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1.  Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study 
The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS).
The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal).
DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making.
DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.
PMCID: PMC3685525  PMID: 23768163
Health service research; Health system research; Healthcare terminology; Healthcare taxonom; Healthcare instrument
2.  A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems 
BMC Psychiatry  2009;9:55.
A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries.
We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components.
We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery.
We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation).
Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.
PMCID: PMC2753585  PMID: 19735562
3.  Bridging the breach in services for ageing people with disabilities in a country with challenging demographic prognoses 
The demography of Bulgaria is characterized by a steady trend for a negative natural growth and increase of the relative share of elderly people. This is a challenge to the health and the social systems. Social reports point out: a) unsatisfactory pensions, and b) impoverishment of the group of elderly persons above retirement age. In this context a greater number of people with disabilities will reach old age.
Even though in Bulgaria there are no functioning programs specifically targeted to the needs of ageing people with disabilities, programs exist that serve both the ‘normally ageing’ and adults with disabilities. Such is the ‘Social assistant’ service package comprising 50 basic main types of care (i.e. help with grooming, shopping) provided in clients’ homes by briefly trained, previously unemployed non-professionals. The program boasts a need-driven, individually tailored approach, and financial sustainability. Over the years social assistants have gone through different training modules, none so far targeted to assessment and treatment of problems that emerge with ageing.
Even within a social service system with scarce resources examples can be found of functioning and sustainable social services’ programs that could be easily adapted to the needs of an ageing disabled population.
To improve the focus and the efficacy of such programs we need: 1) research of social, health and psychological status of ‘normally’ ageing population compared to situation of ageing disabled people; 2) equity policy based on that research; 3) improving the knowledge of carers as to changes, concomitant with ageing.
PMCID: PMC2707534
national service system; demographic trends; equity

Results 1-3 (3)