scholarly journals Process evaluation of a stepped-care program to prevent depression in primary care: patients’ and practice nurses’ experiences

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Alide D. Pols ◽  
Karen Schipper ◽  
Debbie Overkamp ◽  
Susan E. van Dijk ◽  
Judith E. Bosmans ◽  
...  
Keyword(s):  
Primary Care ◽  
Process Evaluation ◽  
Care Program ◽  
Stepped Care ◽  
Practice Nurses ◽  
Primary Care Patients

Facilitators and barriers for promoting healthy eating among primary care patients: results of a qualitative study among practice nurses

2021 ◽  
Author(s):  
Geertruida J Groenendijk-van Woudenbergh ◽  
Marlies C van Hell-Cromwijk ◽  
Ytje J J van der Veen ◽  
Hylkje F Algra ◽  
Willemieke Kroeze
Keyword(s):  
Primary Care ◽  
Communication Skills ◽  
Healthy Eating ◽  
Patient Encounter ◽  
Structured Interviews ◽  
Good Communication ◽  
Practice Nurses ◽  
Professional Characteristics ◽  
Primary Care Patients ◽  
Facilitators And Barriers

Abstract Background Practice nurses have an important role in promoting healthy eating to prevent or delay long-term complications from chronic lifestyle-related diseases. Objective To identify the facilitators and barriers encountered by practice nurses at a professional level when promoting healthy eating among patients. Methods Face-to-face semi-structured interviews were conducted with 21 Dutch practice nurses. Data were recorded, transcribed and analysed using inductive thematic analysis. Results Two main themes were determined: professional characteristics and professional–patient encounter. Professional characteristics included good communication skills and experience facilitated the successful promotion of healthy eating, while a lack of communication skills and lack of knowledge about diet were perceived as barriers. The most frequently identified facilitators for professional–patient encounter included ensuring a personal connection with patients, creating food awareness, focussing on small changes, adopting a tailored approach, motivating and arranging extra consultations. Barriers included lack of skills to raise the topic, lack of persistence, inability to find a common understanding, lack of competence in handling patients’ own choices and underuse of existing educational materials. Conclusions Further research using the identified facilitators and barriers for promoting healthy eating in primary care patients with chronic diseases could assist in the development of future training programmes for practice nurses.

scholarly journals Two-year effectiveness of a stepped-care depression prevention intervention and predictors of incident depression in primary care patients with diabetes type 2 and/or coronary heart disease and subthreshold depression: data from the Step-Dep cluster randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e020412 ◽  
Author(s):  
Alide Danielle Pols ◽  
Marcel C Adriaanse ◽  
Maurits W van Tulder ◽  
Martijn W Heymans ◽  
Judith E Bosmans ◽  
...  
Keyword(s):  
Primary Care ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cumulative Incidence ◽  
Stepped Care ◽  
Subthreshold Depression ◽  
Depression Prevention ◽  
Primary Care Patients

IntroductionMajor depressive disorders (MDD), diabetes mellitus type 2 (DM2) and coronary heart disease (CHD) are leading contributors to the global burden of disease and often co-occur.ObjectivesTo evaluate the 2-year effectiveness of a stepped-care intervention to prevent MDD compared with usual care and to develop a prediction model for incident depression in patients with DM2 and/or CHD with subthreshold depression.MethodsData of 236 Dutch primary care patients with DM2/CHD with subthreshold depression (Patient Health Questionnaire 9 (PHQ-9) score ≥6, no current MDD according to the Mini International Neuropsychiatric Interview (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria)) who participated in the Step-Dep trial were used. A PHQ-9 score of ≥10 at minimally one measurement during follow-up (at 3, 6, 9, 12 and 24 months) was used to determine the cumulative incidence of MDD. Potential demographic and psychological predictors were measured at baseline via web-based self-reported questionnaires and evaluated using a multivariable logistic regression model. Model performance was assessed with the Hosmer-Lemeshow test, Nagelkerke’s R2explained variance and area under the receiver operating characteristic curve (AUC). Bootstrapping techniques were used to internally validate our model.Results192 patients (81%) were available at 2-year follow-up. The cumulative incidence of MDD was 97/192 (51%). There was no statistically significant overall treatment effect over 24 months of the intervention (OR 1.37; 95% CI 0.52 to 3.55). Baseline levels of anxiety, depression, the presence of >3 chronic diseases and stressful life events predicted the incidence of MDD (AUC 0.80, IQR 0.79–0.80; Nagelkerke’s R20.34, IQR 0.33–0.36).ConclusionA model with 4 factors predicted depression incidence during 2-year follow-up in patients with DM2/CHD accurately, based on the AUC. The Step-Dep intervention did not influence the incidence of MDD. Future depression prevention programmes should target patients with these 4 predictors present, and aim to reduce both anxiety and depressive symptoms.Trial registration numberNTR3715.

scholarly journals Medically unexplained symptoms in primary care

2008 ◽  
Vol 14 (6) ◽  
pp. 432-440 ◽  
Author(s):  
Else Guthrie
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Physical Abuse ◽  
Medically Unexplained Symptoms ◽  
Psychological Needs ◽  
Stepped Care ◽  
Childhood Neglect ◽  
Medically Unexplained ◽  
Primary Care Patients ◽  
Unexplained Symptoms

Adult patients with medically unexplained symptoms (somatisation) in primary care are numerous and make disproportionately high demands on health services. Most of these individuals are open to the suggestion that their illness reflects psychological needs. Empowering explanations from doctors can enable patient and doctor to work collaboratively in managing the problem and can reduce healthcare contacts. Parental medically unexplained symptoms, sexual and physical abuse in childhood and childhood neglect are associated with a greater risk of medically unexplained symptoms in adulthood. The overall prognosis for the majority of primary care patients with medically unexplained symptoms is very good. The two most common approaches to dealing with medically unexplained symptoms in primary care are stepped-care approaches and teaching general practitioners new skills to manage consultations more effectively.

Acceptability of the Stepped Care Model of Depression Treatment in Primary Care Patients and Providers

2019 ◽  
Vol 26 (4) ◽  
pp. 402-410 ◽  
Author(s):  
Jim A. Haugh ◽  
Krista Herbert ◽  
Seo Choi ◽  
Joanna Petrides ◽  
Meagan W. Vermeulen ◽  
...  
Keyword(s):  
Primary Care ◽  
Stepped Care ◽  
Depression Treatment ◽  
Care Model ◽  
Primary Care Patients

Cost-Effectiveness of a Collaborative Care Program for Primary Care Patients With Persistent Depression

2001 ◽  
Vol 158 (10) ◽  
pp. 1638-1644 ◽  
Author(s):  
Gregory E. Simon ◽  
Wayne J. Katon ◽  
Michael VonKorff ◽  
Jürgen Unützer ◽  
Elizabeth H.B. Lin ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Collaborative Care ◽  
Care Program ◽  
Primary Care Patients ◽  
Persistent Depression

scholarly journals Descriptive and process evaluation of a shared primary care program

2007 ◽  
Author(s):  
Evelyn Vingilis ◽  
Jann Paquette-Warren ◽  
Nick Kates ◽  
Anne-Marie Crustolo ◽  
Jaimi Greenslade ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Process Evaluation ◽  
Care Program ◽  
Shared Care ◽  
Team Members ◽  
Care Services ◽  
Health And Nutrition ◽  
Nutrition Care ◽  
Patient Database

Purpose: This study involved the conduct of a descriptive and process evaluation to examine the implementation and maintenance of an existing local shared care program: The Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. The program was organized to strengthen links between mental health, nutrition, and primary care services, to improve access to mental health and nutrition care, and to realize the benefits of improved communication, collaboration and mutual support among multiple practitioners, increased continuity of care, and increased family physicians’ comfort and skill in handling more complex problems. Method: A mixed-method, multi-measures evaluation design was used. Data were gathered from the program’s central patient database and by conducting focus groups. Results: Teams of practitioners provide comprehensive primary mental health and nutrition care. Collaboration and education opportunities are extensive although time constraints are an issue. Patients with a range of problems were assessed, treated, and referred among team members. There appears to be a decreased burden on external services. Conclusions & Discussion: This evaluation suggests that implementation and maintenance of shared care programs are possible within community practices.

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