System Wide Domains
Interactions between patients and the health care system; what is done in giving and receiving care. 1,2
FOR EXAMPLE, CARE IS ACCESSIBLE, CARE IS PROVIDED BY A COMPETENT PROVIDER, CARE IS TIMELY AND PROVIDED SAFELY.
All care / service provided meets the expectations of the various stakeholders, recognizing that these expectations may differ, and that the needs of the clients / patients are paramount.3
FOR EXAMPLE, CONSUMERS’ PERCEPTION OF CULTURAL SENSITIVITY AND RESPONSIVENESS.
Clients/patients are able to obtain care and services at the right place and the right time, based on their respective needs. Accessibility would include such things as waiting times, physician availability, geographical proximity, extended service hours, etc.
Care / service provided is relevant to the clients'/patients' needs and based on established standards.3
FOR EXAMPLE, MEDICATION PRESCRIPTIONS BASED ON ESTABLISHED STANDARDS.
Competence involves ensuring that the care provider’s knowledge and skills are appropriate to the care/service being provided. Competent providers are knowledgeable about the use of evidence based psychotherapy and about techniques to improve quality of care.
Services are offered as a coherent and coordinated succession of events in keeping with the health needs and personal context of patients. Health care is linked to other services to support successful treatment.
The care / service, intervention or action achieves the desired results.3
FOR EXAMPLE, IMPROVED MOOD, DECREASED READMISSION RATE FOR PSYCHOSIS.
The desired results are achieved with the most cost-effective use of resources.3
FOR EXAMPLE, PHYSICIANS WORK IN TEAMS WITH NURSING CASE MANAGERS.
The potential risks of an intervention or the environment are avoided or minimized.3
FOR EXAMPLE, REGULAR MONITORING OF DRUG INTERACTIONS, NONVIOLENT CRISIS INTERVENTION.
A continuum of health care services is available that covers health promotion, prevention, treatment and recovery-oriented services offered in a variety of primary care settings.
Patient-centeredness refers to establishing a partnership among practitioners, patients and their families (when appropriate) to ensure that decisions respect patients’ wants, needs and preferences. This includes ensuring that patients have the education and support they need to make their own decisions and participate in their own care.
Health care is provided within the legislative framework.
FOR EXAMPLE, APPROPRIATE IMPLEMENTATION OF THE MENTAL HEALTH ACT, CANADA HEALTH ACT.
The results of interactions between patients and the health system; the effects of care on the patient or groups of patients.
FOR EXAMPLE, CLIENT SATISFACTION, MORTALITY RATES, AND DISABILITY RATES OF THE PRACTICE POPULATION.
Changes to or the characteristics of the health status of an individual which may lead to distress, interference with daily activities, or contact with health services. This also includes symptom severity.
Effects on day-to-day activities, which are associated with the consequences of a health condition. These include body function/structure impairments, activity limitations, and participation restrictions.1
FOR EXAMPLE, DAYS OFF WORK DUE TO DISABILITY, DISABILITY-FREE LIFE EXPECTANCY OF THE PRACTICE POPULATION.
The physical, mental and social well-being of individuals.1
FOR EXAMPLE, SELF-ESTEEM, SELF RATING OF HEALTH, INTERPERSONAL RELATIONSHIPS.
A range of age-specific, condition specific and gender-specific mortality rates.1
FOR EXAMPLE, SUICIDE RATES, AND MORTALITY RATES OF THE PRACTICE POPULATION.
Outputs are services conducted that reach targeted participants/populations e.g. counselling visits. Outputs, if effective, lead to outcomes such as behavioural change in people accessing these services.
Adapted from: http://www.uwex.edu/ces/pdande/evaluation/evallogicmodel.html
Clients' experience of the care or service they received, closely related to their personal expectations of the experience.7
FOR EXAMPLE, CLIENT SATISFACTION SURVEYS.
Impact on Society
Aspects of mental health that go beyond the impact on the patient.8
FOR EXAMPLE, EMPLOYMENT RATES FOR THE PRACTICE POPULATION, BURDEN OF CARE TO RELATIVES.
Characteristics of the settings where care is delivered. These are not direct measures of either health status, non-medical determinants of health, or health system performance.1
Characteristics of the location where care is delivered.18 FOR EXAMPLE, PRIVATE CONSULTATION ROOMS ARE AVAILABLE, LOCATION OF CLINIC IS RELEVANT TO THE NEEDS OF THE COMMUNITY POPULATION, COMPUTER AVAILABLE FOR STAFF.
Management of the health team providing care, or the clinician providing care.18
FOR EXAMPLE, POLICY IN PLACE FOR STAFF TRAINING AND EDUCATION, WORKLOAD OF STAFF IS MONITORED.
Characteristics of how the health team manages information.18
FOR EXAMPLE, ACCESS TO MEDICAL RECORDS IS RESTRICTED, ACCESS TO INTERNET FOR EVIDENCE-BASED INFORMATION.
Characteristics of financial planning and monitoring.18 FOR EXAMPLE, AVAILABILITY OF NECESSARY FUNDS TO MEET CLINIC NEEDS.
Quality and Safety
A system is in place to improve quality and ensure safety.18
FOR EXAMPLE, QUALITY OF CARE SURVEYS FOR CLINIC, MANAGEMENT PERSONNEL HAVE EXPERTISE IN QUALITY IMPROVEMENT TECHNIQUES.
Non-Medical Determinants of Health
Determinants of health outside the sphere of health care, that have been shown to affect health status, and in some cases, access to health care services. 1
FOR EXAMPLE, SOCIAL SUPPORT, LIVING CONDITIONS, PHYSICAL ACTIVITY LEVEL, STRESSFUL WORKING CONDITIONS, WORK-RELATED INJURIES, ENVIRONMENTAL FACTORS.
Aspects of personal behaviour and risk factors that influence health status.1
FOR EXAMPLE, TOBACCO USE, EXERCISE, SEAT BELT USE, SAFE SEX PRACTICES.
Living and Working Conditions
The socioeconomic characteristics and working conditions of the population that affect health.1
FOR EXAMPLE, LOW INCOME RATE OF THE PRACTICE POPULATION, HIGH SCHOOL GRADUATION FOR THE PRACTICE POPULATION.
Characteristics of personal life, such as social support, life stress and school readiness, related to health.
Environmental factors with the potential to influence human health.1
FOR EXAMPLE, WATER AND AIR POLLUTION, NUMBER OF SUN DAYS PER YEAR FOR THE LOCAL AREA.
Being informed about one's own health and health issues.
FOR EXAMPLE, KNOWLEDGE REGARDING HEALTH CONDITION AND EFFECTIVE TREATMENT.
Individuals get the care they need, without inappropriate bias based on their social status or other personal characteristics such as age, gender, ethnicity or place of residence.9
Individuals get the care they need, without inappropriate bias based on their social status or other personal characteristics such as age, gender, ethnicity or place of residence.
Special Area Domains
Mental Health or Addiction problems that may be a source of clinical attention e.g. Mood Disorders
Patients with Comorbid Conditions
A condition in which a person has both a major mental illness and another health problem (e.g., development disability, substance abuse, personality disorder, or other general medical conditions such as heart disease or cancer).
Patients with Chronic Conditions
Long-term conditions that limit what a person can do and require ongoing care.
Patients with Acute Conditions
This special area domain refers to those patients whose conditions require an immediate intervention, such as an emergency room visit.
Patients with Substance Abuse
A maladaptive pattern of substance use leading to clinically significant impairment or distress, and occurring within a 12 month period.10
Patients with Anxiety Disorders
Disorders characterized by an abnormal and overwhelming sense of apprehension and fear often marked by physiological signs (as sweating, tension, and increased pulse), resulting from doubt concerning the reality and nature of the threat, or one's capacity to cope with it (e.g., panic disorder, generalized anxiety disorder).11
Somatoform disorders are physical ailments (such as pain, nausea, dizziness) for which no adequate medical explanation has been found. The complaints are serious enough to cause significant emotional distress and impairment of social and/or occupational functioning.
Patients with Sleep Disorders
Disorders characterized by a disturbance of the normal sleep pattern, which causes health problems such as excessive sleepiness.12
Patients with Eating Disorders
Disorders connected to eating that include anorexia nervosa, where severe weight loss occurs, and bulimia nervosa which involves both fear of fatness with under and over eating.1
Patients with Personality Disorders
Disorder characterized by an enduring pattern of inner experience and behavior that is very different from the expectations of the individual's culture, is pervasive and inflexible, and has an onset in adolescence or early childhood.10
Patients with Mood Disorders
Any of several psychological disorders characterized by abnormal emotional states and including especially major depressive disorder and bipolar disorder. Also called affective disorder.
Patients with Psychosis
Psychosis refers to a serious mental disorder (such as schizophrenia) characterized by defective or lost contact with reality, often with hallucinations or delusions.
Patients with Impulse Control Disorders
Disorders characterized by the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others (e.g., gambling).
Persons 65 years of age and over.13
Patients with Reproductive Mental Health Disorders
Individuals who suffer from mental health conditions associated with pregnancy.
FOR EXAMPLE, POST-PARTUM DEPRESSION, PSYCHOSIS, MANAGEMENT OF EXISTING CONDITIONS DURING PREGNANCY.
Particular populations of individuals who may warrant special consideration due to unique needs
Ethnic / Cultural Minorities
Ethnic and cultural groups with difficulty accessing health services because of language barriers, different expectations about health care, diagnosis and treatment.
People Who Live in Rural Areas
Persons who live in non-urban areas or small towns.
People with a Family History of a Mental Health Condition
Family history factors that may determine predisposition to certain mental health conditions.1
Social Service Welfare Recipients
Persons receiving aid in the form of welfare payments.
Homeless or Itinerant
Persons having no home or permanent place of residence or who travel from place to place.14
Persons without paid or self-employment work.13
Persons who can trace their ancestry to a society whose traditional lands fell in the geographic area that is now Canada.13
Seniors in Facilities
Persons over the age of 65 who are residents of facilities, which provide daily nursing supervision and medical care.
Persons who have fled to a foreign country or power to escape danger or persecution.14
Persons born outside of Canada who have been granted the right to permanently live in Canada.13
Residents of Correctional Institutions
Persons who reside in federal or provincial penal institutions or correctional facilities.13
Inner City Residents
Residents of the, usually, older, poorer, and more densely populated central section of a city.14
Speakers of English as a Second Language
Persons who do not speak English as their first language.
Persons 65 years of age and over and conditions common in this population.13
Persons 20 to 64 years of age and conditions common in this population.
Young people 12 to 19 years of age and conditions common in this population.
Young people 0 to 11 years of age.
Young people 0 to 11 years of age and conditions common in this population
Gender Identities Other Than Men or Women
Therapeutic intervention that are commonly used for Mental Health or Addiction problems e.g. Psychotherapy
Prescription medicine that treats or prevents or alleviates the symptoms of disease.12
The treatment of mental or emotional problems using psychological techniques (e.g., cognitive behavioural therapy, or talking therapy).
Peer support is social/emotional support, frequently coupled with material support - e.g., financial resources or housing - that is mutually offered or provided by persons who have mental health and addiction problems to others who have similar concerns to bring about a desired social or personal change.
The concept of stopping or slowing the development of disease and promoting health through screening programs and lifestyle guidelines.15
Other Somatic Treatments
Therapeutic interventions (excluding medication) that involve direct physiologic effects on the human body e.g. light therapy, electroconvulsive therapy
Diagnosis and initiation of treatment at very early stages of the disease, when little or minimum intervention can bring therapeutic results (e.g., within the first two years of illness).
The process of enabling people to increase control over, and to improve their health (e.g., health literacy).16
Treatment that engages the patient's family in processes of care.
Treatment in the presence of a clinician and other patients.11
Treatment that emphasizes the patient’s central role in managing their health. It uses strategies that include assessment, goal-setting, action planning, problem-solving and follow-up; and organizes internal and community resources to provide ongoing self-management support to patients.17
The restoration of a person by therapeutic measures and re-education to participation in the activities of a normal life within the limitations of the person’s disorder or disability.
Physical Health Intervention
Treatment interventions to address common medical problems in people with mental health conditions (e.g., control of blood sugar level for diabetic patients).
Various types of practice configuration common to primary health care e.g. Solo practitioner practices, Community Health Centres
Collaboration between providers from primary health care and mental health disciplines who share the responsibility for the care an individual receives.
A hospital room or mobile crisis response unit equipped for the reception and treatment of persons requiring immediate medical care.
School-based Mental Health Services
Mental health services administered through a site at an educational facility.
Work-based Mental Health Services
Mental health services administered through a site at a workplace.
Primary health care service provided in non-clinical settings, usually to vulnerable populations (e.g., homebased care, shelter-based care, Assertive Community Treatment teams, street nurses).
Health care delivered by an individual clinician, offering services on a person-to-person basis, such as a family doctor, nurse, or nurse practitioner. 21
Group Family Practitioner
Health care delivered by a group of clinicians, offering services on a person-to-person basis, such as a group of nurse practitioners or a group of family doctors.
Community Health Care Centre
Health care delivered by a multidisciplinary team of providers and specialists, typically offering services to a geographic area or special population.
Walk in Clinics
A clinic providing medical services to patients without an appointment. 11
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