Western Health and Social Care Trust

Derry, United Kingdom

Western Health and Social Care Trust

Derry, United Kingdom
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Loftus A.M.,Aberfoyle General Practice | McCauley F.,Western Health and Social Care Trust | McCarron M.O.,Altnagelvin Hospital
Public Health | Year: 2017

Objectives Social prescribing has emerged as a useful tool for helping patients overcome some of the social and behavioural determinants of poor health. There has been little research on the impact of social prescribing on use of primary healthcare resources. This study sought to determine whether social prescribing activities influenced patient-general practitioner (GP) contacts and polypharmacy. Study design Quality-improvement design with social prescribing activity interventions from an urban general practice in Northern Ireland. Methods Patients over 65 years of age with a chronic condition who attended their GP frequently or had multiple medications were offered a social prescribing activity. Participants' contacts with GP and the new repeat prescriptions before and during the social prescribing activity were measured. The total number of repeat prescriptions per patient was compared at the time of referral and 6–12 months later. Indications for referral, primary diagnoses and reasons for declining participation in a social prescribing activity after referral were prospectively recorded. Results Sixty-eight patients agreed to participate but only 28 (41%) engaged in a prescribed social activity. There was no statistically significant difference in GP contacts (visits to GP, home visits or telephone calls) or number of new repeat prescriptions between referral and completion of 12 weeks of social prescribing activity. Similarly there was no statistically significant difference in the total number of repeat prescriptions between referral and 6–12 months after social prescribing activity in either intention to treat or per protocol analyses. Social prescribing participants had similar demographic factors. Mental health issues (anxiety and/or depression) were more common among participants than those who were referred but declined participation in a social prescribing activity (P = 0.022). Conclusions While social prescribing may help patients' self-esteem and well-being, it may not decrease GP workload. Further research is required to optimise social prescribing benefits. © 2017 The Royal Society for Public Health


Dempster M.,Queen's University of Belfast | Mccarthy T.,Western Health and Social Care Trust | Davies M.,Belfast Health and Social Care Trust
Diabetic Medicine | Year: 2011

Aims To examine the associations between psychological adjustment to Type2 diabetes and the reported quality and type of relationships with partners. Methods All participants (n=88) completed a number of questionnaires, including two measures of relationship quality: the Dyadic Adjustment Scale and the Personal Assessment of Intimacy in Relationships Scale, the Diabetes Quality of Life Scale and the ATT-19 (which assesses personal integration of diabetes). Additionally, HbA1c levels were obtained from medical notes. Results Measures of relationship quality significantly contributed to the explanation of two outcomes: personal integration of diabetes and satisfaction with the burden of self-management behaviours. More specifically, the findings demonstrate that a specific aspect of relationship quality-intimacy in recreational activities-is positively associated with the outcomes mentioned above. Conclusions People with Type2 diabetes who are not taking insulin, who share engagement in physical activities with their partner are more likely to be psychologically well-adjusted to their diagnosis of diabetes. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.


McCorkell G.,Altnagelvin Area Hospital | McCarron C.,Western Health and Social Care Trust | Blair S.,Western Health and Social Care Trust | Coates V.,University of Ulster
Community Practitioner | Year: 2012

In 1995 a cleft liaison service was developed in a health and social care trust which comprises primary and secondary care. The service team includes hospital and community midwives, health visitors and a consultant orthodontist who had a particular interest, and experience in the care of children born with a cleft and often this work was in addition to their existing roles. Anecdotal evidence indicated that the service was of great help to parents but it had never been formally evaluated. Therefore this evaluation was designed to explore the needs and views of parents who had a baby or child with a cleft of the lip and or palate, using a qualitative, cross sectional approach. Following 20 parents interviews responses were recorded, transcribed and a content analysis completed. Three main themes emerged relating to the parents' emotional experiences, their need for information and their experience of caring for a child with a cleft. This study has provided insight into the service delivered by the team and reiterates the need for retaining, maintaining and expanding this specialist service to other localities. Updating midwifery and health visiting staff in terms of knowledge and expertise was implicit to provide a responsive service to meet the needs of the child and family.


O'Kane C.,Western Health and Social Care Trust
Nursing management (Harrow, London, England : 1994) | Year: 2010

This article discusses the work done by Carmel O'Kane as team leader for a community children's home care team that led to her nomination for the title of RCN nurse manager of the year at the Institute of Healthcare Management's excellence in management awards in Northern Ireland.


Delgadillo J.,The Reginald Center | Payne S.,Western Health and Social Care Trust | Gilbody S.,University of York | Godfrey C.,University of York | And 3 more authors.
Drug and Alcohol Dependence | Year: 2012

Background: Anxiety disorders are the most common mental health problems and often co-exist with substance use. Little evidence exists to support the use of brief screening tools for anxiety disorders in routine addictions treatment. This is the first study to test the validity and reliability of GAD-7 and GAD-2 in an outpatient drugs treatment population. Methods: A sample of 103 patients completed brief screening questionnaires and took part in structured diagnostic assessments using CIS-R. A subgroup of 60 patients completed retests after 4 weeks. The results of brief questionnaires were compared to those of gold-standard diagnostic interviews using Receiver Operating Characteristic (ROC) curves. Psychometric properties were also calculated to evaluate the validity and reliability of self-completed questionnaires. Results: A GAD-7 score ≥9 had a sensitivity of 80% and specificity of 86% for any anxiety disorder, also displaying adequate temporal stability at repeated measurements (intra-class correlation = 0.85) and high internal consistency (Cronbach's alpha = 0.91). A GAD-2 score ≥2 had 94% sensitivity and 53% specificity, with adequate internal consistency (0.82). Conclusions: GAD-7 adequately detected the presence of an anxiety disorder in drug and alcohol users; although this study was limited by sample size to determine its reliability for specific diagnoses. Results in this small sample suggest that GAD-7 may be a useful screening tool in addiction services, although replication in a larger sample is warranted. © 2012 Elsevier Ireland Ltd.


Delgadillo J.,Reginald Center | Godfrey C.,University of York | Gilbody S.,University of York | Payne S.,Western Health and Social Care Trust
Mental Health and Substance Use: Dual Diagnosis | Year: 2013

Depression and anxiety disorders commonly coexist with drug and alcohol use. Several general population surveys suggest non-linear associations between alcohol and depression symptoms. It is unclear whether such association patterns occur in clinical samples and in the context of poly-substance use. The aim of the study was to investigate the association patterns between substance use and common mental disorder (CMD) severity. Patients accessing a UK outpatient addictions service were recruited sequentially via routine treatment contacts. Psychiatric diagnosis and severity of symptoms were established using the revised clinical interview schedule (CIS-R) structured diagnostic interview; yielding WHO ICD-10 diagnoses for CMD. Data on substance use patterns in the last month and severity of dependence were collected using standardised measures. ANOVA and multivariate regression models were employed to investigate associations between CMD symptom severity and substance use patterns. The results of the multivariate regression analyses indicated a linear association between weekly alcohol use and CIS-R severity; this was statistically significant when adjusting for severity of dependence, poly-substance use, gender and age. Other drug use patterns were not directly associated with overall psychiatric symptom scores, but some evidence was found that specific patterns of drug use correlate with specific psychological symptoms. In conclusion, only alcohol use was significantly associated with psychiatric symptom severity in the context of poly-substance use. Contrary to epidemiological surveys in the general population, no evidence was found for non-linear associations between CMD and substance use in this clinical sample; nor did we find evidence that recent abstinence increases symptom severity. © 2013 Copyright Taylor and Francis Group, LLC.


Given J.E.,University of Ulster | O'Kane M.J.,Western Health and Social Care Trust | Bunting B.P.,University of Ulster | Coates V.E.,University of Ulster | Coates V.E.,Western Health and Social Care Trust
Diabetic Medicine | Year: 2013

Aims: To synthesize evidence relating to comparisons between patient-generated blood glucose records and meter memory in diabetes and to identify any predictors of agreement. Methods: A systematic literature search was performed to identify articles comparing meter and diary records in those unaware of this assessment. Results: Eleven observational studies, covering patients with Type 1, Type 2 and gestational diabetes were included spanning 1984-2009. Failure to record blood glucose measurements in the diary was the most extensive 'error', but addition of values, which were not measured, was a greater cause for concern. When present to a high degree, 'errors' lead to decreased variability in diary records compared with meter records. Allowing for a minimal amount of disagreement, just over 50% of adult diaries can be considered as 'accurate/reliable'. Disagreements were most extensive in teenagers and young adults, but the pregnant populations were only slightly better. Agreement was not related to sex, number of insulin injections or duration of monitoring. Those who were younger were more likely to have 'errors', while those who monitored more frequently had more 'accurate' diaries. Conclusions: The lack of meter-diary agreement suggests that the real reason for monitoring is not understood by many patients, raising issues about motivation, perceived need to impress healthcare providers and denial of poor control. Considering that diaries are used to inform decisions about therapy when HbA1c is raised or in pregnancy, when HbA1c is not suitable, there is significant cause for concern in relation to their clinical utility. © 2013 Diabetes UK.


Delgadillo J.,Primary Care Mental Health Service | Gore S.,City and South Community Drugs Treatment Service | Jessop D.,Prison Healthcare | Payne S.,Western Health and Social Care Trust | And 2 more authors.
General Hospital Psychiatry | Year: 2012

Objective: The objective was to investigate patients' views on the application of case finding and screening methods for common mental disorders in an addiction treatment service. Method: Qualitative thematic analysis of semistructured interviews with a purposive sample of 19 participants. Participants took part in diagnostic assessments (Revised Clinical Interview Schedule, CIS-R) and completed brief screening questionnaires for depression (Patient Health Questionnaire, PHQ-9) and anxiety (Generalized Anxiety Disorder Scale, GAD-7). Results: Patients generally favored the use of screening questionnaires to detect psychological problems, to monitor changes in symptoms and to facilitate targeted and specialist treatment. On the whole, respondents seemed to find such methods familiar and easy to use. The need for staff support was strongly emphasized, both to deal with the emotional impact of screening and to overcome accessibility and literacy problems. Good therapeutic rapport with practitioners came across as an important factor that influences patients' willingness to discuss psychological problems. Patient readiness and the timeliness of assessments were additional factors influencing acceptability. Participants discussed how psychological problems and substance misuse are associated in complex ways, often resulting in discrimination, poor recognition of such problems and limited access to treatment. Conclusions: Mental health screening is generally acceptable to patients and can help to identify comorbid mental disorders in order to provide appropriate support and treatment. © 2012 Elsevier Inc.


PubMed | One in Four, University College Dublin, Health Service Executive West, Western Health and Social Care Trust and Social Care Institute for Excellence
Type: Journal Article | Journal: Sexual abuse : a journal of research and treatment | Year: 2016

This research explored the therapeutic events both clients and therapists from community-based treatment interventions for perpetrators of sexual abuse identify as significant in their experience of psychological therapy. A qualitative design was utilized to address this research objective. The sample for the present research is comprised of three different treatment programs for sexual offending. Twenty-five clients and nine therapists participated in the study. Two qualitative measures were used to elicit client and therapist responses. Significant Aspects of Therapy Form was administered every second treatment session during each intervention program. The Significant Aspects Follow-Up Interview was conducted with a sub-sample of participants at the conclusion of each treatment module. Thematic analysis was used to identify significant themes noted by clients and therapists from forms and interviews. Thematic analysis resulted in a model of significant events in therapy. In this model, significant events were categorized into six domains. The six domains were as follows: (a) the process of therapy, (b) making changes and progress in therapy, (c) content and structure of therapy, (d) therapist contributions, (e) negative contributions to therapy, and (f) other factors Each domain further contained between 6 and 18 themes, which are also reported. This study found much overlap and similarity in the experiences of therapy between clients of sexual offender therapy and general psychotherapy. Furthermore, there is overlap between therapists and clients in the aspects of therapy they identify as significant. The implications of these findings on effective service development and comprehensive service evaluations are discussed.


PubMed | Dr Rachel Morrow and Western Health and Social Care Trust
Type: Journal Article | Journal: The Ulster medical journal | Year: 2016

Northern Ireland has high mental health needs and a rising suicide rate. Our area has suffered a 32% reduction of inpatient beds consistent with the national drive towards community based treatment. Taking these factors into account, a new Mental Health Crisis Service was developed incorporating a high fidelity Crisis Response Home Treatment Team (CRHTT), Acute Day Care facility and two inpatient wards. The aim was to provide alternatives to inpatient admission. The new service would facilitate transition between inpatient and community care while decreasing bed occupancy and increasing treatment in the community.All services and processes were reviewed to assess deficiencies in current care. There was extensive consultation with internal and external stakeholders and process mapping using the COBRAs framework as a basis for the service improvement model. The project team set the service criteria and reviewed progress.In the original service model, the average inpatient occupancy rate was 106.6%, admission rate was 48 patients per month and total length of stay was 23.4 days. After introducing the inpatient consultant hospital model, the average occupancy rate decreased to 90%, admissions to 43 per month and total length of stay to 22 days. The results further decreased to 83% occupancy, 32 admissions per month and total length of stay 12 days after CRHTT initiation.The Crisis Service is still being evaluated but currently the model has provided safe alternatives to inpatient care. Involvement with patients, carers and all multidisciplinary teams is maximised to improve the quality and safety of care. Innovative ideas including structured weekly timetable and regular interface meetings have improved communication and allowed additional time for patient care.

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