Key Care Providers Research Articles

Priorities in healthcare provision in Parkinson's disease from the perspective of Parkinson Nurses: A focus group study

BackgroundThrough their expertise and diverse skills, Parkinson Nurses are key care providers for people with Parkinson's disease. They are seen as an important profession for person-centered and multidisciplinary care, considered priorities in Parkinson's care delivery. Currently, however, little is known about the priorities that this profession itself defines for the care of Parkinson's patients and how they perceive their own role in the care process. ObjectiveTo explore the perspective of Parkinson Nurses on care priorities in people with Parkinson's disease. DesignQualitative study. Setting(s)The iCare-PD study served as the object of study by establishing an interdisciplinary, person-centered and nurse-led care model in several European countries and Canada. The nurses who participated in this model were part of the study. ParticipantsSix Parkinson Nurses participated in the study. MethodsWe conducted a thematic focus group, adopting the paradigm of pragmatism to draft an interview guide. The focus group was based on the inspiration card method and followed recommendations for co-creation processes. ResultsParkinson Nurses define care priorities for Parkinson's in areas of education, multi-professionalism, and need-orientation. They see themselves as mediators and coordinators of care delivery processes. ConclusionsIn line with international recommendations, Parkinson Nurses prioritize key aspects of multidisciplinary and person-centered care. At the same time, however, the nurses also name care priorities that go beyond the international recommendations. It is therefore crucial to integrate the perspective of this important profession into recommendations for the delivery of healthcare for people with Parkinson's.Tweetable abstract How do specialized nurses define priorities for person-centered Parkinson's care? Answers are sought in this qualitative study by @MarlenaMunster.

Burnout and Resiliency Among Advanced Practice Providers in Oncology Care.

Occupational exhaustion, or burnout, is characterized with three components: emotional exhaustion, depersonalization, and sense of decreased personal accomplishment. Advanced practice providers (APPs) in oncology care are at particular risk for burnout. This was a prospective, comparative, descriptive study utilizing a convenience sample of oncology APPs who completed the Advanced Practice Provider Oncology Web Education Resource (AP-POWER; formerly Oncology Nurse Practitioner Web Education Resource, or ONc-PoWER), developed to provide educational content for new oncology APPs. The study purpose was to utilize the AP-POWER alumni to describe the level of burnout (Maslach Burnout Inventory) as well as resilience (Brief Resilience Scale) after at least 1 year in oncology practice, and to compare these scores according to the number of APP oncology practice years. Of the 133 questionnaires emailed, 30 were returned (22.6% response) and 27 completed (20.3%). Within the Maslach Burnout Inventory, the mean score of the emotional exhaustion subscale was 25.19 (standard deviation [SD] 12.74; high degree of occupational exhaustion), depersonalization 7.74 (SD 5.98; moderate degree), and personal achievement 31.85 (SD 6.20; low degree). The resilience scores had a mean of 22.52 (SD 3.37; normal range). Resiliency was positively associated with personal accomplishment. There was no difference in burnout among newer (< 3 years) and more experienced (> 3 years) oncology APPs. Oncology APPs report key indications of burnout, including a high degree of emotional exhaustion and moderate depersonalization, which was not mitigated through resiliency. The results are worrisome. Burnout scores for oncology APPs are high. Resiliency is present but is not protective for burnout. Strategies must be developed institutionally to support these key cancer care providers.

Optimizing chronic healthcare payment scheme: integrating patient effort in service pricing for enhanced self-management performance

PurposeThe study aims to address a critical gap in existing healthcare payment schemes and care service pricing by recognizing the influential role of patients' decisions on self-management efforts. These decisions not only impact health outcomes but also shape the demand for care, subsequently influencing care costs. Despite the significance of this interplay, current payment schemes often overlook these dynamics. The research focuses on investigating the implications of a novel behavior-based payment scheme, designed to align incentives and establish a direct connection between patients' decisions and care costs. The primary objective is to comprehensively understand whether and how this innovative payment scheme structure influences key stakeholders, including patients, care providers, insurers and overall social welfare.Design/methodology/approachIn this paper, we propose a game-theoretical model to incorporate the performance of self-management with the demand for healthcare service, compare the patient's effort decision for self-management and provider's price decision for healthcare service under a behavior-based scheme with that under two implemented widely payment schemes, that is, co-payment scheme and co-insurance scheme.FindingsOur findings confirm that the behavior-based scheme incentives patient self-management more than current schemes while reducing their possibility of seeking healthcare service, which indirectly induces the provider to lower the price of the service. The stakeholders' utility under various payment schemes is sensitive to the cost of treatment and the perceived health utility of patients. Especially, patient health awareness is not always benefited provider profit, as it motivates patient self-management while diminishing the demand for care.Originality/valueWe provide a novel framework for characterizing behavior-based payment schemes. Our results confirm the need for modification of the current payment scheme to incentivize patient self-management.

Primary care physicians' perspectives on the identification and management of postnatal mental health problems.

Postnatal mental health problems (PMHPs) are prevalent and negatively affect mothers, children, and society. International and local guidelines recommend that Singapore primary care physicians (PCP) screen, assess, and manage mothers with PMHPs. However, little is known about their experiences and views. We conducted semi-structured interviews with 14 PCPs in Singapore. Interview questions elicited perspectives on the identification and management of mothers with PMHPs. The interview guide was developed from a conceptual framework incorporating the knowledge-attitudes-practices, self-efficacy, and socio-ecological models. Interviews were audio-recorded and transcribed. Thematic analysis was used to identify emergent themes. Singapore PCPs viewed themselves as key providers of first-contact care to mothers with PMHPs. They believed mothers preferred them to alternative providers because of greater accessibility and trust. In detection, they were vigilant in identifying at-risk mothers and favoured clinical intuition over screening tools. PCPs were confident in diagnosing common PMHPs and believed that mothers not meeting diagnostic criteria must be readily recognized and supported. In managing PMHPs, PCPs expressed varying confidence in prescribing antidepressants, which were viewed as second-line to supportive counselling and psychoeducation. Impeding physician factors, constraining practice characteristics and health system limitations were barriers. Looking forward, PCPs aspired to leverage technology and multidisciplinary teams to provide comprehensive, team-based care for the mother-child dyad. Singapore PCPs are key in identifying and managing mothers with PMHPs. To fully harness their potential in providing comprehensive care, PCPs need greater multidisciplinary support and technological solutions that promote remote disclosure and enhanced preparation for their role.

The seeds of reform; the evolution of the alternative care system in the Maldives

This article will present the evolution of alternative care provision in the Maldives. The Maldives is a small island nation located in the Indian Ocean, with a population of around 530,000. Since the signing and ratification of the UNCRC in 1991, there have been many improvements in children’s lives; for example, progress has been made in school attendance, improved child literacy rates and infant mortality has been reduced significantly. However, the country still faces several challenges in terms of child welfare, including internal child trafficking, child abuse, neglect and child marriage. There are currently 187 children living apart from their families in alternative care, which accounts for 0.02% of children in the country. The predominant form of alternative care provision remains institutional, which is typified by large numbers of children cared for by relatively low numbers of care staff. The article will explain, how historically, when a child was unable to remain with their parents, informal kinship care was the predominant form of provision. Often this would result in grandmothers, aunts and the wider family/kinship groups looking after children. However, with the establishment of a large reformatory school Islaahiya in Male Atoll in 1979, residential care was created as an option for boys who were described as having behavioural issues. It remained a key alternative care provider in the country until it closed in 2013. In 2004, the state-run institution Kudakudhinge Hiya was established to care for 45 boys and girls from 0 to 9 years old. Then in 2016 with the support of the Qatar Foundation, the state built another institution Fiyavithi, which still cares for 80 children under 13 years of age. The article will conclude with an overview of the most recent developments in the Maldives’ alternative care system. It will highlight how the Child Rights Protection Act (2019) has sown the seeds of care reform with primary legislation enacting regulations for family-based provision. This has formalised the previously established foster care panel that was set up in 2012. There are now 18 registered formal foster carers across the Maldives who are caring for 16 children. Furthermore, in 2020 whilst waiting for the growth in foster care, the state government started to shift from large-scale institutions by establishing nine smaller institutions, located across the atoll, each caring for no more than 25 children. The ministry has also embarked on processes of family reunification. The article will critically discuss these developments, highlight the challenges experienced during these recent reforms and provide key messages for policy and practice going forward.

Seeking a connection: Women’s lived experience of the woman–midwife relationship in mainstream maternity services in Japan

ProblemIn Japan, women continue to suffer from mental health and other postpartum issues despite good clinical outcomes of maternity care. BackgroundAs key care providers, midwives potentially affect women’s overall birth experience. Most women in Japan give birth in hospitals or obstetric clinics where different midwives and nurses provide one woman with fragmented care. Women’s lived experiences of the woman–midwife in these birth facilities are not well known in Japan. AimTo understand women’s birth experience and relationship with midwives in the mainstream maternity care system in Japan to improve maternity care and women’s birth experience. MethodsFace-to-face individual interviews with 14 mothers were conducted. The data were analysed using van Manen’s hermeneutic phenomenological approach, which reveals the meaning of human experience in the everyday world. FindingsFour themes were derived from the hermeneutic phenomenological analysis; 1) Closed hearts and bodies in insecure relationships, 2) Alienation, 3) Hopelessness and helplessness, and 4) Women’s vulnerability and desire for positive relationships. DiscussionIn institutionalised and fragmented maternity care settings, it is difficult for women and midwives to develop a relationship. In such a care environment, women’s birth experience with midwives is negative or even traumatic; yet, women still need and seek the midwife relationship. Respectful care—necessary for women’s positive birth experience—requires positive relationship between women and midwives. ConclusionWomen’s negative birth experience may affect their mental health and parenting. Maternity and midwifery care in Japan needs to develop relationship-based care to improve women’s birth experience.

Primary care pharmacists’ knowledge and perception of Inflammatory Bowel Disease: a cross-sectional study in Australia.

Purpose: Inflammatory bowel disease (IBD) management is complex and challenging, and therefore, requires a multidisciplinary approach. Whilst pharmacists may play a key role as the first point of contact for patients with initial symptoms or disease relapse, there is scant literature on pharmacists’ knowledge in IBD management. We conducted a survey to explore pharmacists’ knowledge and their perception of pharmacists and other healthcare professionals’ roles in managing patients with IBD.Design and Methodology: An online survey was distributed to pharmacists through professional organisations. The survey included questions about demographic information, concepts related to IBD management and the roles of pharmacists and healthcare professionals in managing patients with IBD.Findings: Fifty two respondents completed the survey. The overall knowledge score for the majority of respondents was categorised as ‘low’ (25-50%) to ‘average’ (51-75%). IBD concept that demonstrated the highest level of accuracy in knowledge scores among pharmacists was the importance of vaccination in IBD (94.2%). Pharmacists who had exposure to patients with IBD demonstrated better knowledge scores compared to those who did not have any exposure to IBD patients in their practice (p = 0.005). Furthermore, General Practitioners (GPs) were perceived as the key care providers to IBD patients, whilst pharmacists considered themselves as important in providing medication related information to patients. Conclusion: This study indicated that pharmacists’ knowledge of IBD and its’ management was suboptimal, but with education and training there are opportunities for pharmacists to play a more active role in managing patients with IBD.

An exploration of maternity and newborn exposure, training and education among staff working within the North West Ambulance Service.

Providing emergency and urgent care to pregnant patients and newborns in the pre-hospital setting often presents some of the most challenging and complex incidents attended to by ambulance staff. A service evaluation survey was undertaken to explore current levels of maternity and newborn education, preferred methods of training delivery, exposure and perceived support surrounding maternity and newborn care provision among pre-hospital clinicians working within the North West Ambulance Service (NWAS) NHS Trust. An online, anonymised survey compromising of 22 questions using multiple choice options and free-text questions was circulated among NWAS staff between 27 May 2021 and 21 June 2021. Questions explored the levels of training, education, exposure and confidence relating to maternal and newborn care in the pre-hospital setting. Insights into preferred approaches to engaging with continuing professional development (CPD) activities were also captured. Data were analysed using built-in Microsoft Forms analytics for quantitative response, with a basic thematic analysis undertaken to synthesise qualitative responses. The survey received 509 responses, with data providing valuable insight relating to gaps in training provision, preferred approaches to CPD and barriers to engagement. Key themes focused on 'pre-registration standards and variations', 'barriers and facilitators to continuing professional development' and 'exposure and skill decline: confidence and knowledge'. Areas for service improvement are highlighted, providing ambulance trusts and integrated care systems with key recommendations. These include maternity and newborn standards for education among paramedic science degree programmes; recognition of pre-hospital emergency maternity and newborn care among maternity providers; the need for exposure and regular multidisciplinary team (MDT) skills training for staff; and a collaborative system-led approach to scaling up and delivering MDT training that acknowledges pre-hospital clinicians as key care providers.

Jak provozovat moderní výkonově orientovanou interní ambulanci

Outpatient internal medicine clinics as a key providers of health care are not in their best shape and are facing up to range of economical as well as staffing issues. If current status does not change, outpatient internal medicine can become marginal field of medicine. Article offers analysis of current situation and possible means of change.

Caring for patients with eating deficiencies in palliative care-Registered nurses' experiences: A qualitative study.

The aim was to explore RNs' experiences of caring for patients with eating deficiencies in palliative care. Food and mealtimes are fundamental aspects for wellbeing and social interactions. The worldwide trajectory of ageing populations may result in increased need for palliative care. Everyday life with chronic life limiting illness and eating deficiencies is challenging for patients and families. RNs are key care providers at end-of-life. A qualitative study with an inductive approach was used. Nineteen experienced RNs in palliative care were interviewed through telephone; interviews were audio recorded and transcribed verbatim. Inductive qualitative content analysis was performed, and the COREQ checklist was used to guide proceedings. The overarching theme, Supporting persons with eating deficiencies in-between palliative care and end-of-life care, is represented by three sub-themes: Easy to stick with doing, Just being, without doing, is hard and Letting go. Near end-of-life, eating symbolized social belonging and quality of life for RNs, whereas for patients and families, eating symbolized life. RNs tried practical solutions, however, not always according to patients' and families' preferences. RNs were well prepared to tackle physical inconveniences and provide support, however, less prepared to encounter existential, psychological and social issues in relation to eating deficiencies. Although RNs stated that human beings stop eating when they are about to die, letting nature run its' course and facilitating patients' transition to end-of-life care was challenging. Food and mealtimes represent fundamental aspects of human life and denote central parts in RNs clinical practice in palliative care. The findings can inspire development of a comprehensive palliative care approach to support patients and families. Structured reflection in relation to clinical practice may support and encourage RNs, caring for patients with eating deficiencies, in mastering both doing and being.

Recognition of risk and prevention in safeguarding of children and young people: a mapping review and component analysis of service development interventions aimed at health and social care professionals

BackgroundThe term ‘safeguarding’ covers the protection of health, wellbeing and human rights. Effective safeguarding enables people (particularly children, young adults and other vulnerable people) to live free from fear of abuse, harm or neglect. The UK Children Act 2004 required key agencies, including health and social care providers, to consider the need to safeguard children and promote their welfare. Within a larger evidence synthesis project, we sought to identify and map service development interventions (excluding provision of training) aimed at improving awareness of safeguarding and identifying at-risk children and young people in health and social care settings.MethodsWe searched fourteen health and social care databases from 2004 (date of Children Act) to October 2019 and updated the review via a citation search in March 2021.Studies of any design were eligible if they described or evaluated an intervention (other than training) aimed at health or social care professionals in the United Kingdom and designed to improve recognition of risk in the context of safeguarding children and young people. Studies with no intervention (e.g. qualitative studies) were included to explain why interventions work or fail to work. Included studies were summarised using narrative synthesis. Risk of bias of included studies and overall strength of evidence were assessed using standard methods. We used a 5-item checklist (“TIDieR-Lite”) to map intervention components.ResultsThirty-nine publications were included, of which 31 dealt with service developments, six with use of data and two with other initiatives. Promising service development initiatives include liaison nurses, assessment clinics, secondment, joint protocols and a ‘hub and spoke’ model. Initiatives involving use of routine data appeared promising and unlikely to generate significant additional costs. However, the quality of the evidence was generally low, with a shortage of controlled and long-term studies.ConclusionsHealth and social care services wishing to improve awareness of child safeguarding issues may benefit from looking beyond high-quality training provision. Future research should focus on service-relevant outcomes and ensure the active involvement of young people and their families/carers.

Traditional partería providing women's health care in Latin America: A qualitative synthesis.

To identify practices, beliefs, and potential gaps in knowledge about partería tradicional in Latin America. Partería tradicional (lay midwifery) refers to ancestral knowledge used by laypersons, mainly parteras tradicionales (lay midwives), to provide health care to women and children. This care, initiated prior to formalization of health care continues today. Descriptions of the intergenerational oral transmission of partería tradicional knowledge and practice in Latin America exist without related synthesis. Qualitative synthesis of the literature, including publications in Spanish, English, and Portuguese indexed in public databases over the previous 22 years concerning partería tradicional. Identification of categories, themes, and bias reporting via PRISMA processes, using the Thomas and Harden's approach and the Noblit and Hare's methodological recommendations. Partería tradicional themes included "ancestral knowledge," "destiny and a spiritual calling," "woma's heritage," and "a means for providing health care." Parteras tradicionales are key providers of health care for rural and urban marginalized communities. Limited knowledge and understanding of this practice impacts interactions between parteras tradicionales, midwives, and nurses. An interchange of knowledge is fundamental for care congruent with culture and the humanization of women's reproductive health. Communities with unresolved health care needs benefit via collaboration between formal health practices and partería tradicional. A compelling need for inquiry to preserve the art of partería tradicional exists internationally. Parteras tradicionales must be considered when formulating health care policy, thereby enhancing their historic role among the most vulnerable populations in Latin America: protecting, caring, and addressing health care needs.

Chaplain Training in Evidence-Based Practices to Promote Mental Health and Improve Care for Suicidality in Veterans and Service Members

Objective Chaplains are key care providers in a comprehensive approach to suicide prevention, which is a priority area for the U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD). In a cohort of 87 VA and military chaplains who completed the Mental Health Integration for Chaplain Services (MHICS) training–an intensive, specialty education in evidence-based psychosocial and collaborative approaches to mental health care–we assessed chaplains’ self-perceptions, intervention behaviors, and use of evidence-based practices, including Acceptance and Commitment Therapy (ACT), Problem-Solving Therapy (PST), and Motivational Interviewing (MI), in providing care for suicidality. Method Chaplains responded to a battery of items Pre- and Post-training and provided deidentified case examples describing their use of evidence-based practices in spiritual care for service members and veterans (SM/V) on various levels of a suicide prevention continuum. Results Post-training, chaplains reported increased abilities to provide care and mobilize collaborative resources. Over the course of MHICS, 87% of chaplains used one or more evidence-based practices with a SM/V at risk for suicide or acutely suicidal. Fifty-six percent of chaplains reported intervening with an acutely suicidal SM/V by using principles from ACT, 36% PST, and 48% MI. With persons at risk for suicide, 81% used principles from ACT, 66% PST, and 71% MI. Cases exemplified diverse evidence-based practice applications. Conclusions Findings indicate chaplains trained in evidence-based practices report effective application in caring for SM/V who are suicidal, thus offering a valuable resource to meet needs in a priority area for VA and DoD. HIGHLIGHTS Chaplains provide essential care for SM/V who are at risk for suicide or acutely suicidal Training helps chaplains mobilize interdisciplinary and community resources in suicide care Evidence-based practices can effectively integrate within the scope of chaplaincy practice for suicide care

Palliative Care: Oncology Nurses' Confidence in Provision to Patients With Cancer.

Oncology nurses are key providers of care to patients with cancer in all healthcare settings. However, little is known about oncology nurses' perceived confidence in providing all of the domains of palliative care. The objectives of this study were to examine oncology nurses' perceived confidence in providing palliative care to patients with cancer and to identify the association between nurses' demographic and professional characteristics and their perceived confidence. A descriptive correlational design was employed. The sample included RNs who provided care to patients with cancer and were members of the Oncology Nursing Society (ONS). Participants completed an online survey consisting of 14 demographic questions and a 50-item palliative care confidence scale. Three hundred sixty-six ONS members completed the survey. Results showed that most oncology nurses were confident to very confident in providing palliative care to patients with cancer, but they lacked confidence in providing the psychosocial, spiritual, and legal and ethical aspects of care. Years of experience as an oncology nurse and palliative care training were significantly associated with perceived confidence in providing palliative care.

Evidence-Based Practice for Non-Specific Low Back Pain: Canadian Physiotherapists' Adherence, Beliefs, and Perspectives.

Purpose: Physiotherapists are key providers of care for patients with low back pain (LBP); however, information on Canadian physiotherapists' use of evidence-based clinical practice guidelines (EBCPGs) for LBP is lacking. We aimed to (1) describe Canadian physiotherapists' adherence to EBCPGs for LBP; (2) compare beliefs and attitudes of physiotherapists with higher and lower adherence; (3) identify predictors of adherence; and (4) gather physiotherapists' perceptions about the care provided to patients with LBP. Method: This mixed methods study involved two phases: (1) a survey containing a LBP clinical scenario and (2) qualitative semi-structured interviews with physiotherapists. Results: A total of 406 (77%) of the 525 survey respondents demonstrated higher adherence (score of 3 or 4) to EBCPGs; however, only 29.5% chose interventions to address psychosocial issues. Postgraduate training was the strongest predictor of higher adherence. Interviewed physiotherapists reported being highly satisfied with the care provided to patients with LBP even when psychosocial issues are present, despite low confidence in addressing those issues. Conclusions: Although overall adherence was high, Canadian physiotherapists do not frequently address psychosocial issues with LBP patients, and often do not feel confident or competent in that aspect of practice. This suggests an opportunity for developing additional training for addressing psychosocial issues in LBP patients.

Training Oncology Social Workers: Lessons From the USA

ABSTRACT There are over one million people in Australia who are either living with or have lived with cancer, and approximately 145,000 new cancer cases are expected this year (AIHW, 2019). Oncology social workers are essential members of the health care team in meeting the needs of cancer patients and their families; however, the training and specialisation of social work professionals in the field of oncology is less developed in Australia compared to other western countries. Thus, the purpose of this paper is to examine the strategies implemented in the USA to develop and train oncology social workers and to assess the utility of these strategies in the Australian context. This paper will address the current state of oncology social work in both the USA and Australia, educational models of training oncology social workers, and the research capacity of oncology social workers. The feasibility of adapting some of these key strategies for training oncology social workers in the Australian context will be discussed. IMPLICATIONS It is essential to train skilled oncology social workers to be recognised as key providers of psychosocial care to cancer patients and their families via credentialing or certification. Developing an oncology social work research base is essential for both oncology social workers as well as cancer patients and their families. The strategic alliance and support of the key national cancer bodies (e.g., Clinical Oncology Society of Australia, Cancer Council Australia, and Cancer Australia) are crucial to the formal recognition and support of oncology social workers.

Midwives' and obstetricians' perspectives about pregnancy related weight management in Ethiopia: A qualitative study.

Midwives and obstetricians are key maternity care providers; they are the most trusted source of information regarding nutrition and gestational weight gain. However, their views, practices and perceived barriers to managing pregnancy related weight gain have not been studied in Ethiopia. The aim of this study was to explore midwives' and obstetricians' observations and perspectives about gestational weight gain and postpartum weight management in Ethiopia. We conducted face-to-face interviews with 11 midwives and 10 obstetricians, from January 2019 to March 2019. All interview data were transcribed verbatim. We analysed the data using thematic analysis with an inductive approach. We identified three themes and associated subthemes. Midwives and obstetricians had limited knowledge of the optimal gestational weight gain. Almost all participants were unaware of the presence of the Institute of Medicine recommendations for optimal weight gain in pregnancy. According to the study participants, women in Ethiopia do not want to gain weight during pregnancy, but do want to gain weight after the birth. Counselling about gestational weight gain and postpartum weight management was not routinely provided for pregnant women. This is mostly because gestational weight gain counselling was not considered to be a priority by maternity care providers in Ethiopia. The limited knowledge of and low attention to pregnancy related weight management by midwives and obstetricians in this setting needs appropriate intervention. Adapting a guideline for pregnancy weight management and integrating it into antenatal care is essential.

Adaptive work in the health care response to domestic violence in Palestine

Abstract Background A health system response to domestic violence against women is a global priority. However, little is known about whether or how they work in LMICs where there are greater structural barriers. HERA (HEalthcare Responding to violence and Abuse) aimed to strengthen the primary healthcare response to domestic violence in the West Bank of Palestine. Methods The sample for the qualitative study was 18 participants at two primary health care clinics and included five women, nine primary health care providers, two gender-based violence focal points and two domestic violence trainers. Data were analysed using thematic analysis drawing an Extended Normalisation Process Theory (ENPT) and feminist scholarship. We collected data on identification and referral of domestic violence cases. Results HERA interacted with political, sociocultural and economic aspects of the context, creating a degree of unpredictability and uncertainty in working of the intervention. The political occupation restricted women's movement and access to support services, whilst the concomitant lack of police protection left providers and women feeling exposed to acts of family retaliation. This was interwoven with cultural values that influenced participants' choices as they negotiated normative structures that reinforce violence against women. Participants engaged in adaptive work to negotiate these challenges and ensure that implementation was safe and workable within a context of constraints. Participant narratives highlight the use of subterfuge, hidden forms of agency and governing behaviours (of self and others) to ensure the safety of all involved during implementation. Conclusions The findings have implications for how HERA can be sustained in the long-term, particularly with regards to the provision of support for women. Support at all levels within the health system is needed to enable change and strengthen the response to violence against women. Key messages Health care providers and women worked with and around contextual constraints. The transformation of the clinic case manager role is an emergent feature of HERA. Extended Normalisation Process Theory helped to articulate nuances about intervention-context interactions.

Carers' experiences of involuntary admission under mental health legislation: systematic review and qualitative meta-synthesis.

Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers' experiences of and views about assessment for involuntary admission and subsequent detention is crucial to efforts to improve policy and practice. We aimed to synthesise qualitative evidence of carers' experiences of the assessment and detention of their family and friends under mental health legislation. We searched five bibliographic databases, reference lists and citations. Studies were included if they collected data using qualitative methods and the patients were aged 18 or older; reported on carer experiences of assessment or detention under mental health legislation anywhere in the world; and were published in peer-reviewed journals. We used meta-synthesis. The review included 23 papers. Themes were consistent across time and setting and related to the emotional impact of detention; the availability of support for carers; the extent to which carers felt involved in decision-making; relationships with patients and staff during detention; and the quality of care provided to patients. Carers often described conflicting feelings of relief coupled with distress and anxiety about how the patient might cope and respond. Carers also spoke about the need for timely and accessible information, supportive and trusting relationships with mental health professionals, and of involvement as partners in care. Research is needed to explore whether and how health service and other interventions can improve the involvement and support of carers prior to, during and after the detention of family members and friends.

Improving depression outcomes among Australian primary care patients: protocol for a cluster randomised controlled trial

IntroductionDepression is a common and debilitating condition. In Australia, general practitioners (GPs) are the key providers of depression care. However, available evidence suggests that case finding for depression in primary...