Biomedical subjects

Penny Lenihan

Publications and source records attributed to Penny Lenihan.

7 recordsLinked to original sources

PubMed2006

Is the promotion of physical activity in vulnerable older people feasible and effective in general practice?

There is convincing evidence about the benefits of exercise training in community dwelling frailer older people, but little evidence that this intervention can be delivered in general practice. In this prospective cohort study in 14 general practices in north London we assessed the feasibility and effectiveness of a tailored exercise referral programme for frail elderly patients delivered within a variety of inner city primary care settings. One hundred and twenty-six women and 32 men aged 75 years and older, deemed borderline frail by their GPs, took part in a two-phase progressive exercise programme (Stage 1--primary care setting; Stage II--leisure/community centre setting) using the Timed Up And Go (TUG) test as the primary outcome measure. Baseline TUG measures confirmed that the participants were borderline frail and that GP selection was accurate. Of those referred by their GP or practice nurse 89% took up the exercise programme; 73% completed Stage I and 63% made the transition to the community Stage II programme. TUG improved in Stage I with a mean difference of 3.5 seconds (P<0.001). An individually tailored progressive exercise programme following GP referral, delivered in weekly group sessions by specialist exercise instructors within general practices, was effective in achieving participation in exercise sessions and in improving TUG values in a significant number of frailer older citizens.

Age Factors↗

PubMed2005

The feasibility and acceptability of a specialist health and social care team for the promotion of health and independence in 'at risk' older adults.

Population ageing, escalating costs in pensions, health-care and long-term care have prompted a new policy agenda for active ageing and quality of life in old age across the European Union and other developed countries. In England, the National Service Framework for Older People (NSF OP) explicitly demands for the first time that the NHS and local authorities, in partnership, agree programmes to promote health ageing and to prevent disease in older people. These programmes are expected to improve access for older people to mainstream health promotion services and also to develop multiagency initiatives to promote health, independence and well-being in old age. This paper describes the evaluation of one interagency project team established to test out mechanisms for addressing health promotion for older people through primary care. A mixed methodology was used to understand the processes of service development, the impact of the team's intervention, and the primary and secondary outcomes for older people. The project demonstrated that multi-agency partnerships have the potential to improve the quality of the lives of older people deemed 'at risk' by their general practitioners, particularly through income generation but also in the identification of medical problems such as unrecognised hypertension, hearing loss and visual loss. It also offered some key learning points for other multi-agency groups developing similar services.

Activities of Daily Living↗

PubMed2004

The development of a short instrument to identify common unmet needs in older people in general practice.

BACKGROUND: No structured needs assessment tool exists that is appropriate for older people and also suitable for use in routine consultations in general practice. AIMS: To engage older people in the development of a brief, valid, practical, and acceptable instrument to help identify common unmet needs suitable for use in routine clinical practice in primary care. DESIGN OF STUDY: User involvement in a multi-stages approach to heuristic development. SETTING: General practices, voluntary groups, and community organisations in north and central London. METHOD: Subjects included patients aged 65 years and over in purposively selected practices, voluntary organisations for older people in the same localities, community organisations involving older people, general practitioners and community nurses. Data were collected through mixed methodology interviews using a structured assessment tool (Camberwell Assessment of Need for the Elderly), a postal questionnaire, and focus groups. Synthesis and interpretation of results was done through a consensus conference followed by a Delphi process involving primary care professionals. RESULTS: Five domains of unmet need were identified as priority areas by all three data collection methods, the consensus conference, and the Delphi process: senses (vision and hearing), physical ability (mobility and falls), incontinence, cognition, and emotional distress (depression and anxiety) (SPICE). CONCLUSIONS: Public involvement in the design of clinical tools allowed the development of a brief assessment instrument that could potentially identify common, important, and tractable unmet needs in older people.

Aged↗

PubMed2003

Older people's services. A picture of health.

A scheme offering joint health and social care assessments to people aged over 75 in inner London identified more than a quarter in need of services. The older people were accessed via general practice, but this proved an inefficient way of identifying the target population. In some practices, almost half of those contacted were no longer at the same address. The assessments, conducted by a community nurse and social welfare officer, often involved two visits. The mobility of the elderly population needs to be taken into account when planning joint assessments. Organisations involved had different aspirations for the scheme and management proved problematic.

Activities of Daily Living↗

PubMed2003

Proactive, targeted benefits advice for older people in general practice: a feasibility study.

The aim of the present project was to assess a welfare benefits and advice screening programme offered in a systematic and inclusive way to all patients aged 80 years and over registered with a single general practice. The setting was an inner-city National Health Service group practice with a total of seven full-time general practitioners (GPs) and a list size of 12 000 patients. A total of 280 patients were identified as aged 80 years and over. Using a combination of telephone calls, surgery attendances and home visits, an advice worker contacted as many of these patients as possible. A wide range of advice and assistance of both a statutory and non-statutory nature was offered. Follow-up contacts and liaison with the patients' own GPs were arranged as necessary. Contact was made with a total of 206 patients. In total, the adviser made 98 home visits and carried out 82 consultations in the surgery, as well as undertaking 109 interviews over the phone. The findings indicate that an overall total of pound 137 819 was gained in increased annual income amongst the screened patients; in addition, a further pound 11 433 was awarded in one-off payments. A wide range of other benefits and help, including referral to other services and organisations, was gained. Elderly patients within the practice were under-claiming benefits and had many previously unidentified needs. Adopting a proactive and inclusive approach to offering welfare and advice takes time and expense, but the resulting benefits make it worthwhile. Primary care is an effective base from which advice can be delivered and the development of closer working relationships between primary care and advice services can be an effective and efficient way of helping patients.

Aged↗

PubMed2003

Integrating primary care and public health: learning from the community-oriented primary care model.

Community-oriented primary care (COPC), a 50-year-old widely applied innovative approach to primary care development, seems to be the same combination of public health and general practice perspectives currently sought in the formation of primary care trusts in Britain's NHS. The article reviews the experience of implementing COPC methods, the outcomes, and the applicability to and implications for primary care policy, taking the current British reforms as an example. The COPC model has been developed mainly in underserved populations to integrate public health objectives and primary care through interdisciplinary approaches, with active involvement of the target population. COPC methods are time consuming, can create problems with professional boundaries, and are vulnerable to socioeconomic changes. They can also deliver complex packages of care for target populations, particularly in poor areas underserved by traditional medical services. British primary care reforms may be seen as an unplanned, uncontrolled, nationwide experiment in applying COPC methods. They differ from COPC as applied elsewhere because change has been introduced from above rather than below, into a well-developed primary care system rather than underserved communities. International experience suggests the need for attention to factors promoting and impeding success and to reliable outcome measures. If this experiment succeeds, COPC methodology may facilitate similar changes in other health care systems.

Community Health Services↗

PubMed2002

Applying community-oriented primary care methods in British general practice: a case study.

BACKGROUND: The '75 and over' assessments built into the 1990 contract for general practice have failed to enthuse primary care teams or make a significant impact on the health of older people. Alternative methods for improving the health of older people living at home are being sought. AIM: To test the feasibility of applying community-oriented primary care methodology to a relatively deprived sub-population of older people in a relatively deprived area. DESIGN OF STUDY: A combination of developmental and triangulation approaches to data analysis. SETTING: Four general practices in an inner London borough. METHOD: A community-oriented primary care approach was used to initiate innovative care for older people, supported financially by the health authority and practically by primary care academics. RESULTS: All four practices identified problems needing attention in the older population, developed different projects focused on particular needs among older people, and tested them in practice. Patient and public involvement were central to the design and implementation processes in only one practice. Innovations were sustained in only one practice, but some were adopted by a primary care group and others extended to a wider group of practices by the health authority. CONCLUSION: A modified community-oriented primary care approach can be used in British general practice, and changes can be promoted that are perceived as valuable by planning bodies. However, this methodology may have more impact at primary care trust level than at practice level.

Aged↗