Increasing community participation in an Aboriginal health service

Objective: To increase Aboriginal participation with mainstream health professionals in an Aboriginal health and well‐being centre. Design: Participatory Action Research using Aboriginal traditional symbolism to depict aspects of the research process, interview surveys and a document review. Setting: A regional town with 629 Aboriginal and Torres Strait Islander residents and a newly established Aboriginal health and well‐being centre (Nunyara). Participants: Thirty Aboriginal community members were interviewed about their involvement with Nunyara and their health issues. Participants were selected through purposive ‘pass‐me‐around’ sampling to ensure that all family groups were included. Results: The results are presented in two areas: the structure of the Aboriginal community that affects participation and community views about health issues. Aboriginal people living in the town come from 10 or more different language groups and relate almost exclusively within their own groups. Activities at Nunyara were seen as individual family group events and not for everyone. Aboriginal community participants had a broad view of health as they reported problems that included smoking and alcohol use. Almost all would like more involvement in health issues through Nunyara. Conclusion: Aboriginal community members are willing to get involved in health issues in collaboration with Nunyara. However, fundamental to increasing participation is to bring people together from different family groups and increase social cohesion. This can be done through developing relationships with groups enabling different points of view to be heard and valued.     

The development of a community child and family mental health service

The Community Child and Family Service is a primary care and community-based child mental health service working in a socio-economically disadvantaged area of inner London. This paper outlines the strategic framework and value base from which the service has developed. The clinical projects set up by the service in general practice, community and education settings are described, as are the training and supervision programmes that have been undertaken. The framework for evaluating the clinical and economic outcomes of the projects is outlined. There has been a positive response from purchasers, providers and clients to the introduction of this Service. The relationship between community- and hospital-based child mental health services is discussed, as is the future direction of the Service.     

Evaluation of an occupational health service for general practitioners and their staff in a primary care trust

BACKGROUND: An occupational health service was set up in 2002 for general practitioners (GPs) and their staff in a London primary care trust (PCT). The service was based on a needs assessment undertaken in the locality in 1998. AIMS: To evaluate awareness, usage and perceived helpfulness of the service amongst GPs and practice managers, and to ascertain current perceived priorities for what to include in the service. METHODS: Questionnaire survey sent postally and electronically to 199 named GPs and 69 practice managers in 78 practices in the PCT. RESULTS: Overall 119/268 (44%) responses were received from 54/78 practices (69%). Awareness of the existence of the service was high (76%), and although uptake had been poor, this was not related to a perception that the service was unlikely to be helpful. Almost all those who had used the service had found it helpful. Nineteen (16%) respondents asked for more information about the service. Advice on health and safety law and fitness for work assessments were the highest priorities and hepatitis B immunization lowest, as in the 1998 needs assessment. However, a discrepancy between GPs and practice managers with regard to the perceived relative importance of pre-employment health screening and counselling/stress management emerged. CONCLUSIONS: The service is valued by users but could be developed by exploring new ways to disseminate information about the service and deliver it.     

Evaluation of community mental health services: comparison of a primary care mental health team and an extended day hospital service

Alongside mental health policies emphasising the need to focus on people experiencing serious, long-term problems, recent general healthcare policy is leading to the development in the UK of a primary care-led National Health Service. While most primary care-led mental health initiatives have focused on supporting general practitioners (GPs) in managing milder depression and anxiety, this article describes an evaluation comparing primary care-based and secondary care-based services for people with serious long-term problems. A survey of service users was carried out at three points in time using three measures: the Camberwell Assessment of Need, the Verona Satisfaction with Services Scales and the Lancashire Quality of Life Profile. Staff views were sought at two time intervals and carers' views were obtained towards the end of the 2-year study period. The results indicate that both services reduced overall needs and the users' need for information. The primary care service also reduced the need for help with psychotic symptoms whereas the secondary care service reduced users' need for help with benefits and occupation. There were no major differences in terms of satisfaction or quality of life. Primary care-based services therefore appear to have the potential to be as effective as more traditional secondary care services. However, a more comprehensive range of services is required to address the whole spectrum of needs, a conclusion supported by the views of staff and carers.     

Rural secondary school students living in a small community: their attitudes,beliefs and perceptions towards general practice

Objective: To study the attitudes and beliefs towards general practice of rural secondary school students, in particular, their perception of the barriers to the effective delivery of primary health care. Setting: Students attending a government‐funded secondary school in a rural community of less than 4000 people. Subjects: 250 students in years 7–12 were surveyed, with 177 (71%) replying, 45% of these being male. Design: Cross‐sectional, self‐administered questionnaire survey. Results: The study found that most students value general practitioners (GPs) as valuable sources of health care, feel they have reasonable access to care and in most instances appear to attend appropriately for their health problems. Most felt their doctor would be an empathetic listener, would provide sufficient time to provide effective care and communicated in a language they could understand. Confidentiality issues were considered important, especially by females. Conclusion: Although students have very positive attitudes about general practice, the findings could be used to improve a number of GP services for young people in small rural communities. This is particularly so for presentations which require a high degree of confidentiality and skilful counselling, such as psychological problems and risk‐taking behaviours.     

Upper abdominal ultrasound in general practice: indications, diagnostic yield and consequences for patient management

BACKGROUND: Abdominal ultrasound (US) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care. OBJECTIVE: To assess the influence of upper abdominal US on patient management in general practice. METHODS: A prospective cohort study with 76 GPs and three general hospitals in The Netherlands. A total of 395 patients aged >or=18 years referred by their GPs for upper abdominal US were included. The main outcome was change in anticipated patient management assessed by means of questionnaires filled in by GPs before and after abdominal US. RESULTS: Mean age of the patients was 54.0 +/- 15.8 years, 35% were male. Clinically relevant abnormalities were found in 29% of the abdominal US, mainly cholelithiasis. Anticipated patient management changed in 64% of the patients following abdominal US. Main changes included fewer referrals to a medical specialist (from 45 to 30%); and more frequent reassurance of the patient (from 15 to 43%). However, this reassurance was not perceived as such in almost 40% of these patients. A change in anticipated patient management occurred significantly more frequently in patients with a prior cholecystectomy (82%). CONCLUSION: Anticipated patient management by the GP changed in 64% of patients following upper abdominal US. Abdominal US substantially reduced the number of intended referrals to a medical specialist, and more patients could be reassured by their GP.     

Persuasion and types of enticements offered by pharmaceutical companies to Gold Coast general practitioners in an attempt to encourage a health website recommendation

This study was undertaken to determine if pharmaceutical companies persuade and offer enticements to Gold Coast (Queensland, Australia) general practitioners (GPs), in an attempt to encourage them to recommend health websites to the health consumer. A survey instrument consisting of seven single response questions was mailed to 250 (61%) out of 410 GPs. Questions were designed to measure the percentages (%) and proportions associated with levels of persuasion and types of enticements pharmaceutical companies are offering GPs, in an attempt to encourage them to recommend health websites to the health consumer. The survey instrument allowed participants to indicate their (1) gender, (2) age and (3) years of experience (less experienced ≤ 10 years/more experienced ≥ 10 years). One hundred and eight (43%) of the 250 GPs returned a completed survey. The return rate for male GPs was 72 (40%) and for female GPs, it was 36 (33%). Sixty-eight (63%) GPs indicated that they actively recommend health websites to their patients [male GPs – 48 (71%), female GPs – 20 (29%)]. This study highlights that female GPs (80%), those aged between 31 and 40 (77%) and GPs with < 10 years experience (72%) were more frequently targeted by pharmaceutical companies. This study reports that pharmaceutical companies are offering various types of enticements in an attempt to persuade Gold Coast GPs to recommend specific health websites to the health consumer. Further research should explore if similar levels of persuasion and types of enticements are being offered to GPs across Australia.     

Costs and efficiency of gatekeeping under varying numbers of general practitioners

We study the relationship between gatekeeping on one hand and costs as well as efficiency on the other hand. We do this with special focus on the relative amount of general practitioners in the system when compared with all practitioners. Data collected between 2002 and 2011 by The Organization for Economic Co‐operation and Development on 34 countries were analyzed. Of those, 18 countries have gatekeeping systems while 16 do not. The association between gatekeeping and health care costs was examined with regression analysis. Efficiency was assessed with data envelopment analysis. Finally, the efficiency assessments were analyzed with regression techniques to examine if gatekeeping and/or the ratio of GPs to all practitioners was associated with efficiency. Point estimates indicate that total costs tend to be lower in systems where GPs act as gatekeepers. However, efficiency is slightly lower where gatekeeping exists. Neither of these results is statistically significant at the 95% confidence level. There is also indication that the efficiency of a gatekeeping system increases with increased amount of GPs. When GPs are over 30% of practitioners, gatekeeping countries have more efficient health care systems than their counterparts. Consistent with other studies, we estimate income elasticity of health care demand to be 1.12, suggesting that those societies consider health care to be a luxury good.     

The concepts of community care and primary care in the UK: the 1960s to the 1990s

The concepts of community care and primary care in UK health policy have emerged over a number of decades. This paper uses historical methods to investigate the changing definitions of community care and primary care in health policy since the 1960s. It draws on published primary and secondary sources including government documents, journals and the professional press. While policy makers have tended to separate community and primary care, the roles of the professions have tended to cut across the two sectors. The emergence and substantially separate development of the two concepts in policy and professional practice between 1960 and 1990 is described and analysed, illustrating the structural constraints on integration but noting the increasing tendency for the boundaries to be called into question. The second part of the paper examines the impact of the 1990 NHS and Community Care Act, the implementation of reforms during the 1990s and the policies currently being implemented by the Labour government. Community care and primary care have continued to be treated separately in the minds of policy makers. Policy for the former has been largely driven by governments' concern to control social security and NHS spending, whilst primary care policy largely focused on the role of general practitioners (GPs) in implementing market reforms. The new Labour government has put renewed emphasis on public health and reducing fragmentation, stressing partnership and cooperation. But the continued dominance of general practice in primary care policy may continue to be an obstacle to the integration of community care and primary care.     

邮政分发调查法在评价社区卫生服务机构满意度中的运用

目的为了客观评价社区卫生服务效果,减少主观因素的干扰,利用邮政分发系统作为第三方对社区卫生服务机构进行群众满意度的评价。结果第三方评价真实的反映了武汉市社区卫生服务机构的现状,居民对社区卫生服务的满意度达到83%以上。结论利用邮政分发来对现有的社区卫生服务机构进行第三方的评价,客观、快捷,而且可行、可信。     

Variation in how mothers, health visitors and general practitioners use the personal child health record

BACKGROUND: In the UK, a national personal child health record (PCHR) with local adaptations is in widespread use. Previous studies report that parents find the PCHR useful and that health visitors use it more than other health professionals. This study was carried out in Nottingham, where the local PCHR is similar to the national PCHR. OBJECTIVES: To explore variation in use of the PCHR made by mothers with differing social characteristics, to compare heath visitors' and general practitioners' (GPs') use of the PCHR, and to compare health visitors' and GPs' perceptions of the PCHR with those of mothers for whose children they provide care. METHODS: Questionnaires to 534 parents registered with 28 general practices and interviews with a health visitor and GP at each practice. A score per mother for perceived usefulness of the PCHR was developed from the questionnaire, and variation in the score was investigated by linear regression adjusted for clustering. RESULTS: Four hundred and one (75%) questionnaires were returned. Three hundred and twenty-five (82%) mothers thought the PCHR was very good or good. Higher scores for usage of the PCHR were significantly associated with teenage and first-time mothers, but no association was found with mother's social class, education or being a single parent. There was no association between variation in the score and practice, health visitor or GP characteristics. Mothers, health visitors and GPs reported that mothers took the PCHR to baby clinic more frequently than when seeing their GP, and that health visitors wrote in the PCHR more frequently than GPs. Eighteen (67%) health visitors and 20 (71%) GPs said they had difficulty recording information in the PCHR. CONCLUSION: The PCHR is used by most mothers and is important for providing health promotion material to all families with young children. It may be particularly useful for first-time and teenage mothers.     

Evaluation of an integrated service delivering post diagnostic care and support for people living with dementia and their families

Greater integration of health and social care services is considered vital to ensure sustainable long‐term quality provision for the growing numbers of people living with dementia and their families. Integration of services is at the heart of government policy in England. We evaluated a new integrated service for post diagnostic dementia care, funded as a pilot and delivered through a partnership of statutory and voluntary sector health and social care organisations. The service used an adapted Admiral Nursing service model with a workforce of Admiral Nurses (ANs) and Dementia Advisers (DAs). A mixed method approach was used to assess implementation and outcomes. It involved collection of service activity data, carer reported experience survey data, focus group discussions and interviews with the service delivery team, and the management group. Qualitative data was analysed using a framework approach. About 37.8% of the eligible population registered with the service over the 14‐month pilot period. The self‐referral route accounted for the majority of referrals, and had enabled those not currently receiving specialist dementia care to engage with the service. Carer satisfaction surveys indicated high levels of satisfaction with the service. The caseload management system offered specific benefits. Individual caseloads ensured continuity of care while the integrated structure facilitated seamless transfer between or shared working across AN and DA caseloads. The skill mix facilitated development of the DA role increasing their potential contribution to dementia care. Challenges included managing large workloads and agreeing responsibilities across the skill mix of staff. This model of fully integrated service offers a novel approach to address the problems of fragmented provision by enabling joined‐up working across health and social care.     

Child health care centres: an academic model for comprehensive child health care in the community

The challenge of the discipline of paediatrics in the 21st century is to promote health and development of children in a way that will enable them to maximize their biological and social potential. The community child health centre (CHC) in Israel is a model of community health care service built to provide comprehensive health care to children and adolescents, as well as an academic setting for under- and postgraduate paediatric training. Today there are 34 CHCs in Israel, serving a population of 220 000 children from birth to 18 years of age. The CHC combines the advantages of group practice with those of an academic medical centre and enables flexibility and mutual learning. Further expansion and development are required to realize the CHC's mission of a true comprehensive academic centre for paediatric community health.     

城市居民对社区卫生服务中现有服务模式的满意度分析

分析社区卫生服务中心供需双方的满意度及其原因,提出提升满意度的建议。

从上海市16个区247家社区卫生服务中心进行随机抽样,通过现场问卷调查的方式对在职员工及就诊患者进行数据采集。

本次调查社区卫生服务中心返回合格问卷10 334份。其中,7 712份来自社区居民患者,2 622份来自社区卫生服务中心在职员工。2021年,公众对社区卫生服务中心满意度评分为96.51分,员工总体满意度得分为94.08分;其中,公众对门诊基本药物配备满意度较低,而员工对薪酬福利、工作认同以及职业发展满意度较低。家庭医生签约服务方面,有73.38%的公众签约了家庭医生,仍有23.57%的公众不了解家庭医生签约服务,16.18%的公众认为需要增强对基本公共卫生服务的宣传力度。

公众对社区卫生服务整体服务满意度逐步提升,社区卫生基本医疗服务受居民认可,药物配备亟待改进,宣传推广有待进一步加强。员工总体满意度高,但在薪酬福利、工作认同、职业拓展等方面需进一步提升。

     

Economic Evaluation and the Shifting Balance Towards Primary Care: Definitions,Evidence and Methodological Issues

Current UK government policy places considerable emphasis on shifting the balance of health care provision from secondary towards primary care. Despite this emphasis, however, there has been very little economic evaluation of initiatives designed to achieve this shift. In view of this deficiency, our article has three main aims. First, it offers a working definition of shifts in the balance of care at the primary–secondary care interface. Second, it systematically reviews the existing literature on the cost-effectiveness of initiatives designed to shift the balance of care. Third, it identifies a range of methodological issues that need to be addressed if future economic evaluations in this area are to be carried out satisfactorily. © 1997 by John Wiley & Sons, Ltd.     

A national survey of turnover intention among general practitioners in China

Studies on turnover intention among Chinese general practitioners (GPs) at the national level are limited. This study aimed to assess intention to leave and its associated factors among a nationally representative sample of GPs. The participants were selected using a multistage stratified random sampling method. A self-administered structured questionnaire was used to collect data from 3236 GPs in China between October 2017 and February 2018. A multiple linear stepwise regression analysis was used to identify factors associated with turnover intention. Over 70.0% GPs had a moderate or high turnover intention. GPs who were male, were younger, had a higher education level, had a lower professional title, had a lower income level, and had a temporal work contract had higher turnover intention. In addition, GPs who worked night shifts, had low job satisfaction, and had few opportunities for professional development reported higher turnover intention. Substantial gender and regional differences in predictors of turnover intention among GPs were observed. The study showed that turnover intention in Chinese GPs is high, and the factors influencing turnover intention were low professional title and income level, high education level, having a temporary work contract, working night shifts, and limited opportunities for professional development.     

Service providers' views of community participation at six Australian primary healthcare services: scope for empowerment and challenges to implementation

Community participation is a key principle of comprehensive primary health care (PHC). There is little literature on how community participation is implemented at Australian PHC services. As part of a wider study conducted in partnership with five South Australian PHC services, and one Aboriginal community controlled health service in the Northern Territory, 68 staff, manager, regional health executives, and departmental funders were interviewed about community participation, perceived benefits, and factors that influenced implementation. Additional data were collected through analysis of policy documents, service reports on activity, and a web‐based survey completed by 130 staff. A variety of community participation strategies was reported, ranging from consultation and participation as a means to improve service quality and acceptability, to substantive and structural participation strategies with an emphasis on empowerment. The Aboriginal community controlled health service in our study reported the most comprehensive community participation. Respondents from all services were positive about the benefits of participation but reported that efforts to involve service users had to compete with a centrally directed model of care emphasising individual treatment services, particularly at state‐managed services. More empowering substantive and structural participation strategies were less common than consultation or participation used to achieve prescribed goals. The most commonly reported barriers to community participation were budget and lack of flexibility in service delivery. The current central control of the state‐managed services needs to be replaced with more local management decision making if empowering community participation is to be strengthened and embedded more effectively in the culture of services. Copyright © 2014 John Wiley & Sons, Ltd.     

General psychiatric services in the community as an alternative to hospital admission: a review of recent research evidence

There have been a number of systematic investigations of alternative ways of delivering psychiatric care, a number of studies of so-called ‘alternatives’ to psychiatric care, and some studies of community care services received after in-patient care. This paper reviews research evidence which suggests that when general psychiatric services are located in community settings, for example psychiatric out-patient services in primary care settings, or multidisciplinary teams in a community base, the use of psychiatric beds in hospital can be reduced.