Models of psychological service provision under Australia's better outcomes in mental health care program

The Access to Allied Psychological Services component of Australia's Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found: 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way; Allied health professionals were providing services from GPs' rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%. Many of these models were being used in combination. No model was predictive of differential levels of access, suggesting that the approach of adapting models to the local context is proving successful.

Lessons from the National Mental Health Integration Program

Three projects were funded under the national Mental Health Integration Program (MHIP) in 1999, each of which employed a different model aimed at improving linkages between disparate parts of the mental health system. A national evaluation framework guided local evaluations of these projects, and this paper presents a synthesis of the findings. For providers, the projects improved working relationships, created learning opportunities and increased referral and shared care opportunities. For consumers and carers, the projects resulted in a greater range of options and increased continuity of care. For the wider system, the projects achieved significant structural and cultural change. Cost-wise, there were no increases in expenditure, and even some reductions. Many of the lessons from the projects (and their evaluations) may be generalised to other mental health settings and beyond.

Modelo de gestión para la atención integral de pacientes con enfermedades huérfanas o raras en Colombia

Las enfermedades raras o huérfanas corresponden a aquellas con baja prevalencia en la población, y en varios países tienen una definición distinta de acuerdo con el número de pacientes que afectan en la población. La Organización Mundial de la Salud (OMS), las define como un trastorno que afecta de 650 a 1.000 personas por millón de habitantes, de las que se han identificado alrededor de 7.000. En Colombia su prevalencia es menor de 1 por cada 5.000 personas y comprenden: las enfermedades raras, las ultra-huérfanas y las olvidadas. Los pacientes con este tipo de enfermedades imponen retos a los sistemas sanitarios, pues si bien afectan a un bajo porcentaje de la población, su atención implica una alta carga económica por los costos que involucra su atención, la complejidad en su diagnóstico, tratamiento, seguimiento y rehabilitación. El abordaje de las enfermedades raras requiere un manejo interdisciplinar e intersectorial, lo que implica la organización de cada actor del sistema sanitario para su manejo a través de un modelo que abraque las dinámicas posibles entre ellos y las competencias de cada uno. Por lo anterior, y teniendo en cuenta la necesidad de formular políticas sanitarias específicas para la gestión de estas enfermedades, el presente trabajo presenta una aproximación a la formulación de un modelo de gestión para la atención integral de pacientes con enfermedades raras en Colombia. Esta investigación describe los distintos elementos y características de los modelos de gestión clínica y de las enfermedades raras a través de una revisión de literatura, en la que se incluye la descripción de los distintos actores del Sistema de Salud Colombiano, relacionados con la atención integral de estos pacientes para la documentación de un modelo de gestión integral.

Physiotherapy practice in the private sector: organizational characteristics and models.

BACKGROUND: Even if a large proportion of physiotherapists work in the private sector worldwide, very little is known of the organizations within which they practice. Such knowledge is important to help understand contexts of practice and how they influence the quality of services and patient outcomes. The purpose of this study was to: 1) describe characteristics of organizations where physiotherapists practice in the private sector, and 2) explore the existence of a taxonomy of organizational models. METHODS: This was a cross-sectional quantitative survey of 236 randomly-selected physiotherapists. Participants completed a purpose-designed questionnaire online or by telephone, covering organizational vision, resources, structures and practices. Organizational characteristics were analyzed descriptively, while organizational models were identified by multiple correspondence analyses. RESULTS: Most organizations were for-profit (93.2%), located in urban areas (91.5%), and within buildings containing multiple businesses/organizations (76.7%). The majority included multiple providers (89.8%) from diverse professions, mainly physiotherapy assistants (68.7%), massage therapists (67.3%) and osteopaths (50.2%). Four organizational models were identified: 1) solo practice, 2) middle-scale multiprovider, 3) large-scale multiprovider and 4) mixed. CONCLUSIONS: The results of this study provide a detailed description of the organizations where physiotherapists practice, and highlight the importance of human resources in differentiating organizational models. Further research examining the influences of these organizational characteristics and models on outcomes such as physiotherapists' professional practices and patient outcomes are needed.

Organizational, intermediate (field), (direct and general support), and depot maintenance repair parts and special tools list : engine, gasoline, 6 HP, military standard models, DOD model 4A032-1, 4A032-2, NSN 2805-00-776-0483, 2805-00-068-7512.

"April 1977."

Organizational and field maintenance manual : sewing machines for the repair of parachutes and allied equipment, Singer models 112W116, (FSN 3530-171-2123) ... 111W155, (FSN 3530-359-8856).

Includes index.

Organizational maintenance manual : truck, lift, fork, gasoline, 4,000 lb capacity, Towmotor models, 462SG4024-100 (solid tire) ... Army model MHE-191 ... FSN 3930-781-3856 ....

"October 1964."

Organizational maintenance repair parts and special tools lists : tractor, wheeled, warehouse, gasoline engine driven; pneumatic tired, 4000 lb. drawbar pull Army models MHE 189, MHE 189A, and MHE 189B, NSN 3930-00-724-8146, United Tractor models G40, G40A, and G40B.

Includes index.

Organizational, direct support, and general support maintenance manual : tractor, crawler, low-speed, DED, 16,000 to 24,900 lb. drawbar pull, 60 in. min. gage, segmented, air-transportable, w/mounting kit (Caterpillar models D5A), FSN 2410-142-5283 and FSN 2410-230-2767.

"March 1972."

Operator, organizational, intermediate (field), (direct support and general support), and depot level maintenance manual : engine, gasoline, 6 HP, military standard models, DOD model 4A032-1, 4A032-2, NSN 2805-00-776-0483, 2805-00-068-7512.

Includes index.

Operator's, organizational, field and depot maintenance manual for body, stake, component of truck bridging, FSN 2320-200-1682 (all makes and models) for mounting on ORD M-139 chassis, (FSN 2510-510-5191).

Includes index.

Organizational, intermediate (field) (direct support and general support) and depot maintenance repair parts and special tools list : engine, gasoline, 1 1/2 HP; military standard models (model 1A08-1, NSN 2805-00-601-5181), (model 1A08-II, NSN 2805-00-714-8552), (model 1A08-III, NSN 2805-00-068-7510).

"Department of the Marine Corps stock list, SL-4-81283B."

Organizational, maintenance repair parts, and special tools lists : welding machine, arc, generator, GED, 300 amp, DC (Libby welding models) (model LE-300) FSN 3431-810-9696, (model LEW-300) FSN 3431-991-2961, (model LEB-300) FSN 3431-072-0327.

"January 1971."