Service provision for people with schizophrenia

1997 ◽  
Vol 171 (2) ◽  
pp. 165-168 ◽  
Author(s):  
F. H. Lang ◽  
E. C. Johnstone ◽  
G. D. Murray
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
General Practice ◽  
Service Provision ◽  
Improve Patient Care ◽  
Postal Questionnaire ◽  
Working Practices ◽  
Additional Support ◽  
Regular Contact ◽  
Improve Patient

BackgroundThis second report of a study of service provision for patients with schizophrenia describes patients' contact with general practice and general practitioners' (GPs’) views of the mental health services.MethodA postal questionnaire was sent to the GPs, and patients' primary care records were examined.ResultsData were collected on 131 subjects. The majority of patients (96) (73%) were in regular contact with their GP and were consulting for many different reasons; 27 (21%) were posing particular difficulties for the primary care team. GPs reported that 27 (21%) patients required additional support and that the care arrangements for 50 (38%) patients could be improved if alterations were made to the roles of the professionals already involved.ConclusionsGPs are central to service provision for patients with schizophrenia. Both additional resources and changes in working practices are required to improve patient care. The service implications of these findings are discussed.

scholarly journals Acute General Practice – the 7 year itch

2015 ◽  
Vol 14 (3) ◽  
pp. 132-135
Author(s):  
Ben Jameson
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Patient Care ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Service Design ◽  
Improve Patient Care ◽  
Medical Assessment ◽  
Improve Patient

The Acute GP Service has operated in Plymouth for the last 7 years. We have a mandate to improve patient care through supporting community GPs and their patients at the point of need for urgent medical assessment. I outline our service design and delivery and make the argument for the use of primary care physicians to help manage the interface between primary and secondary care.

Anaemia in primary care: iron deficiency and anaemia of chronic disease

2021 ◽  
Vol 3 (10) ◽  
pp. 422-426
Author(s):  
Margaret Perry
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Chronic Disease ◽  
Care Setting ◽  
Primary Care Setting ◽  
Improve Patient Care ◽  
Global Scale ◽  
Practice Nurses ◽  
Anaemia Of Chronic Disease ◽  
Improve Patient

This article will look at iron defciency anaemia and anaemia of chronic disease. Both are problems encountered frequently at a global scale and in the primary care setting. Both conditions can potentially affect any age, although anaemia of chronic disease is more common among older adults. It is hoped that the information provided will give general practice nurses and nurse prescribers greater confidence in the recognition, diagnosis, and management of these conditions, to improve patient care.

General Practice Recruitment for People at Risk of Schizophrenia: The Buckingham Experience

2000 ◽  
Vol 34 (1_suppl) ◽  
pp. A131-A136 ◽  
Author(s):  
Ian R. H. Falloon
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Primary Care ◽  
At Risk ◽  
General Practice ◽  
Early Detection ◽  
Psychotic Disorders ◽  
Community Sample ◽  
Signs And Symptoms ◽  
Psychotic Episode

Objective The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings. Methods A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project. Results General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered. Conclusions It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.

scholarly journals Capturing Relevant Patient Data in Clinical Encounters Through Integration of an Electronic Patient-Reported Outcome System Into Routine Primary Care in a Boston Community Health Center: Development and Implementation Study (Preprint)

2019 ◽  
Author(s):  
Stephanie Loo ◽  
Chris Grasso ◽  
Jessica Glushkina ◽  
Justin McReynolds ◽  
William Lober ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Health Center ◽  
Community Health Centers ◽  
Community Health Center ◽  
Improve Patient Care ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Patient Provider Communication ◽  
Improve Patient

BACKGROUND Electronic patient-reported outcome (ePRO) systems can improve health outcomes by detecting health issues or risk behaviors that may be missed when relying on provider elicitation. OBJECTIVE This study aimed to implement an ePRO system that administers key health questionnaires in an urban community health center in Boston, Massachusetts. METHODS An ePRO system that administers key health questionnaires was implemented in an urban community health center in Boston, Massachusetts. The system was integrated with the electronic health record so that medical providers could review and adjudicate patient responses in real-time during the course of the patient visit. This implementation project was accomplished through careful examination of clinical workflows and a graduated rollout process that was mindful of patient and clinical staff time and burden. Patients responded to questionnaires using a tablet at the beginning of their visit. RESULTS Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model in terms of applying technological innovation to streamline clinical processes and improve patient care. CONCLUSIONS Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model for application of technological innovation to streamline clinical processes and improve patient care.

scholarly journals Experiences of support from primary care and perceived needs of parents bereaved by suicide: a qualitative study

2020 ◽  
Vol 70 (691) ◽  
pp. e102-e110 ◽  
Author(s):  
Verity Wainwright ◽  
Lis Cordingley ◽  
Carolyn A Chew-Graham ◽  
Nav Kapur ◽  
Jenny Shaw ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Qualitative Study ◽  
Support Needs ◽  
Structured Interviews ◽  
Perceived Needs ◽  
The North ◽  
Suicide Bereavement ◽  
Additional Support ◽  
The Uk

BackgroundPeople bereaved by suicide are a vulnerable group, also at risk of dying by suicide. The importance of postvention support (intervention after suicide) has recently been highlighted; however, little is known about the support needs of parents bereaved by suicide in the UK, and the role played by general practice.AimTo explore the perspectives, experiences, and support needs of parents bereaved by suicide.Design and settingThis was a qualitative study, with semi-structured interviews conducted between 2012 and 2014 in the north of England and the Midlands, with parents bereaved by their son or daughter’s suicide.MethodInterviews explored parents’ experiences of suicide bereavement following the death of their son or daughter, with a focus on their experiences of support from primary care. Interviews were analysed thematically using constant comparison.ResultsTwenty-three interviews were conducted. Three themes were identified from the data: the importance of not feeling alone; perceived barriers to accessing support; and the need for signposting for additional support. Some parents reported having experienced good support from their general practice; others described a number of barriers to accessing help, including triage processes. Primary care was considered to be an important avenue of support but GPs were often perceived as uncertain how to respond. The need for information, signposting to avenues of support, and the helpfulness of group support were also highlighted.ConclusionParents believed it was important that people working in general practice have an awareness of suicide bereavement and understanding of their needs, including knowledge of where to direct people for further support.

scholarly journals 96 Will Routine Frailty Identification by GPS Improve Patient Care? A Review of the 2017 GMS Contract For General Practitioners (GPS) Using Pestle Analysis Tool

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i30-i32
Author(s):  
M Kaneshamoorthy
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Improve Patient Care ◽  
Cost Effective ◽  
Alternative Methods ◽  
Analysis Tool ◽  
Frail Patients ◽  
The Government ◽  
Improve Patient ◽  
Work Burden

Abstract Introduction It is well established in the literature that frailty is associated with high health costs (Bock 2016, England: BioMed Central). Early identification improves patient outcomes. The 2017 GMS contract for General Practioners’ (NHS England 2017) had tried to implement this. This is a result from the government wanting to improve care for frail patients from the “Five Year Forward Review”. This is first policy worldwide to introduce a policy on frailty screening (Reeves, 2018, BMJ, 362, pp. k3349). Majority of frail patients’ first contact with the NHS is through Primary Care. However, with ever reducing number of GPs and increasing work burden, is it appropriate to ask GPs to undertake this? Methods This review uses the policy analysis tool PESTLE (Political, Economical, Social, Technological, Legal, and Environmental) (Visconti 2016, Corporate Ownership and Control,13), to assess the implications of this new contract obligation on GPs and patients. Results Once frail patients are identified, it is advised that they are reviewed by GPs annually. Whether this actually benefits patients are not clear (Page 2017 British Journal of Clinical Pharmacology, 82(3), pp. 583–623). The evidence for interventions being cost-effective is also inconsistent (Hamilton 2017, BMJ, 358, pp. j4478). Alternative methods include implementing a nurse-led community frailty service, has shown some benefit in Netherlands (Bleijenberg 2017, JAMDA). Clinical Pharmacist can aid with medication reviews and focusing on Geriatrician “outreach” clinics in primary care can improve patient care and outcomes (Goldstein 2014, CJEM, 16(5), pp. 370). Due to the work burden, GPs are often seen to be reactive rather than proactive (Goodwin 2010, The King’s Fund). The shift in focus on frailty can simulate more constructive dialogue between primary care, secondary care, patients and their carers. The BMA has also tried to reassure GPs this is not an added burden, but this is controversial (BMA 2017). Conclusions To successfully implement such a policy, emphasis on clear objective outcomes and strategy is needed. There is a risk of frailty identification becoming a tick box exercise.

scholarly journals Why did Divisions of General Practice implement some Access to Allied Psychological Services mental health initiatives and not others?

2015 ◽  
Vol 39 (1) ◽  
pp. 18
Author(s):  
Kylie King ◽  
Angela Nicholas ◽  
Justine Fletcher ◽  
Bridget Bassilios ◽  
Lennart Reifels ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
General Practice ◽  
Indirect Evidence ◽  
Psychological Services ◽  
The Self ◽  
Health Programs ◽  
Self Identity ◽  
Health Initiatives ◽  
Mental Health Programs

Objective The Access to Allied Psychological Services (ATAPS) programs implemented through Divisions of General Practice (now Medicare Locals) enables general practitioners (GPs) to refer consumers with high-prevalence mental disorders for up to 12 individual and/or group sessions of evidence-based mental health care. The great strength of ATAPS is its ability to target vulnerable and hard-to-reach populations. Several initiatives have been introduced that focus on particular at-risk populations. This study aimed to determine the factors that had influenced Divisions’ decisions to implement the various Tier 2 initiatives. Methods An online survey was sent to all Divisions. The survey contained mostly multiple choice questions and sought to determine which factors had influenced their decision-making. Results The most common factors influencing the decision to implement an initiative were the perception of local need and whether there was an existing service model that made it easier to add in new programs. The most commonly cited factors for not implementing were related to resources and administrative capacity. Conclusions This research provides valuable insights into the issues that primary care organisations face when implementing new programs; the lessons learnt here could be useful when considering the implementation of other new primary care programs. What is known about the topic? Previous evaluations of ATAPS have shed light on some of the factors that act as barriers to the implementation of new mental health initiatives by Divisions operating in primary care, but there is nothing known about why Divisions choose to implement some programs over others. Previous research suggests that ‘barriers’ to change, as reported by organisations, may be constructions that are used to make sense of a situation and that the real impediment to change are intra-organisational factors such as the self-identity of organisations. What does this paper add? This paper reports on a survey that was undertaken with Divisions regarding the reasons they chose to implement particular mental health initiatives. The paper provides insight into the barriers that Divisions perceived when implementing new mental health programs. They were primarily cited as funding and resource barriers. The findings also provide further indirect evidence of the role of the self-identity of organisations in change. What are the implications for practitioners? The study has some implications for government policy development both locally and internationally. For instance, it is likely that primary care organisations such as Divisions, especially smaller ones, require support in terms of increased funding and resources if new mental health initiatives are to be successful. Mandating the delivering of initiatives also contributes to their successful uptake. It is likely that as primary care organisations become more experienced with implementing new mental health programs, the perceived barriers will reduce and implementation will occur with more ease.

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