School of Medicine, Department of General Practice, Western Sydney University, Campbelltown Campus, Building 30.3.18, Locked Bag 1797, Penrith, NSW, 2751, Australia.
BMC Health Serv Res. 2019 Jul 26;19(1):524. doi: 10.1186/s12913-019-4360-2.
Mental illness is a leading cause of illness and disability and around 75% of people suffering mental illness do not have access to adequate care. In Australia, nearly half the population experiences mental illness at some point in their life. The Australian Government developed a National program called Partners in Recovery (PIR) to support those with severe and persistent mental illness. The program was implemented through 48 consortia across Australia. One of these was led by the Nepean Blue Mountains Medicare Local who adapted the program according to its specific local needs.
We conducted an early evaluation of the PIR program in Nepean Blue Mountains (NBMPIR) using a program logic model (PLM) to frame the evaluation and complemented this with an additional thematic analysis. Participants (n = 73) included clients and carers, program management and staff of the Consortium and other partners and agencies, and clinical, allied health, and other service providers. Our PLM utilised multiple data sources that included document review, open and closed survey questions, and semi-structured interviews. Quantitative data received a descriptive analysis and qualitative data was analysed both in alignment with the PLM framework and inductively.
We aligned our results to PLM domains of inputs, activities, outputs, outcomes and impacts. The NBMPIR consortium implemented a recovery approach and provided greater access to services by enhancing healthcare provider partnerships. Our thematic analysis further described five key themes of collaboration; communication; functioning of PIR; structural/organisational challenges; and understanding of PIR approaches. Facilitators and barriers to the NBMPIR program centred on the alignment of vision and purpose; building an efficient system; getting the message out and sharing information; understanding roles and support and training of staff; building capacity and systems change; addressing service gaps; and engaging peers.
Our study provided helpful insights into the coordinated management of complex mental illness. The NBMPIR's focus on partnerships and governance, service coordination, and systems change has relevance for others engaged in this work. This PLM effectively mapped the program, including its processes and resources, and is a useful framework providing a baseline for future evaluations. Full report available at https://researchdirect.westernsydney.edu.au/islandora/object/uws:33977/.
精神疾病是导致疾病和残疾的主要原因,大约 75%的精神疾病患者无法获得足够的治疗。在澳大利亚,近一半的人在其一生中的某个时候会经历精神疾病。澳大利亚政府制定了一个名为“合作伙伴康复计划”(Partners in Recovery,简称 PIR)的国家计划,以支持那些患有严重和持续精神疾病的人。该计划通过澳大利亚各地的 48 个联盟实施。其中一个由 Nepean Blue Mountains Medicare Local 领导,该组织根据其特定的当地需求对该计划进行了调整。
我们使用程序逻辑模型(Program Logic Model,简称 PLM)来评估 Nepean Blue Mountains(简称 NBMPIR)的 PIR 计划,并对其进行了补充分析。参与者(n=73)包括客户和护理人员、联盟的项目管理和工作人员以及其他合作伙伴和机构,以及临床、联合健康和其他服务提供商。我们的 PLM 利用了多个数据源,包括文件审查、开放式和封闭式调查问题以及半结构化访谈。定量数据进行了描述性分析,定性数据根据 PLM 框架进行了分析,并进行了归纳分析。
我们将结果与输入、活动、输出、结果和影响的 PLM 领域对齐。NBMPIR 联盟实施了一种康复方法,并通过加强医疗保健提供者的合作伙伴关系,提供了更多的服务机会。我们的主题分析进一步描述了合作的五个关键主题;沟通;PIR 的运作;结构/组织挑战;以及对 PIR 方法的理解。NBMPIR 计划的促进者和障碍集中在愿景和目的的一致性;建立一个高效的系统;传达信息和分享信息;理解角色和支持以及员工培训;建立能力和系统变革;解决服务差距;以及吸引同行。
我们的研究为协调管理复杂的精神疾病提供了有益的见解。NBMPIR 对伙伴关系和治理、服务协调以及系统变革的关注,对从事这项工作的其他人具有相关性。该 PLM 有效地映射了该计划,包括其流程和资源,是一个有用的框架,为未来的评估提供了基线。完整报告可在 https://researchdirect.westernsydney.edu.au/islandora/object/uws:33977/ 上获取。