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Paisi M, Withers L, Erwin J, Horrell J, Witton R, Shawe J, Byng R. Embedding health and wellbeing opportunities for people experiencing homelessness in a wider support system. Perspect Public Health 2023; 143:126-128. [PMID: 37232254 DOI: 10.1177/17579139231157527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- M Paisi
- Peninsula Dental School, University of Plymouth, Plymouth, UK
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - L Withers
- Research and Community Partner, Plymouth, UK
| | - J Erwin
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - J Horrell
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - R Witton
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - J Shawe
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - R Byng
- Peninsula Medical School, University of Plymouth, Plymouth, UK
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Grünwald LM, Duddy C, Byng R, Crellin N, Moncrieff J. The role of trust and hope in antipsychotic medication reviews between GPs and service users a realist review. BMC Psychiatry 2021; 21:390. [PMID: 34348680 PMCID: PMC8340528 DOI: 10.1186/s12888-021-03355-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/26/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners (GPs) have the confidence and experience to appropriately review and adjust doses of antipsychotic medication without secondary care support. AIM To explore barriers and facilitators of conducting antipsychotic medication reviews in primary care for individuals with no specialist mental health input. DESIGN & SETTING Realist review in general practice settings. METHOD A realist review has been conducted to synthesise evidence on antipsychotic medication reviews conducted in primary care with service users diagnosed with schizophrenia or psychosis. Following initial scoping searches and discussions with stakeholders, a systematic search and iterative secondary searches were conducted. Articles were systematically screened and analysed to develop a realist programme theory explaining the contexts (C) and mechanisms (M) which facilitate or prevent antipsychotic medication reviews (O) in primary care settings, and the potential outcomes of medication reviews. RESULTS Meaningful Antipsychotic medication reviews may not occur for individuals with only primary care medical input. Several, often mutually reinforcing, mechanisms have been identified as potential barriers to conducting such reviews, including low expectations of recovery for people with severe mental illness, a perceived lack of capability to understand and participate in medication reviews, linked with a lack of information shared in appointments between GPs and Service Users, perceived risk and uncertainty regarding antipsychotic medication and illness trajectory. CONCLUSIONS The review identified reciprocal and reinforcing stereotypes affecting both GPs and service users. Possible mechanisms to counteract these barriers are discussed, including realistic expectations of medication, and the need for increased information sharing and trust between GPs and service users.
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Affiliation(s)
- L M Grünwald
- Division of Psychiatry, University College London, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7NF, UK.
- Comprehensive Clinical Trials Unit, 90 High Holborn, London, WC1V 6LJ, UK.
| | - C Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - R Byng
- Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - N Crellin
- Nuffield Trust, 59 New Cavendish Street, London, W1G 7LP, UK
| | - J Moncrieff
- Division of Psychiatry, University College London, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7NF, UK
- Research and Development Department, North East London Foundation Trust, Maggie Lilley Suite, Goodmayes Hospital, Barley Lane, Ilford, Essex, IG3 8XJ, UK
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Swancutt D, Jack E, Neve H, Tredinnick-Rowe J, Axford N, Byng R. 26 Introducing the Sherpa Model for Managing Multi-Morbidity to Trainee GPS: Outcomes and Relevance to Elderly CareÂ. Age Ageing 2021. [DOI: 10.1093/ageing/afab029.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Primary care trainees are traditionally taught to use a consultation model which focuses on eliciting the patients’ main reason for consulting “today”. As the number of patients with multi-morbidity increases, this approach is often inappropriate or unhelpful. Patients can be left without an understanding of their interacting health issues. The SHERPA model provides a biopsychosocial framework for consulting patients with multi-morbidity. We aimed to examine the responses to this model when integrated into a training programme for newly registered GPs.
Methods
Sixteen participants provide qualitative data on their experience and follow-up use of SHERPA. Four hours of teaching were observed. Twenty-four feedback templates on training (n = 18) and SHERPA application (n = 6) were collected. Individual semi-structured one-to-one interviews were conducted with trainees (n = 5) and trainers (n = 3). Data were transcribed and, using the Framework approach, systematically analysed focussing on the trainees’ reaction to the teaching sessions and their ability to use the SHERPA consultation model.
Results
Participants engaged well with the teaching sessions, enjoying the scenarios and bringing observations from their own experience. Five participants went on to apply SHERPA successfully with their patients. Barriers to using this approach were: not seeing appropriate patients with multi-morbidities (due to current placement or patient type); time; lack of confidence and familiarity; concern about missing important immediate clinical issues; and viewing the approach as “in addition” rather than key to shared decision-making.
Conclusion
The SHERPA model was viewed as a helpful addition by trainee GPs, although practical issues, fears and not seeing it as their priority for their case-mix, limited their application of it. Regular support from trainers, where trainees reflect on their experience of using SHERPA, could increase their confidence and familiarity with this method. These findings suggest that SHERPA may be relevant to other specialities such as geriatric medicine, where multi-morbidity is common.
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Thomas F, Hansford L, Ford J, Wyatt K, McCabe R, Byng R. How accessible and acceptable are current GP referral mechanisms for IAPT for low-income patients? Lay and primary care perspectives. J Ment Health 2019; 29:706-711. [DOI: 10.1080/09638237.2019.1677876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- F. Thomas
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - L. Hansford
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - J. Ford
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - K. Wyatt
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - R. McCabe
- School of Health Sciences, City University, London, UK
| | - R. Byng
- Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
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Thompson TP, Greaves CJ, Ayres R, Aveyard P, Warren FC, Byng R, Taylor RS, Campbell JL, Ussher M, Michie S, West R, Taylor AH. Factors associated with study attrition in a pilot randomised controlled trial to explore the role of exercise-assisted reduction to stop (EARS) smoking in disadvantaged groups. Trials 2016; 17:524. [PMID: 27788686 PMCID: PMC5084338 DOI: 10.1186/s13063-016-1641-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/06/2016] [Indexed: 12/23/2022] Open
Abstract
Background Study attrition has the potential to compromise a trial’s internal and external validity. The aim of the present study was to identify factors associated with participant attrition in a pilot trial of the effectiveness of a novel behavioural support intervention focused on increasing physical activity to reduce smoking, to inform the methods to reduce attrition in a definitive trial. Methods Disadvantaged smokers who wanted to reduce but not quit were randomised (N = 99), of whom 61 (62 %) completed follow-up assessments at 16 weeks. Univariable logistic regression was conducted to determine the effects of intervention arm, method of recruitment, and participant characteristics (sociodemographic factors, and lifestyle, behavioural and attitudinal characteristics) on attrition, followed by multivariable logistic regression on those factors found to be related to attrition. Results Participants with low confidence to quit, and who were undertaking less than 150 mins of moderate and vigorous physical activity per week at baseline were less likely to complete the 16-week follow-up assessment. Exploratory analysis revealed that those who were lost to follow-up early in the trial (i.e., by 4 weeks), compared with those completing the study, were younger, had smoked for fewer years and had lower confidence to quit in the next 6 months. Participants who recorded a higher expired air carbon monoxide reading at baseline were more likely to drop out late in the study, as were those recruited via follow-up telephone calls. Multivariable analyses showed that only completing less than 150 mins of physical activity retained any confidence in predicting attrition in the presence of other variables. Conclusions The findings indicate that those who take more effort to be recruited, are younger, are heavier smokers, have less confidence to quit, and are less physically active are more likely to withdraw or be lost to follow-up.
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Affiliation(s)
- T P Thompson
- Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK.
| | - C J Greaves
- University of Exeter Medical School, Exeter, UK
| | - R Ayres
- Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F C Warren
- University of Exeter Medical School, Exeter, UK
| | - R Byng
- Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
| | - R S Taylor
- University of Exeter Medical School, Exeter, UK
| | | | - M Ussher
- Institute of Population Health Research, St George's University of London, Cranmer Terrace, London, UK
| | - S Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, UK
| | - R West
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, UK
| | - A H Taylor
- Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
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Pearson M, Brand SL, Quinn C, Shaw J, Maguire M, Michie S, Briscoe S, Lennox C, Stirzaker A, Kirkpatrick T, Byng R. Using realist review to inform intervention development: methodological illustration and conceptual platform for collaborative care in offender mental health. Implement Sci 2015; 10:134. [PMID: 26415961 PMCID: PMC4584430 DOI: 10.1186/s13012-015-0321-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 09/04/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This paper reports how we used a realist review, as part of a wider project to improve collaborative mental health care for prisoners with common mental health problems, to develop a conceptual platform. The importance of offenders gaining support for their mental health, and the need for practitioners across the health service, the criminal justice system, and the third sector to work together to achieve this is recognised internationally. However, the literature does not provide coherent analyses of how these ambitions can be achieved. This paper demonstrates how a realist review can be applied to inform complex intervention development that spans different locations, organisations, professions, and care sectors. METHODS We applied and developed a realist review for the purposes of intervention development, using a three-stage process. (1) An iterative database search strategy (extending beyond criminal justice and offender health) and groups of academics, practitioners, and people with lived experience were used to identify explanatory accounts (n = 347). (2) From these accounts, we developed consolidated explanatory accounts (n = 75). (3) The identified interactions between practitioners and offenders (within their organisational, social, and cultural contexts) were specified in a conceptual platform. We also specify, step by step, how these explanatory accounts were documented, consolidated, and built into a conceptual platform. This addresses an important methodological gap for social scientists and intervention developers about how to develop and articulate programme and implementation theory underpinning complex interventions. RESULTS An integrated person-centred system is proposed to improve collaborative mental health care for offenders with common mental health problems (near to and after release) by achieving consistency between the goals of different sectors and practitioners, enabling practitioners to apply scientific and experiential knowledge in working judiciously and reflectively, and building systems and aligning resources that are centred on offenders' health and social care needs. CONCLUSIONS As part of a broader programme of work, a realist review can make an important contribution to the specification of theoretically informed interventions that have the potential to improve health outcomes. Our conceptual platform has potential application in related systems of health and social care where integrated, and person-centred care is a goal.
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Affiliation(s)
- M Pearson
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - S L Brand
- Centre for Clinical Trials and Health Research, Plymouth University Peninsula Schools of Medicine and Dentistry, ITTC Building, Davy Road, Plymouth Science Park, Plymouth, PL6 8BX, UK.
| | - C Quinn
- Centre for Clinical Trials and Health Research, Plymouth University Peninsula Schools of Medicine and Dentistry, ITTC Building, Davy Road, Plymouth Science Park, Plymouth, PL6 8BX, UK.
| | - J Shaw
- Institute of Brain, Behaviour and Mental Health, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - M Maguire
- Centre for Criminology, University of South Wales, Pontypridd, CF37 1DL, UK.
| | - S Michie
- UCL Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - S Briscoe
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - C Lennox
- Institute of Brain, Behaviour and Mental Health, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - A Stirzaker
- Avon & Wiltshire Mental Health Partnership Trust, Old Town Surgery, Curie Avenue, Swindon, SN1 4GB, UK.
| | - T Kirkpatrick
- Centre for Clinical Trials and Health Research, Plymouth University Peninsula Schools of Medicine and Dentistry, ITTC Building, Davy Road, Plymouth Science Park, Plymouth, PL6 8BX, UK.
| | - R Byng
- Centre for Clinical Trials and Health Research, Plymouth University Peninsula Schools of Medicine and Dentistry, ITTC Building, Davy Road, Plymouth Science Park, Plymouth, PL6 8BX, UK.
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Watkins ER, Taylor RS, Byng R, Baeyens C, Read R, Pearson K, Watson L. Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial. Psychol Med 2012; 42:1359-1371. [PMID: 22085757 PMCID: PMC3359637 DOI: 10.1017/s0033291711002480] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 09/29/2011] [Accepted: 09/30/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND The development of widely accessible, effective psychological interventions for depression is a priority. This randomized trial provides the first controlled data on an innovative cognitive bias modification (CBM) training guided self-help intervention for depression. METHOD One hundred and twenty-one consecutively recruited participants meeting criteria for current major depression were randomly allocated to treatment as usual (TAU) or to TAU plus concreteness training (CNT) guided self-help or to TAU plus relaxation training (RT) guided self-help. CNT involved repeated practice at mental exercises designed to switch patients from an unhelpful abstract thinking habit to a helpful concrete thinking habit, thereby targeting depressogenic cognitive processes (rumination, overgeneralization). RESULTS The addition of CNT to TAU significantly improved depressive symptoms at post-treatment [mean difference on the Hamilton Rating Scale for Depression (HAMD) 4.28, 95% confidence interval (CI) 1.29-7.26], 3- and 6-month follow-ups, and for rumination and overgeneralization post-treatment. There was no difference in the reduction of symptoms between CNT and RT (mean difference on the HAMD 1.98, 95% CI -1.14 to 5.11), although CNT significantly reduced rumination and overgeneralization relative to RT post-treatment, suggesting a specific benefit on these cognitive processes. CONCLUSIONS This study provides preliminary evidence that CNT guided self-help may be a useful addition to TAU in treating major depression in primary care, although the effect was not significantly different from an existing active treatment (RT) matched for structural and common factors. Because of its relative brevity and distinct format, it may have value as an additional innovative approach to increase the accessibility of treatment choices for depression.
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Affiliation(s)
- E R Watkins
- Mood Disorders Centre, University of Exeter, UK.
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Dowrick C, Flach C, Leese M, Chatwin J, Morriss R, Peveler R, Gabbay M, Byng R, Moore M, Tylee A, Kendrick T. Estimating probability of sustained recovery from mild to moderate depression in primary care: evidence from the THREAD study. Psychol Med 2011; 41:141-150. [PMID: 20346195 DOI: 10.1017/s0033291710000437] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is important for doctors and patients to know what factors help recovery from depression. Our objectives were to predict the probability of sustained recovery for patients presenting with mild to moderate depression in primary care and to devise a means of estimating this probability on an individual basis. METHOD Participants in a randomized controlled trial were identified through general practitioners (GPs) around three academic centres in England. Participants were aged >18 years, with Hamilton Depression Rating Scale (HAMD) scores 12-19 inclusive, and at least one physical symptom on the Bradford Somatic Inventory (BSI). Baseline assessments included demographics, treatment preference, life events and difficulties and health and social care use. The outcome was sustained recovery, defined as HAMD score <8 at both 12 and 26 week follow-up. We produced a predictive model of outcome using logistic regression clustered by GP and created a probability tree to demonstrate estimated probability of recovery at the individual level. RESULTS Of 220 participants, 74% provided HAMD scores at 12 and 26 weeks. A total of 39 (24%) achieved sustained recovery, associated with being female, married/cohabiting, having a low BSI score and receiving preferred treatment. A linear predictor gives individual probabilities for sustained recovery given specific characteristics and probability trees illustrate the range of probabilities and their uncertainties for some important combinations of factors. CONCLUSIONS Sustained recovery from mild to moderate depression in primary care appears more likely for women, people who are married or cohabiting, have few somatic symptoms and receive their preferred treatment.
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Affiliation(s)
- C Dowrick
- Division of Primary Care, University of Liverpool, Liverpool, UK.
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Kendrick T, Chatwin J, Dowrick C, Tylee A, Morriss R, Peveler R, Leese M, McCrone P, Harris T, Moore M, Byng R, Brown G, Barthel S, Mander H, Ring A, Kelly V, Wallace V, Gabbay M, Craig T, Mann A. Randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of selective serotonin reuptake inhibitors plus supportive care, versus supportive care alone, for mild to moderate depression with somatic symptoms in primary care: the THREAD (THREshold for AntiDepressant response) study. Health Technol Assess 2009; 13:iii-iv, ix-xi, 1-159. [PMID: 19401066 DOI: 10.3310/hta13220] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To determine (1) the effectiveness and cost-effectiveness of selective serotonin reuptake inhibitor (SSRI) treatment plus supportive care, versus supportive care alone, for mild to moderate depression in patients with somatic symptoms in primary care; and (2) the impact of the initial severity of depression on effectiveness and relative costs. To investigate the impact of demographic and social variables. DESIGN The study was a parallel group, open-label, pragmatic randomised controlled trial. SETTING The study took place in a UK primary care setting. Patients were referred by 177 GPs from 115 practices around three academic centres. PARTICIPANTS Patients diagnosed with new episodes of depression and potentially in need of treatment. In total, 602 patients were referred to the study team, of whom 220 were randomised. INTERVENTIONS GPs were asked to provide supportive care to all participants in follow-up consultations 2, 4, 8 and 12 weeks after the baseline assessment, to prescribe an SSRI of their choice to patients in the SSRI plus supportive care arm and to continue treatment for at least 4 months after recovery. They could switch antidepressants during treatment if necessary. They were asked to refrain from prescribing an antidepressant to those in the supportive care alone arm during the first 12 weeks but could prescribe to these patients if treatment became necessary. MAIN OUTCOME MEASURES The primary outcome measure was Hamilton Depression Rating Scale (HDRS) score at 12-week follow-up. Secondary outcome measures were scores on HDRS at 26-week follow-up, Beck Depression Inventory, Medical Outcomes Study Short Form-36 (SF-36), Medical Interview Satisfaction Scale (MISS), modified Client Service Receipt Inventory and medical record data. RESULTS SSRIs were received by 87% of patients in the SSRI plus supportive care arm and 20% in the supportive care alone arm. Longitudinal analyses demonstrated statistically significant differences in favour of the SSRI plus supportive care arm in terms of lower HDRS scores and higher scores on the SF-36 and MISS. Significant mean differences in HDRS score adjusted for baseline were found at both follow-up points when analysed separately but were relatively small. The numbers needed to treat for remission (to HDRS > 8) were 6 [95% confidence interval (CI) 4 to 26)] at 12 weeks and 6 (95% CI 3 to 31) at 26 weeks, and for significant improvement (HDRS reduction > or = 50%) were 7 (95% CI 4 to 83) and 5 (95% CI 3 to 13) respectively. Incremental cost-effectiveness ratios and cost-effectiveness planes suggested that adding an SSRI to supportive care was probably cost-effective. The cost-effectiveness acceptability curve for utility suggested that adding an SSRI to supportive care was cost-effective at the values of 20,000 pounds-30,000 pounds per quality-adjusted life-year. A poorer outcome on the HDRS was significantly related to greater severity at baseline, a higher physical symptom score and being unemployed. CONCLUSIONS Treatment with an SSRI plus supportive care is more effective than supportive care alone for patients with mild to moderate depression, at least for those with symptoms persisting for 8 weeks and an HRDS score of > or = 12. The additional benefit is relatively small, and may be at least in part a placebo effect, but is probably cost-effective at the level used by the National Institute for Health and Clinical Excellence to make judgements about recommending treatments within the National Health Service. However, further research is required.
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Affiliation(s)
- T Kendrick
- Primary Medical Care, Aldermoor Health Centre, University of Southampton, UK
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Byng R, Smith K. Time heals! Using time as a currency. Br J Gen Pract 2001; 51:950-1. [PMID: 11761223 PMCID: PMC1314166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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Abstract
Thirty-nine primary health care workers were interviewed in the Esteli Region of Nicaragua to determine their knowledge, attitudes and ideas for change regarding mental illness in primary care. The aim was to provide a qualitative description in order to assess learners' needs and plan a training programme in mental health care to be carried out by the Esteli mental health team. The results showed a wide range in knowledge regarding diagnoses and treatments. Many of the workers were keen to learn more and nearly all had positive ideas as to how primary care and links with secondary care could be improved. The study is an example of how a small qualitative study can help planning of training programmes and can highlight those primary health care issues relevant to the local situation.
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