Structuring health needs assessments: the medicalisation of health visiting

Cowley, Sarah; Mitcheson, Jan; Houston, Anna M.

doi:10.1111/j.0141-9889.2004.00403.x

Cited by 43 publications

(39 citation statements)

References 31 publications

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“…Although not identical, this shares many of the ideas and assumptions underlying the use of disease templates and indicators, introduced as part of the QOF in primary care, 284 which aim to provide a structure to the ways in which GPs monitor patients' lifestyle behaviours and prompt them to offer lifestyle advice to patients or to use structured needs assessments in social care and health visiting to ensure that certain topics are addressed with clients. 241,285 In summary, PROMs feedback is assumed to help clinicians monitor the impact of patients' treatment on their health, which in turn may lead to changes in treatment, referrals or further tests to explore the problem. It is thought that this in turn will lead to improved patient outcomes.…”

Section: Patient-reported Outcome Measures As Clinical Monitoring Toolsmentioning

confidence: 99%

“…302 Other studies have also highlighted the tensions between implementing standardised approaches to patient assessment and care and maintaining and building a relationship with patients. 241,284,285,368,369 Our review suggests that PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians' communication practices with patients. Patients valued both standardised and individualised PROMs as tools to do this, although our review also suggests that thought is required about which patients may benefit and which may not.…”

Section: Actionabilitymentioning

confidence: 99%

See 1 more Smart Citation

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

170

257

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BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Patient-reported Outcome Measures As Clinical Monitoring Toolsmentioning

confidence: 99%

Section: Actionabilitymentioning

confidence: 99%

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

170

257

View full text Add to dashboard Cite

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“…Hayter (2007) found that nurses' use of medico-statistical facts downgraded potential side effects. Cowley, Mitcheson, and Houston (2004) showed how the talk and work of home visiting nurses achieved the requirements of institutional agendas. 2.…”

Section: Problem Statementmentioning

confidence: 99%

Informing choice: The organization of institutional interaction in clinical midwifery care

McKenzie

2009

Library & Information Science Research

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Researchers in LIS have called for the study of the social practices out of which informing is achieved. This article analyzes the informed choice discussion (ICD) between midwives and childbearing women as a form of institutional interaction that accomplishes informing. The ICD institutionally presumes a woman to have information needs that must be met before she can make a decision. Conversation analysis, a method commonly used to study practitioner-client interaction but little used in LIS, is employed to identify the unique "fingerprint" of the ICD. Analysis shows how participants develop a joint sense of the interactional tasks of informing and deciding. As an ideal, informed choice divides the cognitive labor: informing is midwife-led and deciding is client-led. In practice, however, informing and deciding are intertwined to such an extent that their resolution is neither automatic nor straightforward but must be negotiated. To be accepted as adequate, a decision must also be deemed adequately informed. Difficulties in negotiating transitions can result in one speaker treating a decision as resolved while another treats it as still open. Analyzing the fingerprints of institutional informing interactions can provide a starting point for analyzing the interactional accomplishment of informing in other settings.

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“…Advocates of structured assessment tools emphasise how they are to be used in partnership with the patient who can be talked through a list of questions, prompts and triggers, which help the patient to think about their own needs (Cowley et al, 2004). Little is known about professionals' views and experiences of using assessment tools and some negative views have been reported about their use (Hughes et al, 2003;Baba et al, 2007).…”

Section: Introductionmentioning

confidence: 99%