Assessment of care provision integration in a community-based mental health system: balanced care model implementation in Andalusia (Spain).

Balanced care model Cartographic representation Decision support system Health care system assessment Mental health services Relative technical efficiency

Journal

BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562

Informations de publication

Date de publication:
30 Sep 2024
Historique:
received: 13 01 2024
accepted: 24 09 2024
medline: 1 10 2024
pubmed: 1 10 2024
entrez: 30 9 2024
Statut: epublish

Résumé

Andalusia is the second largest region in Spain, and it has developed a comprehensive mental health (MH) plan that encourages the consolidation of the balanced care model. However, its geographical and socioeconomic disparity is a great challenge for a community-based MH system. Both the assessment of the implementation of the MH plan and the development of new tools to support decision-making can be considered critical. The present study aims (i) to assess how the integration of different types of MH care may influence system performance and (ii) to check the performance evolution of the integration process geographically regarding the small MH areas of Andalusia. The performance of the Andalusian MH system was assessed by combining Monte Carlo simulation, fuzzy inference and data envelopment analysis. The relative technical efficiency was the main performance indicator. A correct integration of appropriate types of MH care, according to population needs, increases the performance of the Andalusian MH system both from global and regional perspectives. The spatial representation (based on small MH areas) of the results highlights how the performance depends on specific geographical characteristics. By analyzing the identified spatial clusters, defined by different management patterns depending on user and socioeconomic characteristics, benchmark areas and areas for improvement can be studied to design evidence-informed policies and interventions. A global analysis of MH system performance was carried out, including both the successive integration of different types of care and its spatial evolution. Although an appropriate integration of different types of MH care has a positive effect on the Andalusian MH system, this process has different profiles depending on specific geographically based user and socioeconomic characteristics. The balanced care model can be considered the paradigm for assessing the performance of a large and populated territory such as Andalusia, which has a community-based MH system. This methodological approach (performance assessment and spatial analysis) may be used as a guide for developing future evidence-informed policies and managerial interventions.

Sections du résumé

BACKGROUND BACKGROUND
Andalusia is the second largest region in Spain, and it has developed a comprehensive mental health (MH) plan that encourages the consolidation of the balanced care model. However, its geographical and socioeconomic disparity is a great challenge for a community-based MH system. Both the assessment of the implementation of the MH plan and the development of new tools to support decision-making can be considered critical.
OBJECTIVES OBJECTIVE
The present study aims (i) to assess how the integration of different types of MH care may influence system performance and (ii) to check the performance evolution of the integration process geographically regarding the small MH areas of Andalusia.
METHODS METHODS
The performance of the Andalusian MH system was assessed by combining Monte Carlo simulation, fuzzy inference and data envelopment analysis. The relative technical efficiency was the main performance indicator.
RESULTS RESULTS
A correct integration of appropriate types of MH care, according to population needs, increases the performance of the Andalusian MH system both from global and regional perspectives. The spatial representation (based on small MH areas) of the results highlights how the performance depends on specific geographical characteristics. By analyzing the identified spatial clusters, defined by different management patterns depending on user and socioeconomic characteristics, benchmark areas and areas for improvement can be studied to design evidence-informed policies and interventions.
CONCLUSIONS CONCLUSIONS
A global analysis of MH system performance was carried out, including both the successive integration of different types of care and its spatial evolution. Although an appropriate integration of different types of MH care has a positive effect on the Andalusian MH system, this process has different profiles depending on specific geographically based user and socioeconomic characteristics. The balanced care model can be considered the paradigm for assessing the performance of a large and populated territory such as Andalusia, which has a community-based MH system. This methodological approach (performance assessment and spatial analysis) may be used as a guide for developing future evidence-informed policies and managerial interventions.

Identifiants

pubmed: 39350100
doi: 10.1186/s12889-024-20169-6
pii: 10.1186/s12889-024-20169-6
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

2671

Subventions

Organisme : Consejería de Transformación Económica, Industria, Conocimiento y Universidades. Junta de Andalucía
ID : PY18-RE-0022
Organisme : Consejería de Transformación Económica, Industria, Conocimiento y Universidades. Junta de Andalucía
ID : PY18-RE-0022

Informations de copyright

© 2024. The Author(s).

Références

Santomauro DF, Mantilla Herrera AM, Shadid J, Zheng P, Ashbaugh C, Pigott DM, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021;398(10312):1700–12.
doi: 10.1016/S0140-6736(21)02143-7
World Health Organization. World mental health report: transforming mental health for all: executive summary [Internet]. World Health Organization. 2022. https://iris.who.int/handle/10665/356115
WHO Regional Office for Europe. WHO European Framework for Action on Mental Health 2021–2025 [Internet]. Copenhagen. 2022. https://apps.who.int/iris/rest/bitstreams/1414471/retrieve
Vollset SE, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M et al. Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021. Lancet [Internet]. 2024;403(10440):2204–56. https://linkinghub.elsevier.com/retrieve/pii/S0140673624006858
Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007;370(9590):878–89.
doi: 10.1016/S0140-6736(07)61239-2 pubmed: 17804062
Suárez Alonso AG, Díez Fernández ME, García Sastre M, González Zapico NA, Pedreira Massa JL, Piedra Cristóbal J. Estrategia en Salud Mental del Sistema Nacional de Salud 2022–2026 [Internet]. 2022. https://www.consaludmental.org/publicaciones/Estrategia-Salud-Mental-2022-2026.pdf
Salvador-Carulla L, Costa-Font J, Cabases J, McDaid D, Alonso J. Evaluating mental health care and policy in Spain. J Ment Health Policy Econ. 2010;13(2).
Carmona Calvo J, de la García-Cubillana P, Millán Carrasco A, Huizing E, Fernández Regidor G, Rojo Villalba M et al. III Plan Integral de Salud Mental de Andalucía: 2016–2020. 2016; Available from: http://217.12.23.249/bitstream/10668/2455/1/IIIPlanSaludMental_2016.pdf.
Cervilla JA, Ruiz I, Rodríguez-Barranco M, Rivera M, Ibáñez-Casas I, Molina E, et al. Protocolo Y metodología del estudio epidemiológico de la salud mental en Andalucía: PISMA-ep. Rev Psiquiatr Salud Ment. 2016;9(4):185–94.
doi: 10.1016/j.rpsm.2015.11.004 pubmed: 27237041
González-López MC, Rodríguez-López CM, Parrón-Carreño T, Luna JD, Del Pozo E. Trends in the dispensation of antidepressant drugs over the past decade (2000–2010) in Andalusia, Spain. Soc Psychiatry Psychiatr Epidemiol. 2015;50(5):705–12.
doi: 10.1007/s00127-014-0995-9 pubmed: 25527208
Garrido-Cumbrera M, Almenara-Barrios J, López-Lara E, Peralta-Sáez JL, García-Gutierrez JC, Salvador-Carulla L. Development and spatial representation of synthetic indexes of outpatient mental health care in Andalusia (Spain). Epidemiol Psichiatr Soc [Internet]. 2008;17(3):192–200. https://www.cambridge.org/core/product/identifier/S1121189X00001287/type/journal_article
Rodero-Cosano ML, Garcia-Alonso CR, Salinas-Pérez JA. A deprivation analysis for Andalusia (Spain): an approach based on structural equations. Soc Indic Res. 2014;115(2):751–65.
doi: 10.1007/s11205-012-0226-2
Romero-Lopez-Alberca C, Alonso-Trujillo F, Almenara-Abellan JL, Salinas-Perez JA, Gutierrez-Colosia MR, Gonzalez-Caballero J-L et al. A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study. J Med Internet Res [Internet]. 2021;23(3):e24930. http://www.jmir.org/2021/3/e24930/
Furst MA, Bagheri N, Salvador-Carulla L. An ecosystems approach to mental health services research. BJPsych Int [Internet]. 2021;18(1):23–5. https://www.cambridge.org/core/product/identifier/S2056474020000240/type/journal_article
Salvador-Carulla L, Lukersmith S, Sullivan W. From the EBM pyramid to the Greek temple: a new conceptual approach to guidelines as implementation tools in mental health. Epidemiol Psychiatr Sci. 2017;26(2):105–14.
doi: 10.1017/S2045796016000767 pubmed: 28290273 pmcid: 6998697
Almeda N, Garcia-Alonso CR, Gutierrez-Colosia MR, Salinas-Perez JA, Iruin-Sanz A, Salvador-Carulla L. Modelling the balance of care: Impact of an evidence-informed policy on a mental health ecosystem. PLoS One [Internet]. 2022;17(1 January):1–16. https://doi.org/10.1371/journal.pone.0261621
Salvador-Carulla L, Almeda N, Álvarez-Gálvez J, García-Alonso C. En la montaña rusa: breve historia del modelo de atención de salud mental en España. Informe SESPAS 2020. Gac Sanit [Internet]. 2020;34(1):3–10. https://doi.org/10.1016/j.gaceta.2020.06.009
Chung Y, Bagheri N, Salinas-Perez JA, Smurthwaite K, Walsh E, Furst MA et al. Role of visual analytics in supporting mental healthcare systems research and policy: A systematic scoping review. Int J Inf Manage [Internet]. 2020;50(May 2019):17–27. https://doi.org/10.1016/j.ijinfomgt.2019.04.012
Tansella M, Thornicroft G, Lempp H. Lessons from community mental health to drive implementation in health care systems for people with long-term conditions. Int J Environ Res Public Health. 2014;11(5):4714–28.
doi: 10.3390/ijerph110504714 pubmed: 24785742 pmcid: 4053874
Calovi M, Seghieri C. Using a GIS to support the spatial reorganization of outpatient care services delivery in Italy. BMC Health Serv Res. 2018;18(1):1–16.
doi: 10.1186/s12913-018-3642-4
Caban JJ, Gotz D. Visual analytics in healthcare - opportunities and research challenges. J Am Med Inf Assoc. 2015;22(2):260–2.
doi: 10.1093/jamia/ocv006
García-Alonso CR, Almeda N, Salinas-Pérez JA, Gutiérrez-Colosía MR, Iruin-Sanz Á, Salvador-Carulla L. Use of a decision support system for benchmarking analysis and organizational improvement of regional mental health care: efficiency, stability and entropy assessment of the mental health ecosystem of Gipuzkoa (Basque Country, Spain). PLoS ONE. 2022;17(3 March):1–18.
Almeda N, García-Alonso C, Alberto Salinas-Pérez J, Gutiérrez-Colosía R, Salvador-Carulla M. L. Assessment of Relative Technical Efficiency of Small Mental Health Areas in Bizkaia (Basque Country, Spain). In: Proceedings of the 6th International Conference on Operations Research and Enterprise Systems [Internet]. SCITEPRESS - Science and Technology Publications; 2017. pp. 377–84. http://www.scitepress.org/DigitalLibrary/Link.aspx?doi=10.5220/0006195603770384
Almeda N, García-Alonso CR, Killaspy H, Gutiérrez-Colosía MR, Salvador-Carulla L. The critical factor: the role of quality in the performance of supported accommodation services for complex mental illness in England. PLoS ONE. 2022;17(3):e0265319.
doi: 10.1371/journal.pone.0265319 pubmed: 35298512 pmcid: 8929565
Diaz-Milanes D, Almeda N, Gutierrez-Colosia MR, Garcia-Alonso CR, Sadeniemi M, Salvador-Carulla L. Impact of the workforce allocation on the technical performance of mental health services: the collective case of Helsinki-Uusimaa (Finland). Heal Res Policy Syst [Internet]. 2023;21(1):108. https://health-policy-systems.biomedcentral.com/articles/ https://doi.org/10.1186/s12961-023-01061-y
García-Alonso CR, Almeda N, Salinas-Pérez JA, Gutiérrez-Colosía MR, Uriarte-Uriarte JJ, Salvador-Carulla L. A decision support system for assessing management interventions in a mental health ecosystem: The case of Bizkaia (Basque Country, Spain). Campos M, editor. PLoS One [Internet]. 2019;14(2):e0212179. https://doi.org/10.1371/journal.pone.0212179
Servicio Andaluz de Salud. Salud mental. Red de recursos [Internet]. [cited 2021 Sep 3]. https://www.sspa.juntadeandalucia.es/servicioandaluzdesalud/el-sas/servicios-y-centros/salud-mental/salud-mental-red-de-recursos
FAISEM. Fundación Pública Andaluza para la Integración social de Personas con Enfermedad Mental [Internet]. [cited 2022 Jun 3]. https://www.faisem.es/
Servicio Andaluz de Salud. Información por centros [Internet]. [cited 2021 Sep 3]. https://www.sspa.juntadeandalucia.es/servicioandaluzdesalud/el-sas/servicios-y-centros/informacion-por-centros
Romero-López-Alberca C, Gutiérrez-Colosía MR, Salinas-Pérez JA, Almeda N, Furst M, Johnson S et al. Standardised description of health and social care: A systematic review of use of the ESMS/DESDE (European Service Mapping Schedule/Description and Evaluation of Services and DirectoriEs). Eur Psychiatry [Internet]. 2019;61:97–110. https://linkinghub.elsevier.com/retrieve/pii/S0924933819301221
Salvador-Carulla L, Amaddeo F, Gutiérrez-Colosía MR, Salazzari D, Gonzalez-Caballero JL, Montagni I et al. Developing a tool for mapping adult mental health care provision in Europe: the REMAST research protocol and its contribution to better integrated care. Int J Integr Care [Internet]. 2015;15(4). http://www.ijic.org/article/ https://doi.org/10.5334/ijic.2417/
Salvador-Carulla L, Alvarez-Galvez J, Romero C, Gutiérrez-Colosía MR, Weber G, McDaid D et al. Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study. BMC Health Serv Res. 2013;13(1).
Montagni I, Salvador-Carulla L, Mcdaid D, Straßmayr C, Endel F, Näätänen P et al. The REFINEMENT Glossary of Terms: An International Terminology for Mental Health Systems Assessment. Adm Policy Ment Heal Ment Heal Serv Res [Internet]. 2018;45(2):342–51. https://doi.org/10.1007/s10488-017-0826-x
Salinas-Pérez JA, Gutiérrez-Colosia MR, Romero López-Alberca C, Poole M, Rodero-Cosano ML, García-Alonso CR, et al. Todo está en El mapa: Atlas Integrales De Salud Mental para la planificación de servicios. Informe SESPAS 2020. Gac Sanit. 2020;34:11–9.
doi: 10.1016/j.gaceta.2020.06.015 pubmed: 32933792
Torres-Jiménez M, García-Alonso CR, Salvador-Carulla L, Fernández-Rodríguez V. Evaluation of system efficiency using the Monte Carlo DEA: the case of small health areas. Eur J Oper Res. 2015;242(2):525–35.
doi: 10.1016/j.ejor.2014.10.019
Klir GJ. Uncertainty and information: foundations of generalized information theory. New Yersey: John Wiley & Sons, Inc; 2006.
Nakayama MK. Statistical analysis of simulation output. In: Mason SJ, Hill RR, Mönch L, Rose O, Jefferson T, Fowler JW, editors. Proceedings of the 2008 Winter Simulation Conference. Piscataway, New Jersey: Institute of Electrical and Electronics Engineers (IEEE); 2008. pp. 62–72.
Thornicroft G, Tansella M. The balanced care model for global mental health. Psychol Med [Internet]. 2013;43(4):849–63. https://www.cambridge.org/core/product/identifier/S0033291712001420/type/journal_article
Thornicroft G, Tansella M. Community Mental Health Care in the Future. J Nerv Ment Dis [Internet]. 2014;202(6):507–12. http://journals.lww.com/00005053-201406000-00015
Salvador-Carulla L, García-Alonso C, Gonzalez-Caballero JL, Garrido-Cumbrera M. Use of an operational model of community care to assess technical efficiency and benchmarking of small mental health areas in Spain. J Ment Health Policy Econ. 2007;10(2):87–100.
pubmed: 17603149
Charnes A, Cooper WW, Rhodes E. Measuring the efficiency of decision making units. Eur J Oper Res [Internet]. 1978;2(6):429–44. https://linkinghub.elsevier.com/retrieve/pii/0377221778901388
Dominguez-Lara S. Magnitud del efecto, una guía rápida. Educ Médica [Internet]. 2018;19(4):251–4. https://linkinghub.elsevier.com/retrieve/pii/S1575181317301390
Thornicroft G, Tansella M. Better Mental Health Care [Internet]. Cambridge University Press. Cambridge: Cambridge University Press; 2008. https://www.cambridge.org/core/product/identifier/9780511544347/type/book
Eaton J, McCay L, Semrau M, Chatterjee S, Baingana F, Araya R et al. Scale up of services for mental health in low-income and middle-income countries. Lancet [Internet]. 2011;378(9802):1592–603. https://doi.org/10.1016/S0140-6736(11)60891-X
Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, et al. Barriers to improvement of mental health services in low-income and middle-income countries. Lancet. 2007;370(9593):1164–74.
doi: 10.1016/S0140-6736(07)61263-X pubmed: 17804061
Cetrano G, Salvador-Carulla L, Tedeschi F, Rabbi L, Gutiérrez-Colosía MR, Gonzalez-Caballero JL et al. The balance of adult mental health care: provision of core health versus other types of care in eight European countries. Epidemiol Psychiatr Sci [Internet]. 2020;29:e6. https://www.cambridge.org/core/product/identifier/S2045796018000574/type/journal_article
Moreno Küstner B. ¿Por qué no funcionan Los sistemas de información en salud mental? Diez requisitos necesarios para su implementación. Rev La Asoc Española Neuropsiquiatría. 2012;32(113):29–38.
doi: 10.4321/S0211-57352012000100003
Okumura Y, Sugiyama N, Noda T. Timely follow-up visits after psychiatric hospitalization and readmission in schizophrenia and bipolar disorder in Japan. Psychiatry Res [Internet]. 2018;270(March):490–5. https://doi.org/10.1016/j.psychres.2018.10.020
Sloan PA, Asghar-Ali A, Teague A, Body E, Kunik ME. Psychiatric hospitalists and continuity of care: a comparison of two models. J Psychiatr Pract. 2010;16(3):170–6.
doi: 10.1097/01.pra.0000375713.85454.8f pubmed: 20485105
Guzmán-Parra J, Bordallo-Aragón A, Moreno-Küstner B, Mayoral-Cleries F. Factors Associated with High Use of Hospital Psychiatric Services in Málaga, Spain: analysis of first admissions. J Nerv Ment Dis. 2020;208(1):65–9.
doi: 10.1097/NMD.0000000000001088 pubmed: 31834191
Thornicroft G, Tansella M. Components of a modern mental health service: a pragmatic balance of community and hospital care. Overview of systematic evidence. Br J Psychiatry. 2004;185(OCT):283–90.
doi: 10.1192/bjp.185.4.283 pubmed: 15458987
Thornicroft G, Ruggeri M, Goldberg D. Improving mental health care: the global challenge. Wiley; 2013.
Pereira MA, Camanho AS. The ‘Healthcare Access and Quality Index’ revisited: A fuzzy data envelopment analysis approach. Expert Syst Appl [Internet]. 2024;245(January 2023):123057. https://doi.org/10.1016/j.eswa.2023.123057

Auteurs

Diego Diaz-Milanes (D)

Department of Quantitative Methods, Universidad Loyola Andalucia, Seville, Spain. ddiaz@uloyola.es.
Health Research Institute, University of Canberra, Canberra, ACT, Australia. ddiaz@uloyola.es.

Nerea Almeda (N)

Department of Psychology, Universidad Loyola Andalucia, Seville, Spain.

Maria Luisa Rodero-Cosano (ML)

Department of Quantitative Methods, Universidad Loyola Andalucia, Seville, Spain.

Jose A Salinas-Perez (JA)

Department of Quantitative Methods, Universidad Loyola Andalucia, Seville, Spain.
Health Research Institute, University of Canberra, Canberra, ACT, Australia.

Carlos R Garcia-Alonso (CR)

Department of Quantitative Methods, Universidad Loyola Andalucia, Seville, Spain.
Health Research Institute, University of Canberra, Canberra, ACT, Australia.

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