Introduction: Symptom prevalence and management have important implications for the use of healthcare services, as well as the health of individuals. Aim: To describe symptom prevalence and management in the UK and to investigate decision-making and preferences for care. Methods: Two questionnaire surveys were undertaken: 1) a symptom survey of 8,000 working-age adults in the UK, 2) a discrete choice experiment (DCE) with 1,370 respondents to the symptom survey. Results: Symptom survey - Over 75% of respondents experienced at least one symptom in the last two weeks (mean 3.7). The two-week prevalence of symptoms varied from 0.2% for coughing-up blood to 41.3% for feeling tired/run down. Prevalence of specific symptoms was associated with a number of participant characteristics. The most common response to symptoms was doing nothing at all (49%) followed by over-the-counter medicine use (25%). Approximately 8% consulted a GP, while use of other members of the primary-care team (pharmacist, nurse, complementary practitioner and NHS24/NHSDirect) was very small (<2%). Symptom characteristics were more commonly associated with actions taken than participant characteristics. DCE - Significant differences were found for three symptom scenarios of increasing seriousness (diarrhoea, dizziness and chest pain). Self-care was the preferred option for diarrhoea. Consulting a GP was the preferred option for dizziness and chest pain. For all symptom scenarios there was a preference for less waiting time, less cost, greater convenience/availability and a very good chance of a satisfactory outcome. These preferences were valued more highly as the seriousness of the symptom scenario increased. Respondents were willing to trade between different attributes, with waiting time and chance of a satisfactory outcome being the attributes most likely to influence preferences for different actions. Conclusion: Further research is required to examine the public’s knowledge and perceptions of the services offered by different members of the primary care team for managing symptoms.

Thesis (Ph.D.) - University of Glasgow, 2004. / Ph.D thesis submitted to the Departments of Public Health and Palliative Medicine, Faculty of Medicine, University of Glasgow, 2004. Includes bibliographical references (p. 272-293). Print version also available. Mode of access : World Wide Web. System requirements : Adobe Acrobat reader required to view PDF document.

Youth depression is a serious mental health disorder that may have detrimental consequences. Half of all lifetime cases of mental illness begin before the age of 14 (Hagan, Shaw, & Duncan, 2008). Depression in youth is linked to increased morbidity and mortality, along with high-risk behaviors. Mental health and mood disorders are the leading cause of illness and burden among youth (Patel, 2013). Nationally, suicide is the third leading cause of death for individuals aged 15 to 24. In North Dakota, suicide is the first leading cause of death for individuals aged 15 to 24 (American Foundation for Suicide Prevention, 2016). Unfortunately, depression remains largely underdiagnosed and undertreated; only about 50 percent of youth with depression are diagnosed before they reach adulthood (Zuckerbrot, Cheung, Jensen, Stein, & Laraque, 2007). The purpose of this project was to improve the mental health of youth through increasing universal screening in the primary care setting, and improve the confidence and ability of the primary care provider to diagnose and treat youth depression. Primary care provider education was launched through collaboration with Essentia Health, providing education regarding youth depression focused on universal screening, identification of youth depression, and treatment modalities. To evaluate primary care provider education, a pretest/posttest was completed, along with key stakeholder interviews. Surveys demonstrated an increased intent to screen and increased confidence in identifying and managing youth depression. The interview with key stakeholders was used to determine the effectiveness and feasibility of universal screening and management of youth depression in the primary care setting.

The demands for high quality primary care have become strained by a deficit in the primary care physician supply and the complexity of delivering care to aging populations that are often living with complex co-morbidities. Provider co-management has emerged in practice to help alleviate some of the care delivery demands by having more than primary care provider (PCP) complete care management tasks for the same patient. There is extensive literature investigating two physicians co-managing patient care, and physician-physician assistant co-management, yet limited studies have investigated nurse practitioner (NP)-physician co-management. NPs currently are the fastest growing health care workforce in the United States. Several organizations support the expanded utilization of NPs in primary care. As more U.S. states are granting NPs independent scope of practice, which is free of physician oversight, the potential for NPs to co-manage patients with physicians, and alleviate some of the primary care strain, has increased. However, there are limited to no studies that have investigated NP-physician co-management in primary care. Further, there is a lack of evidence of PCP perspectives about co-managing care, its impact on patient and practice outcomes, or a tool to measure NP-physician co-management in practice or research. More evidence about NP-physician co-management is warranted and will be investigated in this dissertation. The purpose of this dissertation is to investigate NP-physician co-management in primary care by synthesizing the existing evidence, gathering data from PCPs about NP-physician co-management and to develop a valid and reliable tool to measure it. In Chapter 1, background of the current demands on primary care is presented and accompanied by a discussion about the need to expand the NP workforce in primary care to help meet the demand. Evidence about the history of provider co-management is presented and gaps in the literature are identified. Specific aims of the dissertation are introduced and tied to existing theoretical underpinnings. In Chapter 2, aim one of the dissertation is addressed by qualitatively obtaining data on the PCP perspective of NP-physician co-management. In Chapter 3, aim two of the dissertation is addressed. A systematic review of the literature was conducted to determine the effects of NP-physician co-management compared to a single physician delivering care. In Chapter 4, aim three is addressed. Based on the collective findings of Aim 1 and Aim 2, a new tool is developed and psychometrically tested to measure NP-physician co-management. Content validity and reliability testing of the tool is conducted. In Chapter 5, the results of the dissertation are synthesized. Practice, policy, and research implications are discussed, and strengths and limitations of the dissertation are presented.

published_or_final_version / Public Health / Master / Master of Public Health

Thesis (B.A.)--Haverford College, Independent College Programs, 2008. / Includes bibliographical references.

Thesis (Ph. D.)--Illinois State University, 2003. / Title from title page screen, viewed Dec. 16, 2004. Dissertation Committee: Dissertation Committee: Edward R. Hines (chair), Kenneth H. Strand, Ross A. Hodel, Zeng Lin. Includes bibliographical references (leaves 79-83) and abstract. Also available in print.

No description available.

Bibliography: leaves 233-306. A study of the phenomenon of somatization as it occurs in the primary care setting. The phenomenon was studied in terms of aspects of illness behaviour and risk of psychiatric morbidity. It is suggested that abnormal illness behaviour in the form of somatization may be an important factor in the non-recognition of mild non-psychotic psychiatric illness in the primary care setting. The results of the study indicate that an assessment of the patients' attitudes and beliefs about symptoms, and an exploration of psychosocial issues, may lead to a better understanding of why the patients have sought help, and may lead to early identification and appropriate treatment of somatizing behaviour and the psychiatric morbidity underlying such behaviour.

Thesis (M.A.(Applied))--Victoria University of Wellington, 2006. / Includes bibliographical references.