 1.08-1.46) instead of 40-49 hours per week and night/shift work (OR: 1.27, 95% CI: 1.06-1.51) were associated with unmet health care need.ConclusionLong working hours and night/shift work are risk factors for unmet health care need among the Korean working population.
Project description:BackgroundPublic involvement adds value to numerous aspects of health research, yet few studies have attempted to evaluate its impact on research. Evidence of such impact is needed to develop recommendations for best practice and ensure adequate resourcing.AimTo evaluate public involvement within a large interdisciplinary Science, Technology, Engineering and Mathematics (STEM) research project that focused on digital health.MethodsThe evaluation was conducted with members of the project's Public Advisory Groups (PAG) and with researchers who had participated in involvement activities. Two questionnaires were designed based on a public involvement value systems and clusters framework.ResultsResponses from members of the PAG (n = 10) were mostly positive towards normative values, which include moral, ethical and political aspects of involvement in research, and towards values concerning the conduct of public involvement and best practices. Researchers' responses (n = 16) indicated they felt that involvement was generally effective and increased the quality, relevance and generalizability of their work. However, their responses about the validity of involvement in research were varied. They also highlighted several challenges including how well public involvement impacted on research, how decisions made in the research might differ from the views generated from public involvement, and barriers to researchers' participation.Discussion and conclusionOur evaluation suggests that members of the public and the researchers value involvement. However, there is a need to consider how to embed public involvement to an even greater extent in STEM contexts and a need to address any barriers for researchers' own involvement.