Implementing a stepped-care approach in primary care: results of a qualitative study

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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Primary Mental Health Care Part 2: Three European Primary Mental Health Care Examples as Basis for Change to the Irish System

10.53902/jpssr.2021.01.000509 ◽

2021 ◽

Vol 1 (2) ◽

Author(s):

Smith L

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Mental Health Care ◽

Health Care Systems ◽

Stepped Care ◽

Primary Mental Health Care ◽

Alternative Vision ◽

Care Approach ◽

Care Systems

The successes and limitations of primary mental health care systems in three countries outside of Ireland are examined in order to inform potential change for the Irish primary mental health care system. Systems currently at work within Scotland, England, and the Netherlands are outlined, all of which employ versions of the “stepped-care” approach to primary care. It is acknowledged that Ireland is attempting to modify primary care to include the stepped-care approach. However, there are significant limitations to the current Irish system. With the Scottish, English, and Dutch systems in mind, an alternative vision of primary mental health care for Ireland is suggested.

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SP0017 A stepped care approach towards hip and knee osteoarthritis in primary care

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2012-eular.1492 ◽

2013 ◽

Vol 71 (Suppl 3) ◽

pp. 5.3-5

Author(s):

S. Bierma-Zeinstra

Keyword(s):

Primary Care ◽

Knee Osteoarthritis ◽

Stepped Care ◽

Care Approach

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Transitions to palliative care in acute hospitals in England: qualitative study

BMJ ◽

10.1136/bmj.d1773 ◽

2011 ◽

Vol 342 ◽

pp. d1773 ◽

Cited By ~ 77

Author(s):

Merryn Gott ◽

Christine Ingleton ◽

Michael I Bennett ◽

Clare Gardiner

Keyword(s):

Primary Care ◽

Palliative Care ◽

Qualitative Study ◽

Health Professionals ◽

Secondary Care ◽

Acute Hospital ◽

Smooth Transition ◽

Acute Hospitals ◽

Care Approach ◽

Policy Guidance

Objective To explore how transitions to a palliative care approach are perceived to be managed in acute hospital settings in England.Design Qualitative study.Setting Secondary or primary care settings in two contrasting areas of England.Participants 58 health professionals involved in the provision of palliative care in secondary or primary care.Results Participants identified that a structured transition to a palliative care approach of the type advocated in UK policy guidance is seldom evident in acute hospital settings. In particular they reported that prognosis is not routinely discussed with inpatients. Achieving consensus among the clinical team about transition to palliative care was seen as fundamental to the transition being effected; however, this was thought to be insufficiently achieved in practice. Secondary care professionals reported that discussions about adopting a palliative care approach to patient management were not often held with patients; primary care professionals confirmed that patients were often discharged from hospital with “false hope” of cure because this information had not been conveyed. Key barriers to ensuring a smooth transition to palliative care included the difficulty of “standing back” in an acute hospital situation, professional hierarchies that limited the ability of junior medical and nursing staff to input into decisions on care, and poor communication.Conclusion Significant barriers to implementing a policy of structured transitions to palliative care in acute hospitals were identified by health professionals in both primary and secondary care. These need to be addressed if current UK policy on management of palliative care in acute hospitals is to be established.

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