EPA-1436 - Primary care, long-term conditions and mental health co-morbidity: Resource implications

2014 ◽  
Vol 29 ◽  
pp. 1 ◽  
Author(s):  
G. Ivbijaro
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Long Term Conditions ◽  
Co Morbidity

Hospital cost differences and payment by results

2007 ◽  
Vol 2 (4) ◽  
pp. 429-433 ◽  
Author(s):  
JAMES M. MALCOMSON
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Average Cost ◽  
Best Practice ◽  
Community Services ◽  
Total Expenditure ◽  
Long Term Conditions ◽  
Care Requirements ◽  
Cost Differences

Street and Maynard (2007) argue the case for refining the system of payment by results currently being introduced for English hospitals. On the basis of international experience, they recommend, among other things, moving away from setting prices equal to average cost towards setting them equal to best practice costs, adjusting them for quality and using them to signal what activities are desirable. They also discuss how to control total expenditure for primary care trusts (PCTs) under payment by results and question the merits of extending payment by results to mental health services, ambulances, community services, and long-term conditions, ‘where it is difficult to describe patient care requirements and cost variations may be high’ (p. 9).

scholarly journals M.I.C.E—Mental Health Intervention for Children with Epilepsy: a randomised controlled, multi-centre clinical trial evaluating the clinical and cost-effectiveness of MATCH-ADTC in addition to usual care compared to usual care alone for children and young people with common mental health disorders and epilepsy—study protocol

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sophie D. Bennett ◽  
◽  
J. Helen Cross ◽  
Anna E. Coughtrey ◽  
Isobel Heyman ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Usual Care ◽  
Psychological Intervention ◽  
Mental Health Disorders ◽  
Long Term Conditions ◽  
Children And Young People ◽  
Health Disorders ◽  
Randomised Controlled

Abstract Background Mental health disorders in the context of long-term conditions in children and young people are currently overlooked and undertreated. Evidence-based psychological treatments for common childhood mental health disorders (anxiety, depression and disruptive behaviour disorders) have not been systematically evaluated in young people with epilepsy despite their high prevalence in this population. The aim of this multi-site randomised controlled trial is to determine the clinical and cost-effectiveness of adding a modular psychological intervention to usual care for the mental health disorders in comparison to assessment-enhanced usual care alone. Methods In total, 334 participants aged 3–18 years attending epilepsy services will be screened for mental health disorders with the Strengths and Difficulties Questionnaire (SDQ) and the diagnostic Development and Wellbeing Assessment (DAWBA). Those identified as having a mental health disorder and consenting to the trial will be randomised to either receive up to 22 sessions of the modular psychological intervention (MATCH-ADTC) delivered over the telephone over 6 months by non-mental health professionals in addition to usual care or to assessment-enhanced usual care alone. Outcomes will be measured at baseline, 6 months and 12 months post-randomisation. It is hypothesised that MATCH-ADTC plus usual care will be superior to assessment-enhanced usual care in improving emotional and behavioural symptoms. The primary outcome is the SDQ reported by parents at 6 months. Secondary outcomes include parent-reported mental health measures such as the Revised Children’s Anxiety and Depression Scale, quality of life measures such as the Paediatric Quality of Life Inventory and physical health measures such as the Hague Seizure Severity Scale. Outcome assessors will be blinded to group assignment. Qualitative process evaluations and a health economic evaluation will also be completed. Discussion This trial aims to determine whether a systematic and integrated approach to the identification and treatment of mental health disorders in children and young people with epilepsy is clinically and cost-effective. The findings will contribute to policies and practice with regard to addressing mental health needs in children and young people with other long-term conditions. Trial registration ISRCTN ISRCTN57823197. Registered on 25 February 2019.

FRAILTY AND SARCOPAENIA TRIALS IN PRIMARY CARE – IDENTIFYING AND OVERCOMING KEY BARRIERS TO SUCCESSFUL CLINICIAN PARTICIPATION

2015 ◽  
pp. 1-2
Author(s):  
A. SINCLAIR
Keyword(s):  
Primary Care ◽  
Target Population ◽  
Population Based ◽  
Care Staff ◽  
Long Term Conditions ◽  
Primary Care Research ◽  
Wide Range ◽  
Primary Care Practitioners ◽  
Primary Care Staff

Primary care research involving older people brings together a wide range of primary care practitioners. Key areas of activity include: health promotion, disease prevention, screening and early diagnosis, as well as the management of common and long-term conditions such as frailty and sarcopaenia which are under-researched domains of health in this setting. Few interventional studies have identified frail or sarcopaenic patients as the target population based on recent definitions of either condition. Several barriers to successful research in the primary care area exist and overcoming such barriers is not straightforward but involves a multidimensional approach that attempts to enhance the confidence and opportunity to engage in research of primary care staff and the consideration of factors that allow external leads of research to coordinate their programme.

scholarly journals Improving the Care of People with Long-Term Conditions in Primary Care: Protocol for the Enhance Pilot Trial

2015 ◽  
Vol 5 (1) ◽  
pp. 135-149 ◽  
Author(s):  
Emma L. Healey ◽  
Clare Jinks ◽  
Valerie A. Tan ◽  
Carolyn A. Chew-Graham ◽  
Sarah A. Lawton ◽  
...  
Keyword(s):  
Primary Care ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Pilot Trial ◽  
Integrated Approach ◽  
Long Term Conditions ◽  
Delivery Of Care ◽  
Care Protocol ◽  
Engagement Assessment

Background Long-term conditions (LTCs) are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. Objective To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. Design The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENAHNCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes) will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. Discussion Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418.

Electronic Patient Records (EPR), Library Services (LS) and Multidisciplinary Team (MDT) Meetings

2017 ◽  
pp. 179-197
Author(s):  
Shahid Muhammad ◽  
Malcolm Rigler ◽  
Meshia Adams
Keyword(s):  
Primary Care ◽  
Multidisciplinary Team ◽  
Library Services ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Long Term Conditions ◽  
Health Records ◽  
Care Services ◽  
Primary Care Services

Patients with Long-Term Conditions (LTCs) account for around 50% of General Practitioner (GP) appointments, 64% of outpatient appointments and 70% of hospital bed days. There needs to be a wider access to knowledge and understanding such as directories with information leaflets, documents, books on lifestyle, helpful contacts and sources to information that can support patients and the general public on the most important elements their health. This cannot be achieved just through patients accessing their health records in sole. The objective of this paper is to 1) highlight the importance of integrating General Practice (GP), Electronic Patient Records (EPR) with Library Services (LS) and 2) also explore why it would be advantageous to implement patient-centred Multidisciplinary Team (MDT) meetings in primary care for patients with Long-Term Conditions (LTCs). This article provides a UK glance and how primary care services can be improved, integrating for the better. Having access to Electronic Patient Records (EPR) alone will not help or encourage a patient to gain confidence and/ or understanding especially if patients are overwhelmed by their healthcare choices and Health Literacy (HL) complexities. Patients' whose first language is not English for example, approaching more methods to support HL is/ will be challenging. Library and Health Services partnerships should be initiated to allowing access to wider resources. In addition, patient-centred Multidisciplinary Team (MDT) meetings should be arranged at dedicated time points between a doctor and patient/ carer and these can take place in a private section within library setting involving wider participation in care plans. Given that more patients and the public will have opportunity to access their health records, a “Libraries and Health” partnership can help integrate primary healthcare better thus allowing all to access health-related literature, using books, leaflets and digital media in a comfortable environment in a setting that also has staff that can support with HL and technology. An EPR and MDT initiative should be supported with library and health partnerships; this needs to be encouraged.

The context of healthcare

2020 ◽  
pp. 1-34
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Northern Ireland ◽  
Healthcare Services ◽  
Health Profile ◽  
Long Term Conditions ◽  
Key Concepts ◽  
The Uk

This chapter begins by covering the UK health profile, then defines the key concepts in primary care and public health, and outlines the generic long-term conditions model. It provides a brief overview of the National Health Service, including differences in England, Northern Ireland, Scotland, and Wales. It covers current NHS entitlements for people from overseas, commissioning of services, and public health in a broader context. It also describes health needs assessment, and provides an overview of the services in primary care, the role of general practice, and other primary healthcare services. Further services, including those to prevent unplanned hospital admission, aid hospital discharge, those that support children and families, housing, social support, and care homes are all covered.

scholarly journals Personality disorder co-morbidity in primary care ‘Improving Access to Psychological Therapy’ (IAPT) services: a qualitative study exploring patient perspectives on treatment experience

2020 ◽  
pp. 1-15
Author(s):  
Gary Lamph ◽  
John Baker ◽  
Tommy Dickinson ◽  
Karina Lovell
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Personality Disorder ◽  
Qualitative Study ◽  
Patient Group ◽  
Stepped Care ◽  
Research Approach ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Co Morbidity

Abstract Background: High numbers of people present with common mental health disorders and co-morbid personality disorder traits in primary care ‘Improving Access to Psychological Therapies’ (IAPT) services in England and they receive sub-optimal treatments. No previous studies have explored the treatment experiences or needs of this patient population in England. Aims: This qualitative study explored the treatment experiences of patients (n = 22) with common mental health difficulties and co-morbid personality disorder as indicated by a score of 3 or more on the ‘Standardised Assessment of Personality – Abbreviated Scale’ (SAPAS) in receipt of primary care-based IAPT treatment. Method: A qualitative health research approach was used. Qualitative individual face-to-face semi-structured interviews were conducted. All interviews were audio recorded, data were transcribed verbatim and analysed using a framework analysis approach. Results: Findings revealed a need to adapt away from prescriptive cognitive behavioural therapy (CBT) treatment models towards more flexible, personalised and individualised treatment with this patient group. Time to emotionally offload, build a therapeutic relationship and link past experiences to presenting problems were highlighted as important. Conclusions: For the first time, the needs and treatment experiences of this patient group have been explored. This paper provides a unique patient experience insight that should be considered when exploring new approaches to working with and developing effective interventions via a stepped care approach.

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