This study set out to examine the impact of a health and personal development programme (the Social, Personal and Health Education Programme) which had been ‘enhanced’ by the addition of a mental health promotion component. Students aged 12–16 years attending 17 secondary schools were randomly allocated as clusters to participate in either the standard programme (SP) or the enhanced programme (EP). Both programmes were delivered over an eight-month period. Questionnaires assessing help-seeking, emotional and behavioural difficulties and students’ views of school social environment were completed by students in both groups at pre-intervention, post-intervention and at six-month follow-up. One thousand and seventy-two students participated. Analyses were carried out on the 782 students (72.9%) for whom data were available at all three time points. Both groups showed improvement over time in terms of emotional and behavioural difficulties, with male students identified as ‘at risk’ in the EP showing significantly greater improvements than males ‘at risk’ in the SP. Although there were few differences in outcomes between the groups, males identified as ‘at risk’ appeared to benefit selectively from the EP.
Management and referral guidelines are effective in improving patient access and the ratio of appropriate to unnecessary referrals. Such guidelines are well accepted and used by primary care practitioners in this setting.
OBJECTIVE AND DESIGN: A prospective evaluation of the effectiveness of otolaryngology evaluation, treatment, and referral guidelines developed collaboratively by otolaryngologists and primary care physicians on referrals and access to otolaryngology. Comparisons of appropriate to unnecessary referrals, the percentage of patients referred with disorders addressed to those without disorders addressed in the guidelines, access to otolaryngology, and questionnaire evaluations of primary care physician and patient satisfaction were measured before and after guideline implementation.
RESULTS: A significant decrease in appropriate to unnecessary referrals was seen, from 55% before to 12% after guidelines. The percentage of patients seen within 1 month of scheduling improved from 39% to 59%. Guideline-addressed disorders decreased from 63% to 40%. The need for patients to see another physician for the referred symptom while waiting to see an otolaryngologist decreased from 31 % to 3%. Patient satisfaction with wait times improved. Eighty-six percent of the primary care physicians used the guidelines, and 85% wanted to expand the guidelines to other specialty areas.
CONCLUSIONS: Management and referral guidelines are effective in improving patient access and the ratio of appropriate to unnecessary referrals. Such guidelines are well accepted and used by primary care practitioners in this setting.
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