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1.
Health Soc Care Deliv Res ; 11(8): 1-137, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37470109

RESUMO

Background: The Children and Young People's Mental Health Trailblazer programme is funding the creation of new mental health support teams to work in schools and further education colleges. Mental health support teams directly support children and young people with 'mild to moderate' mental health problems and work with school and college staff to promote well-being for all. A new workforce of education mental health practitioners is being trained for the teams. Objective(s): The National Institute for Health and Care Research Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre and Policy Innovation and Evaluation Research Unit undertook an early evaluation of the Trailblazer programme to examine the development, implementation and early progress of mental health support teams in the programme's first 25 'Trailblazer' sites. Design: A mixed-methods evaluation, comprising three work packages: 1. Establishing the baseline and understanding the development and early impacts of the Trailblazer sites, including two rounds of surveys with key informants and participating education settings in all 25 sites. 2. More detailed research in five purposively selected Trailblazer sites, including interviews with a range of stakeholders and focus groups with children and young people. 3. Scoping and developing options for a longer-term assessment of the programme's outcomes and impacts. Fieldwork was undertaken between November 2020 and February 2022. The University of Birmingham Institute for Mental Health Youth Advisory Group was involved throughout the study, including co-producing the focus groups with children and young people. Results: Substantial progress had been made implementing the programme, in challenging circumstances, and there was optimism about what it had the potential to achieve. The education mental health practitioner role had proven popular, but sites reported challenges in retaining education mental health practitioners, and turnover left mental health support teams short-staffed and needing to re-recruit. Education settings welcomed additional mental health support and reported positive early outcomes, including staff feeling more confident and having faster access to advice about mental health issues. At the same time, there were concerns about children who had mental health problems that were more serious than 'mild to moderate' but not serious enough to be accepted for specialist help, and that the interventions offered were not working well for some young people. Mental health support teams were generally spending more time supporting children with mental health problems than working with education settings to develop 'whole school' approaches to mental health and well-being, and service models in some sites appeared to be more clinically oriented, with a strong focus on mental health support teams' therapeutic functions. Limitations: Despite efforts to maximise participation, survey response rates were relatively low and some groups were less well represented than others. We were not able to gather sufficiently detailed data to develop a typology of Trailblazer sites, as was planned. Conclusions: Key lessons for future programme implementation include: - Whether mental health support teams should expand support to children and young people with more complex and serious mental health problems. - How to keep the twin aims of prevention and early intervention in balance. - How to retain education mental health practitioners once trained. Future work: The findings have important implications for the design of a longer-term impact evaluation of the programme, which is due to commence in summer 2023. Study registration: Ethical approval from the University of Birmingham (ERN_19-1400 - RG_19-190) and London School of Hygiene and Tropical Medicine (Ref: 18040) and Health Research Authority approval (IRAS 270760). Funding: The Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre is funded by the National Institute for Health and Care Research Health Services and Delivery Research programme (HSDR 16/138/31). The Policy Innovation and Evaluation Research Unit is funded by the NIHR Policy Research Programme (PR-PRU-1217-20602).


Assuntos
Educação em Saúde , Saúde Mental , Adolescente , Humanos , Criança , Inquéritos e Questionários , Grupos Focais , Instituições Acadêmicas
2.
Med Care Res Rev ; 75(2): 201-218, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-27698072

RESUMO

Patient evaluations of physician communication are widely used, but we know little about how these relate to professionally agreed norms of communication quality. We report an investigation into the association between patient assessments of communication quality and an observer-rated measure of communication competence. Consent was obtained to video record consultations with Family Practitioners in England, following which patients rated the physician's communication skills. A sample of consultation videos was subsequently evaluated by trained clinical raters using an instrument derived from the Calgary-Cambridge guide to the medical interview. Consultations scored highly for communication by clinical raters were also scored highly by patients. However, when clinical raters judged communication to be of lower quality, patient scores ranged from "poor" to "very good." Some patients may be inhibited from rating poor communication negatively. Patient evaluations can be useful for measuring relative performance of physicians' communication skills, but absolute scores should be interpreted with caution.


Assuntos
Comunicação , Variações Dependentes do Observador , Satisfação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Médicos/psicologia , Médicos/normas , Encaminhamento e Consulta/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravação de Videoteipe
3.
BMJ Open ; 7(3): e014718, 2017 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-28255096

RESUMO

OBJECTIVE: To examine concordance between responses to patient experience survey items evaluating doctors' interpersonal skills, and subsequent patient interview accounts of their experiences of care. DESIGN: Mixed methods study integrating data from patient questionnaires completed immediately after a video-recorded face-to-face consultation with a general practitioner (GP) and subsequent interviews with the same patients which included playback of the recording. SETTING: 12 general practices in rural, urban and inner city locations in six areas in England. PARTICIPANTS: 50 patients (66% female, aged 19-96 years) consulting face-to-face with 32 participating GPs. MAIN OUTCOME MEASURES: Positive responses to interpersonal skills items in a postconsultation questionnaire ('good' and 'very good') were compared with experiences reported during subsequent video elicitation interview (categorised as positive, negative or neutral by independent clinical raters) when reviewing that aspect of care. RESULTS: We extracted 230 textual statements from 50 interview transcripts which related to the evaluation of GPs' interpersonal skills. Raters classified 70.9% (n=163) of these statements as positive, 19.6% (n=45) neutral and 9.6% (n=22) negative. Comments made by individual patients during interviews did not always express the same sentiment as their responses to the questionnaire. Where questionnaire responses indicated that interpersonal skills were 'very good', 84.6% of interview statements concerning that item were classified as positive. However, where patients rated interpersonal skills as 'good', only 41.9% of interview statements were classified as positive, and 18.9% as negative. CONCLUSIONS: Positive responses on patient experience questionnaires can mask important negative experiences which patients describe in subsequent interviews. The interpretation of absolute patient experience scores in feedback and public reporting should be done with caution, and clinicians should not be complacent following receipt of 'good' feedback. Relative scores are more easily interpretable when used to compare the performance of providers.


Assuntos
Medicina Geral , Clínicos Gerais/normas , Satisfação do Paciente , Relações Médico-Paciente , Habilidades Sociais , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
4.
Br J Gen Pract ; 66(652): e786-e793, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27621292

RESUMO

BACKGROUND: In recent years, hospitals have made use of new technologies, such as real-time feedback, to collect patient experience information. This approach is currently rarely used in primary care settings, but may provide practices with a useful tool that enables them to take prompt, focused action to improve their services. AIM: To identify the factors inhibiting and enabling the implementation of real-time feedback in general practices. DESIGN AND SETTING: Qualitative study embedded within an exploratory trial (July 2014 to February 2015) of a real-time feedback intervention targeting patient experience in general practices in south-west England and Cambridgeshire. METHOD: Semi-structured interviews (n = 22) and focus groups (n = 4, total of 28 attendees) with practice staff were audiorecorded, transcribed, and analysed thematically, using a framework based on constructs from normalisation process theory. RESULTS: Staff engagement with real-time feedback varied considerably, and staff made sense of real-time feedback by comparing it with more familiar feedback modalities. Effective within-team communication was associated with positive attitudes towards real-time feedback. Timing of requests for feedback was important in relation to patient engagement. Real-time feedback may offer potential as a means of informing practice development, perhaps as a component of a wider programme of capturing and responding to patients' comments. CONCLUSION: Successful implementation of real-time feedback requires effective communication across the practice team to engender thorough engagement. Feedback processes should be carefully introduced to fit with existing patient and practice routines. Future studies should consider making real-time feedback content relevant to specific practice needs, and support participation by all patient groups.


Assuntos
Feedback Formativo , Medicina Geral/normas , Equipe de Assistência ao Paciente , Satisfação do Paciente/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Inglaterra , Grupos Focais , Medicina Geral/educação , Humanos , Pesquisa Qualitativa
5.
Br J Gen Pract ; 63(608): e200-8, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23561787

RESUMO

BACKGROUND: The UK government has encouraged NHS services to obtain patient feedback to support the further development of patient-centred care. In 2009, the English GP Patient Survey included a sample of 5.5 million, but little is known about its potential utility in informing developments aimed at improving the quality of patients' experiences of primary care. AIM: To investigate primary care providers' response to feedback on patient experience from a national survey. DESIGN AND SETTING: Qualitative interview study in 10 general practices from four primary care trusts in England. METHOD: Semi-structured interviews were conducted with GPs, practice nurses, and practice managers (n = 37). Transcripts were analysed thematically. RESULTS: Although some participants reported making changes to their practice in response to the survey data, many expressed doubts about the credibility of the results. Key issues included: concerns about practical aspects of the survey, such as the response rate and representativeness of the sample; the view that it gave insufficient detail to facilitate change and failed to address some salient issues; and unease about the influence of political influences underpinning its introduction and use. CONCLUSION: Although, in general, primary care professionals have positive attitudes towards patient feedback, this study suggests a mismatch between the conventional demonstration of the objectivity of a questionnaire survey and the attitudes and experiences of those receiving the data. This is likely to prevent doctors from engaging constructively with the survey. These concerns may well militate against the potential of the survey to act as a simple means of capturing, and effectively using, feedback from patients.


Assuntos
Atitude do Pessoal de Saúde , Retroalimentação , Medicina Geral/normas , Atitude Frente a Saúde , Inglaterra , Enfermeiros de Saúde da Família/psicologia , Feminino , Clínicos Gerais/psicologia , Humanos , Masculino , Satisfação do Paciente , Administração da Prática Médica , Inquéritos e Questionários
6.
BMC Fam Pract ; 13: 71, 2012 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-22831570

RESUMO

BACKGROUND: The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority in England for chronic disease management. However, it is not clear how care planning is currently understood, translated and implemented in primary care. This study explores experience of care planning in patients with long term conditions in three areas in England. METHODS: We conducted semi-structured interviews with 23 predominantly elderly patients with multiple long term conditions. The interviews were designed to explore variations in and emergent experiences of care planning. Qualitative analysis of interview transcripts involved reflexively coding and re-coding data into categories and themes. RESULTS: No participants reported experiencing explicit care planning discussions or receiving written documentation setting out a negotiated care plan and they were unfamiliar with the term 'care planning'. However, most described some components of care planning which occurred over a number of contacts with health care professionals which we term "reactive" care planning. Here, key elements of care planning including goal setting and action planning were rare. Additionally, poor continuity and coordination of care, lack of time in consultations, and patient concerns about what was legitimate to discuss with the doctor were described. CONCLUSIONS: Amongst this population, elements of care planning were present in their accounts, but a structured, comprehensive process and consequent written record (as outlined in English Department of Health policy) was not evident. Further research needs to explore the advantages and disadvantages of different approaches to care planning for different patient groups.


Assuntos
Doença Crônica/terapia , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Idoso , Inglaterra , Feminino , Política de Saúde , Humanos , Entrevistas como Assunto , Masculino , Planejamento de Assistência ao Paciente/normas , Atenção Primária à Saúde/métodos , Pesquisa Qualitativa , Autocuidado
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