Anticipatory care in very deprived areas

Watt, Graham

doi:10.3399/bjgp11x561401

Cited by 3 publications

(6 citation statements)

References 2 publications

(1 reference statement)

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“…In other words, this first attempt at engagement was indicative of a fundamentally limited response to the scale of the social determinants of health that offers little in tackling health inequalities. Watt (2011) argues, for example, that screening approaches such as KW fail to recognise the long-term, nuanced and contingent work that is involved in shifting patients from reactive to proactive modes of health-seeking enquiry and reminds us that it was this kind of approach which informed the work of Julian Tudor-Hart. Nevertheless, pilot areas did learn quickly that traditional methods of reach were inadequate and developed new approaches which, over the course of time, took many managers and practitioners to the stage of utilising more user-focused means of engagement.…”

Section: Discussionmentioning

confidence: 99%

Reaching the Hard-to-Reach: Conceptual Puzzles and Challenges for Policy and Practice

Mackenzie

Reid²,

Turner³

et al. 2012

J. Soc. Pol.

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The concept of systematic inequalities in social and health outcomes has come to form part of contemporary policy discourse. This rhetoric is deployed even in the face of policy decisions widely viewed as iniquitous. Moreover, there is a widespread view, expressed across the political spectrum, that those in more deprived circumstances are less likely than their more affluent counterparts to be in receipt of optimal public services. Such individuals and communities are variously described as excluded, disadvantaged, underserved or hard to reach. Across countries and policy domains the term ‘hard to reach’ is used to refer to those deemed not to be in optimal receipt of public sector services which are intended to increase some aspect of material, social or physical wellbeing. It is increasingly used in health policy documents which aim to address health inequalities. However, it is an ill-defined and contested term. The purpose of this paper is two-fold. First, it offers a critical commentary on the concept of hard-to-reachness and asks: who are viewed as hard to reach and why? Second, using a case-study of a Scottish health improvement programme that explicitly aims to reach and engage the ‘hard to reach’ in preventive approaches to cardiovascular disease, it tests the policy and practice implications of the concept. It finds that a lack of conceptual clarity leads to ambiguous policy and practice and argues for possible theoretical refinements.

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Section: Discussionmentioning

confidence: 99%

Reaching the Hard-to-Reach: Conceptual Puzzles and Challenges for Policy and Practice

Mackenzie

Reid²,

Turner³

et al. 2012

J. Soc. Pol.

View full text Add to dashboard Cite

show abstract

“…[35][36][37] It has been suggested that a health check approach is 'simplistic and flawed, in relation to the needs of patients with complex needs' as it does not address the long-term needs of patients. 1 The present study found that Keep Well was developing a system-wide approach, which was attempting to integrate approaches addressing both the health and social determinants of inequalities. However, the extent to which health services, such as general practice and health promotion, integrate and collaborate with non-health services, such as employment advice and literacy services, was dependent on previous relationships and collaborations within a geographical area.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…[29][30][31] However, many practitioners felt that the focus on patients aged 45-64 years was too late and that activity should focus on younger patients, especially in deprived areas, where (as already commented on) poorer health and health-related behaviours are already entrenched. 1 Keep Well was designed to address disparities in CVD, 12 by reducing the gap in health between the most deprived and more affluent populations. However, at least two approaches developed across the pilot sites: some practices focused only on the most deprived patients within their population, while others encouraged all patients within the eligible age range to attend for a health check.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…However, the implementation of primary prevention strategies can result in tensions between population-based public health activity, such as the identification of at-risk populations and screening of those individuals, and the care of individuals at the level of the consultation. 1 An additional problem is that individuals from lower socioeconomic groups are less likely to participate in preventive programmes, thus exacerbating inequalities in health and healthcare use. 2,3 While this may be an issue at the public health level, Watt argues that it is not such a problem at the level of primary care, where patients living in areas of deprivation build up longstanding relationships with their practice through repeated access to and use of primary care services.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 While this may be an issue at the public health level, Watt argues that it is not such a problem at the level of primary care, where patients living in areas of deprivation build up longstanding relationships with their practice through repeated access to and use of primary care services. 1 While prevention programmes may aim to tackle inequalities in health, such approaches often focus on the medical aspects of care, ignoring the fact that health inequalities are clearly intertwined with social determinants of health, including education, housing, employment, and income. [4][5][6] As a result, some argue that health services must be redesigned to address both sets of determinants.…”

Section: Introductionmentioning

confidence: 99%

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Delivering a national programme of anticipatory care in primary care: a qualitative study

O’Donnell

Mackenzie²,

Reid³

et al. 2012

Br J Gen Pract

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BackgroundPrimary prevention often occurs against a background of inequalities in health and health care. Addressing this requires practitioners and systems to acknowledge the contribution of health-related and social determinants and to deal with the lack of interconnectedness between health and social service providers. Recognising this, the Scottish Government has implemented a national programme of anticipatory care targeting individuals aged 45-64 years living in areas of socioeconomic deprivation and at high risk of cardiovascular disease. This programme is called Keep Well. AimTo explore the issues and tensions underpinning the implementation of a national programme of anticipatory care. Design and settingA qualitative study in five Wave 1 Keep Well pilot sites, located in urban areas of Scotland, and involving 79 general practices. MethodAnnual semi-structured interviews were conducted with 74 key stakeholders operating at national government level, local pilot level and within general practices, resulting in 118 interviews. Interview transcripts were analysed using the framework approach. ResultsFour underlying tensions were identified. First, those between a patient-focused generalpractice approach versus a population-level health-improvement approach, linking disparate health and social services; secondly, medical approaches versus wider social approaches; thirdly, a population-wide approach versus individual targeting; and finally, reactive versus anticipatory care. ConclusionImplementing an anticipatory care programme to address inequalities in cardiovascular disease identified several tensions, which need to be understood and resolved in order to inform the development of such approaches in general practice and to develop systems that reduce the degree of fragmentation across health and social services. Keywordsanticipatory care; cardiovascular diseases; inequalities, health; primary prevention. decisionmaking.

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What do we know about who does and does not attend general health checks? Findings from a narrative scoping review

et al. 2012

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BackgroundGeneral and preventive health checks are a key feature of contemporary policies of anticipatory care. Ensuring high and equitable uptake of such general health checks is essential to ensuring health gain and preventing health inequalities. This literature review explores the socio-demographic, clinical and social cognitive characteristics of those who do and do not engage with general health checks or preventive health checks for cardiovascular disease.MethodsAn exploratory scoping study approach was employed. Databases searched included the British Nursing Index and Archive, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE), EMBASE, MEDLINE, PsycINFO and the Social Sciences Citation Index (SSCI). Titles and abstracts of 17463 papers were screened; 1171 papers were then independently assessed by two researchers. A review of full text was carried out by two of the authors resulting in 39 being included in the final review.ResultsThose least likely to attend health checks were men on low incomes, low socio-economic status, unemployed or less well educated. In general, attenders were older than non-attenders. An individual’s marital status was found to affect attendance rates with non-attenders more likely to be single. In general, white individuals were more likely to engage with services than individuals from other ethnic backgrounds. Non-attenders had a greater proportion of cardiovascular risk factors than attenders, and smokers were less likely to attend than non-smokers. The relationship between health beliefs and health behaviours appeared complex. Non-attenders were shown to value health less strongly, have low self-efficacy, feel less in control of their health and be less likely to believe in the efficacy of health checks.ConclusionRoutine health check-ups appear to be taken up inequitably, with gender, age, socio-demographic status and ethnicity all associated with differential service use. Furthermore, non-attenders appeared to have greater clinical need or risk factors suggesting that differential uptake may lead to sub-optimal health gain and contribute to inequalities via the inverse care law. Appropriate service redesign and interventions to encourage increased uptake among these groups is required.

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Anticipatory care in very deprived areas

Cited by 3 publications

References 2 publications

Reaching the Hard-to-Reach: Conceptual Puzzles and Challenges for Policy and Practice

Reaching the Hard-to-Reach: Conceptual Puzzles and Challenges for Policy and Practice

Delivering a national programme of anticipatory care in primary care: a qualitative study

What do we know about who does and does not attend general health checks? Findings from a narrative scoping review

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