1
|
Enthoven P, Menning L, Öberg B, Schröder K, Fors M, Lindbäck Y, Abbott A. Physiotherapists' experiences of implementation of the BetterBack model of care for low back pain in primary care - a focus group interview study. Physiother Theory Pract 2024:1-13. [PMID: 38189338 DOI: 10.1080/09593985.2023.2301436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION The BetterBack model of care (MoC), a best practice physiotherapy MoC for low back pain (LBP), was implemented in Swedish primary care to improve management of patients with LBP and provide patients with support tools to better self-manage episodes of LBP. PURPOSE The objective was to describe how physiotherapists in primary care experienced the implementation of the BetterBack MoC for LBP. METHODS Focus group interviews were conducted with physiotherapists in 2018-2019, 14-18 months after the introduction of the BetterBack MoC. Data were analyzed using qualitative content analysis. RESULTS Five focus group interviews with 23 (15 female and 8 male) physiotherapists, age range 24-61 years were analyzed. A supportive organization and adaptation to the local culture, combined with health care professionals' attitudes and collaboration between physiotherapists emerged as important factors for a successful implementation and for long-term sustainability of the MoC. Physiotherapists had differing opinions if the implementation led to change in clinical practice. Improved confidence in how to manage patients with LBP was expressed by physiotherapists. CONCLUSIONS Several barriers and facilitators influence the implementation of a best practice physiotherapy MoC for LBP in primary care, which need to be considered in future implementation and sustainability processes.
Collapse
Affiliation(s)
- Paul Enthoven
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Linnea Menning
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Karin Schröder
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Maria Fors
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Yvonne Lindbäck
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden
| |
Collapse
|
2
|
Montavon F, Vandenberghe F, Eap CB. Use of pharmacological treatment for posttraumatic stress disorder: Analysis of a psychiatric population in Switzerland and comparison with international guidelines. L'ENCEPHALE 2023; 49:446-452. [PMID: 35973850 DOI: 10.1016/j.encep.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Several international guidelines for the pharmacological treatment of posttraumatic stress disorder (PTSD) have been published. However, it is unclear whether clinicians use these procedures in their daily practice. We compared the psychopharmacological prescription patterns in a Swiss adult psychiatric center with international clinical guidelines at admission and discharge. METHODS Retrospective chart review study between 2005 and 2015 of adult patients with PTSD and no other documented psychiatric comorbidity. RESULTS Fifty-two outpatients and 21 inpatients were included; 47% had at least one psychopharmacological treatment at admission. Among them, 47% had one or several antidepressants, mainly escitalopram (31%, n=5) or citalopram. At discharge, 68% had at least one psychopharmacological treatment. Among them, 76% had at least one antidepressant, mainly escitalopram (34%, n=13) or mirtazapine (21%, n=8). They were compared to the guidelines of the Department of Veterans Affairs and Department of Defense (VA/DoD), showing 19% of the patients treated with antidepressants at admission were in agreement with the guidelines (sertraline, fluoxetine, paroxetine, venlafaxine), and 26% at discharge. In addition, we found prescriptions of benzodiazepines (62% at admission and 50% at discharge), antipsychotics (12% and 22%), Z-drugs (zolpidem, zopiclone: 15 and 40%) and a few pregabalin prescriptions (n=4). CONCLUSIONS Clinicians in this study frequently prescribed antidepressants to treat PTSD, as recommended. However, most of the antidepressants used were not recommended in the VA/DoD guidelines. Benzodiazepines and Z-drugs remained widely used, although they are not recommended.
Collapse
Affiliation(s)
- F Montavon
- Psychiatric ambulatory unit of Orbe, Psychiatry of the Adult (SPANO) - North, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Orbe, Switzerland.
| | - F Vandenberghe
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
3
|
Bennett SD, Cross JH, Coughtrey AE, Heyman I, Ford T, Chorpita B, Moss-Morris R, Byford S, Dalrymple E, Reilly C, Stephenson T, Doré C, Varadkar S, Blackstone J, Chowdhury K, Ganguli P, Deane L, Shafran R. M.I.C.E-Mental Health Intervention for Children with Epilepsy: a randomised controlled, multi-centre clinical trial evaluating the clinical and cost-effectiveness of MATCH-ADTC in addition to usual care compared to usual care alone for children and young people with common mental health disorders and epilepsy-study protocol. Trials 2021; 22:132. [PMID: 33573674 PMCID: PMC7876975 DOI: 10.1186/s13063-020-05003-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health disorders in the context of long-term conditions in children and young people are currently overlooked and undertreated. Evidence-based psychological treatments for common childhood mental health disorders (anxiety, depression and disruptive behaviour disorders) have not been systematically evaluated in young people with epilepsy despite their high prevalence in this population. The aim of this multi-site randomised controlled trial is to determine the clinical and cost-effectiveness of adding a modular psychological intervention to usual care for the mental health disorders in comparison to assessment-enhanced usual care alone. METHODS In total, 334 participants aged 3-18 years attending epilepsy services will be screened for mental health disorders with the Strengths and Difficulties Questionnaire (SDQ) and the diagnostic Development and Wellbeing Assessment (DAWBA). Those identified as having a mental health disorder and consenting to the trial will be randomised to either receive up to 22 sessions of the modular psychological intervention (MATCH-ADTC) delivered over the telephone over 6 months by non-mental health professionals in addition to usual care or to assessment-enhanced usual care alone. Outcomes will be measured at baseline, 6 months and 12 months post-randomisation. It is hypothesised that MATCH-ADTC plus usual care will be superior to assessment-enhanced usual care in improving emotional and behavioural symptoms. The primary outcome is the SDQ reported by parents at 6 months. Secondary outcomes include parent-reported mental health measures such as the Revised Children's Anxiety and Depression Scale, quality of life measures such as the Paediatric Quality of Life Inventory and physical health measures such as the Hague Seizure Severity Scale. Outcome assessors will be blinded to group assignment. Qualitative process evaluations and a health economic evaluation will also be completed. DISCUSSION This trial aims to determine whether a systematic and integrated approach to the identification and treatment of mental health disorders in children and young people with epilepsy is clinically and cost-effective. The findings will contribute to policies and practice with regard to addressing mental health needs in children and young people with other long-term conditions. TRIAL REGISTRATION ISRCTN ISRCTN57823197 . Registered on 25 February 2019.
Collapse
Affiliation(s)
- Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - J Helen Cross
- Great Ormond Street Hospital NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Department of Psychiatry, Cambridge University, Cambridge, UK.,Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Rona Moss-Morris
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emma Dalrymple
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Colin Reilly
- National Centre for Young People with Epilepsy, Surrey, UK
| | - Terence Stephenson
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Caroline Doré
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Sophia Varadkar
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - James Blackstone
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Kashfia Chowdhury
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Poushali Ganguli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Liz Deane
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. .,Great Ormond Street Hospital NHS Foundation Trust, London, UK.
| |
Collapse
|
4
|
Iqbal Z, Airey ND, Brown SR, Wright NMJ, Miklova D, Nielsen V, Webb K, Sajjad A. Waiting list eradication in secondary care psychology: Addressing a National Health Service blind spot. Clin Psychol Psychother 2021; 28:969-977. [PMID: 33415754 DOI: 10.1002/cpp.2551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Waiting times for secondary care psychological therapy remain a 'blind spot' in serious mental illness (SMI) provision, and their reduction is a priority within the National Health Service (NHS) Five Year Forward View. The paper describes the eradication of waiting times within a community-based NHS service and the effectiveness of strategies whilst examining help-seeking behaviour, compliance and therapeutic need. METHODS Analyses are reported for treatment compliance and therapeutic outcomes for 208 waiting-list cohort individuals seen by the SMI psychology service over an 18-month period between October 2014 and March 2016. RESULTS No significant clinical or demographic differentiation between individuals who successfully completed therapy compared to those who disengaged was observed. Despite an average 2.20-year waiting time, this alone did not significantly impact engagement with psychological treatment and all psychological therapies provided led to a significant clinical improvement and no individuals who completed therapy required re-referral at 12-month follow-up. CONCLUSIONS If imposed appropriately over a suitable time frame evidence-based practice coupled with effective operationalization can result in efficient needs-led psychological provision within SMI and secondary care. Potentially debilitating waiting times for service users and other referring professionals can be avoided, whilst psychology provision retains a flexible, formulation-based and person-centred approach.
Collapse
Affiliation(s)
- Zaffer Iqbal
- Faculty of Health Sciences, University of Hull, Hull, UK.,Psychological Services, NAViGO Health and Social Care CiC, Grimsby, UK
| | - Nicola D Airey
- Psychological Services, NAViGO Health and Social Care CiC, Grimsby, UK
| | - Sophie R Brown
- Faculty of Health Sciences, University of Hull, Hull, UK.,Psychological Services, NAViGO Health and Social Care CiC, Grimsby, UK
| | | | - Deborah Miklova
- Psychological Services, NAViGO Health and Social Care CiC, Grimsby, UK
| | - Victoria Nielsen
- Psychological Services, NAViGO Health and Social Care CiC, Grimsby, UK
| | - Kathryn Webb
- Oxford Institute of Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust, Oxford, UK.,Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital, Oxford, UK
| | - Aamer Sajjad
- Psychological Services, NAViGO Health and Social Care CiC, Grimsby, UK
| |
Collapse
|
5
|
Gatej AR, Lamers A, van Domburgh L, Vermeiren R. Perspectives on clinical guidelines for severe behavioural problems in children across Europe: a qualitative study with mental health clinicians. Eur Child Adolesc Psychiatry 2020; 29:501-513. [PMID: 31278526 PMCID: PMC7103577 DOI: 10.1007/s00787-019-01365-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/24/2019] [Indexed: 12/28/2022]
Abstract
Clinical guidelines for severe behavioural problems (SBPs) in children have recently been developed in several European countries. However, questions emerged regarding their applicability to practice. Our study aimed to provide a first European insight into guidelines' fitness-for-purpose by exploring mental health clinicians' familiarity with, use and perceived value of guidelines for SBPs in children. Participants included 161 clinicians, primarily psychiatrists, from 24 countries. Clinicians completed a semi-structured qualitative questionnaire on existing SBPs guidelines and development of new guidelines where not available. Clinicians' responses were mapped against academic experts' perceptions on SBPs guidelines highlighted in a previous study (Gatej et al. in Eur Psychiatry 57:1-9, 2019). Under half of the clinicians reported being unaware of guidelines. Of these, 37.6% represented countries where guidelines were available according to experts. The remaining half of clinicians who were aware of guidelines on average reported being moderately familiar with their content, perceiving them as moderately useful and using them some of the time. Additionally, 60.8% clinicians agreed that SBPs guidelines need to be developed, as these would create a shared scientific knowledge base and common practice. Guideline improvements included taking a multifactorial approach, creating specific case recommendations, and dissemination efforts. The modest familiarity with and use of guidelines amongst practitioners may highlight guidelines poor fitness-for-purpose, or, alternatively, an underlying confusion around the meaning and purpose of guidelines. Moving forward, efforts should be directed at disseminating clearer definitions of guidelines, addressing existing challenges, and unifying efforts to further develop and audit application of international guidelines for SBPs.
Collapse
Affiliation(s)
- Alexandra-Raluca Gatej
- Curium-LUMC, Academic Centre of Child and Youth Psychiatry, Endegeesterstraatweg 27, 2342 AK Oegstgeest, The Netherlands
| | - Audri Lamers
- Curium-LUMC, Academic Centre of Child and Youth Psychiatry, Endegeesterstraatweg 27, 2342 AK Oegstgeest, The Netherlands
- De Opvoedpoli, Child and Youth Psychiatry, Rode Kruisstraat 32, 1025 KN Amsterdam, The Netherlands
| | - Lieke van Domburgh
- Department of Child and Adolescent Psychiatry, VU University Medical Centre, 1007 MB Amsterdam, The Netherlands
- Intermetzo/Pluryn, Research and Development Department, PO Box 53, 6500 AB Nijmegen, The Netherlands
| | - Robert Vermeiren
- Curium-LUMC, Academic Centre of Child and Youth Psychiatry, Endegeesterstraatweg 27, 2342 AK Oegstgeest, The Netherlands
- Lucertis – de Jutters, Child and Adolescent Psychiatry, Parnassia Group, The Hague, The Netherlands
| |
Collapse
|
6
|
Carlfjord S, Nilsing-Strid E, Johansson K, Holmgren T, Öberg B. Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy: A qualitative study. J Eval Clin Pract 2019; 25:622-629. [PMID: 30246293 DOI: 10.1111/jep.13034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/31/2018] [Indexed: 01/04/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES To provide best available care, the practitioners in primary health care (PHC) must have adequate knowledge about effective interventions. The implementation of such interventions is challenging. A structured implementation strategy developed by researchers at Linköping University, Sweden, was used for the implementation of an evidence-based assessment and treatment programme for patients with subacromial pain among physiotherapists in PHC. To further develop strategies for implementation of evidence-based practices, it was deemed important to study the implementation from the practitioners' perspective. The aim of this study was to explore the practitioners' experiences from the implementation. METHODS A qualitative design with focus group discussions was applied. The implementation in terms of perceptions of process and outcome was evaluated by focus group discussions with, in total, 16 physiotherapists in the target group. Data were analysed using the method qualitative content analysis. RESULTS The components of the strategy were viewed positively, and the applicability and evidence base behind the programme were appreciated. The programme was perceived to be adopted, and the practitioners described a changed behaviour and increased confidence in handling patients with subacromial pain. Both patient- and provider-related challenges to the implementation were mentioned. CONCLUSIONS The practitioners' experiences from the implementation were mainly positive. A strategy with collaboration between academy and practice, and with education and implementation teams as facilitators, resulted in changes in practice. Critical voices concerned interprofessional collaboration and that the programme was focused explicitly on the shoulder, not including other components of physical function.
Collapse
Affiliation(s)
- Siw Carlfjord
- Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden
| | - Emma Nilsing-Strid
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kajsa Johansson
- Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden
| | - Theresa Holmgren
- Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden.,Department of Orthopaedics, Region Östergötland, Linköping, Sweden
| | - Birgitta Öberg
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
7
|
Cooke A, Smythe W, Anscombe P. Conflict, compromise and collusion: dilemmas for psychosocially-oriented practitioners in the mental health system. PSYCHOSIS 2019. [DOI: 10.1080/17522439.2019.1582687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Anne Cooke
- Salomons Institute for Applied Psychology, School of Psychology, Politics and Sociology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - William Smythe
- Salomons Institute for Applied Psychology, School of Psychology, Politics and Sociology, Canterbury Christ Church University, Tunbridge Wells, UK
| | | |
Collapse
|
8
|
Randall-James J, Coles S. Questioning diagnoses in clinical practice: a thematic analysis of clinical psychologists' accounts of working beyond diagnosis in the United Kingdom. J Ment Health 2018; 27:450-456. [PMID: 29421934 DOI: 10.1080/09638237.2018.1437599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The British Psychological Society proposes that clinical psychologists are well placed to move beyond psychiatric diagnoses and develop alternative practices. AIMS This study sought to explore what the application of these guiding principles looks like in clinical practice, the challenges faced and possible routes forward. METHODS A purpose-designed survey was completed by 305 respondents and a thematic analysis completed. RESULTS Thematic analysis was used to identify five superordinate themes relating to individuals, relational, others, structures and society, comprising of a total of 21 group themes. The presented group themes highlight an array of approaches to practicing beyond diagnosis and factors that help and hinder such action; from scaffolding change, becoming leaders, relating to the multi-disciplinary team, restructuring services and the processes of change. A key concept was "playing the diagnostic game". CONCLUSIONS "Playing the diagnostic game" enables psychologists to manage an array of tensions and anxieties: conflicts between belief and practice, relationships with colleagues, and dilemmas of position and power. It also potentially limits a concerted questioning of diagnosis and consideration of alternatives. An alternative conceptual framework for non-diagnostic practice is needed to aid the collective efforts of clinical psychologists developing their practice beyond diagnosis, some of which have been highlighted in this study. Until then, ways of mitigating the perceived threats to questioning diagnosis need further exploration, theorising and backing.
Collapse
Affiliation(s)
- James Randall-James
- a Department of Psychology and Sport Sciences , University of Hertfordshire Doctoral College , Hatfield , UK , and
| | - Steven Coles
- b Nottinghamshire Healthcare Foundation NHS Trust , Nottinghamshire , UK
| |
Collapse
|
9
|
Abstract
Evidence-based psychotherapies have been shown to be efficacious and cost-effective for a wide range of psychiatric conditions. Psychiatric disorders are prevalent worldwide and associated with high rates of disease burden, as well as elevated rates of co-occurrence with medical disorders, which has led to an increased focus on the need for evidence-based psychotherapies. This chapter focuses on the current state of evidence-based psychotherapy. The strengths and challenges of evidence-based psychotherapy are discussed, as well as misperceptions regarding the approach that may discourage and limit its use. In addition, we review various factors associated with the optimal implementation and application of evidence-based psychotherapies. Lastly, suggestions are provided on ways to advance the evidence-based psychotherapy movement to become truly integrated into practice.
Collapse
Affiliation(s)
- Sarah C Cook
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | |
Collapse
|