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Search Results: 1 - 10 of 3267 matches for " Linda Gask "
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Improving the quality of mental health care in primary care settings: a view from the United Kingdom
Gask,Linda;
The European Journal of Psychiatry , 2007, DOI: 10.4321/S0213-61632007000100003
Abstract: background and objectives: in the forty years since 'general practice' became a focus for research in psychiatry the uk there have been considerable developments in policy, practice and research. the aim of this paper is to review recent research and policy developments concerned with improving quality of mental health in primary care settings. methods: narrative review of the literature. results: disappointing results from large scales trials in the last decade have led to a move towards more exploratory studies and attempts to understand more about contextual factors. policy initiatives such as the nice (national institute of health and clinical excellence) guidelines have set clear standards for the delivery of care, but considerable variation in quality of care persists in primary care settings. the medical research council of the uk has suggested a sequential model for future randomised trials of complex interventions. conclusion: major outstanding challenges are the difficulties in recruiting gps (general practitioners) into research studies who are not particularly interested in mental health and linking research and policy such that the findings of such studies are effectively implemented in everyday practice.
Improving the quality of mental health care in primary care settings: a view from the United Kingdom
Linda Gask
The European Journal of Psychiatry , 2007,
Abstract: Background and objectives: In the forty years since 'general practice' became a focus for research in psychiatry the UK there have been considerable developments in policy, practice and research. The aim of this paper is to review recent research and policy developments concerned with improving quality of mental health in primary care settings. Methods: Narrative review of the literature. Results: Disappointing results from large scales trials in the last decade have led to a move towards more exploratory studies and attempts to understand more about contextual factors. Policy initiatives such as the NICE (National Institute of Health and Clinical Excellence) guidelines have set clear standards for the delivery of care, but considerable variation in quality of care persists in primary care settings. The Medical Research Council of the UK has suggested a sequential model for future randomised trials of complex interventions. Conclusion: Major outstanding challenges are the difficulties in recruiting GPs (General Practitioners) into research studies who are not particularly interested in mental health and linking research and policy such that the findings of such studies are effectively implemented in everyday practice.
Reasons for illicit drug use in people with schizophrenia: Qualitative study
Carolyn J Asher, Linda Gask
BMC Psychiatry , 2010, DOI: 10.1186/1471-244x-10-94
Abstract: Seventeen people with a diagnosis of schizophrenia and who had used street drugs were interviewed and asked to describe, in narrative form, their street drug use from their early experiences to the present day. Grounded theory was used to analyse the transcripts.We identified five reasons for continuing street drug use. The reasons were: as an 'identity defining vocation', 'to belong to a peer group', due to 'hopelessness', because of 'beliefs about symptoms and how street drugs influence them' and viewing drugs as 'equivalent to taking psychotropic medication'. Street drugs were often used to reduce anxiety aroused by voice hearing. Some participants reported street drugs to focus their attention more on persecutory voices in the hope of outwitting their perceived persecutors.It would be clinically useful to examine for the presence of the five factors in patients who have a diagnosis of schizophrenia and use street drugs, as this is likely to help the clinician to tailor management of substance misuse to the individual patient's beliefs.Illicit drug use is common in schizophrenia. Reported prevalence rates vary, for instance, in a recent study 11.9% of people with schizophrenia had comorbid drug abuse or dependence [1]. A recent meta-analysis showed about 1 in 4 patients with schizophrenia had cannabis use disorder [2]. This is up to five times higher than in the general population [3] and results in higher rates of relapse, hospitalisation, suicide and other adverse outcomes [4]. The reasons for this comorbidity are complex and a number of competing theories have been generated and studied using quantitative methods [5-8]. Reviewers have sought to evaluate the degree of empirical support that exists for each theory [6,9]. Psychosocial factors appear to be important in maintaining substance use in this population [5,6,8,9] and a thorough assessment of psychosocial factors is important in engagement and tailoring interventions [5,6,10]. To answer the question as to
Dissemination and implementation of suicide prevention training in one Scottish region
Linda Gask, Gillian Lever-Green, Rebecca Hays
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-246
Abstract: Participants attending STORM training in Highland Region provided by 12 trained facilitators during the period March 2004 to February 2005 were recruited. Quantitative data collection from participants took place at three time points; immediately before training, immediately post-training and six months after training. Semi-structured telephone interviews were carried out with the training facilitators and with a sample of course participants 6 months after they had been trained. We have utilized the conceptual model described by Greenhalgh and colleagues in a Framework analysis of the data, for considering the determinants of diffusion, dissemination and implementation of interventions in health service delivery and organization.Some 203 individuals completed a series of questionnaire measures immediately pre (time 1) and immediately post (time 2) training and there were significant improvements in attitudes and confidence of participants. Key factors in the diffusion, dissemination and implementation process were the presence of a champion or local opinion leader who supported and directed the intervention, local adaptation of the materials, commissioning of a group of facilitators who were provided with financial and administrative support, dedicated time to provide the training and regular peer-support.Features that contributed to the success of STORM were related to both the context (the multi-dimensional support provided from the host organisation and the favourable policy environment) and the intervention (openness to local adaptation, clinical relevance and utility), and the dynamic interaction between context and the intervention.Across Scotland during the period 1989–2004 male suicide rates increased by 22 percent and female suicide rates by 6 percent [1]. Over this period, Scotland has experienced a greater number of deaths from suicide than other countries in the UK [2] and the increase in deaths in men has led to a change in its rank from 12th to 11th h
Beyond the limits of clinical governance? The case of mental health in English primary care
Linda Gask, Anne Rogers, Stephen Campbell, Rod Sheaff
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-63
Abstract: Framework analysis, based on the Normalisation Process Model (NPM), of attempts over a five year period to develop clinical governance for primary mental health services in Primary Care Trusts (PCTs). The data come from a longitudinal qualitative multiple case-study approach in a purposive sample of 12 PCTs, chosen to reflect a maximum variety of organisational contexts for mental health care provision.The constant change within the English NHS provided a difficult context in which to attempt to implement 'clinical governance' or, indeed, to reconstruct primary mental health care. In the absence of clear evidence or direct guidance about what 'primary mental health care' should be, and a lack of actors with the power or skills to set about realising it, the actors in 'clinical governance' had little shared knowledge or understanding of their role in improving the quality of mental health care. There was a lack of ownership of 'mental health' as an integral, normalised part of primary care.Despite some achievements in regard to monitoring and standardisation of prescribing practice, mental health care in primary care seems to have so far largely eluded the gaze of 'clinical governance'. Clinical governance in English primary mental health care has not yet become normalised. We make some policy recommendations which we consider would assist in the process normalisation and suggest other contexts to which our findings might apply.One specific approach in the international 'quest for quality' in health care has been a standardization of practices in medicine. It began early in the twentieth century, but gathered speed with the emerging discourse of 'Evidence-Based Medicine' in the 1990's [1]. Most attention has been given to the development and operationalisation of practice and clinical guidelines, which assemble evidence from scientific research into particular recommendations for health practitioners [2]. Less attention has been given to the organisational as opposed
Improving access to psychosocial interventions for common mental health problems in the United Kingdom: narrative review and development of a conceptual model for complex interventions
Gask Linda,Bower Peter,Lamb Jonathan,Burroughs Heather
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-249
Abstract: Background In the United Kingdom and worldwide, there is significant policy interest in improving the quality of care for patients with mental health disorders and distress. Improving quality of care means addressing not only the effectiveness of interventions but also the issue of limited access to care. Research to date into improving access to mental health care has not been strongly rooted within a conceptual model, nor has it systematically identified the different elements of the patient journey from identification of illness to receipt of care. This paper set out to review core concepts underlying patient access to mental health care, synthesise these to develop a conceptual model of access, and consider the implications of the model for the development and evaluation of interventions for groups with poor access to mental health care such as older people and ethnic minorities. Methods Narrative review of the literature to identify concepts underlying patient access to mental health care, and synthesis into a conceptual model to support the delivery and evaluation of complex interventions to improve access to mental health care. Results The narrative review adopted a process model of access to care, incorporating interventions at three levels. The levels comprise (a) community engagement (b) addressing the quality of interactions in primary care and (c) the development and delivery of tailored psychosocial interventions. Conclusions The model we propose can form the basis for the development and evaluation of complex interventions in access to mental health care. We highlight the key methodological challenges in evaluating the overall impact of access interventions, and assessing the relative contribution of the different elements of the model.
Psychotherapy mediated by remote communication technologies: a meta-analytic review
Penny E Bee, Peter Bower, Karina Lovell, Simon Gilbody, David Richards, Linda Gask, Pamela Roach
BMC Psychiatry , 2008, DOI: 10.1186/1471-244x-8-60
Abstract: Systematic review (including electronic database searching and correspondence with authors) of randomised trials of individual remote psychotherapy. Electronic databases searched included MEDLINE (1966–2006), PsycInfo (1967–2006), EMBASE (1980–2006) and CINAHL databases (1982–2006). The Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDAN-CTR). All searches were conducted to include studies with a publication date to July 2006.Thirteen studies were identified, ten assessing psychotherapy by telephone, two by internet and one by videoconference. Pooled effect sizes for remote therapy versus control conditions were 0.44 for depression (95%CI 0.29 to 0.59, 7 comparisons, n = 726) and 1.15 for anxiety-related disorders (95%CI 0.81 to 1.49, 3 comparisons, n = 168). There were few comparisons of remote versus face-to-face psychotherapy.Remote therapy has the potential to overcome some of the barriers to conventional psychological therapy services. Telephone-based interventions are a particularly popular research focus and as a means of therapeutic communication may confer specific advantages in terms of their widespread availability and ease of operation. However, the available evidence is limited in quantity and quality. More rigorous trials are required to confirm these preliminary estimates of effectiveness. Future research priorities should include overcoming the methodological shortcomings of published work by conducting large-scale trials that incorporate both clinical outcome and more process-orientated measures.Psychological disorders account for over 15% of the total burden of disease within established economies, a significant proportion of which manifests in depressive and anxiety-related disorders [1]. For these disorders, effective treatment options often include non-pharmacological as well as pharmacological interventions. Consensus guidelines recommend the
A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality
Carolyn Chew-Graham, Mike Slade, Carolyn Montana, Mairi Stewart, Linda Gask
BMC Health Services Research , 2007, DOI: 10.1186/1472-6963-7-117
Abstract: Qualitative study nested in a randomised controlled trial. Interviews with general practitioner (GP) referrers, CMHT Consultant Psychiatrists and team leaders. Taping of referral allocation meetings.There was a superficial agreement between the referrers and the referred to on the function of the CMHT, but how this was operationalised in practice resulted in a lack of clarity over the referral process, with tensions apparent between the views of the referrers (GPs) and the CMHT team leaders, and between team members. The process of decision-making within the team was inconsistent with little discussion of, or reflection on, the needs of the referred patient.CMHTs describe struggling to deal with GPs who are perceived as having variable expertise in managing patients with mental health problems. CMHT rhetoric about defined referral criteria is interpreted flexibly with CMHT managers and Psychiatrists concentrating on their own capacity, roles and responsibilities with limited consideration of the primary care perspective or the needs of the referred patient.ISRCTN86197914The direction of mental health policy in the United Kingdom (UK) over the last two decades has had two main thrusts: to prioritise the "severely mentally ill" and to move away from a traditional hospital-based and institutional approach towards community-based services which focus on the needs of the individual[1]. At the same time, National Health Service (NHS) policy has stressed the importance of a 'primary care led NHS' [2]. Generic Community Mental Health Teams (CMHTs) are now the main vehicle for co-ordinating and delivering specialist community mental health care in England [3-5]. The concept of the multidisciplinary CMHT, usually consisting of community psychiatric nurses and social workers with input from a clinical psychologist, occupational therapist and psychiatrist, as the focal point of the interface between primary care and specialist mental health care has evolved in the UK over the l
Delivering the WISE (Whole Systems Informing Self-Management Engagement) training package in primary care: learning from formative evaluation
Anne Kennedy, Carolyn Chew-Graham, Thomas Blakeman, Andrew Bowen, Caroline Gardner, Joanne Protheroe, Anne Rogers, Linda Gask
Implementation Science , 2010, DOI: 10.1186/1748-5908-5-7
Abstract: Normalisation Process Theory provided a framework for development of the intervention. Practices were recruited from an inner city Primary Care Trust in NW England. All practice staff were expected to attend two afternoon training sessions. The training sessions were observed by members of the training team. Post-training audio recordings of consultations from each general practitioner and nurse in the practices were transcribed and read to provide a narrative overview of the incorporation of WISE skills and tools into consultations. Face-to-face semi-structured interviews were conducted with staff post-training.Two practices out of 14 deemed eligible agreed to take part. Each practice attended two sessions, although a third session on consultation skills training was needed for one practice. Fifty-four post-training consultations were recorded from 15 clinicians. Two members of staff were interviewed at each practice. Significant elements of the training form and methods of delivery fitted contemporary practice. There were logistical problems in getting a whole practice to attend both sessions, and administrative staff founds some sections irrelevant. Clinicians reported problems incorporating some of the tools developed for WISE, and this was confirmed in the overview of consultations, with limited overt use of WISE tools and missed opportunities to address patients' self-management needs.The formative evaluation approach and attention to normalisation process theory allowed the training team to make adjustments to content and delivery and ensure appropriate staff attended each session. The content of the course was simplified and focussed more clearly on operationalising the WISE approach. The patient arm of the approach was strengthened by raising expectations of a change in approach to self-care support by their practice.The effective management of long-term conditions is a key focus of health for which policy and support for self-management has been a core com
General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study
Christopher Dowrick, Linda Gask, John G Hughes, Huw Charles-Jones, Judith A Hogg, Sarah Peters, Peter Salmon, Anne R Rogers, Richard K Morriss
BMC Family Practice , 2008, DOI: 10.1186/1471-2296-9-46
Abstract: A nested attitudinal survey and qualitative study in sixteen primary care teams in north-west England. All practitioners participating in the trial (n = 74) were invited to complete a structured survey. Semi-structured interviews were undertaken with a purposive sub-sample of survey respondents, using a structured topic guide. Interview transcripts were used to identify key issues, concepts and themes, which were grouped to construct a conceptual framework: this framework was applied systematically to the data.Seventy (95%) of study participants responded to the survey. Survey respondents often found it stressful to work with patients with medically unexplained symptoms, though those who had received reattribution training were more optimistic about their ability to help them. Interview participants trained in reattribution (n = 12) reported that reattribution increased their confidence to practice in a difficult area, with heightened awareness, altered perceptions of these patients, improved opportunities for team-building and transferable skills. However general practitioners also reported potential barriers to the implementation of reattribution in routine clinical practice, at the level of the patient, the doctor, the consultation, diagnosis and the healthcare context.Reattribution training increases practitioners' sense of competence in managing patients with medically unexplained symptoms. However, barriers to its implementation are considerable, and frequently lie outside the control of a group of practitioners generally sympathetic to patients with medically unexplained symptoms and the purpose of reattribution. These findings add further to the evidence of the difficulty of implementing reattribution in routine general practice.Approximately 20% of patients present physical symptoms in primary care which general practitioners (GPs) are unable to explain by physical disease [1,2]. These patients frequently receive extensive investigation, referral and treatm
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