Search results

Problem alcohol use (PAU) is common and associated with considerable adverse outcomes among patients receiving opioid agonist treatment (OAT). The purpose of this paper is to describe a qualitative feasibility assessment of a primary care-based complex intervention to promote screening and brief intervention for PAU, which also aims to examine acceptability and potential effectiveness.

Semi-structured interviews were conducted with 14 patients and eight general practitioners (GPs) who had been purposively sampled from practices that had participated in the feasibility study. The interviews were transcribed verbatim and analysed thematically.

Six key themes were identified. While all GPs found the intervention informative and feasible, most considered it challenging to incorporate into practice. Barriers included time constraints, and overlooking and underestimating PAU among this cohort of patients. However, the intervention was considered potentially deliverable and acceptable in practice. Patients reported that (in the absence of the intervention) their use of alcohol was rarely discussed with their GP, and were reticent to initiate conversations on their alcohol use for fear of having their methadone dose reduced.

Although a complex intervention to enhance alcohol screening and brief intervention among primary care patients attending for OAT is likely to be feasible and acceptable, time constraints and patients’ reticence to discuss alcohol as well as GPs underestimating patients’ alcohol problems is a barrier to consistent, regular and accurate screening by GPs. Future research by way of a definitive efficacy trial informed by the findings of this study and the Psychosocial INTerventions for Alcohol quantitative data is a priority.

To the best of the knowledge, this is the first qualitative study to examine the capability of primary care to address PAU among patients receiving OAT.

“Integrated care” (IC) is an approach to health and social care delivery that aims to prevent problems arising from fragmented care systems. The collective content of the IC literature, whilst valuable, has become extensive and wide-ranging to such a degree that knowing what is most important in IC is a challenge. This study aims to address this issue.

A scoping review was conducted using Arksey and O'Malley's framework to determine IC priority areas.

Twenty-one papers relevant to the research question were identified. These included studies from many geographical regions, encompassing several study designs and a range of populations and sample sizes. The findings identified four priority areas that should be considered when designing and implementing IC models: (1) communication, (2) coordination, collaboration and cooperation (CCC), (3) responsibility and accountability and (4) a population approach. Multiple elements were identified within these priorities, all of which are important to ensuring successful and sustained integration of care. These included education, efficiency, patient centredness, safety, trust and time.

The study's findings bring clarity and definition to what has become an increasingly extensive and wide-ranging body of work on the topic of IC. Future research should evaluate the implementation of these priorities in care settings.

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 purpose of this paper is to describe the development and process evaluation of an educational intervention, designed to help general practitioners (GPs) identify and manage problem alcohol use among problem drug users.

The educational session was developed as part of a complex intervention which was informed by the Medical Research Council framework for complex interventions. A Cochrane review and a modified Delphi-facilitated consensus process formed the theoretical phase of the development. The modelling phase involved qualitative interviews with professionals and patients. The training's learning outcomes included alcohol screening and delivery of brief psychosocial interventions and this was facilitated by demonstration of clinical guidelines, presentation, video, group discussion and/or role play.

Participants (n=17) from three general practices and local medical school participated in four workshops. They perceived the training as most helpful in improving their ability to perform alcohol screening. Most useful components of the session were the presentation, handout and group discussion with participants appreciating the opportunity to share their ideas with peers.

Training primary healthcare professionals in alcohol screening and brief psychosocial interventions among problem drug users appears feasible. Along with the educational workshops, the implementation strategies should utilise multi-level interventions to support these activities among GPs.

The field of Human Resource Management (HRM) has long recognized the importance of interpersonal influence for employee and organizational effectiveness. HRM research and practice have focused primarily on individuals’ characteristics and behaviors as a means to understand “who” is influential in organizations, with substantially less attention paid to social networks. To reinvigorate a focus on network structures to explain interpersonal influence, the authors present a comprehensive account of how network structures enable and constrain influence within organizations. The authors begin by describing how power and status, two key determinants of individual influence in organizations, operate through different mechanisms, and delineate a range of network positions that yield power, reflect status, and/or capture realized influence. Then, the authors extend initial structural views of influence beyond the positions of individuals to consider how network structures within and between groups – capturing group social capital and/or shared leadership – enable and constrain groups’ ability to influence group members, other groups, and the broader organizational system. The authors also discuss how HRM may leverage these insights to facilitate interpersonal influence in ways that support individual, group, and organizational effectiveness.

This chapter examines the conundrum of juvenile immigration law and policy and argues that it is a present-day manifestation of “child-saving” in rhetoric, disposition, and human capital harm. In support of this thesis, the chapter reviews the pertinent human rights, law, and social science evidence, and it concludes that the maintenance of the nation’s existing immigration policy only makes sense within the context of the intentions of the 19th century child-saving movement. To substantiate this view, the political-economic drivers of contemporary US immigration policy (i.e., its child-saving dynamics) are explored. The chapter concludes by speculatively addressing the character (i.e., the form and quality) of modern-day juvenile immigration policy as child-saving informed by the philosophy and criticism of Psychological Jurisprudence (PJ).

Grief and its concomitant loneliness are common problems in the social process of ageing. Using case study accounts, this paper describes the perceptions of four elderly bereaved people and their experiences of loneliness following conjugal bereavement. Case study accounts provide an opportunity to explore, describe and interpret data that may not yield to a simple analysis. In this paper the accounts include a collection of information on the respondents' experience of loss in the form of ‘durable biographies’ (Walter, 1996) that were typical, revelatory and critical. The respondents took part in semi‐structured interviews about their experiences as part of a larger ethnographic study. This paper reflects on their comments and raises a number of interesting theoretical and practical issues to do with loneliness following conjugal bereavement. The paper points out that bereavement research is dominated by psycho‐analytical conceptualisations which place emphasis on the ‘grief work’ hypoThesis, with less attention paid to bereavement models that highlight the social impact of loss on older people.

Presents the results of an international marketing research, in which they integrate culture with manifestation of values, trust, and commitment as vital components of business‐to‐business relationships. Analyses trust, relationship commitment, and values in the context of business relationships in two former Yugoslav markets, Serbia and Croatia. The results from a survey of over 400 large‐ and medium‐sized companies show that Serbian firms evaluate trust and relationship commitment as more important than Croatian companies. Differences in evaluations of values, trust, and commitment for business‐to‐business relationships are explained as outcomes of culture and market situations. These findings provide companies with action menus of potential advantages to pursue for maintaining and developing business relationships.

The urban environment is perceived through multiple senses in parallel, which means that visual understanding of space is aided and complemented by auditory, basic-orienting, and haptic stimuli – although mainly unconsciously. Sensory conditions are inherent attributes of urban places, but are often overlooked in research. To include these aspects in any way in analysis of the urban landscape, they need to be understood as properties of urban space, to be translated from attributes of the perceiver to attributes of the perceived. Using the relation between a designed garden and its suburban context in Bad Oeynhausen (DE) as an example, I will explore an alternative analytical methodology that takes the first-hand perspective view of the subject moving through the city as the starting point. The human body explores space by moving through it; walking is the most direct way to access, study, and research the physical qualities of the (urban) landscape, involving not only visual experience but also sound, rhythm, kinaesthesia, balance, and so forth. A notation technique that discloses the interrelation between visual qualities and their perception over time is the technique of ‘scoring’. Scores are symbolisations of processes, which extend over time. They can objectively represent non-visual qualities of space, communicating the relation between such processes and their spatial context to others in other places and other moments. These representations of movement expose the qualities of the surroundings that change as one moves through them, thus communicating the experiential aspects of urban landscape.