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Biomedical subjects

Helen Lester

Publications and source records attributed to Helen Lester.

At least 19 recordsLinked to original sources
PubMed2006

Physical health care of patients with schizophrenia in primary care: a comparative study.

BACKGROUND: Excess morbidity and mortality associated with schizophrenia is well established. Despite this, no previous multi-centre study has investigated whether patients with schizophrenia receive equitable physical healthcare within primary care. OBJECTIVE: To determine whether patients with a diagnosis of schizophrenia receive the same levels of physical health care from primary care practitioners as patients without schizophrenia. METHODS DESIGN: Case-matched retrospective case note review. SETTING: Twenty-two general practices in the Birmingham area (UK). SUBJECTS: 195 patients with a diagnosis of schizophrenia, 390 matched controls with a diagnosis of asthma and 390 general control patients. MAIN OUTCOME MEASURES: Proportions of patients within each group having received six pre-defined routine health checks in a 3 year period. Conditional logistic regression models were used to identify differences between groups. RESULTS: Patients with schizophrenia were half as likely as asthma controls to have blood pressure and cholesterol levels recorded (odds ratio 0.51; 95% confidence interval (CI) 1.35-0.73 and 0.50; 0.31-0.82, respectively) and were also less likely to have smoking status noted (0.60; 0.41-0.85). Similarly, patients with schizophrenia were significantly less likely than general population controls to have either blood pressure or cholesterol recorded (0.68; 0.47-0.97 and 0.58; 0.35-0.95). The significant differences observed were maintained after adjusting for potential confounders with the exception of cholesterol recording between the asthma and schizophrenia groups (0.57; 0.30-1.05). CONCLUSIONS: Patients with a diagnosis of schizophrenia are less likely to receive some important general health checks than patients without schizophrenia.

Adult↗
PubMed2006

Current issues in providing primary medical care to people with serious mental illness.

This article explores some of the current issues in providing primary care for people with serious mental illness. In contrast to many patients in the United States, up to half of patients with serious mental illness in the United Kingdom are seen only by the primary care team. However many General Practitioners feel that the care of this patient group is beyond their remit. In the United Kingdom during the last decade, there have been a variety of policy initiatives, influenced by the generic principle of "partnership working" and the increasing recognition of the importance of patient choice, that have aimed to increase the role of primary care in the delivery of health care to people with serious mental illness. On the ground, these policy imperatives have been realised through different models of shared care and schemes to encourage better communication across the primary/secondary interface. Most recently, and perhaps most effectively, the introduction of a type of performance related pay into primary care may lead to changes to the way in which General Practitioners think and act in terms of their roles and responsibilities with this patient group. Theoretically, therefore the United Kingdom may be entering a new "golden age" of primary care based mental health services for people with serious mental illness, where holistic care, preventive care and health promotion are increasingly seen not as the gold standard, but the norm.

Community Mental Health Services↗
PubMed2006

Patient involvement in primary care mental health: a focus group study.

BACKGROUND: Patient involvement in health care is a strong political driver in the NHS. However in spite of policy prominence, there has been only limited previous work exploring patient involvement for people with serious mental illness. AIM: To describe the views on, potential for, and types of patient involvement in primary care from the perspectives of primary care health professionals and patients with serious mental illness. DESIGN OF STUDY: Qualitative study consisting of six patient, six health professional and six combined focus groups between May 2002 and January 2003. SETTING: Six primary care trusts in the West Midlands, England. METHOD: Forty-five patients with serious mental illness, 39 GPs, and eight practice nurses participated in a series of 18 focus groups. All focus groups were audiotaped and fully transcribed. Nvivo was used to manage data more effectively. RESULTS: Most patients felt that only other people with lived experience of mental illness could understand what they were going through. This experience could be used to help others navigate the health- and social-care systems, give advice about medication, and offer support at times of crisis. Many patients also saw paid employment within primary care as a way of addressing issues of poverty and social exclusion. Health professionals were, however, more reluctant to see patients as partners, be it in the consultation or in service delivery. CONCLUSIONS: Meaningful change in patient involvement requires commitment and belief from primary care practitioners that the views and experiences of people with serious mental illness are valid and valuable.

Adolescent↗
PubMed2005

Patients' and health professionals' views on primary care for people with serious mental illness: focus group study.

OBJECTIVE: To explore the experience of providing and receiving primary care from the perspectives of primary care health professionals and patients with serious mental illness respectively. DESIGN: Qualitative study consisting of six patient groups, six health professional groups, and six combined focus groups. SETTING: Six primary care trusts in the West Midlands. PARTICIPANTS: Forty five patients with serious mental illness, 39 general practitioners (GPs), and eight practice nurses. RESULTS: Most health professionals felt that the care of people with serious mental illness was too specialised for primary care. However, most patients viewed primary care as the cornerstone of their health care and preferred to consult their own GP, who listened and was willing to learn, rather than be referred to a different GP with specific mental health knowledge. Swift access was important to patients, with barriers created by the effects of the illness and the noisy or crowded waiting area. Some patients described how they exaggerated symptoms ("acted up") to negotiate an urgent appointment, a strategy that was also employed by some GPs to facilitate admission to secondary care. Most participants felt that structured reviews of care had value. However, whereas health professionals perceived serious mental illness as a lifelong condition, patients emphasised the importance of optimism in treatment and hope for recovery. CONCLUSIONS: Primary care is of central importance to people with serious mental illness. The challenge for health professionals and patients is to create a system in which patients can see a health professional when they want to without needing to exaggerate their symptoms. The importance that patients attach to optimism in treatment, continuity of care, and listening skills compared with specific mental health knowledge should encourage health professionals in primary care to play a greater role in the care of patients with serious mental illness.

Adolescent↗
PubMed2005

Design of the BiRmingham Early Detection In untREated psyChosis Trial (REDIRECT): cluster randomised controlled trial of general practitioner education in detection of first episode psychosis [ISRCTN87898421].

BACKGROUND: Treatment delay in first episode psychosis is common. As general practitioners are the first point of contact for many individuals with first episode psychosis, they are well placed to detect the early symptoms and make urgent referrals to specialist secondary care services. However, early psychosis is often difficult to detect. The primary objective of the Redirect trial is to estimate whether an educational intervention targeted at general practitioners increases the general practitioner referral rate of young people with first episode psychosis to Early Intervention Services. METHODS/DESIGN: This paper describes the design of a stratified-cluster randomised controlled trial of an educational intervention on first episode psychosis in primary care. The primary outcome is the number of general practitioner referrals of young people with first episode psychosis to Early Intervention Services. Secondary outcomes are duration of untreated psychosis, time to recovery, use of the Mental Health Act, and general practitioner consultation rate. Young people with first episode psychosis referred to Early Intervention Services will be recruited over a two-year period from 1 March 2004. Seventy-eight out of 89 eligible general practices were recruited. The educational intervention has been implemented and evaluated by general practitioners. The education was well received and considered relevant to clinical practice by the general practitioners. DISCUSSION: The results suggest that the recruitment strategy and implementation of the educational intervention are feasible and acceptable in a primary care setting. The Redirect trial will provide robust information about the efficacy of an evidence-based complex educational intervention targeted at general practitioners on referral rates of young people with first episode psychosis to Early Intervention Services.

Adolescent↗
PubMed2005

The development and implementation of an educational intervention on first episode psychosis for primary care.

INTRODUCTION: This paper describes the development and implementation of an educational intervention to help general practitioners (GPs) recognise young people with first episode psychosis. METHOD: The Medical Research Council complex interventions framework was used to guide the development of the intervention. The theoretical phase included a literature review of previous educational interventions in primary care and consideration of the literature on attitude formation and change, and the relationship between attitudes and behaviour. The modelling phase included focus groups with GPs and service users, and a training needs analysis questionnaire administered to GPs. The 2-stage intervention consisted of a video featuring role-plays of primary care consultations, GP-led discussion and discussion with early intervention service users. The acceptability and utility of the educational programme was evaluated using a 5-point Likert scale questionnaire administered at the end of each session. RESULTS: General practitioners from each of the 39 intervention practices participated in the initial session and from 27 practices in the booster session. Information about symptoms and signs of first episode psychosis was the most valued aspect of the initial session. The booster session was also well received, with GPs valuing the opportunity to gain insight into first episode psychosis from users. CONCLUSIONS: This paper adds a pragmatic description to the literature on the development of educational interventions in primary care. The Medical Research Council framework helped to identify and clarify component parts of the intervention and how the active components may relate to the expected outcome of behaviour change.

Adolescent↗
PubMed2005

'Listen to my madness': understanding the experiences of people with serious mental illness.

This article explores the salience of disability theory for understanding the experiences of people with serious mental illness. Drawing on data from a focus group study, we suggest that users experience both impairment (as embodied irrationality) which can, in itself, be oppressive, and also have to manage their lives within a largely disabling society. We outline some of the strategies adopted by users to manage their situation and ensure they access and receive health services, and illustrate how these are a result of the complex relationship between disability and impairment. We suggest that using a framework of the social model of disability provides a useful way of understanding and making sense of the experience of users with serious mental illness.

Adolescent↗
PubMed2005

Integrated mental health services in England: a policy paradox.

PURPOSE: The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England. DATA SOURCES: Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness. CONCLUSION: We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems. DISCUSSION: We conclude with suggestions for strategies that may facilitate more integrated working.

Journal Article↗
PubMed2004

Cases for change in mental health: partnership working in mental health services.

This article examines our current state of knowledge about partnership working between health and social care in UK adult mental health services. Drawing on a narrative review of the literature commissioned by the National Institute for Mental Health, this paper focuses on 43 documents from the review which discuss partnership issues. After exploring the rationale for partnership working, potential barriers and possible ways forward, the paper identifies gaps in the existing literature and discusses the implications of the review for current health and social care policy.

Cooperative Behavior↗
PubMed2004

Managing crisis: the role of primary care for people with serious mental illness.

BACKGROUND AND OBJECTIVES: More than 30% of patients with serious mental illness in the United Kingdom now receive all their health care solely from primary care. This study explored the process of managing acute mental health crises from the dual perspective of patients and primary care health professionals. METHODS: Eighteen focus groups involving 45 patients, 39 general practitioners, and eight practice nurses were held between May and November 2002 in six Primary Care Trusts across the British West Midlands. The topic guide explored perceptions of gold standard care, current issues and critical incidents in receiving/providing care, and ideas on improving services. RESULTS: Themes relevant to the management of acute crisis included issues of process, such as access, advocacy, communication, continuity, and coordination of care; the development of more structured care that might reduce the need for crisis responses; and issues raised by the development of a more structured approach to care. CONCLUSIONS: Access to services is a complicated yet crucial feature of managing care in a crisis, with patients identifying barriers at the level of primary care and health professionals at the interface with secondary care. The development of more structured systems as a solution may generate its own ethical and pragmatic challenges.

Adolescent↗
PubMed2004

Integrated primary mental health care: threat or opportunity in the new NHS?

In this paper, we argue that mental illness touches everyone's lives, and that mental health care is a core activity of primary care. The increasing move towards a primary care-led National Health Service has now created a climate where primary care can move beyond providing a gatekeeper function for secondary care specialist services. Primary care is also sufficiently mature as a discipline to commission, develop, and deliver integrated patient-focused mental health services grounded in the culture and built on the strengths of primary care. We discuss examples of integrated approaches to mental health care, and highlight the potential tensions created by new ways of working. We also suggest that any changes need to be accompanied by carefully negotiated adjustments to the way primary and secondary healthcare professionals conceptualise their roles and responsibilities, and must be underpinned by new ways of learning together.

Community Mental Health Services↗
PubMed2003

Perceived stress during undergraduate medical training: a qualitative study.

INTRODUCTION: Medical education is long and emotionally taxing. It can involve levels of stress that lead to disruptions in both physical and mental health. This qualitative study explores the views of Year 5 medical students on the causes of stress throughout their undergraduate medical training. METHOD: Semi-structured interviews were conducted with 21 final year medical students at the University of Birmingham between January and May 2001. RESULTS: Pressure of work, especially in terms of preparing for examinations and acquiring professional knowledge, skills and attitudes were reported as the most stressful aspects of medical training. Transition periods, particularly between school and medical school, preclinical and clinical training, and clinical training to approaching qualification were highlighted as particularly stressful. A perceived lack of support from the medical school authorities also appeared to add to student stress levels. DISCUSSION: Student stress may be alleviated by greater guidance and support from the medical school during crucial transition periods. Aspects of professional socialisation may also need to be addressed to reduce the levels of stress associated with undergraduate training for future generations of medical students.

Adaptation, Psychological↗
PubMed2003

The attitudes of medical students towards homeless people: does medical school make a difference?

BACKGROUND: Homeless people have greater health care needs than those who are housed, yet often experience difficulty in accessing health care. Evidence suggests that the attitudes of doctors can create significant barriers to health care for homeless people. METHODS: A validated structured questionnaire, the Attitudes Towards the Homeless Questionnaire (ATHQ), was posted to a year group of 211 medical students 2 weeks prior to their starting at the University of Birmingham in 1997, and again during their final clinical placement 5 years later. The results were explored in more depth through semistructured interviews with the 12 students displaying the greatest degree of attitude change. RESULTS: The response rates for the 1997 and 2002 surveys were 80% and 82%, respectively, with an overall response rate of 65% of eligible students. The mean ATHQ scores for the 2 time periods were 76.3 and 74.7 (mean difference = 1.66 +/- 0.8, paired t test = 2.07, P = 0.04), indicating that attitudes had become more negative during the 5-year period. Semistructured interviews highlighted the importance of professional socialisation and clinical contact on attitude development. CONCLUSION: This study suggests that medical students may hold more negative attitudes towards homeless people at the end of their undergraduate course than they do at the beginning of it. Medical schools may need to address this area of health care more directly in the undergraduate curriculum if tomorrow's doctors are to treat all patients equally.

Analysis of Variance↗
PubMed2003

Satisfaction with primary care: the perspectives of people with schizophrenia.

BACKGROUND: Schizophrenia affects up to 1% of the population in the UK. People with schizophrenia use the National Health Service frequently and over a long period of time. However, their views on satisfaction with primary care are rarely sought. OBJECTIVES: This study aimed to explore the elements of satisfaction with primary care for people with schizophrenia. METHOD: A primary care-based study was carried out using semi-structured interviews with 45 patients with schizophrenia receiving shared care with the Northern Birmingham Mental Health Trust between 1999 and 2000. RESULTS: Five major themes that affect satisfaction emerged from the data: the exceptional potential of the consultation itself; the importance of aspects of the organization of primary care; the construction of the user in the doctor-patient relationship; the influence of stereotypes on GP behaviour; and the importance of hope for recovery. CONCLUSION: Satisfaction with primary care is multiply mediated. It is also rarely expected or achieved by this group of patients. There is a significant gap between the rhetoric and the reality of user involvement in primary care consultations. Acknowledging the tensions between societal and GP views of schizophrenia as an incurable life sentence and the importance to patients of hope for recovery is likely to lead to greater satisfaction with primary health care for people with schizophrenia.

Adult↗