No description available.

This is a study of work place counselling. It responded to four key stimulants: (1) the paucity of workplace counselling evaluations; (2) the need to more fully incorporate the client and organisation into evaluations; (3) the call for an increased qualitative focus in counselling research; (4) the need for practitioners to become research-minded. The site was the Northern Ireland Fire Brigade's (NIFB) external counselling service. The study was inspired by the concept of the workplace counselling triangle - of client, counsellor and organisation. It explores the degree of congruence across the aims, needs, expectations and evaluations of each of the three facets; the aim being to ascertain whether the NIFB 's counselling provision meets the needs of its three primary stakeholders? A qualitative methodology was adopted, with stakeholder perspectives captured by semi-structured interviews. Counselling process assessments, sick absence analysis and a workforce awareness survey were also conducted. The counselling service was dramatically effective from the client perspective. Counsellors, while satisfied with their client work had reservations about organisational links. Their wish for greater primary intervention was matched by the NIFB being surprised that they were not more proactive at this level! A need for effective organisational induction and terms of engagement were identified, so as to allow counsellors to move beyond the personal counselling role. The observed reduction in absenteeism post-counselling was a dividend for the organisation. Although the NIFB counselling service does not currently meet all stakeholder needs, it has been shown to be significantly effective in both human and financial terms. The service is needed, period.

Previous research has indicated that the majority of the UK dentate population suffers from dental disease. This problem was examined in terms of the supply of, and demand for, dental treatment: how might the uptake of dental services be increased and dental health improved? The target population for the main survey was adolescents among whom demand for dental treatment has decreased. In 524 adolescents surveyed, fear of pain was the major deterrent to regular dental visits. The theoretical literature was explored for illuminating and practical approaches to the problem. The theory of reasoned action developed by Fishbein seemed the most promising. This theory was tested and validated on the adolescent sample identifying clear differences between regular and irregular dental attenders which could be usefully exploited by dental health education. A repertory grid analysis study further illuminated perceptions of dental treatment. A survey of a random sample of 716 dentists revealed that most dentists were in favour of delegating work to auxiliary help but few could do so. Auxiliary help would increase supply of services: data revealed an encouraging trend for younger dentists to be more in favour of delegation than older dentists. A survey was carried out of computer systems available for dentists suggesting that this might reduce the need for clerical assistance but would not ususally affect the supply of treatment. However in some dental practices computerisation might increase demand. For example a personalised reminder was developed and evaluated in a controlled study of 938 appointments demonstrating an uptake in dental services. Conclusions are that demand for treatment can be increased in various ways especially by teaching dentists' behavioural strategies to deal with fear and pain. Various recommendations on this are made. If demand were to outstrip supply increased delegation to auxiliary help could provide a viable way of increasing supply.

No description available.

Influences on general practitioner prescribing of drugs continue to be of interest and importance as cost containment becomes central to Government health policy. This thesis employs a plurality of research methods including quantitative and qualitative survey techniques for example, questionnaires, interviews and prescription analyses to investigate some of the factors which may influence GP prescribing such as information sources, hospital consultants and in particular the community pharmacist. When the use and influence of drug information sources by GPs was examined, the community pharmacist was given a relatively low rating as a source but a high rating, similar to that of the consultant, for helpfulness. Influences are needed to improve prescribing and reduce the incidence of iatrogenic disease for the benefit of the patient. The education and expertise of pharmacists and their familiarity with local prescribing habits places them in a unique position to meet the needs of local GPs. As 96.5% of the public always or nearly always take their prescriptions to the same pharmacy, patient medication records, now kept by 77.5% of pharmacies, provide a valuable check on the appropriateness and safety of patients' medication. The barriers to the pharmacist's greater involvement were shown to be suspicion by GPs of pharmacists' motivation, isolation of many community pharmacists, difficulties in leaving the pharmacy for domiciliary visits, residential home care and GP practice meetings. These barriers must be lowered if the pharmacist is to have a greater influence and involvement. It was concluded that changes are necessary in pharmaceutical education, staff training, organisation and remuneration. Some changes in the targeting of remuneration to the pharmaceutical care services provided and registration of patients with pharmacies would contribute greatly to these aims.

Factors affecting the current role of the community pharmacist in responding to symptoms are investigated. Communication and collaboration with general medical practitioners (GPs), and the competency of pharmacists and counter assistants to perform the role of responding to symptoms, are examined. A national survey of GPs, conducted by postal questionnaire, explores attitudes towards the role of the community pharmacist in the treatment of patients' symptoms, and towards future extension of such a role. A majority (over 90%) of respondents thought that the counter prescribing activities of the pharmacist should be maintained or increased. Doctors supported treatment of most minor illnesses by pharmacists, but there was relatively little support for the deregulation of selected Prescription Only Medicines. Three quarters of respondents were in favour of joint educational meetings for pharmacists and doctors. Most GPs (85%) expressed support for a formal referral route from pharmacists to doctors, using a "notification card". A pilot study of the use of a notification card was conducted . Two thirds of the patients who were advised to see their doctor by the pharmacist subsequently did so. In most cases , the GP rated the patients' symptoms " significant" and the card "helpful". Pharmacists' and counter assistants' competency in responding to symptoms was assessed by a programme of pharmacy visits, where previously-defined symptoms were presented. Some pharmacists' questioning skills were found to be inadequate, and their knowledge not sufficiently current. Counter assistants asked fewer and less appropriate questions than did pharmacists, and assistants ' knowledge base was shown to be inadequate. Recommendations are made in relation to the education and training of pharmacists and counter assistants in responding to symptoms.

This thesis examines the present provisions for pre-conception care and the views of the providers of services. Pre-conception care is seen by some clinicians and health educators as a means of making any necessary changes in life style, corrections to imbalances in the nutritional status of the prospective mother (and father) and the assessment of any medical problems, thus maximizing the likelihood of the normal development of the baby. Pre-conception care may be described as a service to bridge the gap between the family planning clinic and the first ante-natal booking appointment. There were three separate foci for the empirical research - the Foresight organisation (a charity which has pioneered pre-conception care in Britain); the pre-conception care clinic at the West London Hospital, Hammersmith; and the West Midlands Regional Health Authority. The six main sources of data were: twenty five clinicians operating Foresight pre-conception clinics, couples attending pre-conception clinics, committee members of the Foresight organisation, staff of the West London Hospital pre-conception clinic, Hammersmith, District Health Education Officers working in the West Midlands Regional Health Authority and the members of the Ante-Natal Care Action Group, a sub-group of the Regional Health Advisory Group on Health Promotion and Preventive Medicine. A range of research methods were adopted. These were as follows: questionnaires and report forms used in co-operation with the Foresight clinicians, interviews, participant observation discussions and informal meetings and, finally, literature and official documentation. The research findings illustrated that pre-conception care services provided at the predominantly private Foresight clinics were of a rather `ad hoc' nature. The type of provision varied considerably and clearly reflected the views held by its providers. The protocol which had been developed to assist in the standardization of results was not followed by the clinicians. The pre-conception service provided at the West London Hospital shared some similarities in its approach with the Foresight provision; a major difference was that it did not advocate the use of routine hair trace metal analysis. Interviews with District Health Education Officers and with members of the Ante Natal Care Action Group revealed a tentative and cautious approach to pre-conception care generally and to the Foresight approach in particular. The thesis concludes with a consideration of the future of pre-conception care and the prospects for the establishment of a comprehensive pre-conception care service.

Introduction As a result of the growing and ageing population in developed countries, improved cancer detection and advances in cancer treatments, there are more people living with cancer for longer. The rising number of cancer survivors and increasing demand for oncology services, has sparked interest in alternative ways of delivering cancer follow-up care. Although a number of alternative cancer follow-up strategies have been developed, information about the relative importance of different characteristics of follow-up and how people trade between these characteristics is still limited. Aims and objectives The overall aim of the thesis was to understand what characteristics (called attributes and levels) of cancer follow-up services are important to survivors of cutaneous melanoma, breast, prostate and colorectal cancer; whether people make trade-offs between these characteristics; and whether survivors of different cancers with different personal characteristics express different preferences for cancer follow-up care. The aim was met by a number of objectives: •To conduct a review of the literature to gather information about characteristics of follow-up that are important to people. • To conduct semi-structured qualitative interviews with cancer survivors living in North East Scotland, to determine their views of current care and preferences for future cancer follow-up. • Based on the findings from the literature and semi-structured interviews, to determine characteristics (attributes and levels) of cancer follow-up services for inclusion in a discrete choice experiment. • To develop and carry out a discrete choice experiment to establish the relative importance of a number of attributes of cancer follow-up amongst cancer survivors treated and followed up for cutaneous melanoma, breast, prostate and colorectal cancer.

No description available.

The research described in this thesis is concerned with examining the views of a range of health and social service professionals towards policies devised by central government in the mid-1970s, relating to the care of particular patient or client groups, namely, elderly, mentally ill. and mentally and physically handicapped people. The policies called for priority in resource allocation to be given to these groups - although this was likely to involve withdrawing resources away from other groups (notably from the acute sector within the health service); they also called for a move away from institutional care towards community care. By the beginning of the 1980s. little progress in achieving such a shift had been made. and recent reports in the late 1980s suggest that subsequent progress has also been slow. Analysts have given various reasons for this failure, but this study is founded on the proposition that professionals in the organisations responsible for the delivery of care to the 'priority' or 'dependency' groups are likely to have played a significant role in the only partial implementation of the policies. It reviews literature on theories of social policy development. organisational behaviour and the role and significance of professionals in organisations, arguing that the beliefs and attitudes of professionals may amount to what can be called ideologies which condition and mould behaviour. The study is based on extended, semi-structured interviews with 236 respondents in three Scottish locations. It finds that distinctive patternings of attitudes emerge according to professional affiliation; other factors, however, also exert a conditioning effect - such as organisational position, agency membership and the practitioner/manager distinction. Attitudes directly relating to the policies themselves are moulded by the significance which the issues hold for the respondents concerned - thus a dichotomy between the abstract and the concrete emerges. Although support for the policies in principle is usually forthcoming, it tends to be couched in equivocal terms. The study concludes that such ambivalent attitudes are likely to play a major part in shaping the outcomes of the policy process.