What factors are associated with improvement after brief psychological interventions in primary care? Issues arising from using routine outcome measurement to inform clinical practice

AbstractWhile the benefits of routine outcome measurement have been extolled and to some degree researched, it is surprising that service user opinions on this common therapy practice have largely not been investigated. This study aimed to assess service users’ experiences of completing measures during psychological therapy, with a view to exploring how therapists can maximize how helpful measures are in therapy. Fifteen participants completed surveys about the use of measures in their current episode of care. Ten clinicians also completed a survey about their use of, and views about, measures. Results showed that despite mixed experiences in how measures were explained and used, service users showed generally favourable attitudes towards their use in therapy, with them being perceived as most helpful when well integrated into sessions by their therapists. Clinicians reported using a wide range of measures, and generally endorsed positive beliefs about measures more strongly than negative ones. Implications for clinical practice, service development, and further research are discussed.

Download Full-text

It's not that bad: the views of consumers and carers about routine outcome measurement in mental health

Australian Health Review ◽

10.1071/ah090093 ◽

2009 ◽

Vol 33 (1) ◽

pp. 93 ◽

Cited By ~ 12

Author(s):

Jennifer Black ◽

Tania Lewis ◽

Pamela McIntosh ◽

Tom Callaly ◽

Tim Coombs ◽

...

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Outcome Measurement ◽

Clinical Use ◽

Self Assessment ◽

Routine Outcome Measurement ◽

The Past ◽

Assessment Measure ◽

Promotional Materials ◽

Mandatory Use

The mandatory use of routine outcome measurement (ROM) has been introduced into all public sector mental health services in Australia over the past 6 years. Qualitative processes were used to engage consumers and carers in suggesting how the measures can be used in clinical practice. The project involved an audit by survey, followed by a range of interactive workshops designed to elicit the views of consumers, carers and clinicians, as well as to involve all parties in dialogue about ROM. In addition, there was engagement of consumers and carers in the training of clinicians in the clinical use of ROM, and in the production of promotional materials aimed at informing consumers and carers about ROM. When consumers and carers have had an opportunity to be involved in ROM they have found it a useful experience, and those who had not been involved can see the potential. Consumers and carers indicated that they believe the greatest opportunity arising from the suite of measures is the use of the consumer self-assessment measure the Behaviour and Symptom Identification Scale (BASIS-32).

Download Full-text

Routine outcome measurement completion rates of the CORE-OM in primary care psychological therapies and counselling

Counselling and Psychotherapy Research ◽

10.1080/14733140600581432 ◽

2006 ◽

Vol 6 (1) ◽

pp. 33-40 ◽

Cited By ~ 11

Author(s):

Bridgette M. Bewick ◽

Karen Trusler ◽

Tracy Mullin ◽

Stewart Grant ◽

Geoff Mothersole

Keyword(s):

Primary Care ◽

Outcome Measurement ◽

Completion Rates ◽

Routine Outcome Measurement ◽

The Core ◽

Psychological Therapies

Download Full-text

Routine outcome measurement in public mental health: results of a clinician survey

Australian Health Review ◽

10.1071/ah060164 ◽

2006 ◽

Vol 30 (2) ◽

pp. 164 ◽

Cited By ~ 30

Author(s):

Tom Callaly ◽

Mary Hyland ◽

Tim Coombs ◽

Tom Trauer

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Outcome Measures ◽

Outcome Measure ◽

Health Workers ◽

Outcome Measurement ◽

Public Mental Health ◽

Mental Health Workers ◽

Clinical Value ◽

Routine Outcome Measurement

This paper explores the attitudes of mental health workers in one public mental health service towards the implementation and use of routine outcome measurement. Two years after their introduction into routine clinical practice, there were equal numbers of positive and negative observations from clinicians about the clinical value of the clinician-rated outcome measures, while more positive observations were made about value of the consumer-rated outcome measure. The most frequent observation from clinicians in relation to making outcome measures more useful to them in clinical practice was that more training, particularly refresher training, is needed. In addition, clinicians indicated that more sophisticated support which assists them to understand the meaning and possible use of outcome measure ratings is required.

Download Full-text

17. Boundaries or overlap: An examination of the community-oriented clinical practice of community medicine specialists and family/general practitioners

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2777 ◽

2007 ◽

Vol 30 (4) ◽

pp. 36

Author(s):

M. L. Russell ◽

L. McIntyre

Keyword(s):

Public Health ◽

Primary Care ◽

Clinical Practice ◽

Community Health ◽

Royal College ◽

Community Medicine ◽

Work Setting ◽

Public Health Medicine ◽

Work Settings ◽

Main Work

We compared the work settings and “community-oriented clinical practice” of Community Medicine (CM) specialists and family physicians/general practitioners (FP). We conducted secondary data analysis of the 2004 National Physician Survey (NPS) to examine main work setting and clinical activity reported by 154 CM (40% of eligible CM in Canada) and 11,041 FP (36% of eligible FP in Canada). Text data from the specialist questionnaire related to “most common conditions that you treat” were extracted from the Master database for CM specialists, and subjected to thematic analysis and coded. CM specialists were more likely than FP to engage in “community medicine/public health” (59.7% vs 15.3%); while the opposite was found for primary care (13% vs. 78.2%). CM specialists were less likely to indicate a main work setting of private office/clinic/community health centre/community hospital than were FP (13.6% vs. 75.6%). Forty-five percent of CM provided a response to “most common conditions treated” with the remainder either leaving the item blank or indicating that they did not treat individual patients. The most frequently named conditions in rank order were: psychiatric disorders; public health program/activity; respiratory problems; hypertension; and metabolic disorders (diabetes). There is some overlap in the professional activities and work settings of CM specialists and FP. The “most commonly treated conditions” suggest that some CM specialists may be practicing primary care as part of the Royal College career path of “community-oriented clinical practice.” However the “most commonly treated conditions” do not specifically indicate an orientation of that practice towards “an emphasis on health promotion and disease prevention” as also specified by the Royal College for that CM career path. This raises questions about the appropriateness of the current training requirements and career paths as delineated for CM specialists by the Royal College of Physicians & Surgeons of Canada. Bhopal R. Public health medicine and primary health care: convergent, divergent, or parallel paths? J Epidemiol Community Health 1995; 49:113-6. Pettersen BJ, Johnsen R. More physicians in public health: less public health work? Scan J Public Health 2005; 33:91-8. Stanwell-Smith R. Public health medicine in transition. J Royal Society of Medicine 2001; 94(7):319-21.

Download Full-text

WikiRecs primary care: developing rapid recommendations for primary care through effective collaboration between systematic review and guideline teams

British Journal of General Practice ◽

10.3399/bjgp18x697085 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697085

Author(s):

Trudy Bekkering ◽

Bert Aertgeerts ◽

Ton Kuijpers ◽

Mieke Vermandere ◽

Jako Burgers ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Clinical Practice ◽

Primary Care Physicians ◽

Urinary Stones ◽

Care Practice ◽

Supporting Evidence ◽

Supervised Exercise ◽

Review Team ◽

New Evidence

BackgroundThe WikiRecs evidence summaries and recommendations for clinical practice are developed using trustworthy methods. The process is triggered by studies that may potentially change practice, aiming at implementing new evidence into practice fast.AimTo share our first experiences developing WikiRecs for primary care and to reflect on the possibilities and pitfalls of this method.MethodIn March 2017, we started developing WikiRecs for primary health care to speed up the process of making potentially practice-changing evidence in clinical practice. Based on a well-structured question a systematic review team summarises the evidence using the GRADE approach. Subsequently, an international panel of primary care physicians, methodological experts and patients formulates recommendations for clinical practice. The patient representatives are involved as full guideline panel members. The final recommendations and supporting evidence are disseminated using various platforms, including MAGICapp and scientific journals.ResultsWe are developing WikiRecs on two topics: alpha-blockers for urinary stones and supervised exercise therapy for intermittent claudication. We did not face major problems but will reflect on issues we had to solve so far. We anticipate having the first WikiRecs for primary care available at the end of 2017.ConclusionThe WikiRecs process is a promising method — that is still evolving — to rapidly synthesise and bring new evidence into primary care practice, while adhering to high quality standards.

Download Full-text

Faculty Opinions recommendation of The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: an observational study based on clinical practice.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.10199.467691 ◽

2006 ◽

Author(s):

Michael Ward

Keyword(s):

Primary Care ◽

Health Care ◽

Clinical Practice ◽

Observational Study ◽

Resource Use ◽

Health Care Resource ◽

Primary Care Patients ◽

Health Care Resource Use ◽

The Uk ◽

The Impact

Download Full-text

Choice and privatisation in Swedish primary care

Health Economics Policy and Law ◽

10.1017/s1744133110000216 ◽

2010 ◽

Vol 6 (4) ◽

pp. 549-569 ◽

Cited By ~ 43

Author(s):

Anders Anell

Keyword(s):

Primary Care ◽

Clinical Practice ◽

Financial Incentives ◽

Degrees Of Freedom ◽

New Wave ◽

Improve Performance ◽

Financial Responsibility ◽

New Models ◽

Financial Characteristics

AbstractIn 2007, a new wave of local reforms involving choice for the population and privatisation of providers was initiated in Swedish primary care. Important objectives behind reforms were to strengthen the role of primary care and to improve performance in terms of access and responsiveness. The purpose of this article was to compare the characteristics of the new models and to discuss changes in financial incentives for providers and challenges regarding governance from the part of county councils. A majority of the models being introduced across the 21 county councils can best be described as innovative combinations between a comprehensive responsibility for providers and significant degrees of freedom regarding choice for the population. Key financial characteristics of fixed payment and comprehensive financial responsibility for providers may create financial incentives to under-provide care. Informed choices by the population, in combination with reasonably low barriers for providers to enter the primary care market, should theoretically counterbalance such incentives. To facilitate such competition is indeed a challenge, not only because of difficulties in implementing informed choices but also because the new models favour large and/or horizontally integrated providers. To prevent monopolistic behaviour, county councils may have to accept more competition as well as more governance over clinical practice than initially intended.

Download Full-text