Service Users In Relation Research Articles

Community pharmacists’ views about prescription medicine co-payments and potential implications for equitable access to medicines: a critical realist interpretation

BackgroundIn many countries the community pharmacist’s role includes collecting prescription medicine co-payments at the point of dispensing. This is a context which can provide unique insights into individuals’ access to prescription medicines, as interactions with service users about out-of-pocket (OOP) expenses that may negatively affect a pharmacist’s patient counselling role. Prior research has identified that OOP expenses for prescription medicines led to decreased treatment adherence. This study aims to understand the role of community pharmacists in the collection of co-payments for prescription medicines in one region of Aotearoa New Zealand, and the possible implications for equitable access to medicines.MethodsThis is a qualitative study using a case study research design. Data were collected through focus groups, individual interviews, and an electronic survey. Using a critical realist approach in thematic analysis, findings were categorised as Causal tendencies (the things that cause the events); Events (the things that community pharmacists experience); and Experiences (the perceptions and feelings of individual participants).ResultsOur analysis finds that the current profession of community pharmacy in Aotearoa New Zealand, is under strain. The results suggest that broader government policies, such as the pharmacist’s role in delivering essential health services, the fairness of standard prescription co-payments, and the role of community pharmacists as gatekeepers, have a significant influence on the profession. In addition, the study found that individual community pharmacists have a unique position in the co-payment process, face power imbalances within their role, and the study indicates evidence of value judgements towards service users.ConclusionsThis study is exploratory; however, its examination of the policy of prescription medicine co-payments from the perspective of community pharmacists, who play a vital role in both dispensing medicines and collecting prescription medicine co-payments, is novel. Despite prescription medicine co-payments being a routine part of pharmacists’ role in many countries, it is a topic where there is limited published peer-reviewed literature. The study adds to existing evidence that funding models influence community pharmacists’ role. In addition, this study identified value judgements about service users in relation to prescription medicine co-payments which may influence service users’ health-seeking behaviour. In this setting, limited representation of at-risk populations in the community pharmacy profession may be a factor that negatively influence interactions between pharmacists and service users.

A scoping review of best practices in home enteral tube feeding

To review the experiences of healthcare professionals (HCPs) and service users on the provision and receipt of home enteral nutrition (HEN) in primary care settings, respectively. HEN supports the nutritional needs of service users in primary care settings who are unable to meet their nutritional requirements through oral intake alone. While HEN supports service users to remain in their home, the provision of HEN services can be variable. The prevalence of HEN is increasing as health systems shift delivery of care from acute to primary care settings, and therefore the evolving needs of HCPs and service users in relation to HEN deserve exploration. Quantitative and qualitative studies were included if they described (1) practices that support best outcomes in adults on HEN and residing in their own homes and/or (2) service user and HCP experiences of HEN. Studies on the economics of HEN were included. Databases searched included MEDLINE/PubMed, EMBASE, Web of Science, and CINAHL. Publications up to March 2021 were included. A descriptive analytical approach was used to summarise the findings. Key themes included the importance of initial education to enable service users to adapt to HEN and the need for support from knowledgeable HCPs. Access to support from HCPs in primary care was limited, and some HCPs felt their knowledge of HEN was inadequate. Service users highlighted the significant impact of HEN on daily living and emphasised the need for support from a HEN team. HEN services were also associated with reduced hospital admissions, lengths of stay in hospital, and costs of hospitalisation. A specialist HEN service can manage enteral nutrition-related complications, reduce unnecessary hospital admissions, and improve quality of care and patient satisfaction. Further education of HCPs is needed on the provision of HEN.

A mixed methods study examining perceptions by service-users of their involuntary admission in relation to levels of insight.

Poor insight is associated with negative attitudes to involuntary admission and care in qualitative studies. The current paper aims to examine and compare retrospective qualitative perceptions of service-users in relation to their involuntary admission with their levels of clinical insight, using a mixed methods approach. Forty two participants were assessed 3 months after the revocation of their involuntary admission. Each provided qualitative data relating to their perceptions of the coercive care process, which was analysed using content analysis, along with a quantitative measurement of insight, the Schedule for the Assessment of Insight-Expanded (SAI-E). Employing a mixed methods design and incorporating NVivo matrix coding queries, the datasets were merged to enable qualitative themes to be identified against the quantitative data. Differences were observed between those with high and low insight in terms of their understanding of the need for treatment, their levels of arousal at the time of admission and how they perceived the compassion of health professionals. Certain negative perceptions of care appeared more universal and were common across those with high and low insight. Some negative perceptions of coercive practices appear linked to inherent elements of psychotic illness such as unawareness of illness. Individuals with higher levels of insight tended to perceive their involuntary admission and receiving a diagnosis as beneficial. Negative views that persist amongst service users with high insight levels can highlight areas for successful service improvement, including increased emphasis on non-pharmacotherapy based supports during the coercive care process.

Implementation of Brazil's National Policy on Complementary and Integrative Practices: strengths and weaknesses.

This narrative review examines the literature on complementary and integrative practices (CIPs) and their incorporation into Brazil's national health system (Sistema Único de Saúde - SUS) in an attempt to understand the strengths and weaknesses of the implementation of the National Policy on Complementary and Integrative Practices in the SUS (PNPIC, acronym in Portuguese). A search was conducted of the MEDLINE, LILACS, and SciELO databases, resulting in final sample of 25 articles. Our analysis identified five key themes in the literature related to the strengths and weaknesses of policy implementation: 1) Professional training in CIPs in the SUS; 2) structuring the provision of CIPs, access, and health promotion; 3) knowledge, access, and acceptance of service users in relation to CIPs; 4) knowledge of SUS professional staff and managers in relation to the PNPIC; and 5) scope and monitoring and evaluation of the PNPIC. In consonance with the conclusions of the PNPIC management reports, the findings provide a deeper insight into policy implementation problems and reinforce the need to empower the actors involved in this process to tackle these challenges.

The feminization of dentistry and the perceptions of public service users about gender issues in oral health.

It was investigated the perception of service users in relation to the professional practice of dentists, based on gender differences. The Primary Care Assessment Tool (PCATool) was applied to 900 users of the Public Service in Curitiba, PR, Brazil. Sixty clinics were selected using random sampling, divided between conventional Primary Health Care (PHC) Units and PHC with Family Health System Units. The attributes of PHC that compound the PCATool were analyzed. A question was added about user preference regarding the gender of the dental professional, thus generating four dyads derived from user gender/dentist gender (FF, FM, MM, MF). The attributes were linked to the dyads by applying the independent sample t test. Using logistic regression, the dyads were linked to 23 factors relating to scaled-up care in PHC. Many users showed a clear preference for being attended by female dentists. Users who prefer to be cared for by women tend to better evaluate PHC on issues related to "active listening", while those who prefer to be cared for by male dentists highlight the attributes of "care integration" and "community guidance". In other factors and attributes studied, there is no difference between the care given by men or women, regardless the unit.

Are reasons for care-giving related to carers' care-related quality of life and strain? Evidence from a survey of carers in England.

In England, choice and control is promoted for service users in relation to social care services. Increased choice and control has also been promoted for unpaid carers, although this is still relatively underdeveloped. There is limited recognition of carers’ choice in terms of the decision of whether to provide care. Alongside the promotion of choice and control, there has also been a focus on quality of life as an outcome of social care for care‐recipients and their carers. Although it is known that carer choice (in terms of the decision of whether or not to provide care) is related to increased burden and poorer psychological health, there is limited evidence of the relationship between reasons for caring and care‐related quality of life (CRQoL) and subjective strain in England. In this study, 387 carers were surveyed across 22 English local authorities between June 2013 and March 2014. Multiple regression analysis explored the relationship between carer‐reported reasons for caring and CRQoL and strain, whilst controlling for individual characteristics (e.g. age). Reasons for caring were important predictors of CRQoL and strain. Where people were carers because social services suggested it or the care‐recipient would not want help from anyone else, this was related to lower CRQoL. By contrast, where carers took on care‐giving because they had time to care, this was significantly associated with better CRQoL. Carers reported greater strain where they provided care because it was expected of them. These findings are relevant to policy and practice because they indicate that, while social care systems rely on carers, the limiting of carers’ choice of whether to provide care is related to worse outcomes. Increased awareness of this relationship would be beneficial in developing policy and practice that improves the QoL of care‐recipients and also their carers.

Oral health knowledge and practices among pregnant women using health services in São Luís, Maranhão, Brazil, 2007-2008

to describe characteristics of oral health care during prenatal check-ups and knowledge about oral health among pregnant women using public and private health services in São Luís, Maranhão, Brazil. this is a descriptive study of 300 women interviewed in public health services and a further 300 interviewed in private health services between August 2007 and July 2008. tooth brushing frequency was similar among users of public and private services (p=0.156), while flossing (64.0% and 47.0%; p<0.001) and mouthwashing (39.7% and 27.0%; p=0.001) was more frequent among private service users in relation to public service users; most users of public services (60.3%) and private services (65.7%) were unaware of the association between oral health and pregnancy. frequency of tooth brushing was similar among pregnant women in public and private services; the effects of pregnancy on oral health were not well known.

The Experiences of Lesbian and Gay Adults on Acute Mental Health Wards: Intimate Relationship Needs and Recovery

This study explores the psychiatric inpatient experiences of lesbian and gay service users in relation to their intimate relationship needs and how these experiences affected their mental health recovery. Semi-structured interviews were conducted with three gay men and three lesbians who had been resident on public sector psychiatric wards in the United Kingdom. The data were analyzed using Interpretative Phenomenological Analysis (IPA). Five master themes emerged: the conceptualization of intimacy, the relationship between intimate relationships and recovery, experiences of the ward, experiences of prejudice and discrimination in services, and a loss of power and personal identity as a service user.

Participatory action research: moving beyond the mental health ‘service user’ identity

Contemporary models of involvement within statutory services pay little regard to the identity of individuals beyond the 'service user' label and in doing so unwittingly perpetuate and sustain the negative impact of mental illness. The aim of this paper is to discuss the process of a 3-year participatory action research study facilitated by a mental health nurse. It highlights the perspective of those involved as co-researchers, all having experience of accessing statutory mental health services. It identifies both the process and the impact of this type of involvement on them illustrating their move beyond an illness identity. The study involved them undertaking a series of interviews with other service users in relation to their life stories. They subsequently mapped and analysed the transcripts. In order that the people were enabled to undertake these roles the study included a process of interviewing and appointing service user researchers followed by a programme of training workshops, supervision and discussion group/peer support. The accounts provided reflect the six researchers' attempts to make sense of their experience and reveal the path of transformation through collaboration.

The People in Control Conference at City University, London: “We have opinions to share about our lives”

PurposeThe purpose of this paper is to consider the benefits of service users contributing to university teaching and having opportunities to present at a conference, both for student learning and clinical development objectives as well as for the service users themselves.Design/methodology/approachWith reference to current policies and good practice guidelines, the article reflects on the experiences of both the students and the service users in relation to the literature and the events that led to the People in Control Conference.FindingsStudents valued the experience in terms of developing knowledge and insight into different techniques to facilitate both receptive and expressive communication. Students also had opportunities to think about their own perceptions of disability. Service users have gained in communication confidence and competence as well as getting opportunities to have their voices heard.Originality/valueIncreased opportunities for service users have cultural and clinical benefits for all involved.

Self-assessment processes within care management: Learning from pilot projects

• Summary: Self-assessment is one of a range of new practices within adult social care, aimed at increasing the choices available to service users in relation to both the assessment process and the way services are delivered. By analysing the results of both project documentation and interviews with managers of pilot projects set up to test out this approach, this article examines issues relating to the introduction of a new initiative within a social care setting and considers whether the introduction of self-assessment poses particular challenges for care management. • Findings: The interviews revealed a mix of general as well as setting and process specific findings. The latter included the importance of the appropriate targeting of self-assessment and the need to reach a clear consensus within the service as to what self-assessment means and how it should be incorporated into an individualized model of practice. Other findings reflected issues highlighted in the literature on the management of change. • Applications: Together the results provide useful lessons for those interested in both the specific area of study and, more generally, the implementation of new initiatives in social care.

Local welfare governance structuring informal carers' dual position

PurposeLocal welfare governance is approached from the vantage point of informal carers caring for older people. A bottom‐up perspective is used to construct a critical view on welfare provision and governance practices at the local level. The paper aims to discuss the issues.Design/methodology/approachThe data consist of 23 in‐depth interviews with informal carers. Universal access to services and equal treatment of citizens is discussed.FindingsThe analysis illustrates how informal carers share care responsibilities with the municipality and gain access to services both as service providers and service users. Informal care comprises a complex mixture of public and private responsibilities that poses a challenge to universalism. There are new inequalities emerging among informal carers, while access to public resources is easier for resource‐rich carers positioned as service providers. Resource‐poor carers identify themselves often as service users in relation to municipality.Originality/valueThe use of original data provides important knowledge on informal carers' dual position in the local welfare governance and contributes to both theoretical and empirical understanding on shifts within Nordic welfare governance. Informal carers' dual position reflects the essence of mixed governance and represents future social policies.

What are the perceived needs of Pakistani women in the North west of England in relation to physiotherapy, and to what extent do they feel their needs are being met?

Objective To gain an insight into the needs of female Pakistani service users in relation to physiotherapy. Design A qualitative research design was utilised, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed and the data were analysed using thematic analysis. Setting A venue of the service user's own choosing in one geographical area of the North west of England. Participants Six, Pakistani, Muslim female patients who had recently received physiotherapy from a range of specialisms. Five participants came to the UK from Pakistan, and one participant of Pakistani heritage came to the UK from East Africa. An interpreter was used in four of the six interviews. Findings Four main themes emerged from data analysis: issues of gender; language issues including the subthemes of crosscultural communication, time and materials; role of exercise; and acquiescence. Conclusions It appears that physiotherapy provision for female patients with Pakistani backgrounds may be failing to meet their needs, which may affect compliance. In order to address these issues, culturally competent health care needs to be provided and the following points are worthy of consideration: • offering service users the choice of gender of therapist and, where appropriate, the provision of single-sex exercise group sessions; • longer appointment times for service users where English is not their first language, and the recruitment of bilingual therapists. Written instructions, in English, with pictures should be provided; • therapists should have some understanding of the culture of their local community to enable them to incorporate the patient's culture into their management; and • there may be a need to explore service provision where a high proportion of female Pakistani service users are failing to attend physiotherapy appointments.

Clinical psychology service users' experiences of confidentiality and informed consent: A qualitative analysis

To explore and describe the experience of clinical psychology service users in relation to the processes associated with confidentiality and the generation of informed consent in individual therapy. A qualitative interview-based study employing interpretative phenomenological analysis was conducted with service users. User researchers were active collaborators in the study. A focus group of four users was convened to explore issues related to confidentiality and consent, which then informed the development of the semi-structured interview schedule. Twelve users of community mental health clinical psychology services were interviewed by user researchers. A user researcher and a clinical psychologist undertook joint analysis of the data. A second clinical psychologist facilitated reflexivity and wider consideration of validity issues. Four main themes were identified from the data: being referred; the participant's feelings, mental health difficulties, and their impact; relationships with workers and carers; and autonomy. The meaningfulness of processes of discussing confidentiality, and generating informed consent, can be improved by psychologists placing a greater emphasis on choice, control, autonomy, individual preferences, and actively involving the user in dialogue on repeated occasions.

The ethics of conducting research with mental health service users

There is a growing emphasis on conducting research that represents the voices of mental health service users in relation to their experiences of and desires for health care. However, this type of research may sometimes be complicated, as mental health users are frequently identified as a vulnerable research participant population. The aims of this article are to firstly highlight some of the main ethical issues that researchers encounter when carrying out research with people who use the mental health services and secondly to identify strategies that can be used to address these issues. The authors draw on their personal experiences of conducting this type of research. While of general relevance, this article is particularly designed to provide guidance to researchers conducting qualitative studies.

Discourses of Inter-Professionalism

This paper explores identity through looking at how different discourses of inter-professionalism are drawn on by professionals and by service users in relation to the multi-professional context of service provision. It follows traditions in critical discursive psychology in understanding talk as constitutive. Glimpses of the emergence of a new professional identity congruent with the demands of inter-professional work can be seen in the online discussions of students on a course in managing care and the paper considers how this identity is constructed. A feature of particular interest in the student forum data is the extent to which they construct colleagues from different professions, managers and service users as ‘the other’ in ways that devalue their contribution, while at the same time praising the benefits of inter-professional collaboration. The paper concludes that new professional identities that fit with a context of new working arrangements and relationships nonetheless continue to show ‘othering’ in the production of a positive identity. However, rigid binaries have been disturbed by an emphasis on inter-professional working. As people work in different and cross-cutting new organizations that involve re-defining what the team is, the binaries become less fixed and more fluid.

Service users, metaphors and teamworking in mental health

Despite the United Kingdom's recent governmental mental health policy directives aimed at strengthening professional collaboration and increasing service user involvement, the prevailing mental health care culture remains steeped in a discourse of treatment and care, control and compliance and professional expertise. Drawing upon the data collected during the two phases of a 2-year national evaluation undertaken for the English National Board for Nursing, Midwifery and Health Visiting, the perceptions of a group of mental health service users in relation to their experiences and contact with the multi-professional team are explored. A series of metaphorical descriptions were developed with these service users drawn from their experience. These begin to illuminate a realistic way of thinking about how teams are set up, how and why they carry out their various roles, and the need to think in non-professional terms about the relationships that are developed with service users. A hierarchy of power was noted that was congruent with the outcomes of other studies. However, there was also a concurrent acknowledgement of the 'usefulness'(to the individual service user) of each of the professional group members. This appeared to have been constructed alongside the power hierarchy and serves to illustrate how individual service users sought to find an accommodation within the social system they were placed in. This paper argues however, that the use of metaphors, as a form of shared communication, can be an effective first step in working towards this objective. Working in the way described here can allow for a greater shared understanding of what each group is experiencing and help ensure that future service development reflects a broader view of the mental health care world.

Between Organizations and Institutions. Legitimacy and Medical Managers

This article focuses on how the National Health Service, as a major public service organization, operating in a dynamic environment and utilizing complex processes of human interaction to deliver health care, creates and manages legitimacy. During the late 1990s the NHS embodied a particular series of changes which demanded novel responses from managers, clinicians and service users in relation to governance and professional standards. Most challenging of all are the attempts being launched to exert influence over the organization and management of clinical services, through clinical governance systems which create ‘shared forums’ for quality improvement (Scottish Office/Department of Health 1998). The emphasis here is to draw upon theoretical constructs of legitimacy and discourse as organizing schema for making sense of such change processes. The role of doctors who assume managerial duties will be examined as a prominent feature of the reform programme. The problem of sourcing, building and maintaining legitimacy in the NHS is viewed through the new medical managers’ representations of their role in the devolved management structures of the NHS in the 1990s. The new medical managers are clinicians who take on a management position within NHS trust organizations. As argued elsewhere the NHS has been for the first fifty years of its life, essentially a federation of professional tribes, each with their own social practices and inclination to attach different subjective meanings to health care processes (Hunter 1994). The new medical managers are seen as occupying a position between the organization that is the NHS trust and the profession-based institutions. Their part in creating an integrated corporate form of legitimacy is of some importance for the NHS in the next century. The developments under examination may signal a radical departure from earlier organizational practices, which relied