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The aim of this article is to provide UK-based primary health care research and development workers with a review of the current range of published, aggregated socio-demographic indicators that can be combined with health and health care datasets, for the purposes of monitoring locality health profiles and planning primary health care. Non-UK readers should nevertheless find the review of some relevance to their own national contexts.
There is an increasing range of resources available for such purposes and many of these datasets are equally useful outside of geographic work. The 2001 census introduced important changes to what routine data are available, as will the 2011 census. These changes have been paralleled by developments in the availability of socio-demographic indicators and the increasing popularity of geographic information systems. Health data can now be combined with those from socio-demographic more efficiently to produce what are termed value-added datasets.
We review recent and planned developments in key data sources currently available in the UK and examine they can be used to monitor inequalities in primary health care inequalities and their role in the integration of primary health care needs mapping and forecasting with the spatial planning of areas undergoing regeneration.
Recent and planned developments in the availability of both socio-demographic datasets in tandem with parallel developments in spatial technologies have provided a flexible, potent geographical methodology for primary health care research and development. The current consultation process for the 2011 census provides those involved with primary health care research and development an opportunity to influence future developments.
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.
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.
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.
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.
To describe the service use and clinical outcomes associated with the implementation of a complex intervention designed to improve care for people with depression in a primary care setting.
Health systems have limited capacity to provide appropriate psychological and pharmacological treatments for people with depression. Guidance on the treatment of depression in primary care in the United Kingdom was clarified by the National Institute for Clinical Excellence in 2004. However, there is little evidence so far of substantial changes in practice: antidepressant prescriptions continue to rise, there is limited access to psychological therapies and uncertainty persists about who should be treated for what and how. Although the welfare of staff is critical to their therapeutic engagement with patients, this is rarely an explicit focus of health systems design.
An observational study examining the implementation of a complex intervention to improve depression care called ‘Doing Well’, based in 14 general practices in a mixed urban-rural area in Scotland, United Kingdom. A small team of clinicians implemented a programme for people with low mood, depression and adjustment disorder, based on primary care. This programme incorporated a number of changes in standard mental health care, including the following: no ‘severity threshold’ for referral to secondary care; routine use of an objective measure of depression severity with continuous outcome monitoring; prompt access to guided self-help; prompt ‘step-up’ care to more formal psychological therapy or medical care, if indicated; and careful attention to staff training and satisfaction.
There was good fidelity to the model of care designed by the programme. There was a high demand for the new service (1.8% of the catchment population each year) but the programme had the capacity to manage this adequately. Clinical outcomes were satisfactory, and antidepressant use adhered to the guidelines.
Studies have established that many depressed adolescent patients do not receive optimal mental health care. Specifically, depression in primary-care settings is underrecognized, undertreated, and stigmatized. Although the seriousness and prevalence of adolescent depression is well known to primary-care physicians, its assessment, diagnosis, and treatment remains a significant problem in general and in rural communities in particular.
Aims and discussion
In this article, the author accomplishes three aims: (1) summarizes the most current evidence-based guidelines for depression care for adolescents in primary-care settings, (2) reviews the empirical literature on how key patient demographic variables (race, gender, and age) may be correlated with and predictive of variations in evidence-based depression care (assessment, diagnosis, and treatment) for adolescent patients, particularly in rural areas, and (3) provides implications for translating empirical research findings to evidence-based depression care in rural primary-care settings.
Depression, isolation, low self-esteem, and lack of hope are just a few of the characteristics evident in adolescents involved in bullying. The aims of this study are as follows: to examine the association between involvement in school bullying and depressive symptoms and suicide ideation among victims, bully victims, and those uninvolved; to investigate the effects of vulnerability factors on depression and suicide ideation among subjects aged 17 involved in school bullying.
A self-reported school-based survey was completed by 290 secondary school students aged 17 years, attending the third grade, coming from 15 different classes of secondary schools in the Tuzla (coming from each municipality in the Tuzla Canton), 2007. Using peer nominations, three groups were established: victims, bully victims, and uninvolved participants as control group subjects. Data were obtained using a self-rated questionnaire on bullying, Beck inventory to identify depression and suicide ideations, and state-trait anxiety scales to assess anxiety state/trait among examinees. Data analysis was performed using SPSS version 12.0.
There was an increased prevalence of depression (29.0% versus 8.8%) and suicidal ideation (16.1% versus 3.5%) in adolescents who have been victims in relationships to respondents who were uninvolved subjects. There was an increased prevalence of depression (17.5% versus 8.8%) and suicidal ideation (15.8.1% versus 3.5%) in adolescents who have been bully victims in relationships to respondents who were uninvolved subjects too. Adolescents who are victims and those who are bully victims are more likely to have suicide ideation compared to uninvolved subjects. Discontent with financial situation is a vulnerability factor associated with elevated levels of depression in victims.
In evaluations of students involved in bullying behavior, it is important to assess depression and suicide ideation.
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.
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.
Participant observations and in-depth interviews are the methods chosen. The data were analysed using qualitative content analysis.
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.
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).
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.
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.
This evaluation demonstrates that the scale has good internal reliability, internal consistency, construct validity, criterion validity, and test-retest reliability.
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.
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.
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.
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.
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.
We investigated patients’ impressions of the effectiveness of treatment provided by health centre physicians. Were the patients’ expectations met, and were the consultations considered effective? Which factors affected consultation success?
The study was conducted in 16 municipalities in the Kanta-Häme region Finland in 2004. Primary healthcare services to these municipalities are provided by five health centres. The municipalities’ total population was 166 648 (31 December 2003).
The data were collected during telephone interviews, supplemented by a mail survey. The study population (2600) was drawn from the Finnish Population Information System by random sampling. A total of 1751 inhabitants participated in the study (response rate: 67%). The respondents were considered able to evaluate treatment effectiveness if they had visited a health centre physician because of an illness or an accident during the past 12 months. Seven hundred and twenty-nine respondents met these criteria.
Most respondents (73%) found that their treatment corresponded with their expectations. According to a logistic regression analysis, the factors that best explained whether the patient’s treatment expectations were met included the physician’s respect for the patient, the consultation duration and the reason for the visit. Of the respondents, 70% thought the consultation had been effective. Factors explaining consultation effectiveness included consultation duration, physician’s respect for the patient and whether the consultation was scheduled within three days. In conclusion, the physician–patient consultations seemed to be very good and clearly worth the effort. Notably, we observed that the same factors helped to explain whether the patient’s treatment expectations were met, and whether the patient found the consultation effective.
To analyse trends in newspaper reporting of British general practitioners’ (GPs’) pay before and after the introduction of the new General Medical Services (GMS) contract.
The introduction of the new GMS contract for GPs in 2004 linked pay to performance. There may have been a range of wider consequences from this, including changes in how GPs are portrayed in the media.
We retrospectively analysed the internet archives of five British newspapers over 2001–2008. The search terms ‘doctor’ or ‘GP’ and ‘pay’ were used in a text search. After checking the relevance of full text articles, we randomly sampled included articles to achieve a quota of up to five articles per newspaper per year. We scored article content using criteria to determine whether GPs were depicted in a positive or negative manner. Summary scores for each article were plotted using locally weighted scatterplot smoothing (LOWESS). We used a grounded approach to identify key themes.
Newspaper coverage of GPs’ salaries became unfavourable following the introduction of the new contract. Initial recognition of GPs’ demanding working conditions and relatively poor rewards for public service transformed into concerns about unfairly excessive income and poor use of public money. Although public trust in GPs has remained fairly robust to media criticism, it cannot be taken for granted as continued negative newspaper coverage of their pay may start to erode public trust in the profession.