Biomedical subjects

Phil McEvoy

Publications and source records attributed to Phil McEvoy.

4 recordsLinked to original sources

PubMed2006

Gatekeeping access to community mental health teams: a qualitative study.

BACKGROUND: Gatekeeping access to services at the interface with primary care has been identified as one of the key issues that community mental health teams (CMHTs) have to confront. OBJECTIVES: The aim of this study was to develop a better understanding of the contextual influences that impact upon the outcome of gatekeeping decisions. DESIGN: An interview-based qualitative study, informed by the philosophy of critical realism. SETTING: An urban catchment area in Northern England. PARTICIPANTS: Twenty-nine interviews were conducted with gatekeeping clinicians and service managers. METHOD: A convenience sample of clinicians was initially approached to take part in a series of semi-structured interviews. This was followed up by a purposive sample of clinicians and service managers, as specific contextual influences were identified and explored in detail. The emerging analysis was then subjected to critical scrutiny by a further sample of gatekeeping clinicians. FINDINGS: A clear hierarchy of appropriateness was identified with four dimensions: severity, risk, beneficence and a moral dimension. It was suggested that the salient contextual influences that shaped the hierarchy were: (a) the need to fit in with strategic planning directives, (b) the burden of responsibility that clinicians carried, (c) the high number of referrals and the relatively slow turnover of patients on clinical caseloads, (d) the position of CMHTs in the economy of care and (e) the character of the relationship between clinicians and service managers. CONCLUSION: The findings from the study support a multi-level view of the gatekeeping process within CMHTs, which takes account of the role that key contextual influences play in shaping the range of options that are available to gatekeeping clinicians.

Attitude of Health Personnel↗

PubMed2004

Using process mapping to improve nursing practice and patient care.

Process mapping is a technique that models the relationship between activities, people and resources. It is used to develop a better understanding of the patient's experience and to drive forward service modernization. This paper offers a brief guide to process mapping and examines the potential impact it may have on nursing services and patient care.

Humans↗

PubMed2003

Access and effectiveness in psychological therapies: self-help as a routine health technology.

The ability of psychological treatment services to deliver effective and accessible mental healthcare, as demanded by the National Service Framework for mental health, is compromised by the traditional configuration of psychological therapy services, powerful gatekeeping by these services and the difficulties which exist in engaging primary care in mental healthcare. Although a number of service models have been suggested, most address access from the perspective of secondary care service providers. In particular, self-help, a powerful ideology and a clinically effective health technology, is given insufficient prominence in psychological therapy services. Self-help is often only considered for mild problems or as an adjunct to therapy, and it is assumed that mental health professionals with traditional therapeutic skills are needed to support self-help. Following a review of access and self-help in psychological therapies, the present authors propose criteria against which services could be designed in order to fully utilise self-help as a powerful health technology in psychological therapies. Accompanying these criteria is a research framework drawn from recent work on access and illness self-management that can be used to evaluate the performance of services attempting to improve access to psychological therapies.

Adaptation, Psychological↗

PubMed2003

Critical realism: a way forward for evaluation research in nursing?

BACKGROUND: Critical realism is a relatively new philosophical perspective that combines a realist ontology with a relativist epistemology in subscribing to a form of "robust" relativism. The potential benefits of adopting a critical realist approach are considered in two areas of evaluation research: theory-driven programme evaluation and policy evaluation. AIM: The aim of the paper is to identify the main features of critical realism and explore its potential as a philosophical framework in the field of evaluation research. CONCLUSION: We argue that critical realism provides a coherent framework for evaluation research that is based on the understanding of causal mechanisms. This is particularly important for frontline services seeking to use evidence-based interventions, as interventions need to be properly understood if they are to be used effectively in the context of clinical practice. Critical realism can also add depth to policy analysis. However, there is a potential for critical realists to drift beyond the boundary that separates scientific knowledge from speculative theory when making recommendations about the best course of action to follow.

Evaluation Studies as Topic↗