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    ABSTRACT: Objective To examine the process of case finding for depression in people with diabetes and coronary heart disease within the context of a pay-for-performance scheme. Design Ethnographic study drawing on observations of practice routines and consultations, debriefing interviews with staff and patients and review of patient records. Setting General practices in Leeds, UK. Participants 12 purposively sampled practices with a total of 119 staff; 63 consultation observations and 57 patient interviews. Main outcome measure Audio recorded consultations and interviews with patients and healthcare professionals along with observation field notes were thematically analysed. We assessed outcomes of case finding from patient records. Results Case finding exacerbated the discordance between patient and professional agendas, the latter already dominated by the tightly structured and time-limited nature of chronic illness reviews. Professional beliefs and abilities affected how case finding was undertaken; there was uncertainty about how to ask the questions, particularly among nursing staff. Professionals were often wary of opening an emotional ‘can of worms’. Subsequently, patient responses potentially suggesting emotional problems could be prematurely shut down by professionals. Patients did not understand why they were asked questions about depression. This sometimes led to defensive or even defiant answers to case finding. Follow-up of patients highlighted inconsistent systems and lines of communication for dealing with positive results on case finding. Conclusions Case finding does not fit naturally within consultations; both professional and patient reactions somewhat subverted the process recommended by national guidance. Quality improvement strategies will need to take account of our results in two ways. First, despite their apparent simplicity, the case finding questions are not consultation-friendly and acceptable alternative ways to raise the issue of depression need to be supported. Second, case finding needs to operate within structured pathways which can be accommodated within available systems and resources.
    Full-text · Article · Aug 2014 · BMJ Open
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    ABSTRACT: To determine the optimal databases to search for studies of faith-sensitive interventions for treating depression. We examined 23 health, social science, religious, and grey literature databases searched for an evidence synthesis. Databases were prioritized by yield of (1) search results, (2) potentially relevant references identified during screening, (3) included references contained in the synthesis, and (4) included references that were available in the database. We assessed the impact of databases beyond MEDLINE, EMBASE, and PsycINFO by their ability to supply studies identifying new themes and issues. We identified pragmatic workload factors that influence database selection. PsycINFO was the best performing database within all priority lists. ArabPsyNet, CINAHL, Dissertations and Theses, EMBASE, Global Health, Health Management Information Consortium, MEDLINE, PsycINFO, and Sociological Abstracts were essential for our searches to retrieve the included references. Citation tracking activities and the personal library of one of the research teams made significant contributions of unique, relevant references. Religion studies databases (Am Theo Lib Assoc, FRANCIS) did not provide unique, relevant references. Literature searches for reviews and evidence syntheses of religion and health studies should include social science, grey literature, non-Western databases, personal libraries, and citation tracking activities.
    Full-text · Article · Apr 2014 · Journal of clinical epidemiology
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    ABSTRACT: Preventable sight loss is one of the Public Health Outcome Indicators in England. Despite availability of NHS-funded eye examinations, many people do not take up their entitlement. This paper explores older adults understanding of eye health and the purpose of eye examinations and the reasons why they do or do not attend for eye examinations. The aim is to provide evidence to inform policy on increasing uptake of eye examinations among older people who have increased risk of preventable sight loss. 10 focus-group meetings were held with people living in deprived areas of Leeds, recruited via community groups and neighbourhood networks. Focus groups were transcribed and a thematic analysis approach was used. The majority of participants were aged over 60, wore spectacles, and had regular eye examinations. Most were eligible for a NHS-funded eye examination. There was poor knowledge about eye disease and the purpose of different elements of the eye examination. Participants felt very vulnerable about getting the tests 'wrong' and looking foolish. Wearing of spectacles was associated with appearing old and frail. Many did not trust the veracity of optometrists, and perceived opticians to be expensive places, where it was difficult to control spending. Many had experienced 'hard sell' and opaque pricing. Most, but not all, were happy with the optometric services received. Participants indicated a preference for utilising a local optometrist located alongside other familiar health care services. Not-for-profit services co-located with other public services are needed to address concerns about cost of spectacles, lack of trust in optometrists, and poor access to eye examinations in local settings. It will also be important to raise public understanding about the purpose of eye examinations in terms of other causes of preventable sight loss and not just refractive error and need for spectacles.
    No preview · Article · Jan 2014 · Ophthalmic and Physiological Optics
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