Carer Expectations Research Articles

Service User and Carer Views and Expectations of Mental Health Nurses: A Systematic Review.

Service users’ views and expectations of mental health nurses in a UK context were previously reviewed in 2008. The aim of this systematic review is to extend previous research by reviewing international research and work published after the original review. Five databases were searched for studies of any design, published since 2008, that addressed service user and carer views and expectations of mental health nurses. Two reviewers independently completed title and abstract, full-text screening and data extraction. A narrative synthesis was undertaken. We included 49 studies. Most included studies (n = 39, 80%) were qualitative. The importance of the therapeutic relationship and service users being supported in their personal recovery by mental health nurses were core themes identified across included studies. Service users frequently expressed concern about the quality of the therapeutic relationship and indicated that nurses lacked time to spend with them. Carers reported that their concerns were not taken seriously and were often excluded from the care of their relatives. Our critical appraisal identified important sources of bias in included studies. The findings of our review are broadly consistent with previous reviews however the importance of adopting a recovery approach has emerged as a new focus.

Carer involvement in the transition from inpatient to community mental healthcare: Experiences of stakeholders

IntroductionThe involvement of informal carers (family and friends) in the care of people with severe mental illness (SMI) contributes to positive clinical outcomes, such as relapse prevention and symptom reduction. To date, the care pathway between inpatient and community care is not clearly defined impeding the smooth transition for patients, whilst carers are still barely involved in shared decision-making processes.ObjectivesTo investigate the views and experiences of patients with SMI, carers and clinicians regarding the transition from inpatient to community mental health services.MethodsFour mixed focus groups were conducted with individuals with SMI (n=12), carers (n=10) and clinicians (n=9) across four different mental health catchment areas in England. Participants discussed their experiences and provided their views on facilitators, barriers and solutions for carer involvement during the transition between mental health services. Data were analysed using thematic analysis.ResultsAll stakeholders highlighted that factors that impede carer involvement are related to: confidentiality issues, unmet (structural and organisational) needs, and carer expectations. Patients with SMI, carers and clinicians agreed that carer involvement can be improved by providing psychoeducation to carers and training to staff, having accessible and transparent clinical procedures, and allocating specialised staff to carers.ConclusionsThe study findings emphasise that carer involvement is still overlooked, particularly when adults with SMI transition between services. The results provide guidance for practice emphasising the need for systematic involvement of carers across inpatient care, and for future research proposing effective ways of maximising carer involvement in mental health care.DisclosureNo significant relationships.

265 Use of support vector machine to predict discharge destination on an acute stroke ward

BackgroundPredicting the discharge destination of stroke patients at admission is important for stream- lining of services, management of patient and carer expectations, and the planning and facilitating of discharge to appropriate destinations.MethodsWe reviewed data from the Sentinel Stroke National Audit Programme (SSNAP) from a single acute stroke ward in South Wales. We analysed age, modified Rankin Scale (mRS) and National Institute of Health Stroke Scale (NIHSS) data using a multi-class Support Vector Machine (SVM) to train and test a model to predict discharge destination.ResultsData was extracted from 1131 patients with acute and subacute stroke admitted to an acute stroke unit between January 1st, 2015, and December 31st, 2016. Per-class sensitivity of the model for final destination or outcome was 0.89 for home, 0.6 community hospital, 0.75 inpatient rehabilitation, 0.45 death. Per-class positive predictive value (PPV) was 0.84 for home, 0.62 community hospital, 0.72 inpatient rehabilitation, 0.55 death.ConclusionFrom data that is available from simple assessments done in routine clinical pratice it is possible to identify patients with acute stroke for whom discharge home or inpatient rehabilitation is highly likely. Collaborations between clinicians and data scientists may help to maximise the value of clinical assessment tools that are already in widespread use.Tom.Hughes2@wales.nhs.uk

Preventive care for physical activity and fruit and vegetable consumption: a survey of family carer expectations of health service delivery for people with a mental health condition

BackgroundChronic disease is a leading cause of death globally, where inadequate fruit and vegetable consumption and inadequate physical activity are consistently implicated as key contributing risk factors for such diseases. People with a mental health condition are reported to experience a higher prevalence of such risks and experience an increased morbidity and mortality from resultant chronic disease. Despite guidelines identifying a need for services accessed by people with a mental health condition to provide care to address such health risk behaviours, sub-optimal care is frequently reported suggesting a need for innovative strategies to increase the provision of physical health care. An exploratory study was conducted to examine: 1) family carers’ expectations of care provision regarding fruit and vegetable consumption and physical activity by health and community services for people with a mental health condition; 2) carer’s own health risk behaviour status and perceptions of the influence of the health risk behaviours on mental health; and 3) possible associations of socio-demographic, clinical and attitudinal factors with carer expectations of care provision for fruit and vegetable consumption and physical activity.MethodsFamily carers (n = 144) of a person with a mental health condition completed a cross-sectional survey. Participants were members of a mental health carer support organisation operating in New South Wales, Australia.ResultsA high proportion of participants considered care for fruit and vegetable consumption and physical activity respectively should be provided by: mental health hospitals (78.5, 82.7%); community mental health services (76.7, 85.9%); general practice (81.1, 79.2%); and non-government organisations (56.2, 65.4%). Most participants perceived adequate fruit and vegetable consumption (55.9%), and physical activity (71.3%) would have a very positive impact on mental health. Carers who perceived adequate fruit and vegetable consumption and physical activity would have a positive impact on mental health were more likely to expect care for such behaviours from some services.ConclusionsThe majority of participants expected care for fruit and vegetable consumption and physical activity be provided by all services catering for people with a mental health condition, reinforcing the appropriateness for such services to provide physical health care for clients in a systematic manner.

Identifying Priorities for Physiotherapy Research in the UK: the James Lind Alliance Physiotherapy Priority Setting Partnership

To identify unanswered questions for physiotherapy research and help set and prioritise the top 10 generic research priorities for the UK physiotherapy profession; updating previous clinical condition- specific priorities to include patient and carer perspectives, and reflect changes in physiotherapy practice, service provision and new technologies. The James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology was adopted, utilising evidence review, survey and consensus methods. Anyone with experience and/or an interest in UK physiotherapy: patients, carers, members of the public, physiotherapists, student physiotherapists, other healthcare professionals, researchers, educators, service providers, commissioners and policy makers. Five hundred and ten respondents (50% patients, carers or members of the public) identified 2152 questions (termed "uncertainties"). Sixty-five indicative questions were developed from the uncertainties using peer reviewed thematic analysis. These were ranked in a second national survey (1,020 responses (62% were complete)). The top 25 questions were reviewed in a final prioritisation workshop using an adapted nominal group technique. The top 10 research priorities focused on optimisation (top priority); access; effectiveness; patient and carer knowledge, experiences, needs and expectations; supporting patient engagement and self-management; diagnosis and prediction. This study is currently the UK's most inclusive consultation exercise to identify patients'and healthcare professionals'priorities for physiotherapy research. The exercise deliberately sought to capture generic issues relevant to all specialisms within physiotherapy. The research priorities identified a range of gaps in existing evidence to inform physiotherapy policy and practice. The results will assist research commissioning bodies and inform funding decisions and strategy.

General practice palliative care: patient and carer expectations, advance care plans and place of death—a systematic review

BackgroundWith an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important.ObjectiveTo...

Perceptions of barriers to the management of respiratory tract infections in general practice settings in Australia.

Inappropriate prescribing of antibiotics for the management of respiratory tract infections (RTIs) has contributed to increased prevalence of antibiotic resistance, and this remains a challenge. The aim of this study was to evaluate the effect of general practitioners' (GPs) participation in the Antibiotics: Clinical e-Audit, a quality-improvement activity, on GP self-reported knowledge and practice change, and explored barriers encountered in the management of respiratory tract infections (RTIs). Participants completed a survey at the end of the activity to assess the usefulness of the audit, any reported changes made and barriers encountered to their clinical practice. More than half of the 872 participants reported the audit assisted them in reviewing patients with RTIs. The majority of GP registrars (48.2%, N=66) indicated that the clinical e-Audit had changed their practice in terms of identifying patients for whom an antibiotic was recommended. GPs identified several barriers to achieving best practice in the management of RTIs, including patient or carer expectations for an antibiotic prescription and non-adherence to symptomatic management by patients. Empowering GPs to overcome these barriers should be the aim of future education and behaviour change programs.

Smoking Cessation Care for People with a Mental Illness: Family Carer Expectations of Health and Community Services

Introduction: Smoking prevalence remains high among people with a mental illness, contributing to higher levels of morbidity and mortality. Health and community services are an opportune setting for the provision of smoking cessation care. Although family carers are acknowledged to play a critical role in supporting the care and assistance provided by such services to people with a mental illness, their expectations regarding the delivery of smoking cessation care have not been examined.Aims: To explore family carer expectations of smoking cessation care provision by four types of health services, to clients with a mental illness, and factors associated with expectations.Methods: A cross-sectional survey was conducted with carers of a person with a mental illness residing in New South Wales, Australia. Carers were surveyed regarding their expectations of smoking cessation care provision from four types of health services. Possible associations between carer expectation of smoking cessation care provision and socio-demographic and attitudinal variables were explored.Results: Of 144 carers, the majority of carers considered that smoking cessation care should be provided by: mental health hospitals (71.4%), community mental health services (78.0%), general practice (82.7%), and non-government organisations (56.6%). The factor most consistently related to expectation of care was a belief that smoking cessation could positively impact mental health.Conclusions: The majority of carers expected smoking cessation treatment to be provided by all services catering for people with a mental illness, reinforcing the appropriateness for such services to provide smoking cessation care for clients in an effective and systematic manner.

Chronic disease risk behaviour care for people with a mental illness: family carer expectations

Background People with a mental illness experience an increased morbidity and mortality compared to the general population; a disparity largely due to increased chronic disease burden. Family carers are implicated as key stakeholders in mental health services, and policies outline the need to involve carers at every level of service planning and delivery; however, carer attitudes towards chronic disease risk behaviour care provision for people with a mental illness within health and community services has not previously been explored. Methods Family carers of people with a mental illness (N = 144), residing in New South Wales, Australia, completed a self-administered questionnaire regarding their expectations of the provision of chronic disease risk behaviour care (for nutrition, physical activity, alcohol, and smoking cessation) by four health and community services: mental health hospitals; community mental health services; general practice; and non-government organisations. Results Of participating carers, the majority expected each of the four services to provide care for: nutrition (56.3% - 81.1%); physical activity (65.4% - 85.9%); harmful alcohol consumption (63.0% - 83.1%); and smoking cessation (56.6% - 82.7%). Further, carers also perceived that having adequate nutrition (84.6%), engaging in adequate physical activity (91.6%), decreasing alcohol consumption (74.1%), and quitting smoking (61.9%) would positively impact mental health. Conclusions Participating carers perceived that improving chronic disease risk behaviours would positively impact mental health; and the majority expected the four health and community services to provide care for chronic disease risk behaviours; reinforcing the appropriateness and need for services to provide such care to all clients with a mental illness. Key messages: - Carers perceived improving risk behaviours would result in a positive impact on mental health for people with a mental illness; suggesting a potential for carers to support behaviour change - Carers expect health and community services to provide chronic disease risk behaviour care for clients with a mental illness; reinforcing the need for services to provide such care for all clients

Survey of parent and carer experiences and expectations of paediatric rheumatology care in New South Wales.

Objective The aim of the present survey of parent and carers was to document the level of care and services currently provided to children diagnosed with rheumatic diseases (RD) in New South Wales (NSW), Australia. Methods The survey included parents and carers of children presenting to paediatric rheumatology (PR) services in NSW. Subjects attending PR clinics in both public and private settings were invited to participate in an online or paper survey. Results Overall, 148 surveys were completed. The process of obtaining the diagnosis of RD was described as being 'difficult' or 'very difficult' by 56.1% (n=83) of the surveyed cohort, and 41.2% (n=61) saw four or more different clinicians before diagnosis. Between symptom onset and final diagnosis, 42.6% (n=63) of participants reported a delay of 5 months or more, and 16.9% (n=25) waited longer than 12 months. Eventually, 91% (n=134) were referred to a paediatric rheumatologist and 63.5% (n=94) were seen within 4 weeks from initial referral. More than half the respondents felt that general practitioners (GPs) and general paediatricians were not aware of RD. Overall, respondents felt that improved knowledge of PR diseases among GPs, improved access to PR clinics, improved educational materials for patients and families, access to speciality rheumatology nurses and coordinated rheumatology teams would have significantly improved the experience of their child's disease. Conclusions Children with RD in NSW still experience significant delays from symptom onset to final diagnosis through consultations with multiple healthcare professionals. Multidisciplinary team care was not the norm for this patient group, despite established national and international management standards. What is known about the topic? Early diagnosis and management by a multidisciplinary team is the gold standard in PR management. Delays in diagnosis may significantly impair the outcomes of children diagnosed with RD, with reduced quality of life, increased pain level and worse long-term prognosis. What does this paper add? Children diagnosed with RD in NSW endure significant delays from symptom onset until a final diagnosis is made, with multiple consultations with different healthcare professionals. When the referral to PR services in NSW is made, RD children are mostly seen within 4 weeks, faster than other international standards. GPs and paediatric rheumatologists in NSW helped improve the children's and their family's experience of the diagnosis and treatment of a rheumatic condition and better informed them using appropriate educational materials. What are the implications for practitioners? This paper provides new evidence to practitioners to increase their knowledge of the current experiences and expectation of the paediatric rheumatology care in NSW.

Methods of information provision for the 1st therapeutic leave after brain injury – Opinions of patients and carers. Patient Education Program: Hemidom

To identify patient and carer expectations regarding information necessary for the first therapeutic leave. This is part of a Patient Education Program on therapeutic leave for patients with brain injury. Questionnaires designed by the multidisciplinary team were given to 30 hospitalised patients and their families before or after the first leave. A semi-quantitative, 4 level scale was used to evaluate the relevance of information received before the first leave, and the choice of information methods. Twenty patients (5 before and 15 after the first leave) and 16 carers (5 before and 11 after) filled in the questionnaire. The results highlighted a need for information on medication (15/20; 75% patients–12/16; 75% carers) and what to do if a problem arose (11/20; 55% patients–11/16; 68.8% carers). Carers reported a need for information regarding emotional (12/16; 75%), cognitive and behavioural (10/16; 62.5%) disorders. Discussion with a professional was the preferred method of information (7/17; 41.2% patients–10/16; 62.5% carers) followed by an information leaflet (5/17; 29.4% patients–3/16; 18.8% carers) and a presentation by a professional (4/17; 23.5% patients–2/16; 12.5% carers). These methods were preferred to a presentation from a professional from out with the hospital (1/1; 5.9% patients–1/16; 6.3% carers). The sub-group of patients who had not yet been on leave preferred the information leaflet (2/5; 40.0%). The study highlighted the benefit of discussion time with a professional to prepare the first therapeutic leave. Patient education is thus relevant in this context and follows the recommendations of the French Health Authority (HAS1).

WITHDRAWN: Arthroplasty versus fusion in single-level cervical degenerative disc disease.

Background There is ongoing debate about whether fusion or arthroplasty is superior in the treatment of single level cervical degenerative disc disease. Mainly because the intended advantage of arthroplasty over fusion, that is, the prevention of symptoms due to adjacent segment degeneration in the long term, is not confirmed yet. Until sufficient long‐term results become available, it is important to know whether results of one of the two treatments are superior to the other in the first one to two years. Objectives To assess the effects of arthroplasty versus fusion for radiculopathy or myelopathy, or both due to single level cervical degenerative disc disease. Search methods We searched the following databases for randomised controlled trials (RCTs): CENTRAL (The Cochrane Library 2011, Issue 2), MEDLINE, EMBASE, and EBMR. Additionally, we searched the System for Information on Grey Literature (SIGLE), subheading Biological and Medical Sciences, the US Food and Drug Administration (FDA) database on medical devices, and Clinicaltrials.gov to identify trials in progress. We also screened the reference list of all selected papers. Date of search: 25 May 2011. Selection criteria We included RCTs that directly compared any type of cervical fusion with any type of arthroplasty, with at least one year of follow‐up. Primary outcomes were arm pain, neck pain, neck‐related functional status, patient satisfaction, neurological outcome, and global health status. Secondary outcomes were the presence of (radiological) fusion, revision surgery at the treated level, secondary surgery on adjacent levels, segmental mobility of treated and adjacent levels, and work status. Data collection and analysis Study selection was performed independently by three review authors, and 'Risk of bias' assessment and data extraction were performed by two review authors. In case of missing data or insufficient information for a judgement about risk of bias, we tried to contact the study authors or the study sponsor. The data were entered into RevMan by one review author and subsequently checked by a second review author. We assessed the quality of evidence using GRADE. We analysed heterogeneity and performed sensitivity analyses for the pooled analyses. Main results We included nine studies (2400 participants), five of which had a low risk of bias. Eight of these studies were industry sponsored. The most important results showed low‐quality evidence for a small but significant difference in alleviation of arm pain at one to two years in favour of arthroplasty (mean difference (MD) ‐1.54; 95% confidence interval (CI) ‐2.86 to ‐0.22; 100‐point scale). A small study effect could not be ruled out for this outcome in the sensitivity analyses. This means that smaller studies (or small published subsets of larger studies) showed larger differences for this outcome, which may indicate publication bias. Also, moderate‐quality evidence showed a small difference in neck‐related functional status at one to two years in favour of arthroplasty (MD ‐2.79; 95% CI ‐4.73 to ‐0.85; 100‐point scale) and a small difference in neurological outcome in favour of arthroplasty (risk ratio (RR) 1.05; 95% CI 1.01 to 1.09). These two outcomes were robust to sensitivity analyses. For none of the primary outcomes, was a clinically relevant difference shown. Additionally, there was high‐quality evidence for a large, statistically significant difference in segmental mobility at one to two years (measured as degrees segmental range of motion) at the treated level (MD 6.90; 95% CI 5.45 to 8.35). There was low‐quality evidence that there was no statistically significant difference in secondary surgery at the adjacent levels at one to two years (RR 0.60; 95% CI 0.35 to 1.02). The latter was not robust to sensitivity analyses. Authors' conclusions There was a tendency for clinical results to be in favour of arthroplasty; often these were statistically significant. However, differences in effect size were invariably small and not clinically relevant for all primary outcomes. Significance was often gained or lost in the varying sensitivity analyses, probably owing to the relatively small number of studies, in combination with the small differences that were found. Given the fact that all of the included studies were not blinded, this could be due to patient or carer expectations. However, at this time both treatments can be seen as valid options with respect to results at a maximum of one to two years. Given the current absence of truly long‐term results, use of these mobile disc prostheses should still be limited to clinical trials. There was high‐quality evidence that the goal of preservation of segmental mobility in arthroplasty was met. A statistically significant effect on the incidence of secondary symptoms at adjacent levels, the primary goal of arthroplasty over fusion, was not found at one to two years. If there was a protective effect, this should become clearer over time. A future update, when studies with 'truly long‐term' results (five years or more) become available, should focus on this issue.

MAXimising Involvement in MUltiMorbidity (MAXIMUM) in primary care: protocol for an observation and interview study of patients, GPs and other care providers to identify ways of reducing patient safety failures

IntroductionIncreasing numbers of older people are living with multiple long-term health conditions but global healthcare systems and clinical guidelines have traditionally focused on the management of single conditions. Having two...

A Pilot Study of Associations Between Treatment for Anorexia Nervosa and Carers' Distress

In order to investigate the degree to which symptom reduction in the treatment of adults with anorexia nervosa (AN) impacted on their carers' psychological distress, we examined 12 participants in an outpatient treatment trial and their nominated 'significant other'. Measures of eating psychopathology in the person being treated for AN were collected on six occasions: baseline, session 4, session 10, session 25 (end of treatment), and at three-month and 12-month follow-up. At these same time points, measures of psychological distress were collected from carers. Early significant reductions in eating psychopathology were found in the AN group at session 4, whereas significant reductions in carers' distress were found at three-month follow-up and maintained at 12-month follow-up. These reductions were moderated by baseline body mass index of the person with AN. Carers whose significant other had a lower BMI at baseline received most benefit in terms of symptom reduction at 12-month follow-up. Clinical implications include the need to provide more direct support to carers in order to achieve more clinically significant reductions in distress, and the need to discuss a carer's expectations of the recovery process. Only 61% of adults being treated for anorexia nervosa (AN) were willing to allow their carer to be contacted by researchers in order to ask them to complete questionnaires over the duration of treatment and follow-up. Significant reductions in eating psychopathology from those being treated for AN was followed by significant reductions in their carers' distress some 12 months later. Reductions of carers' distress was associated with only a small effect size and may indicate that more clinically significant reductions requires individualised support for the carers. Carers whose significant other had a lower body mass index at baseline received most benefit in terms of symptom reduction at 12-month follow-up, which may indicate a need to clarify a carer's expectations of the recovery process.

Prescribed antimicrobial therapy: what parents/carers are told and what they would like to know

AimsThe aims of this study were to:Assess the drug related information provided to parents/carers of children prescribed an antibiotic during their in-patient stay and as part of the discharge process...

The needs of informal carers for people with dementia

There are approximately 800 000 people with dementia in the UK. Dementia is debilitating, not only for sufferers, but also for their informal carers. Drawing on qualitative research, this article considers issues that health and social care practitioners need to take in account so that they can appropriately provide and target their support for informal carers of people with dementia. Specifically, this article considers carer's experiences and expectations of social/informal support and the ways in which they engage with statutory and voluntary sector support. The article highlights that individual carers have different resources to draw upon and it should not be assumed that they will be supported by family and friends. Carers may also have negative experiences of support from formal service providers characterised by a poor provision of information regarding the support services. Health and social care practitioners should not assume that carers are able to discover this information themselves. In sum, practitioners need to be aware of the support needs of not only people with dementia but also their carers.

Stroke survivor and carer perspectives of the concept of recovery: a qualitative study

Purpose: This study was designed to explore the concept of recovery from the perspectives of stroke survivors and informal carers. The aim of this qualitative study was to identify the main factors that are perceived to contribute to recovery after stroke. Method: Data were obtained via focus groups using semistructured questionnaires. One focus group included all participants (n = 14). This was followed by separate focus groups for stroke survivors (n = 8) and informal carers (n = 6). The data from the three focus groups were analysed using thematic analysis, whereby themes and sub-themes were identified and summarised via dual coding. Results: The main theme identified was “individual recovery expectations”. The contributing sub-themes were: “essential elements of recovery”, “returning home” and “the environment of rehabilitation”. The predominant factors to arise from this study surround the concepts of “returning to normality” for the stroke survivor and the “tension of providing care” for informal carers. Conclusions: This study provides a current description of stroke survivor and carer expectations of recovery. There are diverse and ongoing concerns that can be encountered into the chronic phase poststroke. Models of community-based care should adopt targeted interventions that concurrently consider stroke survivor and carer’s individual concepts of recovery.Implications for RehabilitationThe concept of recovery can differ for stroke survivors, carers and the health professionals that they encounter.As it is an individual phenomenon, many factors comprise the notion of recovery.Health professionals need to explore stroke survivor and carer’s views about their concepts of recovery, as greater awareness and attention may maximise individual poststroke potential.

Whose Outcomes are They Anyway? Report of the Pilot Evaluation of a Joint Service

Health and social care partnership working is often predicated on the notion that it improves outcomes for service users. Yet there is a lack of evidence linking partnerships to changes in outcomes. Against this background, the Health Services Management Centre at the University of Birmingham designed the Partnership Outcomes Evaluation Toolkit (POET) specifically to evaluate health and social care partnerships in terms of service user outcomes. This paper reports on the field testing of POET with Sandwell Integrated Support Service. This research provided a number of interesting insights into this service, and indicated some dissonance between staff and service user and carer expectations.

Home Assessment Visits within the Acute Setting: a Discussion and Literature Review

The emphasis on the effective and efficient use of finite resources within acute hospitals has led to close attention being paid to the length of patients' hospital stay and the assessment of risk in facilitating timely hospital discharge. Occupational therapy home assessment visits are valued by the multidisciplinary team as a means of assessing a patient's level of function and environmental risk to ensure safe discharge from hospital. Occupational therapists' education and training and experience mean that they are well placed to predict levels of function postdischarge and to anticipate any problems that may occur in activities of daily living. However, for patients the home assessment visit can be a stressful and bewildering experience. The short-term focus on equipment provision combined with limited postdischarge intervention may not meet patient and carer expectations or concerns with longer-term issues. Although there is a body of evidence to support this intervention, the requirement for evidence-based practice means that there is a need for additional research around the areas of optimal timing, selection of patient groups, therapist's rationale, patient and carer perspectives and any effect that home assessments may have on readmission rates. This paper discusses the literature in relation to the practice of home assessment visits from the acute setting.

A preliminary investigation of patient and carer expectations of their general practitioner in longer-term stroke care.

A preliminary investigation of patient and carer expectations of their general practitioner in longer-term stroke care.