Networking
Oak trees from acorns? An evaluation of local bursaries in primary care
- Muriel Lee, Karen Saunders
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- Published online by Cambridge University Press:
- 31 October 2006, pp. 93-95
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During the period 1997–2002 ResNET and PRO˜Net, the primary care research networks for Buckinghamshire and Oxfordshire respectively, awarded small bursaries to network members to support local research. The bursaries were designed to assist researchers undertaking small, largely unfunded projects. The intention was to encourage research activity that could be shown to lead to evidence-based practice. The bursaries took a broad view of research activity, including enabling projects, skills training and dissemination of findings. A total of £6818 was awarded to 19 applications involving 22 individuals. Semi-structured interviews were carried out with 19 of the recipients plus two correspondences via email to explore a wide range of outcomes and the effects on personal and professional development. Tangible outcomes included six published papers to date, six international conference presentations and 10 national presentations with many local presentations or network newsletter articles as well as securing additional external funding of £117500. The awards enable locally based research that contributes to the agenda of linking practice development with the implementation of findings at the local level essential to improving patient care. In addition, there are perceived benefits to individuals in developing their personal and professional skills, which in turn aid recruitment and retention in primary care.
Development
Maintaining quality in exercise referral schemes: a case study of professional practice
- Diane Crone, Lynne Johnston, Trudi Grant
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- Published online by Cambridge University Press:
- 31 October 2006, pp. 96-103
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The epidemiological evidence regarding physical activity and health has triggered, within health care, an interest in the development of physical activity promotion, in an attempt to address concerns regarding levels of physical inactivity within the population. These initiatives have varied during the past decade, from public health campaigns, to the development of nationally recognized training qualifications. By far the most prolific physical activity programme that has developed however, has been the ‘exercise referral scheme’. These schemes now exist in most towns and cities, providing a formal link between local primary care and leisure provision. However, professional bodies in both medicine and exercise, responsible for the care of their members, have expressed concerns over the duty and quality of care that exists within such schemes. Research too, has provided conflicting evidence regarding their efficacy for health improvement. As such, national recommendations have been produced and published by the Department of Health to set and maintain standards in this growing area of service delivery.
This case study of professional practice provides one innovative approach to ensuring that a countywide exercise referral scheme is a successful conduit for raising physical activity levels, and thus, health. By employing professionals from exercise science to deliver the Proactive Management Service, Somerset Physical Activity Group have devised a unique approach to ensuring and maintaining the quality of service delivery to the patients referred onto the exercise referral scheme within Somerset.
The case study concludes with lessons learnt from these developments and proposals for the future, including, establishing a national register of exercise referral schemes and the importance of addressing the competencies of both health professionals and leisure professionals, who are involved in such schemes.
Original Article
Minority ethnic women and cervical screening: a matter of action or research?
- Lai-Fong Chiu
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- Published online by Cambridge University Press:
- 31 October 2006, pp. 104-116
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Concerns over low uptake of cervical screening among minority ethnic women have spurred much research and practical activity to address the problem. Due to theoretical and methodological difficulties, research in this area has tended to focus on the communication deficit of women, without addressing the social context. This has not only hindered a wider theoretical understanding of the problem but, also, has perpetuated ineffective health promotion practice in this area. Using a participatory action research (PAR) approach, the project ‘Woman-to-woman: promoting cervical screening to minority ethnic women in primary care’, tackled the problem by involving both health professionals and women from the communities. Working in partnership, both professional and lay participants identified the problems from their own perspectives and generated solutions to resolve them. An intervention strategy was formulated in which bilingual women from the communities were recruited as community health educators to provide an informed link between their respective communities and the primary care sector. The outcomes of the intervention were evaluated by all participants. This paper aims to introduce PAR as an alternative approach by presenting an overview of the study. It begins by highlighting some of the common theoretical and methodological problems encountered by researchers; and then introduces the research framework of PAR and describes the research processes. A case observation is presented to illustrate the depth of understanding of the screening processes that can be obtained using this approach. The project has demonstrated that applying PAR cannot only lead to meaningful discoveries and insights into the problem of minority ethnic women and cervical screening, but also change in health promotion practice, which would have been difficult to achieve using a conventional research model. However, this study has also revealed major limitations of PAR, which need to be addressed if the approach is to be further developed.
Assessing service provision and demand in the management of mild to moderate mental health difficulties in primary care
- Lisa Whitehead, Christopher Dowrick
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- Published online by Cambridge University Press:
- 31 October 2006, pp. 117-124
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There is continuing support both politically and professionally for the provision of mental health care within primary care (Department of Health, 1999; The Scottish Office, 1993; 1997; 1998). However tensions exist between the supply and demand for mental health resources in primary care (Department of Health, 2000). In addition to resources, perceptions of need, knowledge and training are likely to influence the services offered and the uptake of these. This study reviews general practitioners’ (GPs) and patients’ perceptions of need, availability of services and GPs’ ability to access mental health services in two local areas using a new assessment tool. The Mental Health Management Options (MHMO) form, a brief instrument, was developed to provide information about GPs’ preferred and actual management options with people experiencing mild to moderate mental health difficulties seen during routine consultations
Sixteen GPs each completed 10 copies of the MHMO, providing data on 160 consultations. Analysis found that discrepancies arose in 69% (n = 109) of the consultations in relation to the action GPs wished to take but were unable to do so. This was related to the inability to access services, to patients who declined to follow suggested management options and to a lack of time and/or ability to manage the patient.
This study highlighted the barriers GPs face in managing people with mild to moderate mental health problems in primary care but also demonstrated the content validity and utility of the MHMO. The MHMO may be a useful new tool in identifying GPs’ perceptions of patterns of management and gaps in services.
Rising to the challenge: a study of patient and public involvement in four primary care trusts
- Jane South
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- Published online by Cambridge University Press:
- 31 October 2006, pp. 125-134
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As new organizations with responsibility for the health and health care of their local populations, primary care trusts (PCTs) need to engage with patients and the wider public. This paper identi. es the challenges faced by PCTs in implementing patient and public involvement and reports on a qualitative study of four PCTs in one health district. Findings from two pieces of data collection are reported on: an audit of community involvement activity and 16 semi-structured interviews with individuals working in the PCTs. The findings show that organizational capacity for undertaking patient and public involvement activities increased considerably over an 18 month period. The PCTs were found to be engaging with individuals and groups from the community and voluntary sector through a range of different structures and processes. Considerable commitment to patient and public involvement was reported but there were concerns over implementation. A number of influencing factors were identified including national policy, organizational factors, leadership, workload, access to experienced involvement workers and the pattern of local community activity. The paper discusses the implications for the development of patient and public involvement in PCTs including the importance of cultural change and the need for organizational development. The potential for PCTs to be involved in a range of participatory activities and to work with other partner organizations in localities is also discussed. The paper concludes that, despite challenges, progress can be made in implementing patient and public involvement as a mainstream activity in PCTs.
Primary care organization board members' views on accident prevention
- Lindsay Groom, Julia Hippisley-Cox, Denise Kendrick
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- Published online by Cambridge University Press:
- 31 October 2006, pp. 135-144
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This study aimed to explore the accident prevention activities of primary care organizations (PCOs) and the views of their board members regarding accident prevention. Qualitative study using semi-structured telephone interviews of 17 board members of PCOs (primary care groups and primary care trusts) in the National Health Service (NHS) Trent Region was undertaken. Accident prevention activity varied substantially between PCOs. The reduction of home hazards was a frequent focus of the PCOs’ accident prevention initiatives. Board members did not see accident prevention as their biggest priority in health improvement, although they had positive attitudes towards it. Local morbidity and NHS guidance were seen to be key determinants of PCOs’ priorities in health promotion. There was little reference to any strategic planning for accident prevention. Information to support accident prevention could be more timely and relevant to PCOs’ needs. The degree of involvement with outside agencies in accident prevention work varied substantially. Collaboration between agencies may be held back by mutual lack of knowledge and differences in culture and priorities. It was concluded that accident prevention appears to be receiving less attention in PCOs than other national health priorities. They may need more support for developing strategies for accident prevention and better provision of information so that they can identify local problems which can be addressed by preventative activities. The accident prevention plans contained in health improvement programmes should be monitored.
How accurately do general practitioners and students estimate coronary risk in hypercholesterolaemic patients?
- Lars Backlund, Johan Bring, Lars-Erik Strender
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- Published online by Cambridge University Press:
- 31 October 2006, pp. 145-152
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Recent guidelines on hyperlipidaemia recommend the calculation of individual coronary risk, at least for patients without previous cardiovascular disease. Although tables and computer programs exist, the estimates are often made on an intuitive basis. The aim of the present work was to study Swedish general practitioners’ (GPs) and medical students’ ability to estimate the 10-year risk of coronary events for hypercholesterolaemic patients. Two hundred randomly selected Swedish GPs and 73 medical students in their final year of medical school were asked to estimate coronary risk for 10 written case descriptions with different cholesterol levels (at least 5.5 mmol/l) and combinations of other risk factors. Both primary and secondary prevention cases were represented. The risk estimates were compared with the estimates from the Framingham equation and a Swedish equation. The interindividual differences in estimated risk were remarkable for both GPs and students. Both GPs and students underestimated coronary risk, especially for high-risk patients. GPs tended to be more accurate than students in ranking the cases. Cases with previous coronary heart disease were not recommended treatment to the extent that the guidelines recommend. Both GPs and students were quite accurate in estimating absolute risk increase attributable to successive cholesterol increases in a scenario with other risk factors kept constant. It was concluded that GPs and medical students need help to differentiate more accurately between patients at high and low coronary risk, and greater effort should be made to communicate the advantages and difficulties involved in multiple risk assessment. The requirements for decision support are discussed. More evidence is needed on the validity of the Framingham equation for new population samples.
Experience of service provision for adolescents with eating disorders
- Sharon Rother, Julia Buckroyd
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- Published online by Cambridge University Press:
- 31 October 2006, pp. 153-161
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Eating disorders of all kinds are common and serious in adolescents and young women. Recent government policies have suggested that adolescent mental health strategies should be developed. They have also laid emphasis on early intervention, accessible local provision and have identified eating disorders as a priority. It is acknowledged that services at primary care level for adolescents with eating disorders are sporadic or nonexistent. It was considered that a service user perspective would be beneficial in contributing to assessing the needs of adolescents with eating disorders. The research project was established to identify the service provision used, if any, by adolescent sufferers of eating disorders and what, in their opinion, would have been desirable at that time. The research consisted of a semi-structured interview with a sample of recovered adult participants to establish their experiences of services they had received as adolescents. Additionally the participants were asked what further help they felt would have been beneficial and where that help would have been usefully situated. The main findings suggest that the majority of health professionals are ill informed and not acutely conscious of the needs of eating disordered adolescents. Only counsellors within the voluntary sector agency showed any real understanding and an ability to help constructively. It was concluded that there is a real lack of help at primary care level and that schools should play a wider role in educating adolescents in a positive belief in themselves and in the destructive nature of an eating disorder.
Alcohol and brief intervention in primary health care: what do patients think?
- Catherine A. Lock
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- Published online by Cambridge University Press:
- 31 October 2006, pp. 162-178
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Excessive alcohol consumption causes major problems in the UK but is responsive to brief intervention. Excessive drinkers represent 20% of patients on practice lists and present twice as often as others. The potential of health professionals to reduce alcohol related problems contrasts sharply with current practice. Health professionals’ report fears about negative reactions and losing rapport with patients. This study explored patients’ attitudes to and experiences of alcohol and brief intervention in primary health care so that health professionals can provide a service which is more acceptable to patients. The study used a qualitative approach to data collection and analysis. Six focus groups, stratified by age and sex, were conducted with 31 patients from practices in northeast England. A combination of random and purposive sampling was used to recruit patients with a range of perspectives on issues emerging from ongoing data-analysis until data saturation occurred. Many patients had recently altered their lifestyle to improve their health, however, only one reported reducing alcohol consumption. Over half the patients had been advised about their lifestyle but this was not always deemed to be appropriate. Patients responded positively to advice when in an appropriate context and by a health professional with whom they had developed a relationship and rapport. Overall the general practitioner was deemed the preferred health professional to discuss alcohol issues. Brief alcohol intervention is a legitimate role of the general practitioner when carried out in an appropriate context. A National Alcohol Strategy should focus on strengthening the public health campaign in order to support general practitioners in brief alcohol intervention.
The effect of population-based health needs assessment on health visitor practice
- Ann Rowe, Lynda Carey
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- Published online by Cambridge University Press:
- 31 October 2006, pp. 179-186
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This paper reports on a study examining the effects of undertaking population-based health needs assessment (HNA) on the knowledge, views and working practices of health visitors. Data were generated through indepth interviews with health visitors who had all utilized a standard mechanism for needs assessment. This was analysed to assess the impact of this work on the research respondents’ knowledge base, their attitudes and approaches to health visiting and their everyday practice. Findings suggest that undertaking health needs assessment increased understanding of public health concepts, enabled a profound reflection on current working practices and increased respondent’s desire to practise differently. However, despite these forces for change, the practitioners in this study found it very difficult to refocus their work in the way they desired due to a combination of inhibiting factors, including custom and practice and the perceptions and demands of others. If health visitors are to expand the scope of their work to incorporate an increased amount of community based activity as the UK Government is proposing, this study would suggest that these inhibiting factors must be addressed not only by health visitors themselves, but also by their employers and other primary care professionals.