Help Seeking and Access to Primary Care for People from “Hard-to-Reach” Groups with Common Mental Health Problems

Bristow, Katie; Edwards, Suzanne; Funnel, E; Fisher, Louise; Gask, Linda; Dowrick, Christopher; Graham, Camille

doi:10.1155/2011/490634

Cited by 39 publications

(49 citation statements)

References 28 publications

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“…Of equal importance is the preference of many to recommend help-seeking from GPs. Primary care providers are often the first point of contact for many people with mental illness (Bristow et al, 2011) and they can also act as gatekeepers to other services.…”

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confidence: 99%

Help‐seeking beliefs for mental disorders among medical and nursing students

Seow

Chua

Mahendran

et al. 2018

Early Intervention Psych

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Medical and nursing students most commonly recommended seeking help from a psychiatrist for mental health-related problems, where help-seeking preferences were associated with various age, academic year and vignette type. As these students will be the future medical and nursing workforce, they need to be equipped with the skills and ability to recognize signs and symptoms of mental illness, to aid timely and appropriate treatment for people with mental illness.

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confidence: 99%

Help‐seeking beliefs for mental disorders among medical and nursing students

Seow

Chua

Mahendran

et al. 2018

Early Intervention Psych

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“…It contributes to a growing body of research emphasising the social processes of help-seeking, and the expertise patients bring to decision-making around health-care use. 286,287 When patients with LTCs feel vulnerable in health crises, it is their previous experience of services that shapes their perception of candidacy and thus their choice of service to access, with patterns of under-or over-use of services becoming established recursively based on these responses. This is consistent with the ACMs and SNs who described making their systems permeable so that patients used them instead of unscheduled care.…”

Section: Use Of Unscheduled Care: Perspectives Of Patients and Healthmentioning

confidence: 99%

CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

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BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…Most older people manage their feelings of distress on their own and do not seek help from healthcare services 10 . This could be because older adults do not recognise distress as a biomedical problem and do not view biomedical treatments as appropriate 11 . Through exploring lay perspectives on the solutions offered by GPs to patients experiencing distress, Geraghty et al 12 reported that GPs primarily offered reassurance, time off work or medication to help them to sleep.…”

Section: Introductionmentioning

confidence: 99%

How do older adults understand and manage distress? A qualitative study

Moult

Kingstone

Chew‐Graham

2020

Preprint

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Background Distress is an expected emotional response to a negative life event. Experiences common in later life may trigger distress such as bereavement or loss of physical mobility. Distress is considered to be distinct to anxiety and/or depression and is not diagnostically labelled as a mental health problem. Older adults will often manage their own distress. Previous literature has focused on how younger adults self-manage mental health problems, however little research has explored the self-management strategies used by older people. There is a need to clarify the role of primary care in the context of distressed older adults who may consult healthcare services. This study seeks to address these gaps through qualitative methods. Methods This study was approved by Keele University’s ethical review panel. Older adults who self-identified as distressed were recruited from community groups in North Staffordshire, England. Data were generated through semi-structured interviews and analysed thematically using constant comparison methods. A patient and public involvement and engagement group contributed to development of the research questions and methods, and offered their perspectives on the findings. Results Data saturation was achieved after 18 interviews. Key themes were: experiences of distress, actions taken, help-seeking from healthcare services and perceptions of treatments offered in primary care. Various forms of loss contributed to participants’ distress. Participants initiated their own self-management strategies which included: pursuing independent activities, seeking social support and attending community groups and church. Five participants reported having consulted a GP when distressed but described a lack of acceptable treatments offered. Conclusions To support older adults who are distressed, healthcare professionals in primary care should consider exploring how patients currently manage their mood problems, provide a broad range of information about potential management options and consider sign-posting older adults to community resources.

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Help Seeking and Access to Primary Care for People from “Hard-to-Reach” Groups with Common Mental Health Problems

Cited by 39 publications

References 28 publications

Help‐seeking beliefs for mental disorders among medical and nursing students

Help‐seeking beliefs for mental disorders among medical and nursing students

CHOICE: Choosing Health Options In Chronic Care Emergencies

How do older adults understand and manage distress? A qualitative study

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