Perinatal Depression and Use of Health Services in British Women of Pakistani Origin

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
I. Mukherjee ◽  
M. Husain ◽  
S. Khan ◽  
N. Husain
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Perinatal Depression ◽  
Perinatal Period ◽  
Health Events ◽  
Care Services ◽  
Significant Difference ◽  
Pakistani Origin ◽  
Health Event ◽  
Depressed Mothers

Background:Perinatal depression (PND) has adverse effects on the well being of the mother-infant dyad. Women with PND often show different patterns of help seeking behaviour.Objective:We aimed to examine the association between PND and the reporting of health events and healthcare use in a cohort of British women of Pakistani origin.Method:Participants were recruited from antenatal clinics in the North West of England and followed up 6 months postnatal. Sixty-seven women diagnosed with depression using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) were compared with 156 non depressed controls in terms of reporting of health events elicited using the Life Events and Difficulties Schedule (LEDS). Health events included any condition that involved attending primary or secondary care.Results:Depressed mothers were 1.5 times more likely to report a health event within the perinatal period (p=0.005) and 1.8 times more likely to report a health event (0.031) outside the perinatal period. Depressed mothers were more likely to attend secondary care services for their children (p=0.001) but there was no significant difference in terms of attendance at primary care.Conclusion:Depressed mothers were more likely to report personal health events and more likely to access secondary care rather than primary care services for health events affecting their children. This highlights the hidden costs of this condition and the need for adequate diagnosis and management of this treatable but under recognised illness.

scholarly journals Referrals to Urgent Dental Centres During the COVID-19 Pandemic: A Multi-Site Analysis Research Project

2021 ◽  
Vol 10 (1) ◽  
pp. 40-45
Author(s):  
Adam Shathur ◽  
Samuel Reeves ◽  
Faizal Sameja ◽  
Vishal Patel ◽  
Allan Jones
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Easy Access ◽  
Dental Services ◽  
Care Services ◽  
Dental Practitioners ◽  
Consultation And Referral ◽  
Care Systems ◽  
Access To Primary Care ◽  
The Uk

Introduction: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. Aims: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. Methods: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. Results: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include ‘advice, analgesia and antimicrobial’ from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. Conclusion: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.

Palpitation referrals from primary care to a secondary care cardiology outpatient clinic: assessing adherence to guidelines

2020 ◽  
Author(s):  
Susil Pallikadavath ◽  
Roshan Patel ◽  
Rishi Sarania ◽  
Talal Ahmad ◽  
Zakariyya Vali ◽  
...  
Keyword(s):  
Primary Care ◽  
Outpatient Clinic ◽  
Secondary Care ◽  
Resonance Imaging ◽  
Adherence To Guidelines ◽  
Common Presentation ◽  
Care Services ◽  
Early Evidence ◽  
Number Of Patients ◽  
Care Guidelines

Abstract Background and aims Palpitations are a common presentation in primary care. Guidelines have been developed to identify patients with palpitations who require further assessment by a cardiologist in secondary care. However, patients that do not meet guideline thresholds for referrals are still referred to secondary care services. This audit evaluated the adherence to referral guidelines at our trust and assessed the characteristics of patients who were referred appropriately versus those referred without meeting guideline referral thresholds (inappropriate referral). Results Palpitation referrals to a single cardiology outpatient clinic were assessed (n = 66). Half the patients referred for palpitations were referred inappropriately (n = 34, 51.5%). Patients referred inappropriately were more likely to have a benign diagnosis after assessment (91.2%). These patients also had significantly fewer investigations [mean difference of 1.1 (confidence interval: 0.6–1.6)]. Specialist investigations, such as cardiac event recorders (P < 0.05) and cardiac magnetic resonance imaging (P < 0.05) were less likely to be used in inappropriately referred patients. Conclusions The results from this audit provide early evidence that there are a significant number of patients who are being referred that could be managed in primary care. Further studies are needed to confirm our findings in larger cohorts and to establish the underlying reasons for inappropriate referrals.

scholarly journals GPs’ role in caring for children and young people with life-limiting conditions: a retrospective cohort study

2020 ◽  
Vol 70 (693) ◽  
pp. e221-e229
Author(s):  
Stuart Jarvis ◽  
Roger C Parslow ◽  
Catherine Hewitt ◽  
Sarah Mitchell ◽  
Lorna K Fraser
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Young People ◽  
Retrospective Cohort Study ◽  
Secondary Care ◽  
Retrospective Cohort ◽  
Clinical Practice Research Datalink ◽  
Children And Young People ◽  
Attendance Patterns ◽  
Significant Difference

BackgroundGPs are rarely actively involved in healthcare provision for children and young people (CYP) with life-limiting conditions (LLCs). This raises problems when these children develop minor illness or require management of other chronic diseases.AimTo investigate the association between GP attendance patterns and hospital urgent and emergency care use.Design and settingRetrospective cohort study using a primary care data source (Clinical Practice Research Datalink) in England. The cohort numbered 19 888.MethodCYP aged 0–25 years with an LLC were identified using Read codes (primary care) or International Classification of Diseases 10 th Revision (ICD-10) codes (secondary care). Emergency inpatient admissions and accident and emergency (A&E) attendances were separately analysed using multivariable, two-level random intercept negative binomial models with key variables of consistency and regularity of GP attendances.ResultsFace-to-face GP surgery consultations reduced, from a mean of 7.12 per person year in 2000 to 4.43 in 2015. Those consulting the GP less regularly had 15% (95% confidence interval [CI] = 10% to 20%) more emergency admissions and 5% more A&E visits (95% CI = 1% to 10%) than those with more regular consultations. CYP who had greater consistency of GP seen had 10% (95% CI = 6% to 14%) fewer A&E attendances but no significant difference in emergency inpatient admissions than those with lower consistency.ConclusionThere is an association between GP attendance patterns and use of urgent secondary care for CYP with LLCs, with less regular GP attendance associated with higher urgent secondary healthcare use. This is an important area for further investigation and warrants the attention of policymakers and GPs, as the number of CYP with LLCs living in the community rises.

scholarly journals The role of trust and hope in antipsychotic medication reviews between GPs and service users a realist review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
L. M. Grünwald ◽  
C. Duddy ◽  
R. Byng ◽  
N. Crellin ◽  
J. Moncrieff
Keyword(s):  
Primary Care ◽  
Antipsychotic Medication ◽  
Perceived Risk ◽  
Secondary Care ◽  
Realist Review ◽  
Service Users ◽  
Programme Theory ◽  
Care Services ◽  
Low Expectations ◽  
Medication Reviews

Abstract Background Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners (GPs) have the confidence and experience to appropriately review and adjust doses of antipsychotic medication without secondary care support. Aim To explore barriers and facilitators of conducting antipsychotic medication reviews in primary care for individuals with no specialist mental health input. Design & setting Realist review in general practice settings. Method A realist review has been conducted to synthesise evidence on antipsychotic medication reviews conducted in primary care with service users diagnosed with schizophrenia or psychosis. Following initial scoping searches and discussions with stakeholders, a systematic search and iterative secondary searches were conducted. Articles were systematically screened and analysed to develop a realist programme theory explaining the contexts (C) and mechanisms (M) which facilitate or prevent antipsychotic medication reviews (O) in primary care settings, and the potential outcomes of medication reviews. Results Meaningful Antipsychotic medication reviews may not occur for individuals with only primary care medical input. Several, often mutually reinforcing, mechanisms have been identified as potential barriers to conducting such reviews, including low expectations of recovery for people with severe mental illness, a perceived lack of capability to understand and participate in medication reviews, linked with a lack of information shared in appointments between GPs and Service Users, perceived risk and uncertainty regarding antipsychotic medication and illness trajectory. Conclusions The review identified reciprocal and reinforcing stereotypes affecting both GPs and service users. Possible mechanisms to counteract these barriers are discussed, including realistic expectations of medication, and the need for increased information sharing and trust between GPs and service users.

scholarly journals Continuity of care in heart failure patients

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
K Olsen ◽  
NF Falun ◽  
HK Keilegavlen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Health Care ◽  
Continuity Of Care ◽  
Secondary Care ◽  
Health Care Services ◽  
Care Services ◽  
Discharge From Hospital ◽  
Patients Experience

Abstract Funding Acknowledgements Type of funding sources: None. Background  Heart failure (HF) requires follow-up over time and by several different health services. The positive effects of follow-up care in secondary care services is well known. However, there is a lack of knowledge in how HF patients experience continuity of care a through various health care services in secondary and primary care. Purpose To explore how HF patients experience continuity of care through secondary and primary health care services. Methods The study used an inductive design by performing four semi-structured focus group interviews. Overall, 17 patients, mean age of 71 years (range 42-95), 11 men and 6 women, All patients were receiving regular and individual follow-up by cardiac nurses in primary care after hospital discharge The interviews were analysed through qualitative content analysis. Results Gaps in continuity of care were described as challenging. Information about HF at the time of discharge from hospital were not always fully comprehended. Patients experienced physical strain of being lost and abandoned after discharge from hospital. They did not know whom to contact for follow-up.  Appointments with the GP was not agreed or scheduled weeks ahead. Patients appreciated home visit by a cardiac nurse in primary care who provided the patients with knowledge in self-care administration. When experiencing deterioration they could call the cardiac nurse, who could facilitate fast track to the hospital. Self-care was difficult to comprehend, especially for those experiencing comorbidities. Patients also  described the importance of sharing knowledge and experience of living with HF with other patients in a secondary care setting, organized by specialised cardiac nurses. Conclusions There are gaps in continuity in patients’ pathways, throughout both secondary and primary healthcare. Even though patients receive information at discharge from hospital, they felt insecure when returning home. Health care services in the primary care provided the patients with both knowledge and confidence as they regularly met the patients, both at home and in organized primary care meetings.

The GP role in improving outcomes for homeless inpatients

2018 ◽  
Vol 22 (1) ◽  
pp. 15-26 ◽  
Author(s):  
Zana Khan ◽  
Philip Haine ◽  
Samantha Dorney-Smith
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Homeless People ◽  
Routine Data ◽  
Community Services ◽  
Structured Interviews ◽  
Content Type ◽  
Complex Needs ◽  
Care Services

Purpose Homeless people experience extreme health inequalities and high rates of morbidity and mortality (Aldridge et al., 2017). Use of primary care services are low, while emergency healthcare use is high (Mathie, 2012; Homeless Link, 2014). Duration of admission has been estimated to be three times longer for homeless patients who often experience poor hospital discharge arrangements (Mathie, 2012; Homeless Link, 2014). This reflects ongoing and unaddressed care and housing needs (Blackburn et al., 2017). The paper aims to discuss these issues. Design/methodology/approach This paper reveals how GPs employed in secondary care, as part of Pathway teams, support improved health and housing outcomes and safe transfer of care into community services. It draws on published literature on role of GPs in working with excluded groups, personal experience of working as a GP in secondary care, structured interviews with Pathway GPs and routine data collected by the team to highlight key outcomes. Findings The expertise of GPs is highlighted and includes holistic assessment, management of multimorbidity or “tri-morbidity” – the combination of addictions problems, mental illness and physical health (Homeless Link, 2014; Stringfellow et al., 2015) and research and teaching. Originality/value The role of the GP in the care of patients with complex needs is more visible in primary care. This paper demonstrates some of the ways in which in-reach GPs play an important role in the care of multiply excluded groups attending and admitted to secondary care settings.

scholarly journals In adults with multimorbidity, does the provision of social care services have an effect on the use of primary care and secondary care health services?

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
David Henderson
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Secondary Care ◽  
Social Care ◽  
Grey Literature ◽  
Qualitative Synthesis ◽  
Delivery Of Care ◽  
Care Services ◽  
Health And Social Care ◽  
The Relationship

ABSTRACT ObjectivesHealth and social care is an area of high policy importance in the UK. Integration of health boards with local authority provided social care in Scotland in 2016 is a major structural change in delivery of care. Improvements in service and efficiency are expected and indeed required in an era of declining budgets.  Intuitively, health and social care are closely linked, particularly for those with multiple morbidities. However, little is known about the relationship between health and social care services and how usage of one has an impact on the other in terms of outcomes and costs. The study aims to describe the methods that have been used to analyse the relationship between social care, primary care and secondary care services. Findings will inform the analysis of a large linked dataset of health care, social care and benefits data that will investigate the interactions between health and social care, multimorbidity and socioeconomic status. ApproachA Scoping review of literature aiming to identify academic studies that have made an assessment of the relationship between health care and social care. A search of academic databases will be augmented by a search of grey literature aiming to identify the extent, range and nature of studies. Data will be extracted on populations, study designs, results and recommendations. Results will be visualised in charts alongside a descriptive qualitative synthesis. ResultsExpected June 2016

scholarly journals Levels of engagement in primary health care professionals: a comparative study in two Brazilian municipalities

2019 ◽  
Vol 23 (3) ◽  
Author(s):  
Luciano Garcia Lourenção ◽  
Albertina Gomes da Silva ◽  
Márcio Andrade Borges
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Community Health ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Care Services ◽  
Primary Health ◽  
Primary Care Services ◽  
Significant Difference

Abstract Objective: To evaluate the levels of engagement of Primary Health Care professionals in two municipalities. Methods: A descriptive study was carried out with 238 health professionals who work in the Primary Care services of two municipalities in the state of São Paulo. The engagement dimensions of the professionals were investigated through the Utrecht Work Engagement Scale. Results: Female predominance (82.8%), age under 40 years (52.9%). Median working time in primary care of three (municipality A), four years (municipality B). Significant difference in levels of engagement in both municipalities. Community health agents presented mean scores in all dimensions. Significant difference in levels of engagement according to professional category in all dimensions. Conclusion and implications for practice: Municipal health professionals with 100.0% coverage by the Family Health Strategy tend to have higher levels of engagement. Nurses presented greater engagement; community health workers reached lower levels than other professionals did. Engagement is an indicator that contributes to the evaluation of the workforce in the Primary Health Care services and can be used to direct strategies that improve the levels of dedication, absorption and vigor of the professionals, benefiting the organization of the primary care services.

How will dental surgery services be commissioned in the future?

2013 ◽  
Vol 95 (2) ◽  
pp. 71-71
Author(s):  
Bernie Speculand ◽  
Rachel Noble
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Social Care ◽  
Dental Services ◽  
Dental Surgery ◽  
Care Services ◽  
Primary Care Services ◽  
Health And Social Care ◽  
The Future

While most secondary care services will be commissioned by GP-led clinical commissioning groups (CCGs), the majority of primary care services – including all primary and secondary care dental services – will be the responsibility of the NHS Commissioning Board (NHS CB). This was first established in shadow form in April 2012, following the passage of the Health and Social Care Act. The Act brings with it a number of new organisations, and several new acronyms to learn.

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