scholarly journals Role of community drug and alcohol services in physical healthcare for people who use illicit opioids: a qualitative study of clinical staff in the UK

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046577
Author(s):  
Molly Bradbury ◽  
Dan Lewer
Keyword(s):  
Qualitative Study ◽  
Health Services ◽  
Physical Health ◽  
Nurse Practitioners ◽  
Health Needs ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Treatment Services ◽  
The Uk ◽  
Drug And Alcohol

ObjectivesTo understand how clinicians working in addiction services perceive their responsibilities for physical healthcare of clients who use opioids, and how physical healthcare could be improved for this group.DesignQualitative study comprising semistructured interviews.Participants16 clinicians, including nurses and nurse practitioners, nurse consultants, addiction psychiatrists, specialist general practitioners and psychiatry specialty registrars.SettingCommunity-based drug and alcohol treatment services in the UK, with services including outpatient opioid agonist therapy.ResultsWe identified three overarching themes. First, clients have unmet physical health needs that are often first identified in community drug and alcohol services. Participants reported attempts to improve their clients’ access to healthcare by liaising directly with health services and undertaking other forms of health advocacy, but report limited success, with many referrals ending in non-attendance. Second, most participants saw their role as supporting access to mainstream health services rather than providing physical healthcare directly, though sometimes reported frustration at being unable to provide certain treatments such as antibiotics for a respiratory infection. A minority of participants felt that people who use illicit opioids would be best served by an integrated ‘one-stop-shop’ model, but felt this model is currently unlikely to receive funding. Third, participants felt isolated from other health services, in part due to commissioning arrangements in which funding is provided through local government rather than the National Health Service.ConclusionsClinicians participating in this study serve a patient group with unmet physical health needs, but lack the resources to respond effectively to these needs.

scholarly journals Stakeholder views of podiatry services in the UK for people living with arthritis: a qualitative study

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Charlotte Dando ◽  
Dawn Bacon ◽  
Alan Borthwick ◽  
Catherine Bowen
Keyword(s):  
Health Services ◽  
Focus Groups ◽  
Health Needs ◽  
Mental Wellbeing ◽  
Structured Interviews ◽  
Foot Health ◽  
Geographical Variations ◽  
Foot Problems ◽  
The Uk ◽  
The Right

Abstract Background The aim of this study was to explore the views of stakeholders in podiatry services, patients, commissioners and general practitioners (GP), to further understand experiences of referral, access and provision of treatment in the National Health Service (NHS) for foot problems for patients living with arthritis. Method To explore in-depth individual views and experiences of stakeholders in podiatry services, 19 patients who had arthritis (osteoarthritis and/or rheumatoid arthritis) participated in one of four focus groups. In addition, seven commissioners and/or GPs took part in semi structured interviews. A purposive sampling strategy was adopted for all focus groups and semi structured interviews. To account for geographical variations, the focus groups and semi structured interviews were conducted across two predetermined regions of the United Kingdom (UK), Yorkshire and Hampshire. Data was rendered anonymous and transcribed verbatim. Thematic analysis was employed to identify key meanings and report patterns within the data. Results Five key themes derived from the focus groups and interviews suggest a variety of factors influencing referral, access and provision of treatment for foot problems within the UK. 1. Systems working together (navigation of different care pathways, access and referral opportunities for people with OA or RA, education around foot health services for people with OA or RA); 2.Finance (financial variations, different care systems, wasting resources); 3. Understanding what podiatry services have to offer (podiatrists are leaders in foot health services, service requirements in relation to training standards and health needs); 4. Person factors of foot pain (arthritis is invisible, affects quality of life, physical and mental wellbeing); 5. Facilitators of foot care (NICE guidelines, stakeholder events, supporting self-management strategies). Conclusion The findings indicate that patients, commissioners and GPs have very similar experiences of referral, access and provision of treatment for foot problems, for patients living with arthritis. Essentially, commissioners and GPs interviewed called for a transformational approach in current systems to include newer models of care that meet the footcare needs of individual patient circumstances. Patients interviewed called for better signposting and information about the different services available to help them manage their foot health needs. To address this, we have formulated a signposting pack for all stakeholders to help them facilitate access to appropriate clinicians ‘at the right time, in the right place’ to manage foot health problems.

scholarly journals Accountable Care Organizations and Clinical Commissioning Groups face an uncertain challenge for improving public health

2012 ◽  
Vol 1 (2) ◽  
pp. 16
Author(s):  
Douglas J. Noble
Keyword(s):  
Public Health ◽  
Health Services ◽  
Population Health ◽  
The United States ◽  
Accountable Care Organizations ◽  
Health Needs ◽  
Local Health ◽  
Accountable Care ◽  
The Usa ◽  
The Uk

<p>Accountable Care Organizations (ACO) in the United States of America (USA) and Clinical Commissioning Groups (CCG) in the United Kingdom (UK) are new proposed organizations in health services both tasked with a role which includes improving public health.  Although there are very significant differences between the UK and USA health systems there appears to be a similar confusion as to how ACO and CCG will regard and address public or population health.  The role of ACO in improving population health and evaluating the health needs of their registered and insured patients remains ill-defined and poorly explored.  Likewise, in the current UK National Health Service (NHS) reorganisation, control and commissioning of appropriate local health services are passing from Primary Care Trusts (PCT) to new cross-organizational structures (CCG).  CCG groups aim to be, like ACO, physician led.  They will also assume a role for public or population health, but this role, like that of the newly-forming ACO, is currently unclear.  Lessons learned from the USA and UK experience of new organizations tasked with a role in improving public health may inform mechanisms for physician led organizations in the UK and the USA to assess health needs, monitor population health information and improve population health outcomes.</p>

Experiences of individuals with severe mental illnesses about physical health services: A qualitative study

2020 ◽  
Vol 34 (4) ◽  
pp. 237-243 ◽  
Author(s):  
Mukaddes Müberra Gedik ◽  
Neslihan Partlak Günüşen ◽  
Sevecen Çelik Ince
Keyword(s):  
Qualitative Study ◽  
Health Services ◽  
Physical Health ◽  
Mental Illnesses

scholarly journals Recruitment into old age psychiatry

2019 ◽  
Vol 43 (3) ◽  
pp. 131-135 ◽  
Author(s):  
Lynsey McAlpine ◽  
Alex Bailey ◽  
Kate Milward ◽  
Charlotte Blewett
Keyword(s):  
Physical Health ◽  
Old Age ◽  
Thematic Analysis ◽  
Social Care ◽  
Health Needs ◽  
Recruitment Strategy ◽  
Factors Affecting ◽  
Qualitative Survey ◽  
Old Age Psychiatry ◽  
The Uk

This research aimed to explore the trainee perspective on factors affecting recruitment into old age psychiatry higher training in the UK. A qualitative survey was created by the Faculty of Old Age Psychiatry and distributed to current higher trainees in all psychiatric subspecialties. A total of 324 higher trainees responded to the survey, representing a broad demographic range. Thematic analysis was carried out, with sufficient responses to achieve saturation. Key themes included concerns about the future of the specialty, issues with social care, lack of support with patients’ physical health needs, issues with training posts, and workload. The need to improve core trainees’ experience of the specialty was highlighted. Many positive themes arose from the data; however, a number of barriers to recruitment were also identified. The findings have implications for recruitment to the specialty and should be used to inform recruitment strategy moving forward.Declaration of interestNone.

scholarly journals How to adapt sexual and reproductive health services to the needs and circumstances of trans people— a qualitative study in Colombia

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Mariana Calderón-Jaramillo ◽  
Ángel Mendoza ◽  
Natalia Acevedo ◽  
Luz Janeth Forero-Martínez ◽  
Sandra Marcela Sánchez ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Qualitative Study ◽  
Health Services ◽  
Sexual And Reproductive Health ◽  
Healthcare Services ◽  
Health Needs ◽  
Access Barriers ◽  
Care Providers ◽  
Reproductive Health Services ◽  
Trans People

Abstract Background People living a trans-life require access to equitable healthcare services, policies and research that address their needs. However, trans people have experienced different forms of violence, discrimination, stigma, and unfair access barriers when dealing with healthcare providers. Therefore, adapting sexual and reproductive health services with the purpose of providing more equitable, inclusive and discrimination-free healthcare services is an urgent need. The article presents an example of how operative research can be used in order to adjust sexual and reproductive healthcare services to trans people’s needs, identities and circumstances. Methods This is a qualitative study written from a constructivist perspective, and it is based on the voices and experiences of trans people in four major cities in Colombia. The research used a combination of focus groups of discussion (n = 6) and in-depth interviews with trans people (n = 13) in Barranquilla, Bogota, Cali and Medellin. This research had two specific objectives: i) identifying the main sexual and reproductive health needs of people living a trans-life; and ii) generating new evidence in order to guide the adaptation of sexual and reproductive health services centered to trans people’s needs, identities, and circumstances. Qualitative data codification and analysis was using NVivo. Results Once access barriers to sexual and reproductive health services, unmet sexual and reproductive health needs were identified, the research helped define strategies to adapt sexual and reproductive health services to the needs, identities, and circumstances of people living a trans-life in Colombia. Amongst the main barriers found were healthcare costs, lack of insurance, stigmatization, discrimination and abuse by health care providers. Perhaps among the most notable sexual and reproductive health needs presented were trans-specific services such as sensitive assistance for the transition process, endocrinology appointments, and sex reaffirmation surgeries. Conclusions The evidence obtained from this research allowed Profamilia, a Colombian healthcare provider, to adapt the sexual and reproductive health services it provides to people living a trans-life in Colombia. Furthermore, it was possible for Profamilia to design and implement an inclusive sexual and reproductive health program that specifically addresses trans people’s needs, identities, and circumstances.

scholarly journals Substance misuse in adolescents

2000 ◽  
Vol 6 (3) ◽  
pp. 201-210 ◽  
Author(s):  
Harith Swadi
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Drug Use ◽  
Health Services ◽  
Substance Misuse ◽  
Preventive Measures ◽  
Treatment Services ◽  
High Prevalence ◽  
The Uk

There is increasing evidence that substance misuse among British adolescents is escalating (Miller & Plant, 1996; Sutherland & Willner, 1998). Swadi (1992) found that, among adolescents aged 12–17 years referred to mental health services, the prevalence of drug use was 13.1% (16.3% among boys and 9.3% among girls). Despite this relatively high prevalence, there are very few organised treatment services for adolescents in the UK. Instead, there is extensive emphasis on prevention even though there is no universal agreement on what prevention can achieve. This approach also overlooks the fact that a significant number of adolescents fail to respond to preventive measures in any form.

scholarly journals Access to Healthcare for Street Sex Workers in the UK: Perspectives and Best Practice Guidance from the Frontline

2021 ◽  
Author(s):  
Lucy C Potter ◽  
Jeremy Horwood ◽  
Gene Feder
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Services ◽  
Sexual Health ◽  
Sex Workers ◽  
Best Practice ◽  
Healthcare Provision ◽  
Trauma Informed ◽  
The Uk ◽  
Drug And Alcohol

Abstract Background: Street sex workers (SSWs) are a highly marginalised and stigmatised group who carry an extremely high burden of unmet health need. They experience multiple and interdependent health and social problems and extreme health inequality. Despite high levels of chronic physical and mental ill-health, there is little evidence of effective healthcare provision for this group. They are often considered ‘hard to reach’, but many individuals and organisations have extensive experience of working with this group.Methods: We conducted a cross-sectional survey of professionals who work with SSWs in the UK on their perspectives on their access to primary care, mental health, sexual health and drug and alcohol services, how well these services met the needs of SSWs and suggestions of best practice.Results: 50 professionals mostly from England, responded. Mainstream general practice and mental health services were found to be largely inaccessible to SSWs. Sexual health, drug and alcohol services and homeless health services better met their needs; this was mostly attributed to flexible services and collaborations with organisations who work closely with SSWs. The main challenges in providing healthcare to SSWs were services being inflexible, under-resourced services and services not being trauma-informed. Best practice in providing healthcare to SSWs includes- seamless partnership working between agencies with case worker support; peer-involvement in service development and engagement, a range of health provision including outreach, presence in community spaces and fast-track access into mainstream services; trauma-informed, gender-sensitive health services in a welcoming environment with flexible, responsive appointment and drop-in systems and consistent clinicians with specialist knowledge of substance misuse, mental health, domestic violence and homelessness.Conclusions: Access to healthcare for SSWs in the UK is highly variable but largely inadequate with regards to primary care and mental health provision. The examples of positive healthcare provision and partnership working presented here demonstrate the feasibility of accessible healthcare that meets the needs of SSWs. These need to be systematically implemented and evaluated to understand their impact and implications. As we build back from COVID-19 there is an urgent need to make accessible healthcare provision the norm, not the exception.

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