Predictors of disengagement from cognitive behavioural therapy for psychosis in a National Health Service setting: A retrospective evaluation

Background. Psychotherapy's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques. We compared the outcomes of contrasting approaches practised in routine care.Method. Patients (n=1309) who received cognitive-behavioural therapy (CBT), person-centred therapy (PCT) and psychodynamic therapy (PDT) at one of 58 National Health Service (NHS) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. Therapists indicated which treatment approaches were used on an End of Therapy form. We compared outcomes of six groups: three treated with CBT, PCT or PDT only, and three treated with one of these plus one additional approach (e.g. integrative, supportive, art), designated CBT+1, PCT+1 or PDT+1 respectively.Results. All six groups averaged marked improvement (pre–post effect size=1·36). Treatment approach and degree of purity (‘only’ vs. ‘+1’) each accounted for statistically significant but comparatively tiny proportions of the variance in CORE-OM scores (respectively 1% and 0·5% as much as pre–post change). Distributions of change scores were largely overlapping.Conclusions. Results for these three treatment approaches as practised routinely across a range of NHS settings were generally consistent with previous findings that theoretically different approaches tend to have equivalent outcomes. Caution is warranted because of limited treatment specification, non-random assignment, lack of a control group, missing data and other issues.

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Indications for ambulatory blood pressure monitoring in a national health service setting

American Journal of Hypertension ◽

10.1016/j.amjhyper.2004.03.130 ◽

2004 ◽

Vol 17 (5) ◽

pp. S52

Author(s):

G PANNARALE

Keyword(s):

Blood Pressure ◽

National Health Service ◽

Health Service ◽

Ambulatory Blood Pressure Monitoring ◽

National Health ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Pressure Monitoring ◽

Service Setting

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Providing Group-Analytic Psychotherapy in the National Health Service Setting: The Southampton Model

Group Analysis ◽

10.1177/0533316488213007 ◽

1988 ◽

Vol 21 (3) ◽

pp. 251-258 ◽

Cited By ~ 1

Author(s):

Pamela M. Ashurst

Keyword(s):

National Health Service ◽

Health Service ◽

National Health ◽

Service Setting

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Cataract surgery refractive outcomes: representative standards in a National Health Service setting

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312209 ◽

2018 ◽

Vol 103 (4) ◽

pp. 539-543 ◽

Cited By ~ 3

Author(s):

Kerr Brogan ◽

Charles J M Diaper ◽

Alan P Rotchford

Keyword(s):

National Health Service ◽

Health Service ◽

Cataract Surgery ◽

National Health ◽

Postoperative Outcome ◽

Absolute Error ◽

European Guidelines ◽

Refractive Outcomes ◽

Service Setting ◽

The Mean

Background/aimsTo report refractive outcomes from an National Health Service (NHS) cataract surgery service and assess if results meet suggested benchmark standard.MethodsDetails of all patients undergoing cataract surgery in the Southern General and New Victoria hospitals in Glasgow, UK, between November 2006 and December 2016 were prospectively entered into an electronic database. Patients were reviewed 4 weeks postoperatively in the eye clinic and underwent refraction at their local optometrist prior to this appointment. Surgically uncomplicated cases with in the bag’ non-toric intraocular lens implantation were included. Patients with previous laser refractive procedures or failing to achieve 6/12 acuity or better postoperatively were excluded. Proximity to targeted postoperative refraction was documented.ResultsOver this 10-year period, 11 083 eyes underwent cataract surgery. Of these, 8943 eyes of 6936 patients (80.69%) met the inclusion criteria and had both target and postoperative outcome refraction recorded. The mean difference between the targeted and outcome refraction was −0.07 D (SD 0.67). The mean absolute error was 0.50 D. Postoperative refraction was within 1 D of target refraction for 7938 eyes (88.76%) and within 0.50 D for 5577 eyes (62.36%).ConclusionRefractive outcomes following routine cataract surgery reported here are well within the targets recommended by the Royal College of Ophthalmologists and European guidelines, but suggest that higher cataract refractive outcome benchmark standards may not yet be a realistic expectation for all NHS units with current biometry practice.

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Evaluating Quality Improvement at Scale: Design Considerations for Routine Reporting to Executive Board of a Healthcare Organisation in the UK National Health Service

10.21203/rs.3.rs-89280/v1 ◽

2020 ◽

Author(s):

Kia-Chong Chua ◽

Claire Henderson ◽

Barbara Grey ◽

Michael Holland ◽

Nick Sevdalis

Keyword(s):

National Health Service ◽

Health Service ◽

National Health ◽

Healthcare Organisation ◽

Retrospective Evaluation ◽

Executive Board ◽

Project Outcomes ◽

Uk National Health Service ◽

The Uk

Abstract BackgroundQuality improvement (QI) in healthcare is a cultural transformation process that requires long-term commitment from the executive board, a critical theme in emerging accounts of QI success in the UK National Health Service (NHS). To help sustain long-term commitment from the executive board, an organisation-wide picture of QI applications and their impact needs to be made routinely visible.MethodWe developed a retrospective evaluation drawing inputs from the resident QI team of a healthcare organisation and academic colleagues in the field of implementation and improvement science, as well as peer-reviewed and grey literature on what constitutes success for QI in healthcare. Formative feedback on content relevance, acceptability, and feasibility issues were used to guide evaluation design. The evaluation was conducted as an online survey so that the data accrual process resembles routine reporting to help surface implementation challenges. A purposive sample of QI projects was identified to maximise contrast between projects that were or were not successful as determined by the resident QI team. To hone strategic focus in what should be reported, we also compared factors that might affect project outcomes. For understanding implementation issues, we reviewed data quality to surface challenges in the design and sustainability of routine reporting for the executive board.ResultsOut of 52 QI projects, 10 led to a change in routine practice (henceforth referred to as adoption). Details of project outcomes were limited. Project team outcomes, indicative of capacity building, were not systematically documented. Service user involvement, quality of measurement plan, fidelity and documentation of plan-do-study-act (PDSA) cycles had a major impact on adoption. The proximal impact of these process factors on adoption was consistently more apparent than the distal impact of input and contextual factors.ConclusionsDesigning a routine reporting framework is an iterative process involving continual dialogue with frontline staff and improvement specialists to navigate data accrual demands. A retrospective evaluation, as in this study, can yield empirical insights for dialogue about the routine visibility of QI applications and their organisation-wide impact, thereby honing the implementation science of QI in a healthcare organisation.

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