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To evaluate the suitability of 80 patients referred for assertive outreach treatment (AOT) and their treatment outcomes, by comparing clinical and social data during the treatment period with data before treatment began. To control for service development across the board, patients on ordinary community treatment were identified and matched to patients undergoing AOT for age, gender, clinical diagnosis and duration, and data acquired for the same time period as the patients on AOT. This was a retrospective mirror-image evaluation with contemporaneous controls.
The patients referred for AOT were more socially disadvantaged and had used more clinical resources than the control patients. Overall, AOT reduced resource uptake markedly following referral, while resource uptake by control patients during the same period remained static or increased; AOT, however, did not lessen most aspects of social disadvantage.
The advantages of AOT include much reduced use of services but not the resolving of social exclusion. Some ordinary community provision may fail to afford the quality of AOT and thus suffer by comparison. The demise of AOT may be premature in such services.
Non-medical staff are eligible to assess trainee doctors through mandatory workplace-based assessments (WPBAs). An anonymous questionnaire was given out to non-medical staff working with trainees in community and in-patient settings at Royal Blackburn Hospital. Our aims were to look at their awareness of and familiarity with assessor guidance, trainee competencies, training needs and assessors' views on completing these assessments.
In total 118 of 150 (79%) individuals returned a questionnaire and 89 WPBAs had been carried out. Most assessors were Band 6 (or equivalent) or below (53%). Most assessors had neither read any assessor guidelines (75%) nor were familiar with the competencies required of a doctor (76%). Although 79% felt that non-medical staff should be assessing trainee doctors, only 44% felt comfortable doing this. None had been trained and 92% felt this would help. Twenty WPBAs (excluding mini-peer assisted tools) were carried out by staff at Band 6 or below.
No respondents received guidance or training on being an assessor. This highlights the need for urgent action and delivery of training. This can easily be adapted from training packages developed for medical staff.
The aims of the project were to develop a simple, low-cost patient satisfaction questionnaire with face validity and to obtain patient feedback on a range of service areas in a community addiction team. A questionnaire was designed and revised after feedback from multidisciplinary team members and a pilot sample. The questionnaire was distributed until 100 correctly completed forms were received.
The survey took approximately 30 h of authors' time from commencement to completion and costs were minimal. The majority of the 12 areas evaluated were rated by patients as good or very good. Overall quality of care was rated as good or very good by 88% of participants. There was no enthusiasm in this sample for more active participation in service development.
All National Health Service staff and services are now enjoined to engage with service users and carers for the purposes of evaluation and development. Simple, affordable methods for obtaining such information about community services can contribute to this process.
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