Search results

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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”.

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.

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.

Throughout the world, healthcare policy has committed to delivering integrated models of care. The interface between primary–secondary care has been identified as a particularly challenging area in this regard. To that end, this study aimed to examine the issue of integrated care from general practitioners’ (GPs) perspectives in Ireland.

This multimethod study involved a cross-sectional survey and semi-structured interviews with GPs in the Ireland East region. A total of 1,274 GPs were identified from publicly available data as practising in the region, of whom the study team were able to identify 430 GPs with email addresses. An email invite was sent to 430 potential participants asking them to complete a 34-item online questionnaire and, for those who were willing, an in-depth interview was conducted with a member of the study team.

In total, 116 GPs completed the survey. Most GPs felt that enhancing integration between primary and secondary care in Ireland was a priority (n = 109, 93.9%). Five themes concerning the state of integrated care and initiatives to improve matters were identified from semi-structured interviews with 12 GPs.

The uniqueness of this study is that it uses a multimethod approach to provide insight into current GP views on the state of integrated care in Ireland, as well as their perspectives on how to improve integration within the Irish healthcare system.

In many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of disease. The interface between primary and secondary care has been identified as a problem area. This paper aims to undertake a scoping review to gain a deeper understanding of the markers of integration across the primary–secondary interface.

A search was conducted of PubMed, SCOPUS, Cochrane Library and the grey literature for papers published in English using the framework described by Arksey and O'Malley. The search process was guided by the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA).

The initial database search identified 112 articles, which were screened by title and abstract. A total of 26 articles were selected for full-text review, after which nine articles were excluded as they were not relevant to the research question or the full text was not available. In total, 17 studies were included in the review. A range of study designs were identified including a systematic review (n = 3), mixed methods study (n = 5), qualitative (n = 6) and quantitative (n = 3). The included studies documented integration across the primary–secondary interface; integration measurement and factors affecting care coordination.

Many studies examine individual aspects of integration. However, this study is unique as it provides a comprehensive overview of the many perspectives and methodological approaches involved with evaluating integration within the primary–secondary care interface and primary care itself. Further research is required to establish valid reliable tools for measurement and implementation.

The Consultation and Relational Empathy (CARE) Measure is a validated tool for assessing the patients' perception of the doctors' communication in primary care. The present study aims to evaluate the potential usefulness of the CARE Measure in secondary care in a single Hospital Trust in Scotland.

A total of 1,015 out‐patients attending 25 consultants across ten specialities anonymously completed the questionnaire immediately after their appointment. Overall satisfaction, estimated consultation length, satisfaction with consultation length, and demographic and socio‐economic variables were also recorded.

The number of missing values and “not applicable” responses to the ten CARE Measure items was extremely low (3.4 per cent). Almost 90 per cent of patients felt the CARE Measure items were of major importance. The measure had a high internal reliability (Cronbach's alpha 0.94) and reduced to a single factor. Overall CARE Measure score correlated with overall satisfaction (r=0.7, p<0.0001), whether patients would recommend the doctor (r=0.6, p<0.0001), and satisfaction with consultation length (r=0.6, p<0.0001). Multi‐regression analysis showed that personal continuity of care, consultation length, and patient age positively influenced CARE Measure score, but the effect size was small. Patients' gender, marital status, general health, and socio‐economic factors did not influence scores. Reliability analysis indicated that 40 patients were required per doctor in order to achieve an overall reliability co‐efficient of above 0.7.

Secondary care patients across a range of specialities have endorsed the CARE Measure as a relevant tool. It has high face and concurrent validity, internal and structural reliability and is not subject to major influences by demographic or socio‐economic factors. These findings support the feasibility and reliability of the CARE Measure in secondary care.

This pilot study indicates that the CARE Measure is considered by most patients to be of high relevance to everyday out‐patient consultations in secondary care.

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.

Integrated care models have shown to deliver efficient healthcare, but implementation has proven to be difficult. The Support Consultation is an integrated care model, which enables full integration by bundled payment, insurer involvement, predefined care pathways and strengthening of primary care. The purpose of this paper is to provide an indication of the improvements in healthcare delivery after implementation of this proposed model and to create a base for extension to similar interfaces between primary and secondary care.

A retrospective study was used to compare the effect on the number of referred patients with non-acute cardiac complaints and the cost effectiveness before and after implementation of the Support Consultation. Patients who previously would have been referred to the cardiologist were now discussed between general practitioner and cardiologist in a primary care setting.

The first consecutive 100 patients (age 55±16 years, male 48 percent), discussed in the Support Consultation, were analyzed. Implementation of the Support Consultation resulted in a net costs (program costs and referral costs) reduction of 61 percent compared with usual care. All involved parties were positive about the program.

The Support Consultation has the ability to provide more effective healthcare delivery and to reduce net costs. The setting of the current study can be used as example for other specialties in countries with a similar healthcare system.

This study provides the potential cost savings after implementation of an integrated care model, based on real-life data.

This paper identifies the challenges of interpreting and implementing appropriate eligibility criteria and assessment processes in adult mental health services, with reference to an inner‐city Trust's own protocols. Central guidance, local interpretation and professional judgment are all legitimate contributions, but also confound both the concept and processes of entry to service.

The Medical Director of an NHS Hospital Trust in the Midlands gives a personal account of his thinking about integrated care and its importance in the immediate future. He underlines that integrated care requires a shift in behaviour, culture and attitudes, and outlines helpful approaches which can stimulate and support this. He illustrates the way change has been approached in local services, with particular emphasis on supporting self‐care and on primary care/secondary care partnership (or vertical integration).

There is an increasing emphasis on strengthening links between the primary and specialist services in order to provide more effective care for patients. The aim of this paper is to focus on a study to engage frontline, secondary care clinicians in a process of reflection on the role of link workers and to identify their view of priorities.

The paper adopts a mixed method study involving focus groups (qualitative method with deductive approach) followed by a survey (quantitative method with an interpretative approach).

The essential role of link workers in managing clinical throughput/flow and improving communication with general practitioners is highlighted. In contrast, crisis intervention and relapse prevention were identified to be of least importance, probably indicating the role of crisis teams and community teams in fulfilling these functions, respectively.

It has become apparent through this evaluation that there may be a need to strike a balance between the emphasis upon greater integration of this role with community mental health teams and closer collaboration with general practitioners.

The study is part of a service evaluation undertaken with a view to evaluating the role of link workers.