London journal of primary care最新文献

[This corrects the article DOI: 10.1080/17571472.2018.1485262.].

Background: With increased delayed discharges from acute NHS hospitals, especially for older patients, solutions like the 'Discharge to Assess' (D2A) scheme aim to facilitate quicker discharge and improve experiences for patients and carers.

Setting: This report examines the quality process from the patient perspective of the D2A scheme implemented in a London Northwest Healthcare NHS Trust (LNWHT). A retrospective audit was conducted using the first cohort of patients discharged through this pilot scheme from April to July 2017.

Question: A brief study to explore patient views of their experience of the D2A scheme.

Methods: An opportunistic audit comprised of brief telephone interviews with patients following discharge from hospital through the D2A scheme.

Results: 30 patients who had been discharged with the D2A scheme, agreed to participate. Overall, patients were positive about their experience and valued the support and services provided. However, there were concerns on the issue of communication. The scheme effectiveness from the patient's perspective improved over the duration of the evaluation.

Discussion: Patients' views about their experiences changed over time, which included patients' perceptions of the discharge process, patients' expectations and the way in which they were able to access services.

The safe and effective treatment of patients accessing multiple NHS services relies upon efficient communication between primary care, secondary care, and out of hours providers. There is a theoretical risk to patient safety from delays in these processes, to which paper communications are particularly vulnerable. When letters are received they must be reviewed and prioritised in order of clinical importance, a process that requires both time and clinical resources. This is relevant to the challenge of resource allocation to maximise patient benefit. This retrospective study investigated the impact on patient safety of 249 clinical letters reporting routine clinical encounters in secondary care and out of hours services that were delayed by an average of 18-24 months to a suburban London general practice. No clinical harm could be attributed to the delay. This small study did not suggest delays in routine communications pose a significant risk to patient safety. Conversely, it questions the efficiency and benefit to patients of prioritising clinical time to reviewing routine letters. The adoption of fully integrated, shared electronic patient records with the function to highlight clinically urgent or important communications might ease clinician workload, to the ultimate benefit of patient care.

This study aims to provide an overview of mental health problems of children and adolescents in Malaysia in general and the state of Terengganu in particular. It also highlights the challenges and the opportunities in the establishment of child and adolescent mental health services (CAMHS). CAMHS in Malaysia are developing slowly but have not reached the standards found in developed countries. Significant improvements are needed to ensure that the service can provide optimal help to children and adolescent as well as their families. Constraining factors such as a lack of trained workers, limited financial resources for training and inadequate facilities are among the challenges. Despite all these challenges, specific strategies are required to optimally utilise the potential existing resources. The Ministry of Health initiatives in creating and implementing the national mental health policy and increasing mental health awareness campaigns for children and adolescents are of paramount importance. To overcome the lack of resources in the implementation of CAMH services, in-service education and training, integration of mental health services with the existing primary health care facilities and cultivation of cooperative and communicative networks between primary care professionals, mental health workers and other relevant agencies are crucial steps.

Japan's healthcare system is primarily focused on general care, and psychiatric services are mainly concerned with institutional solutions to serious mental health issues. As a result, child and adolescent mental health services (CAMHS) have been slow to develop, and there is a limited evidence base to guide treatment. As such, providing treatment to this population is a challenging endeavour. This landscape piece aims to illustrate the current state of child and adolescent services in Japan and provides a description of a recently opened private clinic for children with mental health conditions in Kuroyashi, a city in the Tottori prefecture. The vignette describes steps taken by the clinic's director to overcome systemic challenges and increase access to mental health services to children and adolescents.