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Adamo N, Singh SP, Bölte S, Coghill D, Newcorn JH, Parlatini V, Purper-Ouakil D, Rausch J, Rohde L, Santosh P, Banaschewski T, Buitelaar JK. Practitioner Review: Continuity of mental health care from childhood to adulthood for youths with ADHD - who, how and when? J Child Psychol Psychiatry 2024. [PMID: 39014993 DOI: 10.1111/jcpp.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 07/18/2024]
Abstract
Many youths with attention-deficit/hyperactivity disorder (ADHD) experience significant long-term impairment and may develop concurrent mental and somatic health difficulties as adults. This is associated with burden and costs for the individual and society which could be prevented through continued support in youth. Yet, only few young people transition to adult mental health services for ongoing care in different countries worldwide. We provide an overview on current transition practices, highlighting the gaps in knowledge and the barriers to effective service transitioning, while considering the large geographical variation in available guidelines and service provision. For ease of use, this review is organized in a question-and-answer format covering different aspects of the transition process and considering both service users' and clinicians' perspectives. Consensus is needed to identify those that require continued care, the optimal timing to arrange transition, and the most suitable services. Finally, we discuss cost-effectiveness of transition practices, consider examples of best practice, and propose recommendations on how to improve transitional care, including the importance of service users' input into transition planning.
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Affiliation(s)
- Nicoletta Adamo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Swaran P Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institute & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Jeffrey H Newcorn
- Departments of psychiatry and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Valeria Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Diane Purper-Ouakil
- CHU Montpellier-Saint Eloi, Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, France
- INSERM 1018 CESP Psychiatry, Development and Trajectories, Villejuif, France
| | - Juliane Rausch
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Luis Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Medical School Council, UniEduK, São Paulo, Brazil
- National Institute of Developmental Psychiatry & National Center for Innovation and Research in Mental Health, Sao Paulo, Brazil
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
- HealthTracker Ltd, Gillingham, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jan K Buitelaar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
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Gudka R, Becker K, Ward J, Smith JR, Mughal F, Melendez-Torres GJ, Newlove-Delgado T, Price A. Primary care provision for young people with ADHD: a multi-perspective qualitative study. Br J Gen Pract 2024; 74:e408-e416. [PMID: 38316468 PMCID: PMC11080641 DOI: 10.3399/bjgp.2023.0626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder. UK guidance states that primary care has a vital role in effective ADHD management, including referral, medication prescribing and monitoring, and providing broader mental health and wellbeing support. However, many GPs feel unsupported to provide health care for young people with ADHD. Inadequate health care is associated with rising costs for patients and society. AIM To investigate the experiences of young people with ADHD accessing primary care in England, from the perspectives of people with lived experience of ADHD and healthcare professionals (HCPs). DESIGN AND SETTING A qualitative study. Interviews were conducted with HCPs (GPs, practice managers, and a wellbeing worker) and people with lived experience of ADHD (young people aged 16-25 years and their supporters) located in integrated care systems across England. METHOD Semi-structured interviews were conducted with participants at five purposively selected general practices (varying by deprivation, ethnicity, and setting). Questions focused on experiences of accessing/providing health care for ADHD. Reflexive thematic analysis was undertaken within a critical realist framework to understand how provision works in practice and to explore potential improvements. RESULTS In total, 20 interviews were completed with 11 HCPs and nine people with lived experience. Three themes were generated: a system under stress, incompatibility between ADHD and the healthcare system, and strategies for change in ADHD primary care provision. CONCLUSION Standardisation of ADHD management in primary care, providing better information and support for HCPs, and advising on reasonable adjustments for people with lived experience could help improve access to effective treatments for young people living with ADHD.
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Affiliation(s)
- Rebecca Gudka
- University of Exeter Medical School, University of Exeter, Exeter
| | - Kieran Becker
- University of Exeter Medical School, University of Exeter, Exeter
| | - John Ward
- University of Exeter Medical School, University of Exeter, Exeter; Department of Psychiatry, University of Oxford, Oxford
| | - Jane R Smith
- University of Exeter Medical School, University of Exeter, Exeter
| | | | | | | | - Anna Price
- University of Exeter Medical School, University of Exeter, Exeter
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Price A, Smith JR, Mughal F, Salimi A, Melendez-Torres GJ, Newlove-Delgado T. Protocol for the mixed methods, Managing young people (aged 16-25) with Attention deficit hyperactivity disorder in Primary care (MAP) study: mapping current practice and co-producing guidance to improve healthcare in an underserved population. BMJ Open 2023; 13:e068184. [PMID: 37429692 DOI: 10.1136/bmjopen-2022-068184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents, with an average worldwide prevalence of 5%. Up to 40% of young people continue to experience symptoms into adulthood. Young people with ADHD experience poorer outcomes than their peers across multiple domains, with treatment shown to reduce these risks. Primary care practitioners play an important role in healthcare provision for this group in the UK. However, many feel unsure about how best to provide support, reporting prescribing concerns and need for more evidence-based guidance. A lack of national data on primary care provision hinders efforts to improve access to care and optimise outcomes. This mixed-methods study aims to provide evidence that may be used to improve primary care services for young people aged 16-25 years with ADHD. METHODS AND ANALYSIS There are three interlinked work packages: (a) a mapping study including a survey of stakeholders (healthcare professionals, people with ADHD and commissioners) will map ADHD prescribing practice, shared-care arrangements, available support and practitioner roles by geographic locations across England for different respondent groups; (b) a qualitative study involving semi-structured interviews with stakeholders (10-15 healthcare professionals and 10-15 people with ADHD) will explore experiences of 'what works' and 'what is needed' in terms of service provision and synthesise findings; (c) workshops will integrate findings from (a) and (b) and work with stakeholders to use this evidence to codevelop key messages and guidance to improve care. ETHICS AND DISSEMINATION The protocol has been approved by Yorkshire and the Humber-Bradford Leeds Research Ethics Committee. Recruitment commenced in September 2022. Findings will be disseminated via research articles in peer-reviewed journals, conference presentations, public involvement events, patient groups and media releases. A summary of study findings will be shared with participants at the end of the study. TRIAL REGISTRATION NUMBER NCT05518435.
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Affiliation(s)
- Anna Price
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - Jane R Smith
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - Faraz Mughal
- Keele University School of Medicine, Keele, UK
- Keele University, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Anita Salimi
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
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Young S, Abbasian C, Al-Attar Z, Branney P, Colley B, Cortese S, Cubbin S, Deeley Q, Gudjonsson GH, Hill P, Hollingdale J, Jenden S, Johnson J, Judge D, Lewis A, Mason P, Mukherjee R, Nutt D, Roberts J, Robinson F, Woodhouse E, Cocallis K. Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement. World J Psychiatry 2023; 13:84-112. [PMID: 37033892 PMCID: PMC10075023 DOI: 10.5498/wjp.v13.i3.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/19/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.
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Affiliation(s)
- Susan Young
- Department of Psychology, Psychology Services Limited, Croydon CR9 7AE, United Kingdom
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Cyrus Abbasian
- Psychiatry-UK Limited, Cornwall PL33 9ET, United Kingdom
| | | | - Polly Branney
- ADHD and Autism, Oxford ADHD & Autism Centre, Headington OX3 7BX, United Kingdom
| | - Bill Colley
- CLC Consultancy, Dunkeld PH8 0AY, United Kingdom
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Sally Cubbin
- Adult ADHD, Adult ADHD Clinic Ltd, Oxford OX3 7RP, United Kingdom
| | - Quinton Deeley
- Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London Institute of Psychiatry, London SE5 8AF, United Kingdom
| | - Gisli Hannes Gudjonsson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Peter Hill
- Department of Psychiatry, University of London, London WC1E 7HU, United Kingdom
| | - Jack Hollingdale
- Department of Psychology, Compass Psychology Services Ltd, London BR1 9DX, United Kingdom
| | | | - Joe Johnson
- Halton and Knowsley Adult ADHD Team, Merseycare NHS Foundation Trust, Winwick WA2 9WA, United Kingdom
| | | | - Alexandra Lewis
- Department of Psychiatry, Fulbourn Hospital, Cambridge CB21 5EF, United Kingdom
| | - Peter Mason
- Department of Psychiatry, Dr Peter Mason ADHD & Psychiatry Services Limited, Liverpool L1 9AR, United Kingdom
| | - Raja Mukherjee
- Adult Neurodevelopmental Service, Horizon House, Epsom KT17 4QJ, United Kingdom
| | - David Nutt
- Department of Psychiatry, Imperial College London, London WS12 0NN, United Kingdom
| | - Jane Roberts
- Service User Representative, Gloucestershire GL1 3NN, United Kingdom
| | - Fiona Robinson
- Drug & Alcohol Services, Surrey & Borders Partnership Trust, Leatherhead KT22 7AD, United Kingdom
| | - Emma Woodhouse
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Kelly Cocallis
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington NE63 9JJ, United Kingdom
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Wang STL, Parkinson A, Butler D, Law HD, Fanning V, Desborough J. Real price of health-experiences of out-of-pocket costs in Australia: protocol for a systematic review. BMJ Open 2022; 12:e065932. [PMID: 36600422 PMCID: PMC9772657 DOI: 10.1136/bmjopen-2022-065932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Australians have substantial out-of-pocket (OOP) health costs compared with other developed nations, even with universal health insurance coverage. This can significantly affect access to care and subsequent well-being, especially for priority populations including those on lower incomes or with multimorbidity and chronic illness. While it is known that high OOP healthcare costs may contribute to poorer health outcomes, it is not clear exactly how these expenses are experienced by people with chronic illnesses. Understanding this may provide critical insights into the burden of OOP costs among this population group and may highlight policy gaps. METHOD AND ANALYSIS A systematic review of qualitative studies will be conducted using Pubmed, CINAHL Complete (EBSCO), Cochrane Library, PsycINFO (Ovid) and EconLit from date of inception to June 2022. Primary outcomes will include people's experiences of OOP costs such as their preferences, priorities, trade-offs and other decision-making considerations. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and methodological appraisal of included studies will be assessed using the Critical Appraisal Skills Programme. A narrative synthesis will be conducted for all included studies. ETHICS AND DISSEMINATION Ethics approval was not required given this is a systematic review that does not include human recruitment or participation. The study's findings will be disseminated through conferences and symposia and shared with consumers, policymakers and service providers, and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022337538.
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Affiliation(s)
- Shelley Ting-Li Wang
- School of Medicine and Psychology, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Danielle Butler
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Hsei Di Law
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Vanessa Fanning
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
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Sanavro S, van der Worp H, Jansen D, Stoffelen J, Schers H, Postma M, Koning P, de Boer M, Janus G, Blanker MH. Impact of digital interdisciplinary consultation on secondary care referrals by general practitioners: a protocol for a stepped-wedge cluster randomised controlled trial. BMJ Open 2022; 12:e060222. [PMID: 36456003 PMCID: PMC9716832 DOI: 10.1136/bmjopen-2021-060222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Optimal collaboration between general practice and hospital care is crucial to maintain affordable and sustainable access to healthcare for the entire population. General practitioners (GPs) are the gatekeepers to specialist care and patients will visit hospitals mostly only after referral. However, a substantial part of these referrals may be inappropriate, as communication between GPs and medical specialists can be challenging and referring patients may be the most obvious action for a GP to perform.A new digital platform (Prisma) connects GPs and specialists in interdisciplinary groups and facilitates asynchronous, accessible and fast teleconsultation within the group. No previous research has been done to evaluate the impact of this new platform on the referral rates to the hospital. METHODS AND ANALYSIS A stepped-wedge randomised controlled trial (RCT) will be performed in Zwolle region in the Netherlands to analyse the effect of introduction of the platform on rate of inappropriate referrals to orthopaedic surgery. In four steps, GPs in the region will be given access to the platform. GPs will be part of the control condition until randomisation to the intervention. According to our sample size calculation, we need to include 18 practices with 1008 patients presenting with hip and knee symptoms. Routine care data of hospital registrations will be analysed to calculate the rate of inappropriate referrals (primary outcome). Secondary outcome are costs, primary and secondary care workload, posted cases and user satisfaction. Alongside this quantitative analysis, we will evaluate patient experience, facilitators and barriers for use of the platform. ETHICS AND DISSEMINATION The medical ethics review board of University Medical Center Groningen (UMCG), the Netherlands (METc-number: 2021/288) has confirmed that the Medical Research Involving Human Subjects Act (WMO) does not apply to the process evaluation because the study does not involve randomisation of patients or different medical treatments (letter number: M21.275351). TRIAL REGISTRATION NUMBER NL9704.
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Affiliation(s)
- Sanne Sanavro
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
| | - Henk van der Worp
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
| | - Danielle Jansen
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
| | | | - Henk Schers
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
| | - Maarten Postma
- Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, Groningen, The Netherlands
| | - Paul Koning
- Siilo Holding BV, Amsterdam, The Netherlands
| | - Michiel de Boer
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
- Health Sciences, Section Methodology and Applied Statistics, UMCG, Groningen, The Netherlands
| | - Guus Janus
- Department of Orthopaedic surgery, Isala hospital and Isala movement clinic, Zwolle, The Netherlands
| | - Marco H Blanker
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
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Atlantis E, Chimoriya R, Seifu CN, Peters K, Murphy G, Carr B, Lim D, Fahey P. Enablers and barriers to implementing obesity assessments in clinical practice: a rapid mixed-methods systematic review. BMJ Open 2022; 12:e063659. [PMID: 36446466 PMCID: PMC9710371 DOI: 10.1136/bmjopen-2022-063659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This systematic review aims to improve our knowledge of enablers and barriers to implementing obesity-related anthropometric assessments in clinical practice. DESIGN A mixed-methods systematic review. DATA SOURCES Medline, Embase and CINAHL to November 2021. ELIGIBILITY CRITERIA Quantitative studies that reported patient factors associated with obesity assessments in clinical practice (general practice or primary care); and qualitative studies that reported views of healthcare professionals about enablers and barriers to their implementation. DATA EXTRACTION AND SYNTHESIS We used random-effects meta-analysis to pool ratios for categorical predictors reported in ≥3 studies expressed as pooled risk ratio (RR) with 95% CI, applied inverse variance weights, and investigated statistical heterogeneity (I2), publication bias (Egger's test), and sensitivity analyses. We used reflexive thematic analysis for qualitative data and applied a convergent integrated approach to synthesis. RESULTS We reviewed 22 quantitative (observational) and 3 qualitative studies published between 2004 and 2020. All had ≥50% of the quality items for risk of bias assessments. Obesity assessment in clinical practice was positively associated with patient factors: female sex (RR 1.28, 95% CI 1.10 to 1.50, I2 99.8%, mostly UK/USA), socioeconomic deprivation (RR 1.21, 95% CI 1.18 to 1.24, I2 73.9%, UK studies), non-white race/ethnicity (RR 1.27, 95% CI 1.03 to 1.57, I2 99.6%) and comorbidities (RR 2.11, 95% CI 1.60 to 2.79, I2 99.6%, consistent across most countries). Obesity assessment was also most common in the heaviest body mass index group (RR 1.55, 95% CI 0.99 to 2.45, I2 99.6%). Views of healthcare professionals were positive about obesity assessments when linked to patient health (convergent with meta-analysis for comorbidities) and if part of routine practice, but negative about their role, training, time, resources and incentives in the healthcare system. CONCLUSIONS Our evidence synthesis revealed several important enablers and barriers to obesity assessments that should inform healthcare professionals and relevant stakeholders to encourage adherence to clinical practice guideline recommendations.
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Affiliation(s)
- Evan Atlantis
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Discipline of Medicine, Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ritesh Chimoriya
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Canaan Negash Seifu
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Kath Peters
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Nursing and Midwifery, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Gill Murphy
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Schoolof Nursing and Midwifery, Western Sydney University, Campbelltown, New South Wales, Australia
| | | | - David Lim
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - P Fahey
- Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
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Scarpellini F, Bonati M. Transition care for adolescents and young adults with attention-deficit hyperactivity disorder (ADHD): A descriptive summary of qualitative evidence. Child Care Health Dev 2022; 49:431-443. [PMID: 36223008 DOI: 10.1111/cch.13070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 09/07/2022] [Accepted: 10/08/2022] [Indexed: 11/28/2022]
Abstract
The review presents a summary of available evidence about transition care of ADHD patients from all service users' perspectives. Common barriers, and suggestions for improvement ADHD of transition care, were extrapolated from qualitative research, including case notes studies, and were exposed. A comprehensive search of the PubMed, Embase, PsychInfo and Web of Science databases for articles published up to October 2021 was conducted to summarize recent evidence on the experiences of all stakeholders involved in the transition process. Reviews, other chronic conditions and different meaning of transition were excluded. Authors extracted data and assessed study quality independently. Findings were discussed taking into consideration barriers and suggestions from all service users' perspectives. Findings from 23 studies with different context and methods were collected and summarized. Most of the studies were conducted in UK, using interviews and questionnaires, and addressed to the physicians. The lack of information about ADHD as a condition and about transition process were the barriers most reported, while joint working and sharing transition protocols were the suggestions pointed out by all stakeholders. Despite different perspectives, all stakeholders exposed similar needs. The review reveals an evident need for defining and evaluating the effectiveness of transition programmes from child to adult ADHD services.
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Affiliation(s)
- Francesca Scarpellini
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Asherson P, Leaver L, Adamou M, Arif M, Askey G, Butler M, Cubbin S, Newlove-Delgado T, Kustow J, Lanham-Cook J, Findlay J, Maxwell J, Mason P, Read H, van Rensburg K, Müller-Sedgwick U, Sedgwick-Müller J, Skirrow C. Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations. BMC Psychiatry 2022; 22:640. [PMID: 36221085 PMCID: PMC9553294 DOI: 10.1186/s12888-022-04290-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 09/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND ADHD in adults is a common and debilitating neurodevelopmental mental health condition. Yet, diagnosis, clinical management and monitoring are frequently constrained by scarce resources, low capacity in specialist services and limited awareness or training in both primary and secondary care. As a result, many people with ADHD experience serious barriers in accessing the care they need. METHODS Professionals across primary, secondary, and tertiary care met to discuss adult ADHD clinical care in the United Kingdom. Discussions identified constraints in service provision, and service delivery models with potential to improve healthcare access and delivery. The group aimed to provide a roadmap for improving access to ADHD treatment, identifying avenues for improving provision under current constraints, and innovating provision in the longer-term. National Institute for Health and Care Excellence (NICE) guidelines were used as a benchmark in discussions. RESULTS The group identified three interrelated constraints. First, inconsistent interpretation of what constitutes a 'specialist' in the context of delivering ADHD care. Second, restriction of service delivery to limited capacity secondary or tertiary care services. Third, financial limitations or conflicts which reduce capacity and render transfer of care between healthcare sectors difficult. The group recommended the development of ADHD specialism within primary care, along with the transfer of routine and straightforward treatment monitoring to primary care services. Longer term, ADHD care pathways should be brought into line with those for other common mental health disorders, including treatment initiation by appropriately qualified clinicians in primary care, and referral to secondary mental health or tertiary services for more complex cases. Long-term plans in the NHS for more joined up and flexible provision, using a primary care network approach, could invest in developing shared ADHD specialist resources. CONCLUSIONS The relegation of adult ADHD diagnosis, treatment and monitoring to specialist tertiary and secondary services is at odds with its high prevalence and chronic course. To enable the cost-effective and at-scale access to ADHD treatment that is needed, general adult mental health and primary care must be empowered to play a key role in the delivery of quality services for adults with ADHD.
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Affiliation(s)
- Philip Asherson
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK.
| | | | | | | | - Gemma Askey
- NHS Warrington Clinical Commissioning Group, Warrington, UK
| | - Margi Butler
- NHS Warrington Clinical Commissioning Group, Warrington, UK
| | | | | | - James Kustow
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | | | - James Findlay
- NHS Northamptonshire Clinical Commissioning Group, Northampton, UK
| | | | - Peter Mason
- ADHD And Psychiatry Services Limited, Liverpool, UK
| | | | | | | | - Jane Sedgwick-Müller
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
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Transition from child and adolescent mental health care to adult services for young people with Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) in Europe: Barriers and recommendations. Encephale 2022; 48:555-559. [DOI: 10.1016/j.encep.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/22/2022]
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11
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Vaughan C, Lukewich J, Mathews M, Hedden L, Poitras ME, Asghari S, Swab M, Ryan D. Nursing contributions to virtual models of care in primary care: a scoping review protocol. BMJ Open 2022; 12:e065779. [PMID: 36127080 PMCID: PMC9490598 DOI: 10.1136/bmjopen-2022-065779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Since the onset of the COVID-19 pandemic, virtual care has gained increased attention, particularly in primary care for the ongoing delivery of routine services. Nurses have had an increased presence in virtual care and have contributed meaningfully to the delivery of team-based care in primary care; however, their exact contributions in virtual models of primary care remain unclear. The Nursing Role Effectiveness Model, applied in a virtual care and primary care context, outlines the association between structural variables, nursing roles and patient outcomes. The aim of this scoping review is to identify and synthesise the international literature surrounding nurse contributions to virtual models of primary care. METHODS AND ANALYSIS The Joanna Briggs Institute scoping review methodology will guide this review. We performed preliminary searches in April 2022 and will use CINAHL, MEDLINE, Embase and APA PsycInfo for the collection of sources for this review. We will also consider grey literature, such as dissertations/theses and organisational reports, for inclusion. Studies will include nurses across all designations (ie, nurse practitioners, registered nurses, practical nurses). To ensure studies capture roles, nurses should be actively involved in healthcare delivery. Sources require a virtual care and primary care context; studies involving the use of digital technology without patient-provider interaction will be excluded. Following a pilot test, trained reviewers will independently screen titles/abstracts for inclusion and extract relevant data. Data will be organised using the Nursing Role Effectiveness Model, outlining the virtual care and primary care context (structure component) and the nursing role concept (process component). ETHICS AND DISSEMINATION This review will involve the collection and analysis of secondary sources that have been published and/or are publicly available. Therefore, ethics approval is not required. Scoping review findings will be published in a peer-reviewed journal and presented at relevant conferences, targeting international primary care stakeholders.
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Affiliation(s)
- Crystal Vaughan
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Maria Mathews
- Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Shabnam Asghari
- Center for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Michelle Swab
- Health Sciences Library, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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12
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Quintero J, Rodríguez-Quiroga A, Álvarez-Mon MÁ, Mora F, Rostain AL. Addressing the Treatment and Service Needs of Young Adults with Attention Deficit Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:531-551. [PMID: 35697400 DOI: 10.1016/j.chc.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The transition from adolescence to adulthood is a complex period in which multiple changes take place (education, work, independent living, and social relations). This stage is especially difficult for adolescents suffering from attention deficit hyperactivity disorder (ADHD), who have to move on from child and adolescent mental health services to adult mental health services. This review analyzes developmental and environmental risk and protective factors as well as critical variables such as executive functioning and self-monitoring that influence the course of ADHD in transitional age youth and guide the priorities for an optimal transition of care. The influence of the COVID-19 pandemic is also discussed. We reflect on the unmet needs for an optimal transition of care and propose practice and policy recommendations to achieve this goal.
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Affiliation(s)
- Javier Quintero
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain.
| | - Alberto Rodríguez-Quiroga
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain
| | - Miguel Ángel Álvarez-Mon
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28801 Alcala de Henares, Spain; Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Fernando Mora
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain
| | - Anthony L Rostain
- Department of Psychiatry, Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103, USA
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13
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Appleton R, Loew J, Mughal F. Young people who have fallen through the mental health transition gap: a qualitative study on primary care support. Br J Gen Pract 2022; 72:e413-e420. [PMID: 35504728 PMCID: PMC9090175 DOI: 10.3399/bjgp.2021.0678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Owing to poor continuity of care between child and adult mental health services, young people are often discharged to their GP when they reach the upper boundary of child and adolescent mental health services (CAMHS). This handover is poorly managed, and GPs can struggle to support young people without input from specialist services. Little is known about young people's experiences of accessing mental health support from their GP after leaving CAMHS. AIM To explore the experiences and perspectives of young people and the parents/carers of young people receiving primary care support after CAMHS and to identify barriers and facilitators to accessing primary care. DESIGN AND SETTING Qualitative study with young people and parents in two English counties: London and West Midlands. METHOD Narrative interviews were conducted with 14 young people and 13 parents who had experienced poor continuity of care after reaching CAMHS transition boundary. Data were analysed using reflexive thematic analysis. RESULTS Three themes were identified: unmet mental health needs, disjointed care, and taking responsibility for the young person's mental health care. Barriers included the perception that GPs couldn't prescribe certain medication, anxiety caused by the general practice environment, and having to move to a new practice at university. Young people's positive experiences were more likely to include having a long-term relationship with their GP and finding that their GP made time to understand their needs and experiences. CONCLUSION GPs could help to meet the unmet needs of young people unable to access specialist mental health services after leaving CAMHS. There is a need for comprehensive handover of care from CAMHS to GPs, which could include a joint meeting with the young person and a member of the CAMHS team. Future research should focus on interventions which improve continuity of care for young people after leaving CAMHS, and collaborative working across community mental health services.
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Affiliation(s)
- Rebecca Appleton
- National Institute for Health Research (NIHR) Mental Health Policy Research Unit, Division of Psychiatry, UCL, London
| | - Joelle Loew
- Department of Languages and Literatures, University of Basel, Switzerland; lecturer in English business communication, Lucerne University of Applied Sciences and Arts, Switzerland
| | - Faraz Mughal
- School of Medicine, Keele University, Keele; honorary clinical research fellow, Unit of Academic Primary Care, University of Warwick, Coventry; affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre, Keele University, Keele
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14
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Haun MW, Tönnies J, Graue L, Hartmann M, Wensing M, Szecsenyi J, Wild B, Friederich HC. Mental health specialist video consultations for patients with somatic symptom disorder in primary care: protocol for a randomised feasibility trial (the VISION trial). BMJ Open 2022; 12:e058150. [PMID: 35410935 PMCID: PMC9003599 DOI: 10.1136/bmjopen-2021-058150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION General practitioners (GP) report increasing difficulties in referring patients with somatic symptom disorder (SSD) in specialised psychosocial care. Barriers are structural conditions of the respective healthcare system and patients' reservations against receiving specialised psychosocial care. As patients with SSD often predominantly assume somatic influencing factors for the development and maintenance of their somatic complaints, close collaboration between the GP and mental health specialist (MHS) seems particularly important. Integrating internet-based video consultations by remotely located MHS and primary care can improve effective treatment of patients with SSD by overcoming structural barriers and provide low-threshold and timely care. The aim of this randomised controlled feasibility trial is to investigate the feasibility of implementing MHS video consultations in primary care practices. METHODS AND ANALYSIS Fifty primary care patients with SSD will be individually randomised in two groups receiving either enhanced treatment as usual as provided by their GP (control group) or two versus five video consultations conducted by an MHS additionally to enhanced treatment as usual. The video consultations focus on (a) diagnostic clarification, (b) the development of a biopsychosocial disorder model, and (c) development of a treatment plan against the background of a stepped-care algorithm based on clinical outcomes. We will investigate the following outcomes: effectiveness of the recruitment strategies, patient acceptance of randomisation, practicability of the technical and logistical processes related to implementing video consultations in the practices' workflows, feasibility of the data collection and clinical parameters. ETHICS AND DISSEMINATION This trial has undergone ethical scrutiny and has been approved by the Medical Faculty of the University of Heidelberg Ethics Committee (S-620/2021). The findings will be disseminated to the research community through presentations at conferences and publications in scientific journals. This feasibility trial will prepare the ground for a large-scale, fully powered randomised controlled trial. TRIAL REGISTRATION NUMBER DRKS00026075.
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Leike Graue
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
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15
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Price A, Mitchell S, Janssens A, Eke H, Ford T, Newlove-Delgado T. In transition with attention deficit hyperactivity disorder (ADHD): children's services clinicians' perspectives on the role of information in healthcare transitions for young people with ADHD. BMC Psychiatry 2022; 22:251. [PMID: 35397599 PMCID: PMC8994234 DOI: 10.1186/s12888-022-03813-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND National clinical guidelines emphasise the need for good communication of information by clinicians to young people and their parent/carers about what to expect during transition into adult services. Recent research indicates that of young people in need of transition for attention deficit hyperactivity disorder (ADHD), only a minority experience continuity of care into adulthood, with additional concerns about quality of transition. This qualitative analysis explored the role that information plays in the transition from child to adult mental health services for young people with ADHD, from the perspectives of clinicians working in children's services. METHODS Participants were recruited from National Health Service (NHS) Trusts located across the United Kingdom (UK), with varying service configurations. Twenty-two qualitative interviews were conducted with 15 paediatricians and seven psychiatrists working in child services and supporting young people with ADHD. The Framework Method was used to complete a thematic analysis of data related to the role of information in transitional care. RESULTS Two themes were identified in relation to the role of information in supporting transition and promoting continuity of care. Information for clinicians; about adult mental health services, the young person and their ADHD, and exchanged between services. Sharing information with young people; about transition processes, self-management, to support service engagement, and tailored to be accessible to young people with ADHD. Clinicians in children's services reported variable access to information. Clear protocols and being able to communicate about ADHD as a long-term condition, were described as having a positive impact on the transition process. CONCLUSIONS These findings illustrate that clear information on the transition process, and communication of evidence based and up-to-date information on ADHD as a long-term condition are essential components for clinicians supporting transition into adult services. Information exchange can be supported through transition discussions with young people, and joint meetings between services Discussions should be accompanied by accessible resources for young people and parents/carers such as leaflets and websites. Further efforts should be focussed on enabling clinicians to provide timely and appropriate information to young people with ADHD to support transition.
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Affiliation(s)
- Anna Price
- University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Siobhan Mitchell
- grid.8391.30000 0004 1936 8024University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Astrid Janssens
- grid.8391.30000 0004 1936 8024University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK ,grid.10825.3e0000 0001 0728 0170Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, DK-5000 Odense C, Denmark
| | - Helen Eke
- grid.8391.30000 0004 1936 8024University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Tamsin Ford
- grid.8391.30000 0004 1936 8024University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK ,grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Hershel Smith Building, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SZ UK
| | - Tamsin Newlove-Delgado
- grid.8391.30000 0004 1936 8024University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
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16
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Abstract
OBJECTIVE The evidence base for social prescribing is inconclusive, and evaluations have been criticised for lacking rigour. This realist review sought to understand how and why social prescribing evaluations work or do not work. Findings from this review will contribute to the development of an evidence-based evaluation framework and reporting standards for social prescribing. DESIGN A realist review. DATA SOURCES ASSIA, CINAHL, Embase, Medline, PsycINFO, PubMed, Scopus Online, Social Care Online, Web of Science and grey literature. ELIGIBILITY CRITERIA Documents reporting on social prescribing evaluations using any methods, published between 1998 and 2020 were included. Documents not reporting findings or lacking detail on methods for data collection and outcomes were excluded. ANALYSIS Included documents were segregated into subcases based on methodology. Data relating to context, mechanisms and outcomes and the programme theory were extracted and context-mechanism-outcome configurations were developed. Meta-inferences were drawn from all subcases to refine the programme theory. RESULTS 83 documents contributed to analysis. Generally, studies lacked in-depth descriptions of the methods and evaluation processes employed. A cyclical process of social prescribing evaluation was identified, involving preparation, conducting the study and interpretation. The analysis found that coproduction, alignment, research agency, sequential mixed-methods design and integration of findings all contributed to the development of an acceptable, high-quality social prescribing evaluation design. Context-mechanism-outcome configurations relating to these themes are reported. CONCLUSIONS To develop the social prescribing evidence base and address gaps in our knowledge about the impact of social prescribing and how it works, evaluations must be high quality and acceptable to stakeholders. Development of an evaluation framework and reporting standards drawing on the findings of this realist review will support this aim. PROSPERO REGISTRATION NUMBER CRD42020183065.
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Affiliation(s)
- Megan Elliott
- Wales School for Social Prescribing Research, PRIME Centre Wales, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
| | - Mark Davies
- Wales School for Social Prescribing Research, PRIME Centre Wales, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
| | - Julie Davies
- Valleys Regional Park, Bridgend County Borough Council, Bridgend, UK
| | - Carolyn Wallace
- Wales School for Social Prescribing Research, PRIME Centre Wales, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
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17
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Anderson JK, Newlove-Delgado T, Ford TJ. Annual Research Review: A systematic review of mental health services for emerging adults - moulding a precipice into a smooth passage. J Child Psychol Psychiatry 2022; 63:447-462. [PMID: 34939668 DOI: 10.1111/jcpp.13561] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The transition between child and adult services should aim to support young people into the next stage of their life in a way that optimises their function. Yet financial, organisational and procedural barriers to continuity of care often hamper smooth transition between child and adult services. AIM AND METHOD We reviewed studies of transition from child to adult mental health services, focusing on: (a) rates of referrals and referral acceptance; (b) barriers and facilitators of successful transition; (c) continuity of care during and post-transition and (d) service users' experience of transition. Studies were identified through systematic searches of electronic databases: PsycINFO, Medline, Embase and Child Development and Adolescent Studies. FINDINGS Forty-seven papers describing 43 unique studies met inclusion criteria. Service provision is influenced by previous history and funding processes, and the presence or absence of strong primary care, specialist centres of excellence and coordination between specialist and primary care. Provision varies between and within countries, particularly whether services are restricted to 'core' mental health or broader needs. Unsupportive organisational culture, fragmentation of resources, skills and knowledge base undermine the collaborative working essential to optimise transition. Stigma and young people's concerns about peers' evaluation often prompt disengagement and discontinuation of care during transition, leading to worsening of symptoms and later, to service re-entry. Qualitative studies reveal that young people and families find the transition process frustrating and difficult, mainly because of lack of advanced planning and inadequate preparation. CONCLUSIONS Despite increasing research interest over the last decade, transition remains 'poorly planned, executed and experienced'. Closer collaboration between child and adult services is needed to improve the quality of provision for this vulnerable group at this sensitive period of development.
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Affiliation(s)
| | | | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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18
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van der Heiden W, Lacroix J, Moll van Charante EP, Beune E. GPs' views on the implementation of combined lifestyle interventions in primary care in the Netherlands: a qualitative study. BMJ Open 2022; 12:e056451. [PMID: 35121605 PMCID: PMC8819797 DOI: 10.1136/bmjopen-2021-056451] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Prevention and lifestyle support are emerging topics in general practice. Healthcare insurance companies reimburse combined lifestyle interventions (CLIs) in the Netherlands since January 2019. CLIs support people with overweight (body mass index, BMI 25-30) or obesity (BMI >30) to reduce weight in peer groups. General practitioners (GPs) are key in the successful implementation of lifestyle interventions in primary care. This study explored GPs' experiences and views on the implementation of CLIs to identify barriers and facilitators to the successful implementation in primary care. DESIGN Qualitative study using semistructured interviews. Content analysis consisted of thematic coding and mapping a first stage of predefined and second stage of iterative evolving set of themes. SETTING GPs were interviewed in a variety of primary care practices between February and April 2019. PARTICIPANTS Fifteen GPs were purposively recruited for semi-structured interviews through snowballing. RESULTS Experiences with lifestyle support among GPs ranged from referring patients to other healthcare professionals to taking a proactive role in lifestyle support themselves. Whether or not GPs took an active role in lifestyle support was related to their belief in the effect of lifestyle interventions. Overall, GPs had little experience with CLI in every day practice. Perceived barriers were a lack of availability of CLIs in the region and the potential lack of added value of CLIs on top of existing lifestyle support. Perceived facilitators were coordination of care provision by GP cooperatives and monitoring of the CLI implementation and their results. Reimbursement of CLIs without any costs for participants enabled application. CONCLUSION The importance of lifestyle interventions in primary care was acknowledged by all GPs, but they differed in their level of experience with providing lifestyle support and awareness of CLIs. Successful integration of CLIs with primary care requires a solid promotion, a well-coordinated implementation strategy and structural evaluation of long-term effectiveness.
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Affiliation(s)
- W van der Heiden
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Digital Engagement, Cognition and Behavior, Philips Research, Eindhoven, The Netherlands
| | - Jpw Lacroix
- Department of Digital Engagement, Cognition and Behavior, Philips Research, Eindhoven, The Netherlands
| | - E P Moll van Charante
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ejaj Beune
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Cassidy CE, Kontak JC, Pidduck J, Higgins A, Anderson S, Best S, Grant A, Jeffers E, MacDonald S, MacKinnon L, Mireault A, Rowe L, Walls R, Curran J. Provider perspectives of barriers and facilitators to the transition from pediatric to adult care: a qualitative descriptive study using the COM-B model of behaviour. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2022-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Transition of care can be a complex process that involves multiple providers working together across the pediatric and adult health care system to support youth. The shift from a primarily family-centred approach to a patient-centred approach that emphasizes more personal responsibility for health care management can be challenging for youth, caregivers and providers to navigate. Despite the importance of transition, there is a lack of evidence about the best practices and types of interventions that support the transition of care process from the perspective of both pediatric and adult health care providers. An exploration of barriers and facilitators is a critical first step to identifying important behavioural determinants for designing and implementing evidence-based interventions. As such, the purpose of this study was to identify the barriers and facilitators to the transition of care from the perspective of pediatric and adult health care providers.
Methods
A qualitative descriptive design was used to conduct semi-structured interviews guided by the COM-B Model of Behaviour – a theoretical model that suggests that for any behaviour to occur there must be a change in one or more of the following domains: capability, opportunity and/or motivation. The study took place in the province of Nova Scotia, Canada and focused on three common conditions: Inflammatory Bowel Disease, Diabetes, and Juvenile Idiopathic Arthritis. Participants were recruited through stratified purposeful and convenience sampling and all interviews were conducted virtually on Zoom. Interviews were audio-recorded, transcribed verbatim and imported into NVivo Qualitative Data Software for analysis. Data were first analyzed using directed content analysis, guided by the COM-B model, then further examined using inductive thematic analysis to identify barriers and facilitators within the three domains.
Results
In total, 26 health care providers participated in this study (pediatric, n=13, adult n=13) including a mix of adult and pediatric physicians, nurses, and allied health care professionals. The participants identified primarily as female (n=19.73%) and had a range of years of experience (3–39, mean = 14.84). We identified a range of interconnected barriers and facilitators across each of the COM-B Model of Behaviour domains such as, degree of formalized training (capability), facilitation and coordination responsibilities (opportunity), collaboration across providers (opportunities), securing attachment to adult care system (motivation) and time (opportunity). Findings were categorized by three overarching themes: (1) Knowledge and Skills to Support Transition of Care; (2) Navigation Role for Youth and Caregivers; and (3) System Coordination.
Conclusions
By using the COM-B Model of Behaviour, we identified key barriers and facilitators that intersect to influence the transition of care process. These findings will be used to inform and adapt initiatives and interventions in Nova Scotia to improve the transition experience, as well as may be transferrable to other jurisdictions.
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Affiliation(s)
- Christine E. Cassidy
- School of Nursing , Dalhousie University and IWK Health Centre , Halifax , NS , Canada
| | - Julia C. Kontak
- Maritime SPOR SUPPORT Unit, Nova Scotia Health and Faculty of Health, Dalhousie University , Halifax , NS , Canada
| | | | | | - Scott Anderson
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | | | - Amy Grant
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Elizabeth Jeffers
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | | | | | - Amy Mireault
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Liam Rowe
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Rose Walls
- Mental Health and Addictions, Nova Scotia Health , Halifax , NS , Canada
| | - Janet Curran
- School of Nursing , Dalhousie University and IWK Health Centre , Halifax , NS , Canada
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20
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'The experiences, perspectives, and needs of young people who access support for mental health in primary care: a systematic review'. Br J Gen Pract 2022; 72:e161-e167. [PMID: 34990387 PMCID: PMC8843382 DOI: 10.3399/bjgp.2021.0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background There is an increasing demand for mental health support in primary care, especially for young people. To improve mental health support for young people in general practice, the needs of young people must be considered. Aim To explore the experiences of young people (aged 12–25 years) on receiving mental health care in primary care and identify the needs of young people who present with mental health concerns. Design and setting A systematic review and narrative synthesis. Method This was a systematic review and narrative synthesis. Six databases were searched for literature relating to young people’s experiences of receiving mental health care in primary care. Additional handsearching and manual internet searching were conducted. Narrative synthesis was employed. Results Five papers and a further two reports from manual internet searching were found, resulting in the inclusion of 1823 young people from four different countries (UK, US, Ireland, and Canada) for synthesis. The synthesis generated four themes: the centrality of a trusting relationship; showing empathy and taking concerns seriously; being given time to talk; and barriers to accessing mental health support in primary care. Conclusion Young people need a trusting relationship to discuss sensitive issues. To enable high-quality and effective mental health consultations with young people and the development of trust, GPs require unhurried consultations and the ability to maintain continuity of care.
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21
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Fisher RJ, Riley-Bennett F, Russell L, Lee C, Sturt R, Walker M, Sackley C. Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability. BMJ Open 2021; 11:e052593. [PMID: 34857570 PMCID: PMC8640659 DOI: 10.1136/bmjopen-2021-052593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/29/2021] [Indexed: 12/24/2022] Open
Abstract
In the UK, over 20% of patients leaving hospital after a stroke will be severely disabled. Despite this, limited clinical guidance is available to teams tasked with providing support for this complex population at home. Additionally, many areas across the UK are not commissioned to treat this patient cohort, leaving them with no specialist support on discharge. OBJECTIVES To establish core components of home-based rehabilitation for survivors of stroke with severe disability, based on expert panel consensus. SETTING Virtual nominal group technique (vNGT) across the UK. PARTICIPANTS Experts in the field of stroke rehabilitation (n=14) including researchers, clinicians and those with lived experience. METHODS Two vNGT were completed using a freely available online platform, Microsoft Teams. The technique's five stages were completed virtually; introduction, silent idea generation, round robin, clarifications and scoring. Statements were analysed for consensus, those achieving consensus underwent content analysis to form rich overarching consensus statements. RESULTS A combined total of 421 statements achieved positive consensus (>75% in agreement), which formed 11 overarching consensus statements. These outline key components of home-based rehabilitation for survivors of stroke with severe disability including the structure and members of the team, as well as the skills and knowledge required. CONCLUSION The consensus statements highlight the complexity of managing patients with severe stroke disability following discharge from hospital. This study has the potential to support the provision of services for this patient group, providing a benchmark for commissioners and clinicians as well as setting expectations for stroke survivors and their carers. What remains unknown is how many services currently offer this service to patients with severe disability.
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Affiliation(s)
| | | | - Lal Russell
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Claire Lee
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Ruth Sturt
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Marion Walker
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Cath Sackley
- School of Health Sciences, University of Nottingham, Nottingham, UK
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22
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Benham-Clarke S, Ford T, Mitchell SB, Price A, Newlove-Delgado T, Blake S, Eke H, Moore DA, Emma Russell A, Janssens A. Role of education settings in transition from child to adult health services for young people with ADHD. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2021. [DOI: 10.1080/13632752.2021.1989844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Anna Price
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Sharon Blake
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Helen Eke
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Darren A Moore
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Astrid Janssens
- College of Medicine and Health, University of Exeter, Exeter, UK
- Center for Innovativ Medicinsk Teknologi, University of Southern Denmark, Odense, Denmark
- Center for Research in Partnership with Patients and Relatives, Odense University Hospital, Odense, Denmark
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23
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Hompashe DM, Gerdtham UG, Christian CS, Smith A, Burger R. 'The nurse did not even greet me': how informed versus non-informed patients evaluate health systems responsiveness in South Africa. BMJ Glob Health 2021; 6:bmjgh-2020-004360. [PMID: 33893142 PMCID: PMC8074562 DOI: 10.1136/bmjgh-2020-004360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/13/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction. Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ experiences of non-clinical dimensions. Results We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers’ explanations of health conditions. Conclusion Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.
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Affiliation(s)
- Dumisani MacDonald Hompashe
- Economics, University of Fort Hare Faculty of Management and Commerce, Alice, South Africa .,Economics, Stellenbosch University Faculty of Economic and Management Sciences, Stellenbosch, South Africa
| | | | | | - Anja Smith
- Economics, Stellenbosch University Faculty of Economic and Management Sciences, Stellenbosch, South Africa
| | - Ronelle Burger
- Economics, Stellenbosch University Faculty of Economic and Management Sciences, Stellenbosch, South Africa
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24
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Young S, Asherson P, Lloyd T, Absoud M, Arif M, Colley WA, Cortese S, Cubbin S, Doyle N, Morua SD, Ferreira-Lay P, Gudjonsson G, Ivens V, Jarvis C, Lewis A, Mason P, Newlove-Delgado T, Pitts M, Read H, van Rensburg K, Zoritch B, Skirrow C. Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement. Front Psychiatry 2021; 12:649399. [PMID: 33815178 PMCID: PMC8017218 DOI: 10.3389/fpsyt.2021.649399] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Despite evidence-based national guidelines for ADHD in the United Kingdom (UK), ADHD is under-identified, under-diagnosed, and under-treated. Many seeking help for ADHD face prejudice, long waiting lists, and patchy or unavailable services, and are turning to service-user support groups and/or private healthcare for help. Methods: A group of UK experts representing clinical and healthcare providers from public and private healthcare, academia, ADHD patient groups, educational, and occupational specialists, met to discuss shortfalls in ADHD service provision in the UK. Discussions explored causes of under-diagnosis, examined biases operating across referral, diagnosis and treatment, together with recommendations for resolving these matters. Results: Cultural and structural barriers operate at all levels of the healthcare system, resulting in a de-prioritization of ADHD. Services for ADHD are insufficient in many regions, and problems with service provision have intensified as a result of the response to the COVID-19 pandemic. Research has established a range of adverse outcomes of untreated ADHD, and associated long-term personal, social, health and economic costs are high. The consensus group called for training of professionals who come into contact with people with ADHD, increased funding, commissioning and monitoring to improve service provision, and streamlined communication between health services to support better outcomes for people with ADHD. Conclusions: Evidence-based national clinical guidelines for ADHD are not being met. People with ADHD should have access to healthcare free from discrimination, and in line with their legal rights. UK Governments and clinical and regulatory bodies must act urgently on this important public health issue.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, London, United Kingdom.,Department of Psychology, Reykjavik University, Reykjavik, Iceland.,ADHD Foundation, Liverpool, United Kingdom
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Tony Lloyd
- ADHD Foundation, Liverpool, United Kingdom
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,King's Health Partners Academic Health Science Centre, London, United Kingdom.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Muhammad Arif
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | | | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences & Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent NHS Trust, Southampton, United Kingdom.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States
| | - Sally Cubbin
- The ADHD Clinic, Manor Hospital, Oxford, United Kingdom
| | - Nancy Doyle
- Genius Within, Plumpton Green, United Kingdom.,Department of Organizational Psychology, Birkbeck College, University of London, London, United Kingdom
| | - Susan Dunn Morua
- AADD-United Kingdom, Bristol, United Kingdom.,Bristol Adult ADHD Support Group, Bristol, United Kingdom
| | - Philip Ferreira-Lay
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | - Gisli Gudjonsson
- Department of Psychology, Reykjavik University, Reykjavik, Iceland.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | | | - Alexandra Lewis
- Cambridge & Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Peter Mason
- ADHD Foundation, Liverpool, United Kingdom.,ADHD and Psychiatry Services Limited, Liverpool, United Kingdom.,Cheshire and Wirral Partnership NHS Foundation Trust, Chester, United Kingdom
| | | | - Mark Pitts
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Helen Read
- ADHD Consultancy Limited, London, United Kingdom
| | - Kobus van Rensburg
- Adult ADHD and Asperger's Team & Children and Young People's ADHD and ASD Service, Northamptonshire Healthcare NHS Foundation Trust, Kettering, United Kingdom
| | - Bozhena Zoritch
- ADDmire Clinic, West Byfleet, United Kingdom.,Epsom and St. Helier University Hospital, Epsom, United Kingdom
| | - Caroline Skirrow
- Cambridge Cognition, Cambridge, United Kingdom.,Psychological Sciences, University of Bristol, Bristol, United Kingdom
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25
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"I'm just a long history of people rejecting referrals" experiences of young people who fell through the gap between child and adult mental health services. Eur Child Adolesc Psychiatry 2021; 30:401-413. [PMID: 32274589 PMCID: PMC8019413 DOI: 10.1007/s00787-020-01526-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/31/2020] [Indexed: 11/06/2022]
Abstract
The paediatric-adult split in mental health care necessitates young people to make a transition between services when they reach the upper end of child and adolescent mental health services (CAMHS). However, we know that this transition is often poor, and not all young people who require ongoing support are able to continue care in adult mental health services (AMHS). These young people are said to have fallen through the gap between services. This research aimed to explore the reasons why young people fall through the gap between CAMHS and AMHS, and what effect this has had on them and their families. Narrative interviews were conducted with 15 young people and 15 parents, representing 19 unique transition stories. Themes were identified collaboratively using thematic analysis. Reasons for falling through the gap were grouped into systemic problems and problems with the quality of care received. Effects of falling through the gap were grouped into separate themes for young people (feeling abandoned; struggling to manage without continued care; problems with medication) and parents (emotional impact of care ending; parents taking an active role in the young person's care). To our knowledge, this is the first qualitative study that has focused only on the experiences of young people who have fallen through the gap between services. This research adds novel findings to existing literature regarding barriers to transition and the effects of discontinuity of care.
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26
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Gong X, Wang X, Shi T, Shi J, Yu W, Zhou L, Chen N, Huang J, Wang Z. Disease composition and epidemiological characteristics of primary care visits in Pudong New Area, Shanghai: a longitudinal study, 2016-2018. BMJ Open 2020; 10:e040878. [PMID: 33203636 PMCID: PMC7674101 DOI: 10.1136/bmjopen-2020-040878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study aims to analyse the disease composition of primary care visits rather than specialist visits, the former of which had scarcely been studied. We adopted specific disease classification (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), disease system and communicable/non-communicable/injury disease classification, and variations of sex and age were also analysed. SETTING We extracted data from all community health service centres (CHSCs) and community health service stations in Pudong, Shanghai, from 2016 to 2018 using the electronic health record systems of the Pudong health information centre. PARTICIPANTS Our data included all 46 720 972 primary care visits from 2016 to 2018 in CHSCs in Pudong. RESULTS We found that the top five diseases in primary care visits continued to be primary hypertension, problems related to medical facilities, chronic ischaemic heart disease, unspecified diabetes mellitus and acute upper respiratory infection. Lipoprotein metabolism disorder visits continued to increase over the study years. The numbers and proportions of patients with hypertension and unspecified diabetes were higher among men than women, and other cerebrovascular diseases were higher among women than men. The top five disease systems were circulatory system diseases, respiratory system diseases, endocrine/nutritional/metabolic diseases, factors influencing health status and digestive system diseases. The rankings of respiratory system and endocrine/nutritional/metabolic diseases rose over time. Non-communicable diseases (NCDs) accounted for approximately 90% of the primary care visits-a much higher percentage than other causes. The top five NCDs in primary care visits were cardiovascular and circulatory diseases, musculoskeletal disorders, diabetes, digestive diseases and urogenital diseases. Compared with women, men suffered from cardiovascular diseases at an earlier age. CONCLUSIONS Different from specialist visits, common diseases, especially NCDs, were the main disease composition of current primary healthcare visits while the former focused on intractable diseases such as tumours, indicating that primary healthcare had played the role of gatekeeper of the healthcare system.
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Affiliation(s)
- Xin Gong
- Heart Failure Department, Shanghai East Hospital affiliated to Tongji University School of Medicine, Shanghai, China
| | - Xiaoli Wang
- Pudong Health Information Center, Pudong Institute for Health Development, Shanghai, China
| | - Tianxing Shi
- Pudong Health Information Center, Pudong Institute for Health Development, Shanghai, China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Zhou
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Chen
- School of Medicine, Tongji University, Shanghai, China
| | - Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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27
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He R, Liu J, Zhang WH, Zhu B, Zhang N, Mao Y. Turnover intention among primary health workers in China: a systematic review and meta-analysis. BMJ Open 2020; 10:e037117. [PMID: 33067275 PMCID: PMC7569945 DOI: 10.1136/bmjopen-2020-037117] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To analyse the prevalence and determinants of turnover intention (TI) among primary health workers (PHWs) in China to provide evidence for improving retention measures. DESIGN Systemic review and meta-analysis. DATA SOURCES Four English-language databases (PubMed, EMBASE, Cochrane Library, PsycINFO) and three Chinese databases (CNKI, CSPD, CBM) were searched up to October 2019. ELIGIBILITY CRITERIA Eligible studies were observational or descriptive studies conducted in mainland China. The prevalence of TI among health workers and related factors had to be explicitly reported in each included study. DATA EXTRACTION AND SYNTHESIS Data were extracted by one author and reviewed independently by two other authors. For each factor analysed by a meta-analysis, the factor was required to be the same across different studies, and at least three studies had to include it. The quality of studies was assessed using the Newcastle-Ottawa Scale and heterogeneity was evaluated using the I2 statistic. RESULTS We identified 16 cross-sectional studies investigating a total of 37 672 PHWs. The prevalence of TI was 30.4%. Subgroup analysis revealed that the highest prevalence was observed in the community primary healthcare institutions and the eastern provinces of China. Meta-analyses indicated that 21 factors were significantly associated with TI, including demographic factors (gender, age, education, marital status), job characteristic factors (title, work seniority, remuneration, social status, organisational affiliation, work stress) and job satisfaction factors (learning and training opportunity, interpersonal relationship, work condition and environment, and so on). CONCLUSION This study highlights the problem of TI among PHWs in China. Efforts should be made to improve conditions in both work-related areas and areas outside of work. Policymakers should continue to improve reward systems, the construction of infrastructure and promotion systems, and pay more attention to PHWs' lives outside of work and meet their living needs.
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Affiliation(s)
- Rongxin He
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Jinlin Liu
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Bin Zhu
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Ning Zhang
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Ying Mao
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
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28
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New models of care in general practice for the youth mental health transition boundary. BJGP Open 2020; 4:bjgpopen20X101133. [PMID: 33023869 PMCID: PMC7880174 DOI: 10.3399/bjgpopen20x101133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022] Open
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