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1 – 10 of over 18000Andrew Healey, Alexandra Melaugh, Len Demetriou, Tracey Power, Nick Sevdalis, Megan Pritchard and Lucy Goulding
Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A…
Abstract
Purpose
Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A new service was developed to support people in primary care. “the authors evaluate” whether the phased introduction of the Lambeth Living Well Network (LWN) Hub to a population in south London led to: a reduction in the overall volume of patients referred from primary care for a secondary mental health care assessment; and an increase in the proportion of patients referred who met specialist service eligibility criteria, as indicated by the likelihood of being accepted in secondary care.
Design/methodology/approach
The evaluation applied a quasi-experimental interrupted time series design using electronic patient records data for a National Health Service (NHS) provider of secondary mental health services in south London.
Findings
Scale-up of the Hub to the whole of the population of Lambeth led to an average of 98 fewer secondary care assessments per month (95% CI −118 to −78) compared to an average of 203 assessments per month estimated in the absence of the Hub; and an absolute incremental increase in the probability of acceptance for specialist intervention of 0.20 (95% CI; 0.14 to 0.27) above an average probability of acceptance of 0.57 in the absence of the Hub.
Research limitations/implications
Mental health outcomes for people using the service and system wide-service impacts were not evaluated preventing a more holistic evaluation of the effectiveness and cost-effectiveness of the LWN Hub.
Practical implications
Providing general practitioners with access to service infrastructure designed to help people whose needs cannot be managed within specialist mental health services can prevent unnecessary referrals into secondary care assessment teams.
Social implications
Reducing unnecessary referrals through provision of a primary-care linked mental health service will reduce delay in access to professional support that can address specific mental-health related needs that could not be offered within the secondary care services and could prevent the escalation of problems.
Originality/value
The authors use NHS data to facilitate the novel application of a quasi-experimental methodology to deliver new evidence on whether an innovative primary care linked mental health service was effective in delivering on one of its key aims.
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Considers the changes which are being implemented in primary care, and the patterns which are now beginning to emerge. Examines the changing context within which practices now…
Abstract
Considers the changes which are being implemented in primary care, and the patterns which are now beginning to emerge. Examines the changing context within which practices now function (both political and managerial), and considers the power which GPs are beginning to exert, as well as the impact which they may have on the interface between primary and secondary care. Examines the systems being developed for assuring quality in general practice. Predicts an explosion in the need for appropriate information for management and for medical audit in UK primary care, because the context within which general practitioners (GPs) deliver primary care in the NHS is changing rapidly. It is only now becoming evident that this turbulence may well offer major new opportunities to GPs, as well as permanently altering the balance of power in the NHS between primary and secondary care.
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Saeideh Saeidi and Richard Wall
Severe mental illness affects a significant number of people and, if left untreated, leads to poor quality of life and disability. Many of the aspirations proposed for new models…
Abstract
Purpose
Severe mental illness affects a significant number of people and, if left untreated, leads to poor quality of life and disability. Many of the aspirations proposed for new models of care assert that better preventative services, closer integration between professionals, and increased access to cognitive behavioural therapy in primary care will bring substantial benefits and improved outcomes. The purpose of this paper is to explore the benefits of integrating mental health services into primary care, and improving collaboration between secondary services and primary care. There is a transition underway in healthcare whereby a focus on illness is being supplemented with, or refocused towards achieving better patient well-being. New approaches to service provision are being proposed that: focuses on more holistic outcomes; integrates services around the user; and employs innovative system techniques to incentivise professional and organisational collaboration. Such a transition must be inclusive of those with mental health needs managed in primary care and for those people with serious mental illness in secondary care.
Design/methodology/approach
This paper discusses the issues of professional collaboration and the need to provide mental healthcare in a continuous and coordinated manner and; how this may improve timely access to treatment, early diagnosis and intervention. Importantly, it is essential to consider the limitations and reality of recent integration initiatives, and to consider where the true benefit of better integrating mental health into a more collaborative system may lie.
Findings
Identifying and addressing issues of parity is likely to call for a new approach to service provision that: focuses on outcomes; co-designs services integrated around the user; and employs innovative contracting techniques to incentivise provider integration.
Practical implications
There is a transition underway in healthcare whereby a focus on illness is being supplemented with or refocused towards working towards wellness. Such a transition requires primary care mental health services to be provided in a continuous and coordinated manner in order to meet the health needs of people with serious mental illness.
Originality/value
It discusses the issues of professional collaboration and how this may improve timely access to treatment, early diagnosis and intervention. It is essential to consider the limitations and reality of recent integration initiatives, and to consider where the true benefit may lie.
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Mitch Blair, Mariana Miranda Autran Sampaio, Michael Rigby and Denise Alexander
The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be…
Abstract
The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be different from those directed at adults and considered how these models might be appraised. The project took the multiple and interrelated dimensions of primary care and simplified them into a conceptual framework for appraisal. A general description of the models in existence in all 30 countries of the EU and EEA countries, focusing on lead practitioner, financial and regulatory and service provision classifications, was created. We then used the WHO ‘building blocks’ for high-performing health systems as a starting point for identifying a good system for children. The building blocks encompass safe and good quality services from an educated and empowered workforce, providing good data systems, access to all necessary medical products, prevention and treatments, and a service that is adequately financed and well led. An extensive search of the literature failed to identify a suitable appraisal framework for MOCHA, because none of the frameworks focused on child primary care in its own right. This led the research team to devise an alternative conceptualisation, at the heart of which is the core theme of child centricity and ecology, and the need to focus on delivery to the child through the life course. The MOCHA model also focuses on the primary care team and the societal and environmental context of the primary care system.
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The paper seeks to show that the new General Medical Services (GMS) contract will provide opportunities for NHS staff to enhance their roles, so it is important that adequate…
Abstract
Purpose
The paper seeks to show that the new General Medical Services (GMS) contract will provide opportunities for NHS staff to enhance their roles, so it is important that adequate training assessment and quality control systems are set in place. This paper assesses the implications for NHS staff in primary care.
Design/methodology/approach
In this paper a review of policy documents was undertaken.
Findings
The paper finds that enhanced services set out in the new GMS contract may be provided by primary care organisations and healthcare professionals other than those located in general practitioner (GP) practices. As nurses and other healthcare professionals take on tasks previously conducted by GPs, so GPs will take on more consultant tasks previously confined to secondary care. Personal Medical Services (PMS) and GMS are converging in their contractual obligations and the opportunities offered to staff. As well as General Practitioners with Special Interests (GPwSIs), Practitioners with Special Interests (PwSIs) are important developments, which could promote recruitment and retention in the nursing and allied health professional workforce. Nurses and other healthcare professionals will be the main source of staffing for services shifted from secondary care.
Practical implications
The paper shows that it will be important to identify whether these professionals can substitute for GPs, the boundaries to that substitution, and whether recruitment and retention are enhanced. Training for GPwSIs and PwSIs will be introduced or expanded but also needs accreditation and validation.
Originality/value
The paper provides an overview of the implications of the new GMS contract for nurses and other NHS professionals.
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The purpose of this paper is to increase understanding of the status, vulnerability and needs of the health-care and nursing service customers’ (hereafter, care service…
Abstract
Purpose
The purpose of this paper is to increase understanding of the status, vulnerability and needs of the health-care and nursing service customers’ (hereafter, care service customers’) loved ones.
Design/methodology/approach
The position and vulnerabilities of secondary customers of care services are studied and examples provided by reviewing empirical research reported in the care service literature. A conceptual discussion is developed on the “customer” concept in an extended sense, beyond the focal customers. The “primary customer” and “secondary customer” concepts are employed to supplement the extant discussion on customer units and ecosystems.
Findings
Secondary customers are exposed to secondary vulnerability and their well-being is affected by the services provided primarily to their loved ones. The most recurring needs of secondary customers concern psychosocial support, communication and information and cultural sensitivity.
Practical implications
New perspectives on understanding the “customer” concept in an extended sense. This assists in supporting the customers’ dynamic activities and processes within the customer ecosystems. To address care service customers’ loved ones’ vulnerabilities and needs and to support their well-being, they should also be recognised as customers – “secondary customers” – with patients being the “primary customers”.
Social implications
The results are especially relevant when considering services’ influences on vulnerable customers’ ecosystems and on individuals within them. It is important to recognise that beyond a vulnerable customer, several secondary customers may be exposed to secondary vulnerability, needing support.
Originality/value
The paper is apparently the first to connect the constructs “primary” and “secondary customer” and customer vulnerability to the customer ecosystem discussion. Also, essential future research questions are provided.
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The purpose of this paper is to understand the different kinds of health‐promotion activities undertaken by Chinese individuals in managing their disability from multiple…
Abstract
Purpose
The purpose of this paper is to understand the different kinds of health‐promotion activities undertaken by Chinese individuals in managing their disability from multiple sclerosis (MS).
Design/methodology/approach
The theory of control behavior was used in this study to understand the different kinds of primary and secondary health‐coping strategies used by participants and their impact on intra‐ and inter‐personal empowerments. Using semi‐structured interviews, interpretive phenomenology was used to elicit and analyze attitudes and behaviors of Chinese participants' management of MS.
Findings
Unlike previous studies which only emphasized the tangible aspects of physical health, the current paper suggests the importance of viewing health benefits in a more holistic manner. It was clear from the Chinese participants that “disability” and “healthy” were not viewed as two separate concepts. Being healthy does not mean an absence of disease but as role functioning, energy and vitality, social relationships, and emotional well‐being. The exploratory paper also found that empowerment outcomes involved an interaction of both the inter‐ and intra‐personal components and, at the same time, were driven by primary and secondary control‐related preferences.
Research limitations/implications
Future research should include individuals with other disabilities and different demographic and socio‐cultural characteristics to confirm the generalizability of the findings uncovered here.
Practical implications
The impact of culture and contextual/situational variables on individual's choice of primary and secondary control strategies has important implications for developing health strategies across different ethnic minority groups.
Originality/value
The results provide support for the view that there are two dimensions to the process of patient empowerment. Rather than emphasizing primary control strategies, individuals can empower themselves by maintaining a balance between primary and secondary control strategies with respect to their health‐related goals.
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Luh Putu Febryana Larasanty, Maria Fiani Cahyadi, Ni Made Rai Sudarni and I Made Agus Gelgel Wirasuta
The purpose of this paper is to determine patient expectation and perception of pharmaceutical care services in order to measure the level of patient satisfaction provided by…
Abstract
Purpose
The purpose of this paper is to determine patient expectation and perception of pharmaceutical care services in order to measure the level of patient satisfaction provided by Indonesia’s health coverage (IHC) system.
Design/methodology/approach
A patient satisfaction survey was conducted at primary-level and secondary-level health facilities operating under IHC system. The assessment was performed using a closed-ended questionnaire that had been tested for validity and reliability. The patients’ point of view was evaluated based on their expectation and perception of six dimensions of the pharmaceutical care services they had received. Patient satisfaction was calculated based on the gap between their expectation and their perception.
Findings
A total of 602 patients participated in this research. The levels of the patients’ expectation of the pharmaceutical care services provided at primary-level health facilities range from high (3.39) to very high (3.54), whereas at secondary-level health facilities, the range was from low (2.04) to very high (3.75). This indicates that patients have a higher expectation of the provided pharmaceutical care services compared to the actual experience of the healthcare services that they received, resulting in a low value in the measurement of patient satisfaction levels.
Originality/value
The high level of patient expectation is an opportunity for pharmacists at both primary-level and secondary-level health facilities to continue developing pharmaceutical care services. Improving drug information service, patient counseling and reducing patient waiting time can be good ways to increase patient satisfaction within pharmaceutical care services.
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