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PubMed2002

Attitudes to the public release of comparative information on the quality of general practice care: qualitative study.

OBJECTIVES: To examine the attitudes of service users, general practitioners, and clinical governance leads based in primary care trusts to the public dissemination of comparative reports on quality of care in general practice, to guide the policy and practice of public disclosure of information in primary care. DESIGN: Qualitative focus group study using mock quality report cards as prompts for discussion. SETTING: 12 focus groups held in an urban area in north west England and a semirural area in the south of England. PARTICIPANTS: 35 service users, 24 general practitioners, and 18 clinical governance leads. RESULTS: There was general support for the principle of publishing comparative information, but all three stakeholder groups expressed concerns about the practical implications. Attitudes were strongly influenced by experience of comparative reports from other sectors-for example, school league tables. Service users distrusted what they saw as the political motivation driving the initiative, expressed a desire to "protect" their practices from political and managerial interference, and were uneasy about practices being encouraged to compete against each other. General practitioners focused on the unfairness of drawing comparisons from current data and the risks of "gaming" the results. Clinical governance leads thought that public disclosure would damage their developmental approach to implementing clinical governance. The initial negative response to the quality reports seemed to diminish on reflection. CONCLUSIONS: Despite support for the principle of greater openness, the planned publication of information about quality of care in general practice is likely to face considerable opposition, not only from professional groups but also from the public. A greater understanding of the practical implications of public reporting is required before the potential benefits can be realised.

Access to Information↗

PubMed1995

The relationship between social factors and frequent use of psychiatric services.

The purpose of the study was to develop a comprehensive demographic, diagnostic and social profile of patients who are heavy service users of hospital and community based services within the South Australian Mental Health Services (SAMHS). This paper concentrates on the relationship of social issues to heavy service use. The 50 heaviest users of public adult acute psychiatric services in a defined catchment area of Adelaide were identified. Data were obtained retrospectively from the case notes over a 3 year study period. All patients' primary therapists were interviewed, as were 35 of the patients. These structured interviews included a variety of psychosocial rating scales investigating disability and social networks. The 50 patients studied were found to be seriously disabled by chronic psychiatric illness, with substance abuse often complicating their management and their ability to live successfully in the community. The study confirms the emergence in the literature of a valid global profile of the heavy service user patient, and indicates that social factors are strongly related to heavy service use.

Activities of Daily Living↗

PubMed2002

[Structural analysis of users' needs from a community pharmacy related to home care in a suburban area].

OBJECTIVES: To clarify the needs of home care service users needs from a community pharmacy and the functions related to home care in a suburban area. METHODS: A questionnaire on pharmacy services and functions was submitted to 472 home care service users in a suburban area. Gender, age, family status, presence of carers, health condition, home care services being used, prescription and pharmacy utilization status, presence of family pharmacy, and recognition of the need for drug management guidance by home visiting pharmacists were surveyed as well as the users' needs from a community pharmacy and its functions. Using these results, principal component analysis was performed. RESULTS: It was found that the users had a great need for the following services and functions: adequate medication instruction, listening attentively to users, and a good attitude from pharmacists and clerks. Meanwhile, the users' need for home care related services was relatively low, i.e. counseling about home care and welfare services, provision of a home visiting service, and provision of home care supplies. Also, principal component analysis indicated that users' needs consisted of five components, viz, medical services, material supply, convenience, readiness of service provision, and consideration of privacy. Regarding home care related services, counseling about home care and welfare services was related to the medical services; provision of home care supplies was related to the material supply; provision of a home visiting service was related to convenience. CONCLUSIONS: It was shown that users did not clearly recognize a service need for home care services as a new function of community pharmacies. Rather, users recognized the need for home care services connected to these already provided by community pharmacies. Therefore, information provision and education are necessary so that users can clearly understand the details and merits of the home care services which community pharmacies provide.

Aged↗

PubMed2006

Nurses' in the multi-professional pain team: a study of attitudes, beliefs and treatment endorsements.

BACKGROUND AND AIM: It is widely accepted that chronic pain is best treated by a multidisciplinary team. Team approaches are best facilitated if all members understand their own and each others role. Roles and responsibilities have inherent values and beliefs which need to be understood if the team is going to function optimally. Little is known about the attitudes and beliefs of the pain team or the individual professionals within it. All members of the pain team therefore need to critically examine the values and beliefs they bring to these teams. The aim of this study was to start this process for nurses. This was done uniquely by: finding out what components of pain management nurses endorse as important; investigating their beliefs about pain management; and exploring whether nurses' beliefs differ in relation to other service providers. METHOD: Data from 103 nurses was extracted from a wider research study of the congruence between what service providers and service users believe to be important treatments for chronic pain. Nurses were surveyed regarding their opinions about which specific treatments or treatment components they would endorse for people with chronic pain. Skevington's Beliefs About Pain Control Questionnaire (BPCQ) was also included. This measured beliefs in three crucial areas; the internal or personal control of pain, beliefs that powerful others (doctors) control pain and beliefs that pain is controlled by chance events. Statistical comparisons were made between nurses who endorsed particular treatments and their belief pattern. Differences between nurses and other professionals and service users were explored. RESULTS: The study showed that nurses were high treatment endorsers. There was universal agreement to the importance of 'The nurse', 'The multidisciplinary team', 'relaxation', and 'psychological assessment' for chronic pain management'. Nurses' endorsement patterns were different to the other professionals, because they endorsed more treatments. BPCQ scores were consistently lower than the other professionals and the service users. CONCLUSIONS: The findings of this study are congruent with emerging literature highlighting the complexity of health care. The high endorsement patterns seen in this study could be taken as support that nurses are, either tacitly or overtly, aware of this need to approach pain management in an open-minded and flexible manner.

Adult↗

PubMed1999

Purchasing a quick fix from private pharmacies in the Gaza Strip.

Increasingly, it is recognised by health planners and social scientists that self medication with drugs bought over the counter in private pharmacies is extremely widespread. Some anthropologists see this trend as an aspect of the 'commodification of health'. In this study, group interviews with health service users and providers in Gaza revealed many health service users reporting an inadequate supply of drugs resulting in the purchasing of drugs in private pharmacies. As a result, a survey of the pattern of utilization of three private pharmacies in three contrasting urban areas within the Gaza Strip was undertaken. Using a questionnaire, data were collected from all customers buying drugs. The results show that variations in the patterns of health seeking behaviour were associated with socioeconomic status. Adult males were the most frequent customers of all three pharmacies. They were buying medicines for members of their nuclear family more often than for themselves. Overall, pain and influenza were the most commonly reported conditions. The drugs purchased most frequently for women were for reproductive health problems, particularly infertility. Customers of the pharmacy in the relatively prosperous area more commonly purchased drugs which were prescribed by a private doctor.

Adult↗

PubMed2003

[Questionnaire survey of the actual working conditions of care-managers].

In order to clarify the present status of care-managers, a questionnaire was sent to 1,714 care-managers working in Kanagawa Prefecture in June 2002. The aspects investigated included their background, amount of care-management and degree of achievement, conditions of employment, opinion poll and training system. The response rate was 45.6% (782 out of 1,714). Concerning the total number of users in care at present, 37% of care-managers had less than 30 people, 24% from 31 to 50 and, surprisingly, 39% had more than 51 people. However, 42% answered that less than 30 was an appropriate number of users, 52% said 31 to 50 and only 6% answered that more than 51 people was an appropriate number. The conferences of users service representative were held only 8%. Concerning the burden of care-management, 87% of them answered the evaluation of every month and 86% did the conferences of users service representative. The cases requiring much time for the support, had problems not only the users but also in the household, who lacked the understanding and judgment for long-term care insurance. Most care-managers needed information on the available services and newly open care-service institutions. 27% of care-managers satisfied their care-management, 25% dissatisfied and the remainder were neither off nor on. The satisfaction to the care-management correlated well with the intelligibility of the management leader, motivation regarding care management and the degree of satisfaction with their income. It is concluded that the number of users per care-manager is too large, and that unfortunately it might further increase in the future. The conferences of users service representative were extremely held too low. It is also showed that information of the other service office and informal service with the exception of long-term care insurance are required.

Aged↗

PubMed2003

[Questionnaire survey of the actual working conditions of care-managers].

In order to clarify the present status of care-managers, a questionnaire was sent to 1,714 care-managers working in Kanagawa Prefecture in June 2002. The aspects Investigated included their background, amount of care-management and degree of achievement, conditions of employment, opinion poll and training system. The response rate was 45.6% (782 out of 1,714). Concerning the total number of users in care at present, 37% of care-managers had less than 30 people, 24% from 31 to 50 and, surprisingly, 39% had more than 51 people. However, 42% answered that less than 30 was an appropriate number of users, 52% said 31 to 50 and only 6% answered that more than 51 people was an appropriate number. The conferences of users service representative were held only 8%. Concerning the burden of care-management, 87% of them answered the evaluation of every month and 86% did the conferences of users service representative. The cases requiring much time for the support, had problems not only the users but also in the household, who lacked the understanding and judgment for long-term care insurance. Most care-managers needed information on the available services and newly open care-service institutions. 27% of care-managers satisfied their care-management, 25% dissatisfied and the remainder were neither off nor on. The satisfaction to the care-management correlated well with the intelligibility of the management leader, motivation regarding care-management and the degree of satisfaction with their income. It is concluded that the number of users per care-manager is too large, and that unfortunately it might further increase in the future. The conferences of users service representative were extremely held too low. It is also showed that information of the other service office and informal service with the exception of long-term care insurance are required.

Caregivers↗

PubMed1993

Mental health services--the user's view.

The needs of people with serious mental illnesses have dominated much of the debate on reforming community care. In this article Peter Campbell, who has used mental health services many times in the past, explains how the reforms could affect people like him. He welcomes the thinking behind the changes, particularly the idea that people who use community care should take part in planning services, but he warns that implementing the new philosophy might prove very difficult. Mr Campbell is secretary of a voluntary organisation for users of mental health services called Survivors Speak Out. The views he expresses here are his own, and do not necessarily reflect those of Survivors Speak Out.

Community Mental Health Services↗

PubMed1998

User perspective on needs and satisfaction with mental health services. PRiSM Psychosis Study. 8.

BACKGROUND: Measurement of the impact of different types of service provision on the views of service users is important in planning mental health services. METHOD: Needs (met and unmet) and satisfaction with services, were assessed. People with psychosis (n = 131) were interviewed before (Time 1) and after (Time 2) the introduction of two community mental health services in south London. One was intensive, with two specialist teams, the other standard. Outcomes were compared at Time 2, controlling for the Time 1 values. RESULTS: Overall, 70% of needs were met and mean satisfaction was between 'mixed' and 'mainly satisfied'. There was evidence for higher met needs in the intensive sector, but no evidence for lower unmet needs in the intensive sector or for differences in satisfaction. The additional needs met by the intensive service were associated with aspects of basic living situation. Satisfaction was negatively correlated with both unmet and met needs. CONCLUSIONS: Both services were reasonably successful, with little difference from the user perspective. The intensive service provided benefits in terms of met needs, but this has to be balanced against a possible increase in unmet needs.

Community Mental Health Services↗

PubMed1997

Promoting physician referral services. Prospective users are not necessarily the best advertising target.

Providers of physician referral services (PRSs) often focus advertising toward consumers who are least aware that such services exist. However, focusing advertising toward a more aware audience might be more useful. A recent study found that consumers most familiar with health care services are most likely to remember the concept of a PRS. Since these consumers may discuss PRSs with others, there appears to be value in promoting PRSs to more aware consumers as intermediaries to diffuse information to less aware consumers.

Advertising↗

PubMed2003

The ability of adult mental health services to meet clients' attachment needs: the development and implementation of the Service Attachment Questionnaire.

This study examined the relevance of adult attachment to the relationships between mental health services and their clients. The aim of the study was to develop a self-report measure with acceptable levels of reliability and validity and which was grounded in the experiences of service users, to assess the ability of adult mental health services to meet clients' attachment needs. A combination of qualitative and quantitative methodology was used. The Service Attachment Questionnaire (SAQ) was developed via focus groups of service users, followed by a grounded theory analysis of the group data to identify themes and potential items for inclusion. Two clinical trials were conducted to assess its reliability and validity. The grounded theory analysis produced six key themes forming the basis of the six-subscale, 25-item SAQ. It demonstrated good levels of internal and test-retest reliability. Factor analysis of the subscales revealed a single underlying construct. The SAQ is a reliable and usable self-report measure, and indicates that attachment is relevant to the relationships clients have with mental health services. As the measure is the first of its kind, further exploration of the measure's reliability and validity is recommended.

Clinical Trials as Topic↗

PubMed2005

Quality criteria for patient advice and liaison services: what do patients and the public want?

BACKGROUND: Every NHS trust and Primary Care Trust (PCT) in England now has a Patient Advice and Liaison Service (PALS) which provides an identifiable person to whom service users can turn if they have a problem or need information while using the NHS. This paper reports data from a 2-year qualitative study of London PALS. OBJECTIVE: To develop patient-centred criteria by which to assess PALS. DESIGN: Data were generated from qualitative interviews with 15 PALS service users and 15 members of local user/carer organizations, and from a workshop with representatives of 14 user/carer organizations (national and London-wide). Emergent findings were circulated to other user/carer organizations (n = 32) for critique and comment. RESULTS: Findings suggest that users and their representatives want PALS to: be responsive to the needs and wishes of individuals; be accessible to all sections of the community, including older people, ethnic minorities and groups with special needs; offer clear, accurate and comprehensive information about local health and other services; work with their NHS organization to create a more patient-centred service; collaborate effectively with other organizations; be adequately resourced. CONCLUSIONS: These criteria resemble the national standards for PALS compiled by the Department of Health, with the exception of the need for adequate resourcing. They also resemble previous work on users' and carers' criteria for service delivery. Interestingly, PALS' lack of independence was not a major concern, though clients do need access to independent advocacy when 'insider' trouble-shooting fails. Although an alternative to the adversarial approach of complaints is welcome, PALS, like complaints procedures, may be under-used by marginalized or demoralized service users.

Consultants↗

PubMed2004

Attitude to medication of parents/primary carers of people with intellectual disability.

OBJECTIVE: To investigate the influence of attitudes of carers of people with intellectual disability (ID) towards giving medication. METHOD: Ninety-three carers of service users who are currently attending outpatients clinic (Harrow Learning Disability service) were interviewed, using the RAMS (Rating of Attitude to Medication Scale) interview schedule. RESULTS: A significant association was found between relationship of the carer to the service user and overall positive or negative attitude towards medication, with a disproportionate number of parents expressing a negative attitude in comparison with professional carers (46% vs. 11%). CONCLUSION: This study suggests more work needs to be done with family carers than with professional carers to improve compliance with medication. Stigma is still associated with ID and psychiatric disorders. The family carers responses may be projecting their feelings related to the impact of having a child not only with ID, but also with additional psychiatric problems. The implication of the study for psychiatrists is the identification of a number of areas that could be usefully explored before writing a prescription.

Adolescent↗

PubMed1995

Involving patients in the provision of community care: a change in philosophy.

The National Health Service (NHS) has many different kinds of professionals and managers working underneath its large umbrella: non-clinical managers administer the work of health-care professionals, who in turn are concerned with the management of patients' treatments. Delivery of health-care services involves the managers and professionals working together to achieve a service that is good for, and acceptable to, patients. A change in the philosophy of the NHS is indicated by the growing acceptance, by both managers and professionals, of the necessity to elicit the views of patients (i.e. the expectations and perceptions of service users) and to incorporate these views into the planning and implementation of services. Discusses one such attempt to elicit the perceptions of service users, and reports on the preliminary findings of a patient-centred audit which has been undertaken in Southend Community Care Services NHS Trust. Discusses the effects that the audit has had on the chiropody services in Southend, for both non-clinical managers and health-care professionals, in order to highlight the usefulness of the approach.

Community Health Services↗

PubMed2005

Indicators predicting use of mental health services in Piedmont, Italy.

BACKGROUND: Since the 1978 Italian reform, an integrated network of community mental health services has been introduced. With few exceptions, research on determinants of mental health service use at the district level has focused on inpatient activities and social deprivation indicators. The European Psychiatric Care Assessment Team (EPCAT) standardized methodology allows for an evidence-based comparison of mental health systems between geographical areas. AIMS: To compare service provision and utilization between local catchment areas; to explore quantitative relationships between residential and community service use and socio-demographic indicators at the ecological level. METHODS: The European Socio-demographic Schedule (ESDS) was used to describe area characteristics, and the European Service Mapping Schedule (ESMS) to measure service provision and utilization in 18 catchment areas in Piedmont. RESULTS: Substantial variation in service use emerged. Acute hospital bed occupancy rates were lower in areas with more intensive community continuing care service users and with a smaller percentage of the population living alone. The non-acute hospital bed occupancy rate was directly related to the percentage of the population living alone or in overcrowded conditions, and to the level of mobile continuing care service users. Community continuing care service use was highest in areas with a larger percentage of the population living alone. DISCUSSION: Multiple regression models explained between 48 and 55% of the variation in inpatient and community service use between areas. Relationships based on ecological characteristics do not necessarily apply to the individual. This level of assessment, however, is necessary in evaluating mental health policy and service systems, and in allocating resources. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The distribution of mental health care resources should be weighted in terms of indicators of social deprivation shown to be important predictors of both inpatient and community service use, as these are likely to be related. IMPLICATIONS FOR HEALTH POLICIES: To ensure horizontal equity in access to mental health care, particularly for people with severe mental illness, evaluation of mental health policy should be based on a concurrent evidence-based assessment of the organization and use of both residential and community services, in relation to area level indicators of social deprivation. IMPLICATIONS FOR FURTHER RESEARCH: Cross-national research using an internationally standardized methodology should consider the influence of the social network independently of other socio-economic indicators, to verify the relative importance of this in predicting service use in southern and in northern European countries.

Catchment Area, Health↗

PubMed2003

Impact of an interdisciplinary low vision service on the quality of life of low vision patients.

AIM: To investigate the impact of an interdisciplinary low vision service on the vision related quality of life of service users. METHODS: 71 patients were interviewed 2 weeks before their appointment with the service and again 6 months later to assess any changes in their vision related quality of life. The majority of these patients had age related macular degeneration. RESULTS: After contact with the service the majority of patients indicated a reduction in concern about most quality of life issues. They were significantly less anxious about deterioration of their vision, safety within the home, and coping with everyday life. CONCLUSION: Improvements in many areas of their vision related quality of life indicate that this interdisciplinary low vision service has a positive impact on the lives of service users. However many patients were still unable to carry out their preferred everyday activities, and feelings of loneliness and isolation were unchanged. The identification of issues unrelieved by input from the service will be important in planning future service delivery.

Activities of Daily Living↗

PubMed1998

Women in general practice: responding to the sexual division of labour?

This paper provides an exploration of the gendered nature of the working experience of women within a high status and predominantly male dominated medical specialty, that of general practice or primary care physician. Women currently represent just over a third of all general practitioners in the U.K. and their numbers have been increasing. Women now account for 60% of new recruits into general practice. Despite this increase, consideration of the experience and role of women within medicine has largely focused on hospital medicine. The findings presented are derived from a three year project, that aimed to develop an understanding of the role women health workers play in the U.K. in the construction and provision of primary health care services for women. The methods employed consisted of a series of postal surveys and qualitative interviews conducted with GPs, female nurses and women service users. The first section of the discussion provides an exploration of the nature and impact of the sexual division of labour within general practice and the resulting occupational marginalisation of women GPs. Attention is given to identifying the key processes whereby the sexual division of labour is maintained and reproduced, particularly through the normative expectations of colleagues, patients and women GPs themselves. The final section presents a typology of the differing strategies the sampled women GPs adopted for managing their working roles in response to the existence of a sexual division of labour. The conclusion highlights the possible impact of the differing strategies upon the functioning of women within general practice and their relationship with women users of the service.

Adult↗

PubMed2004

Supporting the psychosocial needs of patients in general practice: the role of a voluntary referral service.

This qualitative study describes and analyses the key features of a practice based voluntary referral service called the Patient Support Service (PSS). This involved collecting interview data from 11 service users and 8 service providers, which was analysed using 'Framework,' a qualitative method of applied policy research. The study findings describe the PSS, its perceived effectiveness and barriers to service provision. Following this, a series of strategic recommendations for service development are presented. It is concluded that voluntary patient referral services, such as the PSS, broaden the referral options available for managing patients with psychosocial problems in primary care.

Attitude of Health Personnel↗