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Despite evidence that early identification of dementia is of growing policy and practice significance in the UK, limited work has been done on evaluating screening measures for use in primary care. The aim of this paper is to offer a clinically informed synthesis of research and practice‐based evidence on the utility, efficacy and quality of dementia screening measures. The study has three elements: a review of research literature; a small‐scale survey of measures employed in three primary care trusts; and a systematic clinical evaluation of the most commonly used screening instruments. The authors integrated data from research and clinical sources. The General Practitioner Assessment of Cognition (GPCOG), Memory Impairment Screen (MIS) and Mini‐Cognitive Assessment Instrument (Mini‐Cog) were found to be: brief; easy to administer; clinically acceptable; effective; minimally affected by education, gender, and ethnicity; and to have psychometric properties similar to the Mini Mental State Examination (MMSE). Although the MMSE is widely used in the UK, this project identifies the GPCOG, MIS and Mini‐Cog as more appropriate for routine use in primary care. A coherent review of evidence coupled with an in‐depth evaluation of screening instruments has the potential to enhance ability and commitment to early intervention in primary care and, as part of a wider educational strategy, improve the quality and consistency of dementia screening.

In the USA, integrated care remains largely aspirational; a majority of Americans receive mental health care entirely within the primary medical care outpatient setting. A new instrument, the Multidimensional Behavioral Health Screen (MBHS) ( McCord, 2020) was developed specifically to address this gap by systematically screening for a broad array of mental health issues in every patient, every visit. The goal of this current feasibility study was to evaluate the perceptions of the primary medical care providers regarding the usefulness and practicality of the MBHS, a necessary step toward broad-based implementation.

The MBHS was given to 101 consenting patients in a primary medical outpatient setting, each of whom was then seen by one of six participating primary care providers (PCPs). Providers completed a brief survey rating the ease of use, understandability, helpfulness and perceived accuracy of the MBHS after each patient visit and a final summary survey at the conclusion of the study.

Ratings were very positive overall, and the MBHS was clearly preferred to the traditional screening measures (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 [GAD-7]). Providers offered suggestions for improvement and particularly for implementation.

The small sample size (101 patients and 6 PCPs) and limited geographical reach may limit generalizability. Surveying providers using similar methodology should be done with larger numbers of providers and more diverse primary medical care settings.

This study provides evidence that the MBHS may be significantly effective in operationalizing the integrated care model in United States (US) healthcare systems.

The MBHS, a new behavioral health screening tool, was perceived by providers as useful in identifying mental health issues and guiding treatment decisions in the primary care setting.

This paper identifies a novel screening instrument that implements new and emerging models of psychological dysfunction in a practical way in primary medical care, making integrated care a reality rather than an aspiration.

The evidence suggests that the current delivery of primary care to people with a learning disability does not adequately meet their needs. In particular, individuals do not access adequate health promotion, are not having treatable illnesses identified and are not having more complex needs addressed. This review examines this evidence, highlights barriers to the effective delivery of health care and assesses these barriers, pilot projects and the few intervention studies published. Effective response to health needs will need a change in the working patterns of primary, secondary and social care providers. The contracting system and the move to locality‐based purchasing may be the ideal catalysts for these changes.

This paper aims to explore the perceptions of facilitators and barriers to their using electronic medical records (EMRs) for these functions and contributes baseline data about the use of EMRs for chronic disease management. The sub‐study reported here is a baseline process evaluation of EMRs and their current use, preliminary to a larger, pragmatic, randomized controlled trial. Its purpose is to understand how EMRs are currently being used by primary care physicians to facilitate chronic disease prevention and screening in their practices.

This is a qualitative case study where the lead physician at each of eight primary care clinics (four in Alberta, four in Ontario) participated in semi‐structured interviews. Data were analyzed using thematic content analysis.

Although EMRs are being used in a limited fashion for chronic disease prevention and screening, clinicians identified few current benefits. Participants noted some instances in which paper charts were preferred and that the lack of human and financial resources is inhibiting the use of chronic disease applications already incorporated in EMRs.

To understand fully how EMRs can best be used in the logistical management of chronic disease prevention and screening requires research efforts towards improvement of the data structures they contain.

Data extraction needs to be easier so that screening of patients, at risk or living with chronic disease, can be facilitated.

Evaluation of the benefits, for the content of care and care relationships, conferred by this new method of communicating, needs to be complemented by a parallel exploration of the risks.

The paper illustrates that with the tremendous investments in EMRs it is important to learn how changes in their design could facilitate improvements in patient care in this important area.

This chapter discusses challenges faced by older adult health-care consumers in obtaining access to responsive care from physicians relevant to a broad spectrum of health issues ranging from prevention to chronic illness and end-of-life care. Based on our prior research with community-dwelling elders (E. Kahana & B. Kahana, 2003, 2010), we propose a conceptual model of consumer self-advocacy for better access to effective health care in late life. We argue that older adults who are well informed and confident health-care partners and who involve their physicians in active dialogue will experience better care, and will be more satisfied with their health care. We present findings from our studies of cancer prevention and from our research focused on end-of-life care relevant to patient self-advocacy. We also discuss the role of educational interventions and of patient empowerment in facilitating greater access to responsive health communication and health care, particularly among elders who are disadvantaged and who have low health literacy.

This study aims to systematically evaluate the impact and effectiveness of two early intervention services in NW Kent.

Data were gathered via evaluation questionnaires for both projects; these included quantitative post-intervention data and qualitative comments. Data on referrals to secondary care and a specialist third sector organisation were also collected for the primary care project.

Findings from the primary care project indicate that targeting a specific age cohort of patients can be effective in terms of: early identification of dementia-related concerns, the provision of support, appropriate referrals to secondary care, and increased referrals to a third sector dementia service. At the end of the project most practitioners felt they were better informed about dementia, more committed to facilitating early diagnosis, and had gained confidence in using a screening tool (the General Practitioner Assessment of Cognition Test). Evidence from evaluating the Carers Group suggests that attendance helped members manage emotional difficulties, increased understanding of dementia, and enhanced coping skills. They also felt less isolated and knew how to access support services.

The projects offer two models of intervention: how a proactive third sector agency can work with primary care professionals to enhance commitment to dementia case finding and the provision of group support to relatives of those in receipt of a recent dementia diagnosis.

The study provides insights into early intervention in dementia care how to evaluate impact of effectiveness.

Primary care cancer lead clinicians (PCCLs) act strategically in primary care trusts (PCTs) in England to improve communication and understanding of cancer across primary and secondary care and provide a link between Cancer Networks and primary care. The aim is to evaluate the first three years of the initiative.

A postal questionnaire was sent to all PCT chief executives in all PCTs in England and some were passed on to other PCT managers for completion. The response rate was 61 per cent. PCT directors of public health were the largest group of respondents (29 per cent). Most (74 per cent) PCCLs were GPs and 22 per cent were nurses.

PCCLs were most likely to focus on palliative care and preventive services. Key achievements were identified as raising awareness of cancer, developing relationships and promoting primary care. The personal skills of the PCCLs were important as was support of colleagues at all levels. Lack of time was a major barrier to achievement, as was a lack of understanding of the role from others. Links with the Cancer Networks were being developed. About 85 per cent of managers wanted the role to continue.

The paper illustrates that PCCLs are at the forefront of improving cancer services in primary care. They are particularly important in view of the priority of reducing premature deaths and promotion of healthy lifestyles.

In recent years, Screening and Brief Intervention (SBI) has become increasingly available to older adults who engage in at-risk drinking behaviors. The results of SBI training sessions that targeted hospital-based healthcare providers, as well as mental health service providers in community-based clinics, are reported. The paper aims to discuss these issues.

In total, 93 participants attended SBI active learning training sessions. The responses of physicians/physicians in training about their intentions to apply the information in professional practice and their willingness to recommend the training to others in their profession were compared to practitioners in other professions.

Although there were no differences in terms of commitment to apply the information or level of comfort using the techniques, physicians/physicians in training were less interested in promoting the SBI training among their colleagues.

The results are limited with respect to the number of training participants engaged and the geography entailed, yet implications for addressing barriers to widespread implementation and training challenges are explored.

Although it may be more difficult to promote SBI training in locations that do not primarily provide mental health services, hospitals, and other primary care settings are precisely where training may be most useful.

The importance of training approaches to SBI that are disseminated within the context of a public health model of clinical preventive services is highlighted.

Original research is presented to highlight the need to improve training receptivity and facilitate the translation into practice.

The study assesses public health programs to shed light on the experiences of low-income and minority women with children seeking health services. Thirteen focus groups were conducted with 111 pregnant women or women with children. Women consumers of public health services experience difficulties accessing health services due to a lack of insurance, information and language barriers about programs and eligibility, a shortage of Medicaid providers and specialist services, long waits, bureaucratic barriers, and dismissive treatment. Accessibility and information barriers were more prominent in rural regions whereas bureaucratic barriers were more pronounced in urban areas. Lower satisfaction with services was reported among ethnic minority women compared to whites.

This paper's aim is to provide an overview of how to respond to alcohol use/abuse and intimate partner violence for men and women attending primary care.

The paper describes the role of family practitioners in identifying patients in primary care who have dual problems of substance use and intimate partner violence.

Primary care is a potential site of early intervention using brief counselling techniques for male perpetrators and female victims of intimate partner violence who also have hazardous or harmful drinking.

Practitioners should be aware of the overlap between these two social public health problems and how to respond.

Practitioners often do not identify the hidden issue of intimate partner violence.