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Aims: To gain structured feedback on a qualitative research methods training programme delivered to primary care researchers over a period of ten years. To examine dilemmas and challenges and how these had been resolved. To examine how the programme could be further developed. Background: The Wolds Primary Care Research Network's (WoReN) qualitative research methods training programme was developed and evolved in response to the needs of primary care practitioners and researchers and the NHS Research Agenda. Methods: Information on participants' professional backgrounds: which workshops they attended; their evaluation sheets, comments; and personal appraisals were collected from 1996 to 2006. Structured telephone conversations with a number of participants and ongoing informal feedback from participants added to this information. Numbers and ranges of professionals attending workshops were ascertained, how far they travelled to workshops and further degrees obtained by them, within the decade, were also noted. Findings: We found a lack of similar training elsewhere. A wide range of people attended workshops, especially general practitioners (GP) and academic researchers. Other practitioners were a significant presence however, and included nurses, pharmacists, health visitors and professions allied to medicine. Participants were prepared to attend extended workshops and to travel significant distances to them. Participants preferred a continuous cycle of workshops rather than discreet sessions, in order for them to consolidate their learning and to develop at their own pace. Practical exercises reflecting the qualitative research process were considered very conducive to learning and participants also appreciated one-to-one consultations about their work and longer-term, ongoing support as they progressed through their projects. Workshop design needed to continually reflect the changing requirements of participants, employers, funders, potential trainers and national NHS requirements. A new audience for training was identified in supervisors not versed in the qualitative paradigm.
Background: Primary health care has recently undergone and is continuing to experience significant change. One issue is the increased emphasis on population health. Public health is at the centre of recent United Kingdom government policy as well as international policy. This paper describes the adoption of a specialist practitioner public health nurse role as a resource for public health practice development. The issues raised by the approach to practice and service development are located within discourses on leadership, modernisation and change in health and social care. The discussion is guided by critical theory approach to facilitate exposure of the factors influencing decisions and consequences of decisions. Evaluation method: The evaluation design drew on the theories of change approach which focuses on ‘surfacing assumptions’ underpinning a change process. Purposive sampling was used to identify a range of stakeholders to the post. Individual interviews were conducted with 11 stakeholders from management, nursing, social work and medical roles. Four focus groups were conducted with health visitors. Findings: Thematic analysis identified three issues that relate to a specialist role aimed at public health capacity development; location of the specialist role within existing teams, the routes available to providing public health subject leadership and sharing expert knowledge, potential for conflict or tensions between specialist and other roles. Conclusions: Capacity to address the public health agenda is being developed at the same time as the modernisation of leadership. The role and impact of historical organizational structures and approaches to management and leadership must be acknowledged. The research indicated that specialist posts have positive potential in relation to public health practice developments. Key success factors included involving the generalist in the rationale development of such a role, sharing expectations of the impact of all roles and where to locate the specialist role with respect to existing teams and structures.
General practice is a principal point of access for individuals who experience problems associated with cannabis use, including dependence on the drug. However, there are no clear guidelines on advice or clinical interventions for primary care practitioners regarding this area. Whilst it has been suggested that specific services to deal with cannabis users are required (Stephens et al., 1993) we have neither a clear idea of how many individuals in local populations may need support to give up or reduce cannabis use, nor of the knowledge or practice of GPs in relation to patients that use cannabis. This study examined GPs’ knowledge of cannabis-related harm, and their own responses and practice in treating patients who present for help. A postal questionnaire was sent to 155 general practitioners in Wandsworth, of which 97 (63%) completed questionnaires were returned. The results showed that GPs in Wandsworth are aware of the risks associated with cannabis use, and are also motivated to improve their knowledge base. Attitudes towards the appropriate setting and approach to treatment interventions were mixed, with some believing that cannabis users could be treated in primary care and others preferring onward referral to specialist drug ser-vices. However, given that 46% (n = 47) of our sample had been approached by a patient wishing to stop using cannabis, effective primary care interventions are required. The study argues for improved primary care engagement with cannabis users seeking support via clear guidelines and training of practitioners, improved signposting to specialist services and shared care, and further consideration of issues around the recording of information relating to cannabis use. In addition, more national and strategic clarity regarding the potential harm of using cannabis, as well as treatment options and care pathways would be welcomed.
The aim of this article is to explore how the development of the theoretical and strategic basis of school nursing offers a vehicle for the delivery of an effective public health strategy for children and adolescents. Through a critical examination of the status and scope of school nursing within the UK and US health care systems it is clear that a deficiency exists regarding the theoretical and strategic basis for the functioning of school nursing. Consideration is given to the concept of the school nurse as ‘navigator’ for the child along the trajectory of the school health journey. This novel approach to school nursing needs to be developed theoretically and evaluated for effectiveness. A rapid review of the evidence to support school nursing interventions has revealed that the evidence base for school nursing interventions/actions remains very weak, thereby challenging the ability of school nurses to deliver desired outcomes for the present ambitious public health agenda. We argue that a planned approach to developing the evidence for school nursing, based on the UK Medical Research Council (MRC, 2000) framework for the evaluation of complex interventions, could help to ensure a robust role for the school nurse. This acknowledgement and development of a novel approach to school nursing could contribute to policy implementation around public health goals for the school-aged population.
In recent years government emphasis on improving access times in general practice has centred on a target of 48-hour access to a doctor. Attempts to achieve this by changing appointment systems may threaten relationship continuity of care, another valued feature of general practice. Now the recent primary care White Paper proposes financial incentives for both these aspects of care. We studied two contrasting booking systems in three large inner London group practices using a one page questionnaire distributed to consecutive patients in the waiting rooms. While most patients in the so-called ‘advanced access’ practice were seen very quickly, fewer patients, especially those with chronic conditions, were able to see their chosen doctor than in two practices offering more scope for booking appointments ahead. This preliminary study in an inner-city area supports other work, as well as anecdotal reports, suggesting that unbalanced emphasis on rapid access may impair patients’ scope to see their practitioner of choice.
We have developed the Female Urinary Symptom Score (FUSS), a symptom questionnaire for the evaluation of urinary incontinence and lower urinary tract symptoms in women and their effect on quality of life. The FUSS is a modified version of the International Prostate Symptom Score adapted for use in women. It consists of a simple questionnaire of only eight questions, which patients can answer quickly on a numerical scale. We performed a validation study of the FUSS by comparing it with the King’s Health Questionnaire (KHQ), a well-validated but longer symptom questionnaire. We sent both questionnaires to 220 women between the ages of 45 and 65 years randomly selected from two general practices in the United Kingdom. Urinary symptom status was unknown; 149 (94%) of the FUSS questionnaires and 115 (73%) of the KHQs were completed correctly. Correlation was conducted on the scores of the 115 matched pairs and was high (r = 0.83). We sent another copy of the FUSS questionnaire to the same group of women after four weeks, and found that the test and re-test scores for FUSS were highly correlated (r = 0.88). We conclude that the FUSS is a simple, reliable and reproducible tool for the diagnosis of urinary symptoms in women. As it is brief, we believe that it will be useful in the primary care setting, enabling women to receive appropriate treatment and care as early as possible.
Background: The increased incidence of chronic disease in recent years represents a significant challenge for the National Health Service. This coupled with substantial reforms in recent years has resulted in many changes in the delivery of healthcare, such as the proliferation of new nursing and midwifery roles. One such role is the Respiratory Nurse Specialist. Aims: The aim of this paper is to explore the role of the RNS from the post-holder and service perspective. This includes examining the organizational infrastructure, working relationships, career paths, perceived benefits and enablers and barriers required to make this role successful. Methods: A naturalistic case study methodology was adopted and a variety of data collection approaches were used. These included semi-structured interviews with the post-holder, line manager and Director of Finance, non-participant observation of practice, review of job description, audit data and other relevant documentation relating to the post. Findings: Findings revealed evidence of the role being innovative and effective. These related to the role context; role delivery, skills and knowledge required; the personal characteristics of the post-holder, the impact on multidisciplinary integrated working and the response to the needs of patients and communities. Conclusions: This case study illustrates the value and potential of nurses to lead and co-ordinate the care for patients with chronic diseases, and specifically the provision of a high-quality respiratory service.
Background: Failure to reach recruitment targets is a widespread problem in RCTs (randomized controlled trials). This paper presents experience of recruiting patients into the PRIDE trial which was carried out in one Primary Care Trust (PCT) in the North West of England. Aim: The aim of this feasibility study was to test the effectiveness of a new model of care for the management of late-life depression. Method: GPs (general practitioners), PNs (practice nurses) and community nurses were invited to refer patients into the study. Over 100 patients were needed (at least 50 in each arm of the trial) for the study to be sufficiently powered. On-target recruitment of over 100 patients over 18 months was achieved. Findings: Data obtained from conversations and from semi-structured interviews with health professionals is presented to give possible explanations for this successful recruitment. Not all practices in the PCT engaged with the study, and the most common reasons given by GPs and their staff for non-participation was being single handed or already having a heavy work-load. All community nurses spoken to agreed to refer patients to the study but only five referrals were made by this group over the course of the study. The main reasons primary care professionals did agree to participate and continue to refer patients was that they felt the trial was offering a local and relevant service to an under-served patient group. The very simple referral process was also an important factor. In addition, the Trial Nurse was perceived to be responsive, responding quickly to referrals made and providing regular and detailed feedback which was perceived to help and support the health professionals in the future management of the patient.
Background: A dietary assessment website for use in the primary health care setting has been developed. The website allows patients, referred from their general practitioners (GP), to self-report their dietary intake. Data from the website feeds to a dietitian who develops individualised dietary advice for the patient. Aim: The aim of this article is to describe the usability testing of the dietary assessment website with its potential users. Methods: Testing was broken into two phases. Forty-two free-living adults with metabolic syndrome volunteered, 17 completed phase 1 and 10 completed phase 2, with a 64% rate of completion. Phase 1 participants spoke aloud as they progressed through the self-administered dietary assessment website under researcher observation. Observed difficulties in website use and need for assistance was recorded and the website underwent modifications between phases. Only four participants in phase 1 required large amounts of assistance. Phase 2 participants progressed through the website without observation or using the think-aloud protocol. This simulated the environment in the GP practice within which the website was to be implemented. All participants completed pre- and post-use questionnaires assessing feelings toward use, computer experience and problems encountered. Findings: Questionnaires were thematically analysed for relationships between website use and participant feelings. Time taken to use the website was recorded automatically. Website features were grouped into ‘action classes’, for example selecting food items, and times taken were calculated for each class. Comparisons (t-tests) were made between the action classes for the two phases. Average time taken to select the food items was 31 min and 24 min for phases 1 and 2, respectively. Total time taken was approximately 1 h and varied by 4 min between phases. Time taken to complete the dietary assessment was comparable to a face-to-face diet history with a dietitian. The website was found to be highly user friendly with little assistance being required for most levels of computer experience. Dietary management may be overlooked by GPs, yet by offering different methods of accessing dietitians, management may improve.