Journal Club cumg UCL

1. Journal Club cumg UCL 24th June 2005 Valérie Dory Jean-Marc Feron CUMG.NET \ nouvelle version \ Journal Club

2. Aims • For GPs and lecturers, to get the best out of the literature for their patients and students • For researchers, to learn how published studies are built and reported, and how to criticize them. CUMG.NET \ nouvelle version \ Journal Club

3. Today • Patients’ and health professionals’ views on primary care for people with serious mental illness: focus group study BMJ april 2005 • GP treatment decisions for patients with depression: an observational study Brit J Gen Pract april 2005 First an intuitive critic, and then a readingframework CUMG.NET \ nouvelle version \ Journal Club

4. Patients’ and health professionals’ views on primary care for people with serious mental illness: Introduction • Prevalence of schizophrenia, bipolar disorder and recurrent depression up to 3 % in UK • Considerable workload for GPs and higher risk of poorer physical health • GPs do not perceived themselves as involved in mental health or overall care of people with serious mental illness • Little research has sought … CUMG.NET \ nouvelle version \ Journal Club

5. Patients’ and health professionals’ views on primary care for people with serious mental illness: Objective To explore the changing experience of providing and receiving primary care from the dual perspectives of primary care health professionals and patients with serious mental illness respectively CUMG.NET \ nouvelle version \ Journal Club

6. Patients’ and health professionals’ views on primary care for people with serious mental illness: • Design: Qualitative study consisting of 6 patients groups (N total: 45), 6 health professionals (39 GPs and 8 nurses) and 6 combined focus groups • Setting: 6 Primary Care Trusts in the West Midlands, selected according to differing levels of deprivation (Townsend score) and population density CUMG.NET \ nouvelle version \ Journal Club

7. Patients’ and health professionals’ views on primary care for people with serious mental illness: • Patients’ recruitment: through existing community based user networks – snowballing technique • Timing: 18 focus groups from May 2002 to January 2003, publication April 2005; 3 researchers CUMG.NET \ nouvelle version \ Journal Club

8. Patients’ and health professionals’ views on primary care for people with serious mental illness: Procedure • Topic guide piloted with 6 patients and 6 health professionals • FG in non clinical settings • Always the same facilitator • No patient registered at a GP’s practice • About the half participated, usually 1 week later, to a combined FG CUMG.NET \ nouvelle version \ Journal Club

9. Patients’ and health professionals’ views on primary care for people with serious mental illness: Analysis • FG, data collection and analysis were concurrent, and FG continued until saturation • All FG audiotaped and transcribed • Software, thematic framework CUMG.NET \ nouvelle version \ Journal Club

10. Patients’ and health professionals’ views on primary care for people with serious mental illness: Results (1/3) • Most of professionals felt that care for people with serious mental illness was too specialised for them • Most patients viewed Primary Care as the cornerstone of their health care and prefer to consult their own GP • Patients' arguments: being listened, swift access CUMG.NET \ nouvelle version \ Journal Club

11. Patients’ and health professionals’ views on primary care for people with serious mental illness: Results (2/3) • Patients exaggerate their symptoms to get urgent appointment to the GP • GPs exaggerate patients’ symptoms to facilitate admission to secondary care • All participants felt that interpersonal and longitudinal continuity was vital for good quality care CUMG.NET \ nouvelle version \ Journal Club

12. Patients’ and health professionals’ views on primary care for people with serious mental illness: Results (3/3) • Professionals perceived serious mental illness as a lifelong condition • Patients emphasised the importance of optimism in treatment and hope for recovery • Both thought that structured reviews for people with serious mental illness (for example: annual check-up) is a good concept CUMG.NET \ nouvelle version \ Journal Club

13. Patients’ and health professionals’ views on primary care for people with serious mental illness: Discussion • Combined FG = a strength • Patient – GP hierarchy ? Seems that not. • Only 8 % of invited professionals agreed to participate • Very important study for the health care system CUMG.NET \ nouvelle version \ Journal Club

14. Patients’ and health professionals’ views on primary care for people with serious mental illness: Intuitive critic CUMG.NET \ nouvelle version \ Journal Club

15. Patients’ and health professionals’ views on primary care for people with serious mental illness: Reading framework • Validity: appropriateness of the chosen method, purposeful sampling, triangulation, respondent validation • Reliability: analysis and interpretation, theoretical models • Relevance • Reflexivity • Transferability CUMG.NET \ nouvelle version \ Journal Club