CUMG.NET \ nouvelle version \ Journal Club Journal Club cumg UCL 24th June 2005 Valérie Dory...

$: CUMG.NET \ nouvelle version \ Journal Club Journal Club cumg UCL 24th June 2005 Valérie Dory Jean-Marc Feron.$
CUMG.NET \ nouvelle version \ Journal Club

Journal Club cumg UCL

24th June 2005

Valérie Dory

Jean-Marc Feron


Aims

• For GPs and lecturers, to get the best out of the literature for their patients and students

• For researchers, to learn how published studies are built and reported, and how to criticize them.


Today

• Patients’ and health professionals’ views on primary care for people with serious mental illness: focus group study BMJ april 2005

• GP treatment decisions for patients with depression: an observational study

Brit J Gen Pract april 2005

First an intuitive critic, and then a reading framework


Patients’ and health professionals’ views on primary care for people with serious mental illness:

Introduction

• Prevalence of schizophrenia, bipolar disorder and recurrent depression up to 3 % in UK

• Considerable workload for GPs and higher risk of poorer physical health

• GPs do not perceived themselves as involved in mental health or overall care of people with serious mental illness

• Little research has sought …



Objective

To explore the changing experience of providing and receiving primary care from the dual perspectives of primary care health professionals and patients with serious mental illness respectively



• Design: Qualitative study consisting of 6 patients groups (N total: 45), 6 health professionals (39 GPs and 8 nurses) and 6 combined focus groups

• Setting: 6 Primary Care Trusts in the West Midlands, selected according to differing levels of deprivation (Townsend score) and population density


Patients’ and health professionals’ views on primary

care for people with serious mental illness: • Patients’ recruitment: through existing

community based user networks – snowballing technique

• Timing: 18 focus groups from May 2002 to January 2003, publication April 2005;

3 researchers



Procedure

• Topic guide piloted with 6 patients and 6 health professionals

• FG in non clinical settings• Always the same facilitator• No patient registered at a GP’s practice• About the half participated, usually 1 week later,

to a combined FG



Analysis

• FG, data collection and analysis were concurrent, and FG continued until saturation

• All FG audiotaped and transcribed• Software, thematic framework



Results (1/3)

• Most of professionals felt that care for people with serious mental illness was too specialised for them

• Most patients viewed Primary Care as the cornerstone of their health care and prefer to consult their own GP

• Patients' arguments: being listened, swift access



Results (2/3)

• Patients exaggerate their symptoms to get urgent appointment to the GP

• GPs exaggerate patients’ symptoms to facilitate admission to secondary care

• All participants felt that interpersonal and longitudinal continuity was vital for good quality care



Results (3/3)

• Professionals perceived serious mental illness as a lifelong condition

• Patients emphasised the importance of optimism in treatment and hope for recovery

• Both thought that structured reviews for people with serious mental illness (for example: annual check-up) is a good concept



Discussion

• Combined FG = a strength• Patient – GP hierarchy ? Seems that not.• Only 8 % of invited professionals agreed to

participate• Very important study for the health care system



Intuitive critic



Reading framework

• Validity: appropriateness of the chosen method, purposeful sampling, triangulation, respondent validation

• Reliability: analysis and interpretation, theoretical models

• Relevance• Reflexivity• Transferability

CUMG.NET \ nouvelle version \ Journal Club Journal Club cumg UCL 24th June 2005 Valérie Dory...

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