Primary care treatment for child and adolescent neuropsychiatric conditions in remote rural Punjab, Pakistan - a cross-sectional survey

Background Pakistan is one of the most populous regions of the world. Previous work has demonstrated that there is reliance on traditional healthcare systems when seeking psychiatric care; however, there is a lack of information on help seeking for child and adolescent population. The aim of this study was to describe types of treatments and families’ perceptions of the effectiveness of those treatments for childhood neuropsychiatric disorders in remote rural Punjab. Method Cross‐sectional survey of consecutive attendees at an advertised mental health consultation day in a remote rural area. Results The effectiveness of these treatments, as rated by patients and their families, was variable, with highest reported effectiveness for general practitioner treatments. In families with a past history of care from a general practitioner, those who had epilepsy reported treatments to be more effective than those with mental retardation. Carers and users described consulting five different types of primary healthcare practitioners that used both physical and psychotherapeutic treatments. Conclusions There is considerable variation in treatments available for child and adolescent neuropsychiatric disorders in remote rural areas of Punjab, a large proportion of which are considered ineffective by the users and carers. This highlights the need to develop effective interventions for child and adolescent neuropsychiatric conditions that can be administered by primary health workers. Our data suggest that the need for this is greatest for mental retardation.     

Quality indicators for primary care mental health services

Objectives: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement.

Design: Modified two-round postal Delphi questionnaire.

Setting: Geographical spread across Great Britain.

Participants: One hundred and fifteen panellists representing 11 different stakeholder groups within primary care mental health services (clinical psychologist, health and social care commissioner, community psychiatric nurse, counsellor, general practitioner, practice nurse/district nurse/health visitor, psychiatrist, social worker, carer, patient and voluntary organisations).

Main outcome measures: Face validity (median rating of 8 or 9 on a nine point scale with agreement by all panels) for assessing quality of care.

Results: A maximum of 334 indicators were rated by panels in the second round; 26% were rated valid by all panels. These indicators were categorised into 21 aspects of care, 11 relating to general practices and 10 relating to health authorities or primary care groups/trusts. There was variation in the total number of indicators rated valid across the different panels. Overall, GPs rated the lowest number of indicators as valid (41%, n=138) and carers rated the highest number valid (91%, n=304).

Conclusions: The quality indicators represent consensus among key stakeholder groups in defining quality of care within primary care mental health services. These indicators could provide a guide for primary care organisations embarking on quality improvement initiatives in mental health care when addressing national targets and standards relating to primary care set out in the National Service Framework for Mental Health for England. Although many of the indicators relate to parochial issues in UK service delivery, the methodology used in the development of the indicators could be applied in other settings to produce locally relevant indicators.

     

Development of a questionnaire to collect public health data for school entrants in London: Child Health Assessment at School Entry (CHASE) project

BACKGROUND: To develop a multiprofessional consensus about the relative contributions of the components of children's health and well-being and to develop a questionnaire that can be used to assess these in London's children. METHODS: Semi-structured interviews with health, education and social services professionals were used to identify areas to include in the questionnaire. These ideas were used as the basis for a wider Delphi consultation, with 79 experts in the area of child health. Round 1 of the Delphi asked panelists to rate 54 items as to whether they should be included in the questionnaire or not. Responses were divided into four categories: item to be included measurement method agreed, item to be included measurement method not agreed, no consensus, or excluded. In round 2, consensus was sought for the categories where there was none following round 1. RESULTS: Themes identified by the interviews were: economic factors, ethnicity, environment, nutrition, hygiene and physical activity, growth, suffers from chronic/serious illness, development, disability and learning, accidents and hospital attendances, self-regulation, psychological well-being, significant life events. After Delphi round 1, items included, where quality measurement method was agreed, were: deprivation index (from postcode), child's ethnicity, temporary accommodation, care status, registered with general practitioner, dental visits, height, weight, special educational needs status, baseline educational assessment result, immunization status, visual and hearing function. Following round 2, items relating to chronic illness, mental health, physical functioning, general health, self-esteem, family cohesion and accident status were agreed for inclusion with a measurement method also agreed. The questionnaire was acceptable to parents. CONCLUSION: The validity, reliability and feasibility of this questionnaire must now be examined. This data set, if collected across London, would substantially increase the public health data available and allow trends in health to be monitored.     

Developing a framework of, and quality indicators for, general practice management in Europe

OBJECTIVES: To develop a framework for general practice management made up of quality indicators shared by six European countries. METHODS: Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six national expert panels, each consisting of 10 members, primarily primary care practitioners and experts in the field of quality in primary care participated in the study. The main outcome measures were: (a) a European framework with indicators for the organization of primary care; and (b) ratings of the face validity of the usefulness of the indicators by expert panels in six countries. RESULTS: Agreement was reached about a definition of practice management across five domains (infrastructure, staff, information, finance, and quality and safety), and a common set of indicators for the organization of general practice. The panellist response rate was 95%. Sixty-two indicators (37%) were rated face valid by all six panels. Examples include out of hours service, accessibility, the content of doctors' bags and staff involvement in quality improvement. No indicators were rated invalid by all six panels. CONCLUSIONS: It proved to be possible to develop a European set of indicators for assessing the quality of practice management, despite the differences in health care systems and cultures in the six different countries. These indicators will now be used in a quality assessment procedure of practice management in nine European countries. While organizational indicators are part of the new GMS contract in the UK, this research shows that many practice management issues within primary care are also of relevance in other European countries.     

The treatment of child and adolescent mental health problems in primary care: a systematic review

BACKGROUND: There is significant potential to increase the accessibility and effectiveness of child and adolescent mental health services through the involvement of primary care professionals and the delivery of interventions in the primary care setting. However, little is known about the actual clinical and cost-effectiveness of such service delivery. OBJECTIVE: The aim of the study was to review systematically the evidence concerning the effectiveness of interventions for child and adolescent mental health problems in primary care, and interventions designed to improve the skills of primary care staff. METHODS: Searches were made of The Cochrane Clinical Trials Register, MEDLINE, PSYCINFO, EMBASE and CINAHL, together with correspondence with subject experts and authors of studies, and checking of references in identified papers. RESULTS AND CONCLUSIONS: There was some preliminary evidence that treatments by specialist staff working in primary care were effective, although the quality of included studies was variable and no data were available on the cost-effectiveness of interventions. Equally, some educational interventions show potential for increasing the skills and confidence of primary care staff, but controlled evaluations were rare and few studies reported actual changes in professional behaviour or patient health outcomes. A significant programme of research is required if the potential for child and adolescent mental health services in primary care is to be realized in an effective and efficient way.     

Combined impact of future trends on healthcare utilisation of older people: A Delphi study

PurposeTo explore the combined effect of trends in older people on their future healthcare utilisation.MethodsA Delphi study consisting of two rounds was conducted. The heterogeneous expert panel (n = 16) in the field of elderly care rated the effect of combinations of trends in the Netherlands on the use of seven healthcare services: i.e. informal, home, general practitioner, acute, specialist, nursing home and mental health care. The percentage and direction of the overall consensus, for the different health services, and for three main trends were analysed.ResultsExperts reached consensus in 57 of 92 ratings (62%). Taking into account the interaction between trends, they expected an extra increase for informal, home, and general practitioner care, but no additional effect of interaction for specialist and acute care. Combinations that included trends leading to less support were expected to lead to an extra increase in utilisation.ConclusionsExperts expect that interaction between trends will lead to an extra increase in the use of general practitioner, home, and informal care. This increase is mainly the result of interaction with trends leading to less support for older persons. The present results show the need to take the effect of interaction into account when designing new health policy and in research on future healthcare utilisation.     

Child mental health services. Side by side

The appointment of a primary care mental health worker can relieve pressure on child and adolescent mental health services. In one health authority, GP practices with access to a liaison clinic run by a primary care mental health worker referred a third fewer cases to child and adolescent mental health services than practices without such access. Referrals by these practices were more likely to be assessed as appropriate and as high priority.     

Parents' use and views of the national standard Personal Child Health Record: a survey in two primary care trusts

BACKGROUND: The Personal Child Health Record (PCHR) is a booklet given to parents in the UK, following the birth of a child, to be used as the main record of their growth, development and uptake of preventative health services. The national standard PCHR has been available since April 2004. The aim of this survey was to explore parental views of the 'new' PCHR, their experiences in receiving it, and its subsequent use, focusing on specific issues of current debate among health professionals. METHODS: A parental questionnaire (n = 89) was administered in July 2004, in 10 child health clinics located in two primary care trusts; one in central London and the other in Buckinghamshire. RESULTS: Nearly all parents (98%) reported that they used the PCHR as a record of their child's health and development and 92% reported that they 'always' took it with them when seeing healthcare staff about their child. Some parents (22%) indicated that they had not been given a satisfactory explanation as to how to use the PCHR, at the time it was issued to them. Parents reported that health visitors were more likely than other health professionals to use the PCHR both to obtain information about their child and to record information. The majority of respondents (78%) were happy for the level of maternal education to be documented in their child's PCHR. CONCLUSIONS: Parents used, appreciated and liked the design of the national standard PCHR. Health visitors and primary care staff used the PCHR more than secondary care staff. The potential benefits of the PCHR will only be maximized if other healthcare professionals respond by using it.     

青春期保健一级预防措施的探讨

目的:探讨青春期保健的一级预防措施,为青春期人群提供适当、适量、适度的健康教育。方法:于2008年1月～2009年12月在福建省福州市6所学校,按青春早、中、晚期,进行28场青春期保健健康知识的分层次传播。课后即向听众发放无记名调查问卷,收回问卷2 036份。定性调查是按整群抽样调查对讲座内容进行讨论,深入评价,提出改进建议等。结果:72%～81%的青少年对所有讲座内容持肯定态度,青春早期者希望更详尽介绍青春期发生的生理变化,青春晚期者希望重点介绍男、女性生理与性心理的各自特点;大多数听众认为青春期常见身心健康问题的讲座内容达到了学以致用的目的,但青春早期者仍存一些不解和迷惑,青春晚期者要求更多地介绍健康问题的具体解决方法;对"青春期如何预防生殖器官疾病或性传播疾病"专题,青少年提出要更详细地介绍治疗方法,在放映图片时要用较多的文字加以说明,多一点有病历特征的图片,青春期健康问题的求助机构不够多、求助渠道不够广,要多设电话询问或面对面咨询点;针对"青春期健康的三级预防"应更多地介绍如何防患于未然,多一些预防心理疾病的方法等。结论:教育行政部门要重视青春期保健的一级预防、各级医疗保健机构应履行公共卫生职能、促进青春期保健学科与相应专科门诊的建设和发展、社会要关注青春期各阶段人群的身心发展;建立由政府埋单的青春期保健服务机制。     

Evaluation of a tele-education programme in Brazil

We evaluated a tele-education programme for primary care staff in Pernambuco State, Brazil. During 2008 and 2009, tele-education sessions occurred four times each week for one hour per day. The topics included public health, child and adolescent health, mental health and nursing. After each session, participants completed an evaluation questionnaire. A total of 73 municipalities and 141 health centres participated in the programme. There were 254 tele-education sessions scheduled during the 20-month study period; of these, 224 sessions were successfully performed and 30 were cancelled. We collected 3504 responses from the satisfaction survey. There was high acceptance of the programme: 97% rated it as excellent or good.     

Parent's views of the importance of making changes in settings where children spend time to prevent obesity

AIM: To examine the kinds of changes parents would like to see in those settings where children spend time (kindergartens and schools, child care centres and after-school care facilities, and the local neighbourhood) in policies and practices that impact on children's risk of obesity, and to establish whether parents might be willing to advocate for changes in these settings. MATERIALS AND METHODS: 175 parents from five randomly selected primary schools and five randomly selected kindergartens located in suburbs of metropolitan Melbourne completed a questionnaire in which they rated the importance of a number of potential changes to promote healthy eating and increase physical activity in their children. RESULTS: Parents of children in kindergarten most commonly rated changes to the eating environment as important. In contrast, parents of primary school children believed changes related to both eating and physical activity in school were important. Ninety-five per cent of parents of kindergarten children and 89% of parents of primary school children believed it was possible for parents to bring about change to provide more opportunities for their child to eat more healthily and be more physically active. One in four parents reported that they had thought about or had tried to bring about changes in their community. CONCLUSIONS: The findings suggest that mobilising parents to take an active role in advocating for change in those settings that have the potential to shape their children's physical activity and eating behaviours may be feasible.     

Do Mothers With or Without Mental Retardation Know What to Report When They Think Their Child Is Ill?

A methodology was developed for determining what parents with mental retardation knew about the information they should provide to the health professional when they suspect that their child is ill Parents with mental retardation were compared to parents without mental retardation using this methodology Neither group was very familiar with basic information such as what temperature means, why it is important to know a child's temperature, and how to accurately determine it Suggestions for systematically preparing parents in the adequate health care of their child are made.     

Parents’ receptiveness to oral health clinic-based vaccination

In the United States, utilization of the human papillomavirus (HPV) vaccine has lagged far below public health goals for achieving satisfactory population-level protection against HPV associated cancers. Oral health professionals such as dentists and dental hygienists are important stakeholders in primary prevention of HPV-associated oropharyngeal cancer. We surveyed parents accompanying children to a local pediatric oral health clinic to ascertain their receptiveness to engaging their child’s oral health team in their child’s immunizations. Parents were generally receptive (86%) to discussing vaccines available for their children with both their child’s dentist and dental hygienist. The majority of parents (79%) reported that they would allow their child’s dentist to administer a vaccine to their child. Oral health providers are trusted healthcare professionals poised to make a positive impact on adolescent vaccination programs and they should be included in efforts to improve HPV vaccination rates.     

新冠肺炎疫情下儿童保健门诊家长心理体验及需求的定性研究

目的 通过现象学研究,探索新冠肺炎疫情背景下儿童保健门诊家长心理体验及需求.方法 采用半结构式深度访谈法和观察法,对17名儿童保健门诊的家长进行质性访谈,借助Nvivo 8软件,应用Colaizzi分析法和合众法对访谈收集到的资料进行整理与分析.结果 新冠肺炎疫情背景下儿童保健门诊家长心理体验及需求共提炼出4个主题:对...     

Perceptions of the quality of life for the adolescent with a chronic illness by teachers,parents and health professionals: a Delphi study

AIMS: The perceptions that teachers, parents and health professionals have on the relative importance of different aspects of quality of life (QOL) for the adolescent with a chronic illness were explored using a three-round Delphi study. METHODS: The first round questionnaire identified the level of importance each panel attached to 16 aspects relating to QOL. Panellists were also encouraged to provide additional comments on why they felt a particular item was important. In round two, panellists were asked to prioritize the items in order of importance, whereas round three attempted to achieve consensus among each of the three panels. RESULTS: Differences between and within panels in the prioritization of items in round one and round two were evident. However, consensus was achieved in round three, except for the prioritization of very important items by the panel of teachers. Items identified by all three panels as extremely important included the adolescent's attitude, family relationships and friendships with the same age group. Themes to emerge from the qualitative responses to the open-ended questions included the perception of the chronically ill adolescent 'not wanting to be different' and the importance of a 'positive attitude'. The majority of participants also perceived adolescents with a chronic illness as having worse QOL than their healthy counterparts. CONCLUSIONS: By increasing the awareness among the different groups of the impact of chronic illness on various aspects of adolescent QOL, the overall care and support of those adolescents could be improved. Further studies should also be undertaken to explore the views of the chronically ill adolescents themselves.     

The “ins” and “outs” of Provider-Parent Communication: Perspectives From Adolescent Primary Care Providers on Challenges to Forging Alliances to Reduce Adolescent Risk

PurposeFor several decades, the goal to protect adolescents' confidentiality in addition to state and professional mandates to provide confidential health services have sometimes outweighed the interest of involving parents in risk reduction efforts. More recently, experts acknowledge that a balance must be found between maintaining adolescent confidentiality and involving parents in preventing poor adolescent outcomes resulting from risky behaviors. The purpose of this research was to elucidate the challenges in and identify solutions to realizing this newer vision in the primary care setting.MethodsWe conducted a qualitative study featuring in-depth interviews with 37 primary care providers among whom a significant component of their practice involved adolescent patients. Purposeful sampling was aimed at a diversity of gender, practice specialty, practice venues, and geographic areas.ResultsWe identified individual and structural barriers and facilitators to involving parents in their adolescents' primary care. Barriers included parents' lack of knowledge and awareness of their children's risk behaviors; providers time constraints and competing clinical demands, concerns for confidentiality and developing a trusting relationship with the child; and legal and system requirements that limit engagement with parents. Facilitators included interest and for some, planned approaches by the provider to engage the parent; encouragement by the provider to the adolescent to communicate with a trusted adult about their risky behavior; and opportunities to educate the parent about risk reduction in general.ConclusionOpportunities for further research on strategies to improve communication and develop a partnership between providers and parents are described.     

Parenting and physical punishment: primary care interventions in Latin America.

Physical punishment is a form of intrafamilial violence associated with short- and long-term adverse mental health outcomes. Despite these possible consequences, it is among the most common forms of violent interpersonal behavior. For many children it begins within the first year of life. The goal of this study was to determine the feasibility of involving public sector primary health care providers to inform parents about alternatives to physical punishment. The study used a qualitative design utilizing focus groups and survey questionnaires with parents and providers at six clinic sites chosen to be representative of public sector practice settings in Costa Rica and in metropolitan Santiago, Chile. The data were collected during 1998 and 1999. In the focus groups and surveys the parents voiced a range of opinions about physical punishment. Most acknowledged its common use but listed it among their least preferred means of discipline. Frequency of its use correlated positively with the parents' belief in its effectiveness and inversely with their satisfaction with their children's behavior. Some parents wanted to learn more about discipline; others wanted help with life stresses they felt led them to use physical punishment. Parents reported they chose other family members more frequently as a source of parenting information than they did health care providers. Some parents saw providers as too rushed and not knowledgeable enough to give good advice. Providers, in turn, felt ill equipped to handle parents' questions, but many of the health professionals expressed interest in more training. Parents and providers agreed that problems of time, space, and resources were barriers to talking about child discipline in the clinics. Many parents and providers would welcome a primary-care-based program on physical punishment. Such a program would need to be customized to accommodate local differences in parent and provider attitudes and in clinic organization. Health care professionals need more training in child discipline and in the skills required to interact with parents on issues relating to child behavior.     

Assessing the quality of preschool child health surveillance in primary care: a pilot study in one health district

OBJECTIVE: To develop a framework for measuring the quality of preschool child health surveillance acceptable to primary health care teams and measurable at individual primary health care team level. DESIGN: Published research evidence was identified and criteria developed by a local multidisciplinary expert group. The criteria were discussed with primary health care teams. How well they were achieved was assessed. SETTING: Twenty-eight general practices in one health authority area. METHODS: Data collection included observation of baby clinics, interviews with health visitors and general practitioners (GPs), questionnaires to parents, collation of child health surveillance reviews recorded in personal child health records and immunization rates. RESULTS: The criteria for assessing preschool child health surveillance were thought to be acceptable and achievable by primary health care teams. Fifteen of the 22 criteria used to assess baby clinics were met by over 90 of practices. Almost all practices completed child health surveillance reviews within a standard time and achieved 90 coverage for primary immunizations. At many practices, less than 90 of parents felt welcome at the baby clinic, usually had enough time to talk to their health visitor or had the purpose or results of the 6 to 8 week child health surveillance review explained to them. GPs were less likely than health visitors to discuss health promotion at child health surveillance reviews (chi(2) 11.52, P = 0.0007). Few practices had a call-up and recall system for all reviews. CONCLUSION: The framework that we developed for assessing preschool child health surveillance was acceptable and achievable by primary health care teams.