Primary Health Care Research & Development最新文献

{"title":"Rural interprofessional primary health care team development and sustainability: establishing a research agenda","authors":"Charmaine M McPherson, Elizabeth A McGibbon","doi":"10.1017/S1463423610000125","DOIUrl":"https://doi.org/10.1017/S1463423610000125","url":null,"abstract":"Primary health care (PHC) plays a pivotal role in health system reform locally and globally. The use of well functioning interprofessional primary health care (IPHC) teams is recognized as a key strategy in widespread health system reform across global, national, and provincial jurisdictions. IPHC teams contribute to the improvement of the health and well being of the population. These teams engage in issues that are a priority for citizens, such as: providing good evidence-based care; supporting the efforts of individuals, families, and communities in leading healthy lives; actively and deliberatively involving citizens in decisions affecting their health and health care system; and addressing the systemic social, economic, and political causes of health disparities, such as poverty, violence, and rural isolation. Many jurisdictions have begun to experiment with and implement major changes in the delivery of PHC. This has required that health care managers and practitioners reconsider the ways in which they have traditionally worked. However, although many innovative PHC services were developed, the notion of how to best develop and sustain the service delivery team itself and within what contexts could have used more deliberate attention. There are no documented best practices for rural IPHC team development and sustainability in the scholarly literature. This paper presents the results of a literature review, including the empirical and conceptual evidence regarding team development, team sustainability, and the role of rural context in IPHC team development. An argument for advancing PHC research that focuses on rural IPHC team development and sustainability is posited.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88835564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of public health nursing consultations: tacit understanding of the importance of relationships","authors":"Anne Clancy, T. Svensson","doi":"10.1017/S1463423610000137","DOIUrl":"https://doi.org/10.1017/S1463423610000137","url":null,"abstract":"Aim This study aims to describe and reflect upon how a sample of nurses, parents and young people experience consultations at local clinics and school health services. Central to the concept of health promotion is ensuring that focus is on the empowerment of clients through dialogue and participation. This study aims to explore public health nursing consultations with this in mind. Background Norwegian public health nurses are in contact with almost all families at the child health clinic. They meet children and young people at school health services and youth clinics; putting them in an important position to promote health and prevent illnesses. Methods Participant observations and in-depth interviews are the methods chosen. The data were analysed using qualitative content analysis. Findings The study shows that good relationships are not only sustained by pleasantness but also by honesty and directness, provided that the relationship is based on trust and sincerity. Continuity and trust in services seem paramount to the service users’ satisfaction. Service users were not always able to put the reason for their appreciation into words, just as the nurses had difficulty verbalising their strategies. Words often fall short when attempts are made to capture the essence of caring, trust and other life phenomena. Openness on agenda and focus on feedback from service users are important in order to ensure empowering services. Further studies should address the interconnectedness of the service and the subtleties of public health nursing consultations.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82849465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rehabilitation in a primary care setting for persons with chronic illness – a randomized controlled trial","authors":"J. Richardson, L. Letts, D. Chan, P. Stratford, C. Hand, D. Price, Linda Hilts, L. Coman, M. Edwards, S. Baptiste, M. Law","doi":"10.1017/S1463423610000113","DOIUrl":"https://doi.org/10.1017/S1463423610000113","url":null,"abstract":"Aim The primary objective of this study was to determine whether adults with a chronic illness within a primary care setting who received a rehabilitation intervention in this setting showed greater improvement in health status and had fewer hospital admissions and emergency room visits compared with adults who do not receive the intervention. Background More than half of Canadians (16 million people) live with chronic illness. Persons with chronic illness in primary care, especially older persons who are most at risk for functional decline, are currently not receiving effective management. Methods A randomized controlled trial was used. A rehabilitation multi-component intervention was delivered by a physiotherapist (PT) and occupational therapist in a primary care setting and included collaborative goal setting for rehabilitation needs, a six-week chronic disease self-management (SM) workshop, referral to community programs and a web-based education programme. Findings Three hundred and three patients participated, n = 152 intervention group and n = 151 in the control group. There was a significant difference between the groups for planned hospital days (F = 6.3, P = 0.00) with an adjusted difference 0.60 day per person, and increased satisfaction with rehabilitation services however no difference on health status or emergency room visits. This rehabilitation intervention which had a strong SM component prevented planned hospitalizations that resulted in a conservative estimated cost saving from reduced hospitalizations of $65 000. Future research needs to examine which patient groups with chronic illness show positive responses to rehabilitation and self-management.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81783242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and reliability of the DMSES UK: a measure of self-efficacy for type 2 diabetes self-management","authors":"J. Sturt, H. Hearnshaw, M. Wakelin","doi":"10.1017/S1463423610000101","DOIUrl":"https://doi.org/10.1017/S1463423610000101","url":null,"abstract":"Objectives Self-efficacy is an important outcome measure of self-management interventions. We aimed to establish UK validity and reliability of the diabetes management self-efficacy scale (DMSES). Methods The 20 item DMSES was available for Dutch and US populations. Consultation with people with type 2 diabetes and health professionals established UK content and face validity resulting in item reduction to 15. Participants were adults with type 2 diabetes enrolled in a randomised controlled trial (RCT) of the diabetes manual, a self-management education intervention, with an HbA1c over 7% and who understood English. Baseline trial data and follow-up control group data were used. Results A total of 175 participants completed all 15 items. Pearson’s correlation coefficient of −0.46 (P < 0.0001) between the DMSES UK and the problem areas in diabetes scale demonstrated criterion validity. Intra-class correlation between data from 67 of these participants was 0.77, demonstrating test-retest reliability. The correlation coefficients between item scores and total scores were >0.30. Cronbach’s alpha was 0.89 over all items. Conclusion This evaluation demonstrates that the scale has good internal reliability, internal consistency, construct validity, criterion validity, and test-retest reliability. Practice Implications The 15 item DMSES UK is suitable for use in research and clinical settings to measure the self-efficacy of people living with type 2 diabetes in managing their diabetes.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research &amp; Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81396290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicidal students’ use of and attitudes to primary care support services","authors":"N. Stanley, S. Mallon, J. Bell, J. Manthorpe","doi":"10.1017/S1463423610000149","DOIUrl":"https://doi.org/10.1017/S1463423610000149","url":null,"abstract":"Aim The aims of this study were to improve responses to students in distress and who are feeling suicidal, to help practitioners to increase their responsiveness to those at high risk of suicide and to develop effective responses to those affected by their deaths. The study sought to build a detailed picture of students’ patterns of service use. Background National suicide prevention strategies emphasise that suicide prevention requires the collaboration of a wide range of organisations. Among these, primary care services play a key role in relation to suicide prevention for young people in crisis. Methods This study, undertaken between 2004 and 2007, focused on 20 case studies of student suicide that took place in the United Kingdom between May 2000 and June 2005. It adopted a psychological autopsy approach to learn from a wide range of informants, including parents, friends, university staff and the records of coroners or procurator fiscals. Twenty families gave permission for their son’s or daughter’s death to be included in the study and agreed to participate in the study. Informants were interviewed in person and the data were analysed thematically. Analysis of the case study data suggested that in a number of cases students had failed to engage with services sufficiently early or in sufficient depth. Primary care practitioners need to be proactive in communicating concerns about vulnerable students to student support services. At local levels, collaboration between student support and National Health Service practitioners varied considerably and channels of communication need to be developed.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research &amp; Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82813963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practice size determines participation in optional activities: cross-sectional analysis of a national primary care system","authors":"D. Mackay, G. Watt","doi":"10.1017/S1463423610000058","DOIUrl":"https://doi.org/10.1017/S1463423610000058","url":null,"abstract":"Background There is widespread, unexplained variation in activity and outcome between general practices. Aim To explore the relationship between practice size and participation in optional activities, including the Quality and Outcomes Framework (QOF). Design of study Cross-sectional analyses of routinely available data on practice characteristics, QOF performance and optional activities including undergraduate teaching, postgraduate training, research, enhanced clinical data collection and service development. Setting All 1031 general practices were located in mainland Scotland. Results The most popular optional activity was undergraduate medical teaching, which involved 41% of all general practices. About a third of practices took part in postgraduate general practitioner training (29%), research (33%), enhanced clinical data collection through the Scottish Programme for Improving Clinical Effectiveness (31%) and the activities of the Scottish Primary Care Collaborative (33%). The most important driver of the number of activities undertaken by a practice is size with single handed, small and medium sized practices all undertaking a significantly lower number of activities than larger practices (P < 0.001). Deprivation had no overall effect, but was associated with lower rates of participation in postgraduate training. The average number of points achieved in the QOF ranged from 961 by the 18% of practices taking part in no optional activities, to 973 by 29% of practices taking part in one activity, 984 by 25% of practices taking part in two activities and 985 in 28% of practices taking part in three or more activities. Single handed practices in urban areas taking part in three or more additional activities had similar QOF point totals to larger practices taking part in three or more activities, and achieved 44 more QOF points than urban single-handed practices taking part in less than two additional activities. Conclusions Practice size is strongly related to participation in optional activities. There is a small but significant relationship between the practice size and number of QOF points achieved by practices taking part in less than two additional activities. Participation in optional activities is a possible indicator of cultural and organisational factors within practices, which constrain the volume and quality of services, which they are able to provide.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research &amp; Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87767914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients’ experiences of prescribed anti-obesity drugs and perceptions of support from primary care: a qualitative study","authors":"A. Psarou, I. Brown","doi":"10.1017/S1463423610000083","DOIUrl":"https://doi.org/10.1017/S1463423610000083","url":null,"abstract":"Aim To explore the views and experiences of obese patients prescribed anti-obesity drugs in primary care, including their understanding of guidance about lifestyle changes. Background Pharmacotherapy treatments are increasingly used to support obesity management. Currently, two anti-obesity drugs are available on the National Health Service (NHS): Orlistat and Sibutramine. Although detailed clinical guidelines for their use are well documented, there is little research about how obese individuals experience and view these drugs in routine care. Methods Qualitative design with semi-structured interviews conducted in participants’ homes or a health centre. Participants recruited from three general practices in Sheffield with socio-economically diverse populations using purposive sampling. Interviews transcribed verbatim and analysed using the ‘framework’ approach. Findings Health concerns are the key factor for patients seeking help with weight loss. Participants are typically ambivalent about taking anti-obesity drugs and expectations vary from unreasonably sceptical to unreasonably optimistic. There appears to be high awareness of the need for lifestyle change. Those prescribed Orlistat understood how it worked, however, those on Sibutramine and Rimonabant did not. Participants’ experiences in taking anti-obesity drugs varied greatly and changed with experiences of weight loss, side effects and quality of support. Most could identify points at which the information, choice and support provided by primary care could be improved. However, most were not aware of other avenues of support. Conclusion This study has identified a number of areas for service improvement. Better understanding of patient expectations around anti-obesity drugs should help the NHS to shape services to meet needs and make the experiences of patients more positive.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research &amp; Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86511986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare staffs perceptions of using interpreters: a qualitative study","authors":"Emina Hadziabdic, B. Albin, Kristiina Heikkilä, K. Hjelm","doi":"10.1017/S146342361000006X","DOIUrl":"https://doi.org/10.1017/S146342361000006X","url":null,"abstract":"Aim The aim of this study was to describe how healthcare professionals experience and perceive the use of interpreters in their contacts with patients with whom they do not share a common language. Background Language barriers lead to poor-quality care and fewer medical contacts. To avoid language barriers and their consequences, interpreters are recommended. However, communicating through an interpreter can be difficult. To develop effective interpreter service it is important to study healthcare staff’s perceptions of using an interpreter. Methods An explorative descriptive study design was used. The study was conducted in different healthcare settings in Sweden and included 24 healthcare staff, of whom 11 were physicians, 9 nurses, 2 physiotherapists and 2 assistant nurses. Data were generated through written descriptions of the use of interpreters in healthcare service and were analysed using qualitative content analysis. Findings Two main categories emerged from the data: 1) aspects related to the interpreter and 2) organizational aspects. The study showed that having a face-to-face, professional, trained interpreter, with a good knowledge of both languages and of medical terminology, translating literally and objectively, was perceived positively. The organizational aspects that affected the perception were functioning or non-functioning technical equipment, calm in the interpretation environment, documentation of the patients’ language ability, respect for the appointed time, and the level of availability and service provided by the interpreter agency. It is important to develop a well-functioning interpreter organization that offers trained interpreters with a professional attitude to improve and ensure cost-effective and high-quality encounters and care.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research &amp; Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82734353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational implementation programme of guidelines on cardiovascular risk factors: an analysis of changes in familiarity, use and attitudes","authors":"Risto Kuronen, P. Jallinoja, Riitta Airola, K. Patja","doi":"10.1017/S1463423609990491","DOIUrl":"https://doi.org/10.1017/S1463423609990491","url":null,"abstract":"Aim To explore changes in self-reported familiarity and use of guidelines dealing with cardiovascular risks (hypertension, dyslipidemia, adult obesity and smoking cessation) and general attitudes towards clinical guidelines before and after implementation programme, as well as the association of guideline training attendance and attitudes towards and use of guidelines. Background The current care guidelines provide a useful tool in the management of cardiovascular risk factors. Evidence-based care and guideline use have a shorter tradition among nurses than among physicians. Methods A self-administered questionnaire was sent to all primary health care nurses and physicians in Päijät-Häme Health and Social Care District, an area of 210 000 inhabitants in Southern Finland, before and after the guideline implementation programme VALTIT. Findings Main outcome measures were self-reported familiarity with and use of guidelines on cardiovascular risks and items measuring attitudes towards clinical guidelines. Among nurses, the reported familiarity with all the guidelines increased, but increase in use occurred only in respect of the dyslipidemia guideline. Among nurses, there was an association between participation in guideline training and guideline use. Physicians’ reported familiarity with and use of the adult obesity guideline increased during the study period. The proportion of nurses and physicians who reported that they had been asked to use the guidelines increased. Perceptions concerning the readiness to adopt the guidelines changed positively among nurses and were more positive among those attending at least one training event. Results are encouraging regarding familiarity with guidelines. Regarding usage our results suggest that a two-year programme might not be enough to alter the deep-rooted practices and attitudes concerning lifestyle change related guidelines. The challenge lies in multi-professional implementation of guidelines on cardiovascular risks with special emphasis on lifestyle change as a treatment option.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research &amp; Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74983299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An evaluation of the implementation of a multidisciplinary persistent pain service in the inner London Borough of Tower Hamlets","authors":"D. Carnes, J. Gallagher, S. Leak, M. Underwood","doi":"10.1017/S1463423610000034","DOIUrl":"https://doi.org/10.1017/S1463423610000034","url":null,"abstract":"Aim The aim of this study was to evaluate the implementation phase of a multidisciplinary persistent pain service (PPS). Background A multidisciplinary PPS was established in January 2008 at the London Borough of Tower Hamlets. Referral is made into the service via general practitioners (GPs). Patients see an appropriate mix of clinicians; they include a pain specialist, physiotherapists, an occupational therapist, psychologists and/or health and advice worker. Method Data were collected by using patient questionnaires, monthly activity reports from clinicians, service administration and patient and staff interviews. Findings Service activity steadily increased to full capacity after nine months. Eighty-two percent (31/38) of Tower Hamlets GP clinics referred patients to the service; the referrals were appropriate. The discharge rate at nine months was 5% while 9% failed to attend or declined to attend. Patients saw on average two clinical specialities, post multidisciplinary team discussion and had four appointments. The majority of patients were female (89/144, 62%); between 41 and 60 years old (55%), unemployed (79%), received disability or incapacity allowances (28%), had pain for more than 10 years (27%) and were not fluent in English (37%). The patient and practitioner interviews highlighted: difficulties keeping track of patients as they progressed through the service, inconsistent administration that affected patient satisfaction, lack of understanding of treatment process and plans and cross discipline learning benefit for staff. Conclusion Implementing a multidisciplinary service requires forethought, and regular monitoring to ensure efficiency. For multidisciplinary services we recommend: GP education, clear delineation of responsibilities between staff, efficient systems for tracking patient progress, regular staff meetings and jointly negotiated treatment plans that patients can keep.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research &amp; Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72689260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}