11,270 research outputs found
Process evaluation for complex interventions in primary care: understanding trials using the normalization process model
No full textBackground: the Normalization Process Model is a conceptual tool intended to assist in understanding the factors that affect implementation processes in clinical trials and other evaluations of complex interventions. It focuses on the ways that the implementation of complex interventions is shaped by problems of workability and integration.Method: in this paper the model is applied to two different complex trials: (i) the delivery of problem solving therapies for psychosocial distress, and (ii) the delivery of nurse-led clinics for heart failure treatment in primary care.Results: application of the model shows how process evaluations need to focus on more than the immediate contexts in which trial outcomes are generated. Problems relating to intervention workability and integration also need to be understood. The model may be used effectively to explain the implementation process in trials of complex interventions.Conclusion: the model invites evaluators to attend equally to considering how a complex intervention interacts with existing patterns of service organization, professional practice, and professional-patient interaction. The justification for this may be found in the abundance of reports of clinical effectiveness for interventions that have little hope of being implemented in real healthcare setting
Embedding effective depression care: using theory for primary care organisational and systems change
No full textBackground: depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting.Methods: we used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development.Results: five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences.Conclusions: ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depressio
The confidential patient: the social construction of therapeutic relationships in general medical practice
No full textThe interpersonal relationship between doctor and patient is fundamental to general medical practice. In this paper we explore the ways in which general practitioners make sense of the changing political economy of this relationship, as it is restructured by ideas about the patient as consumer, and as it increasingly constitutes the consultation as a point of interaction that may be intrinsically therapeutic. In particular, we explore the ways in which the consultation is the site of negotiated power relations between doctor and patient, and is the site of the doctor's negotiation of powerful discourses of professional and institutional identity.<br/
Access to mental health in primary care: A qualitative meta-synthesis of evidence from the experience of people from 'hard to reach' groups
No full textKnowledge about depression, access and help-seeking has increasingly been influenced from a range of disciplines including clinical and applied social science. A range of interventions can improve outcomes of depression and anxiety. However, many in need do not seek help, or their interaction with care-givers does not address their needs. We carried out a systematic search for qualitative articles focusing on the experiences of eight exemplar groups with exceptional problems in access (the homeless, long-term unemployed, adolescents with eating disorders, depressed elderly people, advanced cancer sufferers, patients with medically unexplained symptoms, asylum seekers and people from black and minority ethnic groups). Twenty articles representing these groups were selected, findings were then developed using qualitative meta-synthesis, this suggested a range of mechanisms accounting for poor access among these groups. Many regarded their mental health problems as rooted in social problems and employed a variety of self-management strategies to maintain function. These strategies could involve social withdrawal, focusing available resources on close family relationships and work roles. Over-investment in these roles could result in a sense of insecurity as wider networks were neglected. Material disadvantage affected both the resources people could bring to performing social roles and influenced help-seeking. A tacit understanding of the material, psychological and social 'costs' of engagement by patients and health professionals could influence decisions to seek and offer help. These costs were felt to be proportionally higher in deprived, marginalized and minority communities, where individual resources are limited and the stigma attached to mental ill-health is high. © The Author(s) 2011
sj-pdf-1-pmj-10.1177_02692163221092624 – Supplemental material for Health and social care services for people with dementia at home at the end of life: A qualitative study of bereaved informal caregivers’ experiences
No full textSupplemental material, sj-pdf-1-pmj-10.1177_02692163221092624 for Health and social care services for people with dementia at home at the end of life: A qualitative study of bereaved informal caregivers’ experiences by Caroline Mogan, Karen Harrison Dening, Christopher Dowrick and Mari Lloyd-Williams in Palliative Medicine</p
Interview with Nicholas Christopher, author of Somewhere in the Night: Film Noir and the American City
No full textInterview with Nicholas Christopher, author of Somewhere in the Night: Film Noir and the American Cit
Painful symptoms in depression: under-recognised and under-treated?
No full textCurrent diagnostic systems maintain an artificial division between ‘physical’and ‘psychological’disorders. This is exemplified by the way in which pain symptoms are dealt with in the context of depressive illness. The consequences of this are discussed, and ways to enhance the clinical care of patients with depression and pain are suggested
AD_trmt_in_primary_care_Appendix_Revised – Supplemental material for Antidepressant treatment for primary care patients with depressive symptoms: Data from the <i>diamond</i> longitudinal cohort study
No full textSupplemental material, AD_trmt_in_primary_care_Appendix_Revised for Antidepressant treatment for primary care patients with depressive symptoms: Data from the diamond longitudinal cohort study by Sandra K Davidson, Helena Romaniuk, Patty Chondros, Christopher Dowrick, Jane Pirkis, Helen Herrman, Susan Fletcher and Jane Gunn in Australian & New Zealand Journal of Psychiatry</p
AD_trmt_in_primary_care_Appendix_2_MI – Supplemental material for Antidepressant treatment for primary care patients with depressive symptoms: Data from the <i>diamond</i> longitudinal cohort study
No full textSupplemental material, AD_trmt_in_primary_care_Appendix_2_MI for Antidepressant treatment for primary care patients with depressive symptoms: Data from the diamond longitudinal cohort study by Sandra K Davidson, Helena Romaniuk, Patty Chondros, Christopher Dowrick, Jane Pirkis, Helen Herrman, Susan Fletcher and Jane Gunn in Australian & New Zealand Journal of Psychiatry</p
Matt Christopher Papers - Accession 1309
No full textThe collection includes letters written by the children’s book author, Matt Christopher, to his son, Marty Christopher. Many of the letters also contain newspaper articles of interest to Matt Christopher, which deal with local sports teams, his writing career, his participation in an exhibition baseball game against the New York Giants in 1938, and other of general interest. Most of the letters are personal in nature, however, a majority of the letters delve into Matt Christopher’s writing career, personal interests, the author’s health, as well as his family life.https://digitalcommons.winthrop.edu/manuscriptcollection_findingaids/2649/thumbnail.jp
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