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Hendry, Anne. "Living well in later life in Scotland." Working with Older People 21, no. 1 (March 13, 2017): 22–30. http://dx.doi.org/10.1108/wwop-12-2016-0037.
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Purpose The purpose of this paper is to describe the development, implementation and early impact of a national action plan for active and healthy ageing in Scotland. Design/methodology/approach The Joint Improvement Team, NHS Health Scotland, the Scottish Government and the Health and Social Care Alliance Scotland (ALLIANCE) co-produced the action plan with older people from the Scottish Older People’s Assembly. Together they supported partnerships to embed the action plan as an important element of the reshaping care for older people transformation programme in Scotland. Findings A cross-sector improvement network supported health, housing and care partnerships to use a £300 million Change Fund to implement evidence based preventative approaches to enable older people to live well. Older people in Scotland spent over two million days at home than would have been expected based on previous balance of care and impact of ageing. Practical implications Improving the health and wellbeing of older people is not just the responsibility of health and social care services. Enabling older people to live independent, active and fulfilling lives requires coordinated effort that spans national and local government policy areas, mobilises all sectors of society, and involves all health and care disciplines. Success starts with listening to what matters to older people, and working together, and with older people and local communities, to make that a reality. Originality/value This case study from Scotland offers transferable learning for other systems who have an ageing population and an ambitions to enable them to live well in later life.
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Liao, Xiao-Hui, and G. McIlwaine. "The Health Status and Health Needs of Chinese Population in Glasgow." Scottish Medical Journal 40, no. 3 (June 1995): 77–80. http://dx.doi.org/10.1177/003693309504000306.
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This cross sectional study explored the health problems and health needs in the local Chinese community in Glasgow. Several data collection methods have been used in this study, including face-to-face and telephone structured interviews, postal and hand delivered questionnaires. A total of 800 questionnaires were processed, and 493 were completed, giving an overall response rate 61.6%. The results from the present survey indicated that the health status of Chinese residents in Glasgow is poorer than that of the local population. The most important findings of the study is that the Chinese community in Glasgow underuse health services, and unmet health needs exist in the community. The main barrier to effective use of present health services and benefit from the health promotion and health education programmes is language difficulties. Following discussion with the local community, options for improving the health services for the Chinese community in Glasgow were obtained. The findings of the study have implications for health service purchaser/providers of health care to the Chinese population generally in Scotland.
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Inbadas, Hamilton, José Miguel Carrasco, Michelle Gillies, and David Clark. "The level of provision of specialist palliative care services in Scotland: an international benchmarking study." BMJ Supportive & Palliative Care 8, no. 1 (July 8, 2017): 87–92. http://dx.doi.org/10.1136/bmjspcare-2016-001301.
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ObjectivesComparative benchmarking of specialist palliative care (SPC) services across jurisdictions can be used to assess the adequacy of provision. Published in 2016, the Scottish Atlas of Palliative Care unlocks the possibility of benchmarking Scotland’s provision against other European Union (EU) countries. Our objectives were to describe the provision of SPC services in Scotland and compare this with other EU countries, assessing coverage against European norms.MethodsWe conducted a secondary analysis of data collected as part for the Scottish Atlas by structured telephone (n=33) or online (n=3) survey with informants from 14 territorial health boards and 15 hospices who provided information about SPC services in their locality. National-level Scottish data were compared with data from other EU countries allowing ranking for each service type and service coverage as calculated against European Association for Palliative Care norms.ResultsScotland had a total of 23 SPC inpatient units containing 349 beds, 27 SPC hospital support teams and 38 SPC home care teams. Relative to other EU countries, Scotland ranked seventh for provision of SPC inpatient units and hospital support teams, and fifth for home care teams. Coverage for these services was 85%, 100% and 72%, respectively.ConclusionScotland is positioned among the top 10 EU countries for the level of provision of SPC services. National policy in Scotland has focused on the delivery of palliative care at home or in a homely setting. These data support a focus on developing services in community settings to meet Scotland’s policy ambitions.
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Duncan, Edward, Kay Cooper, Julie Cowie, Lyndsay Alexander, Jacqui Morris, and Jenny Preston. "A national survey of community rehabilitation service provision for people with long Covid in Scotland." F1000Research 9 (March 26, 2021): 1416. http://dx.doi.org/10.12688/f1000research.27894.2.
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Background: Over 50 million cases of COVID-19 have been confirmed globally as of November 2020. Evidence is rapidly emerging on the epidemiology of COVID-19, and its impact on individuals and potential burden on health services and society. Between 10–35% of people with COVID-19 may experience post-acute long Covid. This currently equates to between 8,129 and 28,453 people in Scotland. Some of these people will require rehabilitation to support their recovery. Currently, we do not know how to optimally configure community rehabilitation services for people with long Covid. Methods: This national survey aimed to provide a detailed description of current community rehabilitation provision for people with long Covid in Scotland. We developed, piloted, and conducted a national electronic survey of current community rehabilitation service provision for people presenting with long Covid symptomatology. Our sample were the Allied Health Professions Directors of all 14 territorial NHS Health Boards in Scotland. Fixed response and narrative data were analysed descriptively. Results: Responses were received from all respondents (14/14), enabling a national picture to be gained. Almost all Health Boards (13/14) currently deliver rehabilitation for people with long Covid within pre-existing services. Fatigue (11/14) and respiratory conditions (9/14) were the two most common presenting problems of patients. Most long Covid community rehabilitation services are delivered through a combination of face-to-face and digital contact (13/14). Conclusions: Community rehabilitation for people with long Covid is an emerging reality. This survey provides a national picture of current community rehabilitation for people with long Covid. We do not know how community rehabilitation can be optimally delivered for this population. This is vital as community rehabilitation services were already under pressure prior to the emergence of COVID-19. Further research is urgently required to investigate the implementation, outcomes and cost-effectiveness of differing models of community rehabilitation for this patient population.
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Duncan, Edward, Kay Cooper, Julie Cowie, Lyndsay Alexander, Jacqui Morris, and Jenny Preston. "A national survey of community rehabilitation service provision for people with long Covid in Scotland." F1000Research 9 (December 7, 2020): 1416. http://dx.doi.org/10.12688/f1000research.27894.1.
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Background: Over 50 million cases of COVID-19 have been confirmed globally as of November 2020. Evidence is rapidly emerging on the epidemiology of COVID-19, and its impact on individuals and potential burden on health services and society. Between 10–35% of people with COVID-19 may experience post-acute long Covid. This currently equates to between 8,129 and 28,453 people in Scotland. Some of these people will require rehabilitation to support their recovery. Currently, we do not know how to optimally configure community rehabilitation services for people with long Covid. Methods: This national survey aimed to provide a detailed description of current community rehabilitation provision for people with long Covid in Scotland. We developed, piloted, and conducted a national electronic survey of current community rehabilitation service provision for people presenting with long Covid symptomatology. Our sample were the Allied Health Professions Directors of all 14 territorial NHS Health Boards in Scotland. Fixed response and narrative data were analysed descriptively. Results: Responses were received from all respondents (14/14), enabling a national picture to be gained. Almost all Health Boards (13/14) currently deliver rehabilitation for people with long Covid within pre-existing services. Fatigue (11/14) and respiratory conditions (9/14) were the two most common presenting problems of patients. Most long Covid community rehabilitation services are delivered through a combination of face-to-face and digital contact (13/14). Conclusions: Community rehabilitation for people with long Covid is an emerging reality. This survey provides a national picture of current community rehabilitation for people with long Covid. We do not know how community rehabilitation can be optimally delivered for this population. This is vital as community rehabilitation services were already under pressure prior to the emergence of COVID-19. Further research is urgently required to investigate the implementation, outcomes and cost-effectiveness of differing models of community rehabilitation for this patient population.
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DOBSON, CAROL. "A study of on-call provision in community psychiatric nursing services in Scotland." Journal of Psychiatric and Mental Health Nursing 1, no. 2 (April 1994): 127–28. http://dx.doi.org/10.1111/j.1365-2850.1994.tb00031.x.
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McKenzie, Karen, Dale Metcalfe, Amanda Michie, and George Murray. "Service provision in Scotland for people with an intellectual disability who have, or are at risk of developing, dementia." Dementia 19, no. 3 (June 29, 2018): 736–49. http://dx.doi.org/10.1177/1471301218785795.
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This research aimed to identify current national provision by health services in Scotland in relation to proactive screening and reactive assessment for people with an intellectual disability in Scotland who have, or are at risk of developing, dementia. Staff from 12 intellectual disability services, representing the 11 health board areas in Scotland, completed an online questionnaire which asked about proactive screening and reactive assessment for people with intellectual disability who had, or were at risk of developing, dementia as well as suggested areas for improvement. All of the areas provided services for people with intellectual disability who have, or are at risk of developing, dementia, but differed as to whether this was reactive, proactive or both. Nine services offered intervention following diagnosis. The most common elements used across both proactive screening and reactive assessment were conducting a health check, using a general dementia questionnaire designed for people with an intellectual disability and direct assessment with the person. Clinical psychology and community learning disability nurses were the professions most likely to be involved routinely in both proactive screening and reactive assessments. The psychometric properties of the most commonly used assessments of cognitive and behavioural functioning were mixed. The areas of improvement suggested by practitioners mainly related to ways of improving existing pathways. This research represents the first step in providing an overview of service provision in Scotland. There was some inconsistency in relation to the general and specific components which were involved in proactive screening and reactive assessment. Implications for service provision are discussed.
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Gale, A., and M. C. Watson. "The provision of current and future sexual health services from community pharmacies in Grampian, Scotland." International Journal of Clinical Pharmacy 33, no. 2 (January 28, 2011): 183–90. http://dx.doi.org/10.1007/s11096-010-9458-x.
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Duncan, Edward, Lyndsay Alexander, Julie Cowie, Alison Love, Jacqui H. Morris, Rachel Moss, Jane Ormerod, et al. "Investigating Scottish Long COVID community rehabilitation service models from the perspectives of people living with Long COVID and healthcare professionals: a qualitative descriptive study." BMJ Open 13, no. 12 (December 2023): e078740. http://dx.doi.org/10.1136/bmjopen-2023-078740.
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ObjectivesThis study aimed to explore the perceptions and experiences of barriers and facilitators to accessing Long COVID community rehabilitation.DesignWe used a qualitative descriptive design over two rounds of data collection with three participant groups: (1) people with experience of rehabilitation for Long COVID (PwLC); (2) National Health Service (NHS) staff delivering and/or managing community rehabilitation services (allied health professionals (AHPs)) and (3) NHS staff involved in strategic planning around Long COVID in their health board (Long COVID leads).SettingFour NHS Scotland territorial health boards.Participants51 interviews: eight Long COVID leads (11 interviews); 15 AHPs (25 interviews) and 15 PwLC (15 interviews).ResultsThree key themes were identified: (1) accessing care for PwLC, (2) understanding Long COVID and its management and (3) strengths and limitations of existing Long COVID rehabilitation services.ConclusionsOrganisational delivery of Long COVID community rehabilitation is complex and presents multiple challenges. In addition, access to Long COVID community rehabilitation can be challenging. When accessed, these services are valued by PwLC but require adequate planning, publicity and resource. The findings presented here can be used by those developing and delivering services for people with Long COVID.
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Matheson, C., C. M. Bond, and J. Pitcairn. "Community pharmacy services for drug misusers in Scotland: what difference does 5 years make?" Addiction 97, no. 11 (October 31, 2002): 1405–11. http://dx.doi.org/10.1046/j.1360-0443.2002.00241.x.
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Morral, Kim, and Jordi Morral. "The mental health literacy of British community pharmacists." Journal of Mental Health Training, Education and Practice 12, no. 2 (March 13, 2017): 98–110. http://dx.doi.org/10.1108/jmhtep-12-2015-0054.
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Purpose The purpose of this paper is to examine the mental health literacy (MHL) of British community pharmacists. Design/methodology/approach A survey instrument was sent by facsimile to a random sample of community pharmacists in England, Scotland and Wales. The survey instrument contained items concerning recognition of the symptoms of depression, bipolar disorder or schizophrenia, the helpfulness of a range of interventions, mental health stigma and the degree of comfort providing pharmaceutical care to people with mental health problems. Findings Among community pharmacists (n=329) symptom recognition was high for depression but lower for bipolar disorder and schizophrenia. Pharmacists showed a preference for evidence-based interventions and support for psychological therapies and physical activity for all three mental health problems. Pharmacists expressed less comfort providing pharmacy services to people with bipolar disorder, schizophrenia and depression than cardiovascular disease. Mental health stigma was higher for schizophrenia and bipolar disorder than depression, with many pharmacists holding misperceptions about schizophrenia and bipolar disorder. Practical implications The study findings indicate the need for enhanced mental health content in the undergraduate pharmacy curriculum which should challenge misperceptions of mental illness. Originality/value This is the first study to investigate the MHL of British community pharmacists.
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Gao, Chuang, Mark McGilchrist, Shahzad Mumtaz, Christopher Hall, Lesley Ann Anderson, John Zurowski, Sharon Gordon, et al. "A National Network of Safe Havens: Scottish Perspective." Journal of Medical Internet Research 24, no. 3 (March 9, 2022): e31684. http://dx.doi.org/10.2196/31684.
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For over a decade, Scotland has implemented and operationalized a system of Safe Havens, which provides secure analytics platforms for researchers to access linked, deidentified electronic health records (EHRs) while managing the risk of unauthorized reidentification. In this paper, a perspective is provided on the state-of-the-art Scottish Safe Haven network, including its evolution, to define the key activities required to scale the Scottish Safe Haven network’s capability to facilitate research and health care improvement initiatives. A set of processes related to EHR data and their delivery in Scotland have been discussed. An interview with each Safe Haven was conducted to understand their services in detail, as well as their commonalities. The results show how Safe Havens in Scotland have protected privacy while facilitating the reuse of the EHR data. This study provides a common definition of a Safe Haven and promotes a consistent understanding among the Scottish Safe Haven network and the clinical and academic research community. We conclude by identifying areas where efficiencies across the network can be made to meet the needs of population-level studies at scale.
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June, Andrea, and Carrie Andreoletti. "INTERGENERATIONAL COURSE ABROAD EXPLORES AGE INCLUSIVITY IN SCOTLAND." Innovation in Aging 7, Supplement_1 (December 1, 2023): 25–26. http://dx.doi.org/10.1093/geroni/igad104.0085.
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Abstract In 2017, Central Connecticut State University (CCSU) joined the Age-Friendly University (AFU) global network. Guided by the AFU framework to promote age inclusivity in higher education, many programs and services at CCSU have been expanded to encourage the participation of older adults in all core activities of the university. The authors have a particular interest in fostering intergenerational learning opportunities, for which there are reciprocal benefits (e.g., Andreoletti & Howard, 2016). With the goals of promoting intergenerational connection and global age-inclusivity, we developed a course abroad to Scotland called Global Aging & Age-Friendly Initiatives. Prior to traveling, students are introduced to theory and research in lifespan development and to the World Health Organization’s (WHO) definition of healthy aging and domains of livability aimed at enhancing well-being and longevity. Livability community efforts in the USA are explored so that similarities and differences can be examined while in Scotland. During 9 days of travel, students are exposed to urban and rural areas of Scotland, noting the accessibility of public transportation, the availability of green spaces, the cultural attitude toward older adults, and other domains of livability. They will also hear from local academics and community organizers invested in promoting engagement across the lifespan. In June 2023, eight age-diverse learners will travel with the authors. In addition to providing more detail on the development and implementation of the course abroad, this presentation will share feedback from students and international collaborators with the goal of encouraging other AFUs to develop similar opportunities.
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Doughty, Kevin, Andrew Monk, Carole Bayliss, Sian Brown, Lena Dewsbury, Barbara Dunk, Vance Gallagher, et al. "Telecare, telehealth and assistive technologies: do we know what we're talking about?" Housing, Care and Support 11, no. 3 (November 1, 2008): 36–41. http://dx.doi.org/10.1108/14608790200800023.
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The development of telecare services in the UK has been supported by grants from the respective governments of Scotland and Wales, and by the Department of Health in England. New services are being established, sometimes to operate alongside existing community equipment services and community alarm services. Elsewhere they are embracing a wider range of services including rehabilitation, intermediate care and health services designed to reduce use of unscheduled care services. This paper discusses the difficulties in understanding the scope of telecare services, and the definitions of services that will need to be confirmed if service users are to be able to choose appropriately if offered direct payments. Two service models are offered, one of which uses telehealth as an umbrella term to cover all telecare, e‐care and m‐care, and telemedicine, where the former includes all such services offered in the service user's home, including those of a medical nature. The second model views telecare alongside assistive technologies and telemedicine as one of three technology groups designed to make people more independent, or to bring care closer to home. There is significant overlap between the three groups, which justifies the introduction of a new term ‐ ARTS (assistive and remote technology services) ‐ to describe this area of support.
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Newton, J. Timothy, Alison C. Williams, and Elizabeth J. Bower. "Inequalities in the Provision of NHS Primary Care Dental Services in Scotland in 2004." Primary Dental Care os14, no. 3 (July 2007): 89–96. http://dx.doi.org/10.1308/135576107781327098.
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Objective To assess inequalities in the provision of National Health Service (NHS) primary care dental services between Health Boards and the four provider groups (General Dental Service [GDS] non-specialist, GDS salaried, specialist working in primary care, Community Dental Service [CDS]) in Scotland. Methods A postal questionnaire survey of all dentists (N=2852) registered with the General Dental Council at an address in Scotland was undertaken. The following were assessed: the proportion of primary care dentists not accepting new children/adults for NHS care or using a waiting list, the proportion of dentists working in wheelchair-accessible surgeries, furthest distance travelled by patients to primary care surgery in an average week, waiting time for routine NHS treatment, and the proportion of dentists offering weekend or evening appointments to NHS patients. Data were analysed by Health Board and the four provider groups. Results A total of 2134 (74.8%) completed questionnaires were returned. One thousand, five hundred and seventy-seven dentists (73.9%) of the respondents were providing NHS primary care dental services for at least part of each week. There was a wide variation in the provision of NHS primary care dental services between Health Boards. Borders, Dumfries and Galloway, and Grampian performed poorly on most indicators, whereas Lanarkshire, Greater Glasgow, and Argyll and Clyde generally performed well. The CDS scored well on most indicators of service provision. There were problems with the provision of specialist dental services in primary care, and GDS services provided by Health Boards. Conclusions Because the problem issues differed between Health Boards and the four provider groups, it is likely that both local and national solutions are required to improve the provision of services. Further research on service demand is required to confirm the apparent inequalities in provision suggested by the study.
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Lelliott, Paul, and John Wing. "A National Audit of New Long-Stay Psychiatric Patients." British Journal of Psychiatry 165, no. 2 (August 1994): 170–78. http://dx.doi.org/10.1192/bjp.165.2.170.
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Background.This second report of a national audit of new long-stay (NLS) psychiatric patients describes the services caring for the patients and the reasons why patients were still in hospital.Method.Data analyses addressed the prevalence of NLS patients, the residential resources available to services, the distributions of patients within services, clinicians' views as to the appropriateness of current placement and the reasons for any inappropriate placements.Results.The average point prevalence was 6.1 per 100 000 population; it was significantly lower in England and Wales (5.6, s.d. = 3.2) than in Scotland and Northern Ireland (10.7, s.d. = 6.4, ANOVA F ratio = 10.9, P < 0.01). The estimated rate of accumulation was 1.3 per 100 000 population per year. Many English services had very few non-acute psychiatric beds and 31 % of English NLS patients, despite their protracted lengths of stay, were housed on acute wards. Assessors thought that 61 % of patients would be better placed in a non-hospital setting; 47% were thought to require a community-based residential setting, and of these over one-half were still in hospital because no suitable community placement was available.Conclusions.Many NLS patients remain in hospital because their residential needs are not met by existing community provision.
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Fixsen, Alison, Simon Barrett, and Michal Shimonovich. "Weathering the storm: A qualitative study of social prescribing in urban and rural Scotland during the COVID-19 pandemic." SAGE Open Medicine 9 (January 2021): 205031212110291. http://dx.doi.org/10.1177/20503121211029187.
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Objectives: The non-clinical approach known as social prescribing aims to tackle multi-morbidity, reduce general practitioner (GP) workload and promote wellbeing by directing patients to community services. Usual in-person modes of delivery of social prescribing have been virtually impossible under social distancing rules. This study qualitatively examined and compared the responses of three social prescribing schemes in Scotland to the COVID-19 pandemic. Methods: We interviewed a theoretical sample of 23 stakeholders in urban and rural social prescribing schemes at the start of COVID-19 pandemic. Follow-up interviews with a representative sample were conducted around 10 months later. Interviewees included social prescribing coordinators (SPCs) GPs, managers, researchers and representatives of third sector organizations. Interview transcripts were analysed in stages and an inductive approach to coding was supported by NVivo. Results: Findings revealed a complex social prescribing landscape in Scotland with schemes funded, structured and delivering services in diverse ways. Across all schemes, working effectively during the pandemic and shifting to online delivery had been challenging and demanding; however, their priorities in response to the pandemic had differed. With GP time and services stretched to limits, GP practice-attached ‘Link Workers’ had taken on counselling and advocacy roles, sometimes for serious mental health cases. Community-based SPCs had mostly assumed a health education role, and those on the Western Isles of Scotland a digital support role. In both rural or urban areas, combatting loneliness and isolation – especially given social distancing – remained a pivotal aspect of the SPC role. Conclusion: This study highlights significant challenges and shifts in focus in social prescribing in response to the pandemic. The use of multiple digital technologies has assumed a central role in social prescribing, and this situation seems likely to remain. With statutory and non-statutory services stretched to their limits, there is a danger of SPCs assuming new tasks without adequate training or support.
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Mason, Bruce, Emma Carduff, Sheonad Laidlaw, Marilyn Kendall, Scott A. Murray, Anne Finucane, Sebastien Moine, et al. "Integrating lived experiences of out-of-hours health services for people with palliative and end-of-life care needs with national datasets for people dying in Scotland in 2016: A mixed methods, multi-stage design." Palliative Medicine 36, no. 3 (March 2022): 478–88. http://dx.doi.org/10.1177/02692163211066256.
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Background: Unscheduled care is used increasingly during the last year of life by people known to have significant palliative care needs. Aim: To document the frequency and patterns of use of unscheduled healthcare by people in their last year of life and understand the experiences and perspectives of patients, families and professionals about accessing unscheduled care out-of-hours. Design: A mixed methods, multi-stage study integrating a retrospective cohort analysis of unscheduled healthcare service use in the last year of life for all people dying in Scotland in 2016 with qualitative data from three regions involving service users, bereaved carers and general practitioners. Setting: Three contrasting Scottish Health Board regions and national datasets for the whole of Scotland. Results: People who died in Scotland in 2016 ( n = 56,407) had 472,360 unscheduled contacts with one of five services: telephone advice, primary care, ambulance service, emergency department and emergency hospital admission. These formed 206,841 individual continuous unscheduled care pathways: 65% starting out-of-hours. When accessing healthcare out-of-hours, patients and carers prioritised safety and a timely response. Their choice of which service to contact was informed by perceptions and previous experiences of potential delays and whether the outcome might be hospital admission. Professionals found it difficult to practice palliative care in a crisis unless the patient had previously been identified. Conclusion: Strengthening unscheduled care in the community, together with patient and public information about how to access these services could prevent hospital admissions of low benefit and enhance community support for people living with advanced illness.
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Stalker, Kirsten, Chris Jones, and Pete Ritchie. "All Change? The Role and Tasks of Community Occupational Therapists in Scotland." British Journal of Occupational Therapy 59, no. 3 (March 1996): 104–8. http://dx.doi.org/10.1177/030802269605900302.
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In November 1994, the Scottish Office commissioned a short study of occupational therapy in Scotland. It aimed to examine the structure, scale and outputs of the service and the role of occupational therapy in the context of community care. A variety of methods was employed. The total number of posts for occupational therapists has increased recently but a critical shortage of support posts remains. Staff recruitment and retention are not problematic, In contrast to the situation south of the border. Occupational therapists still spend most of their time on equipment and adaptations. Authorities have been developing a range of strategies for tackling this problem, but more are needed. The Involvement of occupational therapists in care management is at an early stage. Practitioners are working with a more diverse range of clients than before, and some have greater opportunities to utilise their wider skills. Most have compjex extended networks for collaboration, although links with home care and health colleagues are often underdeveloped. Hospital discharge is a problematic area. The findings Indicate the need for occupational therapists to become better Integrated within community care teams, for more authorities to consider developing a unitary workforce straddling social services and health agencies, and for the deployment of occupational therapists to a wider and more Imaginative range of settings.
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Wilson, Philip, Rachael Wood, Kirsten Lykke, Anette Hauskov Graungaard, Ruth Kirk Ertmann, Merethe Kirstine Andersen, Ole Rikard Haavet, et al. "International variation in programmes for assessment of children’s neurodevelopment in the community: Understanding disparate approaches to evaluation of motor, social, emotional, behavioural and cognitive function." Scandinavian Journal of Public Health 46, no. 8 (May 4, 2018): 805–16. http://dx.doi.org/10.1177/1403494818772211.
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Background: Few areas of medicine demonstrate such international divergence as child development screening and surveillance. Many countries have nationally mandated surveillance policies, but the content of programmes and mechanisms for delivery vary enormously. The cost of programmes is substantial but no economic evaluations have been carried out. We have critically examined the history, underlying philosophy, content and delivery of programmes for child development assessment in five countries with comprehensive publicly funded health services (Denmark, Finland, Norway, Scotland and Sweden). The specific focus of this article is on motor, social, emotional, behavioural and global cognitive functioning including language. Findings: Variations in developmental surveillance programmes are substantially explained by historical factors and gradual evolution although Scotland has undergone radical changes in approach. No elements of universal developmental assessment programmes meet World Health Organization screening criteria, although some assessments are configured as screening activities. The roles of doctors and nurses vary greatly by country as do the timing, content and likely costs of programmes. Inter-professional communication presents challenges to all the studied health services. No programme has evidence for improved health outcomes or cost effectiveness. Conclusions: Developmental surveillance programmes vary greatly and their structure appears to be driven by historical factors as much as by evidence. Consensus should be reached about which surveillance activities constitute screening, and the predictive validity of these components needs to be established and judged against World Health Organization screening criteria. Costs and consequences of specific programmes should be assessed, and the issue of inter-professional communication about children at remediable developmental risk should be prioritised.
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Peto, L. M., M. Dent, M. Griffin, and N. Hindley. "Community-based forensic child and adolescent mental health services in England, Scotland and Wales: a national mapping exercise." Journal of Forensic Psychiatry & Psychology 26, no. 3 (February 2, 2015): 283–96. http://dx.doi.org/10.1080/14789949.2015.1004635.
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Coid, Jeremy, Min Yang, Peter Tyrer, Amanda Roberts, and Simone Ullrich. "Prevalence and correlates of personality disorder in Great Britain." British Journal of Psychiatry 188, no. 5 (May 2006): 423–31. http://dx.doi.org/10.1192/bjp.188.5.423.
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BackgroundEpidemiological data on personality disorders, comorbidity and associated use of services are essential for health service policy.AimsTo measure the prevalence and correlates of personality disorder in a representative community sample.MethodThe Structured Clinical Interview for DSM-IV Axis II disorders was used to measure personality disorder in 626 persons aged 16-74 years in households in England, Scotland and Wales, in atwo-phase survey.ResultsThe weighted prevalence of personality disorder was 4.4% (95% CI 2.9-6.7). Rates were highest among men, separated and unemployed participants in urban locations. High use of healthcare services was confounded by comorbid mental disorder and substance misuse. Cluster B disorders were associated with early institutional care and criminality.ConclusionsPersonality disorder is common in the community especially in urban areas. Services are normally restricted to symptomatic, help-seeking individuals, but a vulnerable group with cluster B disorders can be identified early are in care during childhood and enter the criminal justice system when young. This suggests the need for preventive interventions at the public mental health level.
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Metcalfe, Rebecca, Manon Ragonnet-Cronin, Amanda Bradley-Stewart, Andrew McAuley, Harrison Stubbs, Trina Ritchie, Regina O’Hara, et al. "From Hospital to the Community: Redesigning the Human Immunodeficiency Virus (HIV) Clinical Service Model to Respond to an Outbreak of HIV Among People Who Inject Drugs." Journal of Infectious Diseases 222, Supplement_5 (September 2, 2020): S410—S419. http://dx.doi.org/10.1093/infdis/jiaa336.
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Abstract An outbreak of human immunodeficiency virus (HIV) among people who inject drugs in Glasgow, Scotland started in 2014. We describe 156 cases over 5 years and evaluate the impact of clinical interventions using virological and phylogenetic analysis. We established (1) HIV services within homeless health facilities, including outreach nurses, and (2) antiretroviral therapy (ART) via community pharmacies. Implementation of the new model reduced time to ART initiation from 264 to 23 days and increased community viral load suppression rates to 86%. Phylogenetic analysis demonstrated that 2019 diagnoses were concentrated within a single network. Traditional HIV care models require adaptation for this highly complex population.
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Armstrong, S. H., C. V. Ruckley, R. J. Prescott, J. J. Dale, and E. A. Nelson. "Deficiencies in Leg Ulcer Care: A National Survey in Scotland." Phlebology: The Journal of Venous Disease 13, no. 2 (June 1998): 40–44. http://dx.doi.org/10.1177/026835559801300202.
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Objective: To identify what specialist expertise and services are currently available, in Scotland, to support general practitioners (GPs) and community nurses in the management of leg ulcer patients and the perceived need for the improvement of the service. Design: Postal questionnaires to randomly selected samples of GPs and community nurses. Setting: All 15 Scottish Health Board areas. Subjects: Six hundred and seventy-three GPs and 441 community nurses were questioned. Results: Five hundred and twelve (76%) GPs replied. Barely half, 285 (56%), expressed satisfaction with the service and only 155 (30%) had access to a recognized leg ulcer specialist. GPs who had access to a specialist expressed a greater level of satisfaction with the leg ulcer service than those without a local specialist. Community nurse questionnaire: Three hundred and sixty (82%) nurses replied. Two hundred and forty six (68%) indicated that the diagnosis of the cause of ulceration was usually made by both the GP and the nurse but the choice of treatment was most often made by the nurse alone. The great majority (69%) did not have access to a local leg ulcer clinic and only 34 (9%) indicated that they had access to management protocols, almost 90% of nurses expressing a need for protocols. Both questionnaires revealed a lack of specialist support, dedicated leg ulcer clinics, better education and training, and leg ulcer management protocols. Conclusion: Serious deficiencies in the support available for community care of leg ulcer patients have been identified. The situation requires to be remedied if more cost-effective outcomes for leg ulcer patients are to be achieved.
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Fox, Siobhan, Niamh O'Connor, Johnathan Drennan, Suzanne Guerin, W. George Kernohan, Aileen Murphy, and Suzanne Timmons. "Components of a community model of dementia palliative care." Journal of Integrated Care 28, no. 4 (June 30, 2020): 349–64. http://dx.doi.org/10.1108/jica-02-2020-0013.
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PurposeThe Model for Dementia Palliative Care Project will develop a service-delivery model for community-based dementia palliative care. Many countries provide dementia palliative care services, albeit with considerable variability within these. However, little is known about what service providers consider to be the most important components of a dementia palliative care model. This study aimed to address this knowledge gap.Design/methodology/approachAn exploratory design using a survey method was used as an initial phase of the wider project. A web-based survey was developed, piloted (n = 5), revised, and distributed within five healthcare jurisdictions: the Republic of Ireland, Northern Ireland, England, Scotland, and Wales. The target population was health and social care professionals, policymakers, and academics interested in dementia and palliative care. Content analysis of open-ended questions identified common themes; descriptive statistics were applied to the closed-ended questions.FindingsOverall, N = 112 complete surveys were received. Key care principles incorporated the philosophies of palliative care and dementia care; many described “holistic” and “person-centred care” as the core. Important individual service components were the support for carers, advanced care planning, information, education and training, activities for “meaningful living”, comprehensive disease management, coordinated case management, and linking with community health services and social activities. Barriers included poor availability and organisation of healthcare services, stigma, misconceptions around dementia prognosis, insufficiently advanced care planning, and dementia-related challenges to care. Facilitators included education, carer support, and therapeutic relationships.Originality/valueThis study, as part of the larger project, will directly inform the development of a novel service delivery Model of Dementia Palliative Care for Ireland. The results can also inform service planning and design in other countries.
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McCreadie, Robin G., Morven Leese, Deepa Tilak-Singh, Linda Loftus, Tom MacEwan, and Graham Thornicroft. "Nithsdale, Nunhead and Norwood: Similarities and differences in prevalence of schizophrenia and utilisation of service sin rural and urban areas." British Journal of Psychiatry 170, no. 1 (January 1997): 31–36. http://dx.doi.org/10.1192/bjp.170.1.31.
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BackgroundThe prevalence of schizophrenia is known to be greater in urban than in rural areas. Less studied are differences between the patients themselves and, more specifically, their use of psychiatric services.MethodThe prevalence of schizophrenia was determined in rural Nithsdale in Scotland and urban Nunhead and Norwood in South London. Information about patients' psychiatric history, use of services during the study year and global assessment of functioning were obtained from case records and staff.ResultsThere were no significant differences in prevalence rates between Nithsdale patients, all White (2.78 per 1000 general population), Nunhead (3.46 per 1000) and Norwood (2.24 per 1000) Whites; rates were significantly higher among the non-Whites in Nunhead (7.36 per 1000) and Norwood (5.53 per 1000), who were mainly Black Caribbeans. Nithsdale patients were at a higher level of functioning and made substantially more use of psychiatric services. During the study year, 42% of Nithsdale patients used more than one of three principal community services, namely day, out-patient and community psychiatric nursing care.ConclusionsThe prevalence of schizophrenia is no different in rural Nithsdale and inner-city Nunhead and Norwood, when only White patients are considered. Nithsdale patients were at a higher level of functioning and made more use of available psychiatric services.
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Vatalis, Christos, Lorraine McGuinness, and Elizabeth Ogston. "Service Evaluation: Patient Engagement With Online Group Psychotherapy During the COVID-19 Pandemic in West of Scotland." BJPsych Open 8, S1 (June 2022): S146. http://dx.doi.org/10.1192/bjo.2022.419.
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AimsOnline group therapy has gained popularity during the COVID-19 pandemic as an alternative to face-to-face group therapy. This service evaluation is aimed at assessing how this paradigm shift is received by the patients and how the quality of the provided services is assured and potentially improved.Methods1. We have retrospectively compared the attendance records from all psychotherapy groups in North Lanarkshire psychotherapy department between two distinct time periods: from November 2018 to January 2019 when only face-to-face groups were available (5 groups, 29 patients) and from November 2021 to January 2022 when only online groups were available (4 groups, 21 patients).2. In order to prospectively assess patient's views regarding online group therapy, Client Satisfaction Questionnaires (CSQ-4, quantitative and qualitative) were distributed to January 2022 groups only.Results1. The attendance rate was 5% lower in the face-to-face groups (76% vs 81%) while the non-attendance rate was lower by 1% in the online groups (9% vs 8%). The cancellation rate was also smaller by 5% in the online groups (14% to 9%).2. In regard to the service satisfaction rates in the online groups, 57% of patients who responded, answered that “most of their needs have been met by the online services’’, 71% answered “services helped with their problems somewhat’’, 71% answered “they think they would come back to the program again and 66% answered” they are mostly satisfied with the services received.“The predominant positive aspects of the services according to free text comments were” “communication, understanding, sense of community’’ and the negative aspects that need improvement: “return to face-to-face (71% of answers), need personal interaction’’.** We have extended the deadline for the acceptance of the responses to 20th of February 2022 due to mailing systems being slowed down by the pandemic. (7 out of 21 questionnaires have been returned)ConclusionOverall the attendance rates between the online and face-to-face group therapy exhibit minor differences. Concerning the patient satisfaction rates they reveal that the majority of patients who receive group therapy online are above-average satisfied with the services, feel that the online therapy provides a sense community but would prefer to return to face-to-face therapy.Further data and studies will be needed to reach more robust conclusions.
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Cooper, Kay, Edward Duncan, Erin Hart-Winks, Julie Cowie, Joanna Shim, Emma Stage, Tricia Tooman, et al. "Exploring the perceptions and experiences of community rehabilitation for Long COVID from the perspectives of Scottish general practitioners’ and people living with Long COVID: a qualitative study." BMJ Open 14, no. 5 (May 2024): e082830. http://dx.doi.org/10.1136/bmjopen-2023-082830.
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ObjectivesTo explore the experience of accessing Long COVID community rehabilitation from the perspectives of people with Long COVID and general practitioners (GPs).DesignQualitative descriptive study employing one-to-one semistructured virtual interviews analysed using the framework method.SettingFour National Health Service Scotland territorial health boards.Participants11 people with Long COVID (1 male, 10 female; aged 40–65 (mean 53) and 13 GPs (5 male, 8 female).ResultsFour key themes were identified: (1) The lived experience of Long COVID, describing the negative impact of Long COVID on participants’ health and quality of life; (2) The challenges of an emergent and complex chronic condition, including uncertainties related to diagnosis and management; (3) Systemic challenges for Long COVID service delivery, including lack of clear pathways for access and referral, siloed services, limited resource and a perceived lack of holistic care, and (4) Perceptions and experiences of Long COVID and its management, including rehabilitation. In this theme, a lack of knowledge by GPs and people with Long COVID on the potential role of community rehabilitation for Long COVID was identified. Having prior knowledge of rehabilitation or being a healthcare professional appeared to facilitate access to community rehabilitation. Finally, people with Long COVID who had received rehabilitation had generally found it beneficial.ConclusionsThere are several patient, GP and service-level barriers to accessing community rehabilitation for Long COVID. There is a need for greater understanding by the public, GPs and other potential referrers of the role of community rehabilitation professionals in the management of Long COVID. There is also a need for community rehabilitation services to be well promoted and accessible to the people with Long COVID for whom they may be appropriate. The findings of this study can be used by those (re)designing community rehabilitation services for people with Long COVID.
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Flowers, P., G. J. Hart, L. M. Williamson, J. S. Frankis, and G. J. Der. "Does bar-based, peer-led sexual health promotion have a community-level effect amongst gay men in Scotland?" International Journal of STD & AIDS 13, no. 2 (February 1, 2002): 102–8. http://dx.doi.org/10.1258/0956462021924721.
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This paper evaluates the effectiveness of a bar-based, peer-led community-level intervention to promote sexual health amongst gay men. The intervention consisted of peer education within bars, gay specific genitourinary medicine (GUM) services and a free-phone hotline. Data were collected at baseline (1996) and at follow-up (1999) in gay bars in Glasgow (intervention city) and Edinburgh (control city). During the intervention peer educators interacted with 1484 men and new clients increased at the gay specific GUM service. However, the hotline was under-utilized and abused. The outcome measures were: reported hepatitis B vaccination; HIV testing; unprotected anal intercourse (UAI) with casual partners; negotiated safety; and amongst men reporting UAI with a regular partner, the proportion who knew their own and their partner's HIV status. Significant differences in sexual health behaviours were observed across locations and across time, but the only significant intervention effects were amongst men who had direct contact with the intervention, with higher uptake of hepatitis B vaccination and HIV testing. The intervention did not produce community-wide changes in sexual health behaviours. These results question the replication and transferability of peer-led, community-level sexual health promotion for gay men outwith the USA and across time.
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Macaden, Leah, Kirsten Broadfoot, Clare Carolan, Kevin Muirhead, Siobhan Neylon, and Jeremy Keen. "Last Aid Training Online: Participants’ and Facilitators’ Perceptions from a Mixed-Methods Study in Rural Scotland." Healthcare 10, no. 5 (May 16, 2022): 918. http://dx.doi.org/10.3390/healthcare10050918.
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(1) Background: Palliative and end-of-life care services are increasingly gaining centre stage in health and social care contexts in the UK and globally. Death and dying need are relational processes. Building personal and community capacity along with resilience is vital to support families and communities to normalise death and dying. Last Aid Training (LAT) is one such innovative educational initiative which teaches the general public about the fundamentals of palliative care and promotes public discussion about death and dying. The Highland Hospice [HH] in Scotland has pioneered delivery of LAT in face-to-face settings since March 2019 and online since March 2020 to accommodate pandemic restrictions. (2) Methods: This study used a mixed-methods approach, combining an online survey with LAT participants followed by individual semi-structured qualitative interviews with both LAT participants and facilitators. The primary aim of this study was to investigate the impacts of LAT for participants at the individual, family, and community levels, as well as explore participant and facilitator experiences and perspectives of LAT in an online environment. (3) Results: Overall, this evaluation demonstrates that provision of foundational death literacy education in social contexts enhances the personal knowledge, skills, and confidence of individual community members and supports the notion that this personal growth could lead to strengthened community action. (4) Conclusions: Findings from this study concluded that there is potential to include LAT as the foundational core training to promote death literacy in communities with further exploration to integrate/align LAT with other national/global end-of-life care frameworks.
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Barclay, Gillian, and Claire Kerr. "Collaborative working across children’s services: Where are we now?" Educational and Child Psychology 23, no. 4 (2006): 35–46. http://dx.doi.org/10.53841/bpsecp.2006.23.4.35.
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This study explores how collaborative working across mental health and psychological (educational psychology) services is developing in Edinburgh, Scotland. Recent reports from the Scottish Executive, Health and Education, have advised on the importance of developing collaborative working practice. This study looks at to what extent this is currently being implemented and how it might be improved in the future. Questionnaires were distributed to psychological services and child and adolescent mental health services in Edinburgh and follow-up semi-structured interviews were carried out with representatives from these services. The study explored role perception, current levels of collaborative working, what does or does not lead to good collaborative working and how the services might move forward in this respect. All case carrying staff across the services received a questionnaire. However, four professional groups were the focus of questions regarding role perceptions: psychiatrists, community mental health workers, clinical and educational psychologists. One hundred and fifty questionnaires were distributed and 48 (32 per cent) were returned. Five follow-up interviews were then carried out to explore further the arising themes. The results supported much of the literature surrounding this issue. Good communication, improved resources or resource management, informal links and a better understanding of the roles of others leads to better collaborative working. There needs to be change at both individual and systemic levels to promote collaborative working in services. Implications of these findings are discussed and in particular the need for initiatives at a systemic level is highlighted.
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Rapado, R., A. L. Prior, and D. H. James. "Public perceptions of the role of community pharmacy in public health." International Journal of Pharmacy Practice 30, Supplement_1 (April 1, 2022): i36. http://dx.doi.org/10.1093/ijpp/riac019.050.
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Abstract Introduction Community pharmacies are well-placed to provide public health interventions, yet they are underutilised for services of this nature (1), which are needed to achieve public health policy goals. Previous qualitative studies have explored public perceptions of the role of community pharmacy in delivering public health services (2). However, to date, these views have not been captured quantitatively, which means it is not clear if the general public shares these views. Aim The aim was to design a questionnaire to obtain public perceptions of the role of community pharmacy in public health interventions and to establish any barriers and facilitators that exist regarding community pharmacy utilisation. Methods A questionnaire was developed based on published literature and semi-structured interviews. Following initial piloting of a paper-based then online format (by ten individuals) a 42-item questionnaire was completed digitally via Qualtrics by a self-selecting sample of the general public recruited through social media (i.e., Twitter, Instagram and Facebook) in May and June 2021. Principal component analysis with Varimax rotation was used to identify the underlying factors (scales) of the questionnaire. Cronbach’s alpha analysis was undertaken to ensure good internal consistency. Information on frequency of community pharmacy use and for what reason was collected. Content and thematic analysis were conducted on the free text qualitative comments. Content analysis was conducted first to observe which aspects of the questionnaire were mentioned the most. Further to this, thematic analysis was conducted as there were responses which did not fit into the content analysis. Results There were 306 valid questionnaire responses, where 235 (76.8%) were females. The mean age was 34.5 years (SD=15.09). Factor analysis identified four scales with a total of 18-items, all demonstrating good internal consistency. Scales were labelled as (n=number of items; ἀ =Cronbach’s alpha value): Expertise (n=3, ἀ =0.815); Role (n=4, ἀ =0.745); Privacy (n=3, ἀ =0.770) and Relationship (n=8, ἀ =0.862). Scale scores indicated that a lack of awareness of their role and expertise was a barrier and adequate privacy was an important facilitator in delivering public health services. In support of the quantitative findings, content analysis identified lack of privacy as a dominant theme, and further thematic analysis uncovered lack of knowledge of community pharmacy’s role in public health as an important barrier to uptake of services. Thematic analysis uncovered the themes ‘lack of knowledge of services’ and ‘accessibility’. Conclusion The outcome of this study was the development of a four scale, 18-item questionnaire to capture public perceptions of the community pharmacy’s role in public health. This can, therefore, be used in future studies aiming to explore public perceptions of community pharmacy. Strengths include being the first questionnaire to explore perceptions of community pharmacy. Weaknesses include the possibility of bias using social media in recruitment. This could be tackled using paper versions of the questionnaire in different settings. Further research is needed to continue testing the psychometric properties of the questionnaire with consideration given to the addition of a fifth scale to measure perceptions of Accessibility. References (1) Kember, J., Hodson, K., & James, D. H. (2018). The public’s perception of the role of community pharmacists in Wales. International Journal of Pharmacy Practice (26), 120-128. (2) Gidman, W., & Cowley, J. (2013). A qualitative exploration of opinions on the community pharmacists’ role amongst the general public in Scotland, International Journal of Pharmacy Practice, (21), 288-296.
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Matheson, C., C. M. Bond, and M. Tinelli. "Community pharmacy harm reduction services for drug misusers: national service delivery and professional attitude development over a decade in Scotland." Journal of Public Health 29, no. 4 (December 1, 2007): 350–57. http://dx.doi.org/10.1093/pubmed/fdm064.
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Falzon, Danilo, Tessa Parkes, Hannah Carver, Wendy Masterton, Bruce Wallace, Vicki Craik, Fiona Measham, et al. "“It would really support the wider harm reduction agenda across the board”: A qualitative study of the potential impacts of drug checking service delivery in Scotland." PLOS ONE 18, no. 12 (December 14, 2023): e0292812. http://dx.doi.org/10.1371/journal.pone.0292812.
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Drug checking services (DCS) enable individuals to voluntarily submit a small amount of a substance for analysis, providing information about the content of the substance along with tailored harm reduction support and advice. There is some evidence suggesting that DCS may lead to behaviour and system change, with impacts for people who use drugs, staff and services, and public health structures. The evidence base is still relatively nascent, however, and several evidence gaps persist. This paper reports on qualitative interviews with forty-three participants across three Scottish cities where the implementation of community-based DCS is being planned. Participants were drawn from three groups: professional participants; people with experience of drug use; and affected family members. Findings focus on perceived harm reduction impacts of DCS delivery in Scotland, with participants highlighting the potential for drug checking to impact a number of key groups including: individual service users; harm reduction services and staff; drug market monitoring structures and networks; and wider groups of people who use and sell drugs, in shaping their interactions with the drug market. Whilst continued evaluation of individual health behaviour outcomes is crucial to building the evidence base for DCS, the findings highlight the importance of extending evaluation beyond these outcomes. This would include evaluation of processes such as: information sharing across a range of parties; engagement with harm reduction and treatment services; knowledge building; and increased drug literacy. These broader dynamics may be particularly important for evaluations of community-based DCS serving individuals at higher-risk, given the complex relationship between information provision and health behaviour change which may be mediated by mental and physical health, stigma, criminalisation and the risk environment. This paper is of international relevance and adds to existing literature on the potential impact of DCS on individuals, organisations, and public health structures.
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Pelosi, Anthony J., and Max Birchwood. "Is early intervention for psychosis a waste of valuable resources?" British Journal of Psychiatry 182, no. 3 (March 2003): 196–98. http://dx.doi.org/10.1192/bjp.182.3.196.
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The concept of early intervention for psychosis has received much attention in recent years. The experience of pioneer services in the USA and Australia has convinced the UK Government to set aside millions of pounds to make dedicated early intervention teams an integral part of standard mental health services across the country. Other governments are set to follow suit. The rationale for early intervention is that there is a higher success rate if psychotic symptoms are treated early than if they are treated after they have been present for some time. It is also claimed that interventions early in the course of the illness can decrease the psychosocial impact of a psychotic illness that leads to secondary disability. But have these assertions been empirically demonstrated? Do such services simply take valuable resources, both in terms of funding and staff, from an already-overstretched mental health system, or do they change the trajectory of the disease process in a fundamental way? Dr Max Birchwood, Director of the Birmingham Early Intervention Service, and Dr Anthony Pelosi, consultant psychiatrist with a ‘generic’ community service in East Kilbride, Scotland, debate this issue.
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Ruckley, C. V. "Towards a Model of Care for Chronic Leg Ulcer: Lessons Learned from Studies in Scotland." Phlebology: The Journal of Venous Disease 16, no. 1 (March 2001): 17–19. http://dx.doi.org/10.1177/026835550101600105.
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Aim: To highlight the need for a different model of care delivery for chronic leg ulcer. Method: Analysis of data from the Scottish Leg Ulcer Trial and from surveys of leg ulcer care provision among General Practitioners, community nurses and health boards. Synthesis: General Practitioners and community nurses report serious deficiencies in education, training, protocols, equipment and support from the Acute sector. The Scottish Leg Ulcer Trial in a population of 2.65 million showed three-month healing rates of 30% with no improvement after dissemination of National (SIGN) Guidelines even when supplemented by a nationwide nurse training programme. Individual community nurses cared for an average of 1.5 ulcer patients per year. The more chronic the ulcer the poorer the healing rates. Only 17% of Scottish Teaching hospitals or District General hospitals provide a specialist led leg ulcer service. Conclusions: In the population at large, healing rates for leg ulcer are unacceptably low. Individual community nurses do not see enough leg ulcer patients to acquire or sustain the necessary clinical skills. Very few acute hospitals provide leg ulcer services. A new model of leg ulcer care is urgently required centred on multi-disciplinary teams, working in the interface between primary and secondary care, whose prime objectives should be prevention and early intervention. As an
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Chin, Caroline N., Kate Sullivan, and Stephen F. Wilson. "A 'snap shot' of the health of homeless people in inner Sydney: St Vincent's Hospital." Australian Health Review 35, no. 1 (2011): 52. http://dx.doi.org/10.1071/ah09824.
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Objectives. The poor health profile of people who are homeless results in a disproportionate use of health resources by these people. An in-hospital count of demographic and health data of homeless patients was conducted on two occasions at St Vincent’s Hospital in Sydney as an indicator of health resource utilisation for the Sydney region. Methods. Two in-hospital counts were conducted of homeless patients within the boundaries of St Vincent’s Hospital to coincide with the inaugural City of Sydney homeless street counts in winter 2008 and summer 2009. Data collected included level of homelessness, principal diagnosis, triage category, bed occupancy and linkages to services post hospital discharge. Results. Homeless patients at St Vincent’s utilised over four times the number of acute ward beds when compared with the state average. This corresponds to a high burden of mental health, substance use and physical health comorbidities in homeless people. There was high utilisation of mental health and drug and alcohol services by homeless people, and high levels of linkages with these services post-discharge. There were relatively low rates of linkage with general practitioner and ambulatory care services. Conclusion. Increasing knowledge of the health needs of the homeless community will assist in future planning and allocation of health services. What is known about the topic? The poor health status of people who are homeless has been previously noted in the USA, Canada and Scotland. What does this paper add? Homeless people living in Sydney also have a poor health profile and a disproportionate use of health resources when compared to people in the general population. What are the implications for practitioners? Health services for homeless people should be equipped to deal with mental health, substance use and physical health comorbidities.
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Watson, Margaret C., Karin Silver, and Ross Watkins. "How does the public conceptualise the quality of care and its measurement in community pharmacies in the UK: a qualitative interview study." BMJ Open 9, no. 3 (March 2019): e027198. http://dx.doi.org/10.1136/bmjopen-2018-027198.
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ObjectivesThis study explored citizens’ perspectives about the quality of community pharmacy services in the UK and whether and how the quality of community pharmacy services should be measured.DesignSemistructured interviews and focus groups were conducted and were audio recorded, transcribed and analysed systematically using an interpretive approach.ParticipantsMembers of the public were approached via networks, such as Health and Social Care Alliance Scotland, as well as community groups and personal networks.SettingScotland, England and Wales.ResultsData were collected from 20 participants: 11 interviews and 2 focus groups (in community settings, with five and four participants). Quality was conceptualised as multidimensional with inter-related overarching themes of person-centredness, professionalism and privacy. The importance of relational aspects with pharmacy personnel was emphasised including the need for a ‘friendly’ caring service, continuity of care, being known to personnel, including their awareness of individual’s health conditions: ‘it’s quite a personal service I would say…I think it means that they care about your welfare’. Participants discussed the importance of a professional approach to customer interactions including staff behaviour and appearance. Pharmacy design influenced perceptions of privacy, including having sufficient space or a separate consultation room to promote confidential consultations with a pharmacist. Participants suggested that quality assurance is needed to improve quality and to inspire confidence in the public ‘it would drive up quality standards overall’ but suggested that quality ratings were unlikely to influence their use of specific pharmacies. They emphasised the need for multidimensional quality ratings and for transparency with their derivation.ConclusionsThe public conceptualises quality of community pharmacy services as multidimensional and value relational aspects of care provided by personnel in this setting. While the development and application of quality indicators may drive improvement, it seems unlikely to influence the public’s use of individual pharmacies.
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Boardman, Jed, and Carolyn Steele. "NHS Direct – a telephone helpline for England and Wales." Psychiatric Bulletin 26, no. 2 (February 2002): 42–44. http://dx.doi.org/10.1192/pb.26.2.42.
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NHS Direct is a nurse-led telephone helpline covering England and Wales. The intention to develop this helpline was announced in December 1997 in a White Paper, The New NHS, Modern and Dependable (Department of Health, 1997), following recommendations in the Chief Medical Officers' report, Developing Emergency Services in the Community (Caiman, 1997). Three initial pilot sites were set up in Lancashire, Milton Keynes and Northumbria and began taking calls in March 1998. The project was extended in April 1999 to cover 40% of the population of England and by November 2000 was available throughout the whole of England and Wales. NHS Direct provides 24-hour advice and information via 22 call centres and is the largest telephone health care service in the world. A similar system is planned in Scotland, NHS 24.
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Metcalfe, Rebecca, Rebecca R. Acquah, Janine Simpson, Gwendolyn Allardice, and Andrew Winter. "An observational study of the impact of the 2014 XX Commonwealth Games on the sexual and reproductive health services in Glasgow, Scotland." Sexual Health 13, no. 5 (2016): 480. http://dx.doi.org/10.1071/sh16011.
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Background: Large sporting events have raised concerns about the effect on the sexual and reproductive health (SRH) of visiting and resident populations to the host city and increased demand on SRH services. However, there is little evidence to support these concerns. The aim of this study is to investigate if the 2014 XX Commonwealth Games had an effect on the service demands of a Glasgow city-wide integrated SRH service. Methods: Electronic patient records, city-wide pharmacy data and case note review was used to assess aspects of SRH; this included overall attendance at integrated services, clinic and community emergency contraception prescriptions, victims of sexual assault, acute sexually transmissible infections (STIs), post exposure prophylaxis after sexual exposure (PEPSE) prescriptions, condom distribution and termination of pregnancy. Results: There was a significant decrease in core sexual health attendances, total acute STIs and emergency hormonal contraception prescriptions. There was no change in PEPSE prescriptions or the number of reported sexual assaults throughout the city. Conclusions: This study found no evidence that the 2014 XX Commonwealth Games placed any increased demand on the local SRH services, and showed no increase in STIs, emergency hormonal contraception prescriptions or sexual assaults. These findings will help service planning in host cities hosting future large sporting events.
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Pitchforth, Emma, Ellen Nolte, Jennie Corbett, Céline Miani, Eleanor Winpenny, Edwin van Teijlingen, Natasha Elmore, et al. "Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies." Health Services and Delivery Research 5, no. 19 (June 2017): 1–220. http://dx.doi.org/10.3310/hsdr05190.
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BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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McQueen, Jean M., and Jennifer Turner. "Exploring forensic mental health service users' views on work: an interpretative phenomenological analysis." British Journal of Forensic Practice 14, no. 3 (August 3, 2012): 168–79. http://dx.doi.org/10.1108/14636641211254897.
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PurposeThis paper aims to capture the views of forensic mental health service users; focusing on how services promote the aspiration to work, the development of skills for work, and the vocational rehabilitation process. It seeks to provide insight into forensic mental health service users' views on the barriers and enablers to accessing work together with suggestions for enhancing practice, and implications for further research.Design/methodology/approachTen participants from a range of forensic mental health services throughout Scotland took part in semi‐structured interviews. Participants were involved in either paid work, voluntary work or work preparation. Interpretative phenomenological analysis (IPA) allowed exploration of an individual's lived experiences and how they make sense of this.FindingsService users valued the opportunity to address vocational issues at the earliest opportunity in their rehabilitation. Work had an overwhelmingly positive impact on mental health. Analysis of interview transcripts revealed three master themes: “Normalising my life”: the positive impact of work; “Gradual steps”: facing barriers; and “Practical help and encouragement”: feeling supported. There is much to gain from good multidisciplinary rehabilitation within secure hospitals and the community, with work playing an important role in recovery and symptom control. Forensic services should focus on employment and the aspiration to work early, demonstrating awareness that attitude and the aspiration to work are a much more reliable indicator of success than diagnosis and mental health symptoms.Originality/valueFew qualitative studies have investigated service users' views of work within forensic mental health, yet such information can be crucial to enhance and improve service delivery.
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McCormack, Brendan, Clare Cable, Jane Cantrell, Alison Bunce, Jane Douglas, Julie Fitzpatrick, Nikki Forsyth, et al. "The Queen’s Nurses collaborative inquiry - understanding individual and collective experiences of transformative learning." International Practice Development Journal 11, no. 1 (May 19, 2021): 1–18. http://dx.doi.org/10.19043/ipdj.111.002.
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Background: In contemporary health and social care services and systems, there is a critical need for nursing care that is agile in its delivery, integrated across sectors, responsive to complex need, and focused on prevention, self-care and wellbeing. Community nurses are at the centre of these services, working in and across a variety of complex systems that depend on the expertise they bring to individuals, communities and populations. However, ensuring this capability is brought to the forefront of quality frameworks is a challenge as care practices are often reduced to moments of interaction or intervention that are tangible and objectively measured. We know, though, that community nurses bring vital and wide-ranging expertise to the health of populations. The Queen’s Nursing Institute Scotland has re-established the Queen’s Nurse Development Programme to address these contemporary agendas and ensure the potential of expert community nursing is demonstrated and recognised. Aim: To engage in a participatory evaluation of the experience of the nine-month development journey of the 2019 Queen’s Nurse Development Programme participants. Methods: A Collaborative Critical Creative Inquiry (CCCI) methodology was used, operationalised through a five-phase inquiry process, informed by Theory U ‘presencing ’and its five movements for attending to and co-shaping reality to achieve presencing. Our embedded and embodied data-collection methods drew specifically on participants ’creative expressions, reflective diaries and journals, and project notes. Findings: The results of each phase of inquiry informed subsequent phases, culminating in a final phase (synthesis) where key themes representing the findings from all phases were derived. These themes were self-growth, community and practical impacts. Conclusion and implications for practice: The importance of slowing and stillness, linked to the spaces created for creative reflective learning and development has been significant in this programme. Being present to listen to self, and engage in self-care and self-growth is something the programme provides and that is highly valued. We would argue that if health systems are serious about the transformation of services and people, then these kinds of programmes are critical to success.
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Gadsby, Erica W., Floor Christie-de Jong, Sunil Bhopal, Heather Corlett, and Stephen Turner. "Qualitative analysis of the impact of the SARS-CoV-2 pandemic response on paediatric health services in North of Scotland and North of England." BMJ Open 12, no. 2 (February 2022): e056628. http://dx.doi.org/10.1136/bmjopen-2021-056628.
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ObjectiveTo capture the extent and impact of changes in the delivery of child health services in the UK, resulting from the SARS-CoV-2 pandemic response, from the perspectives of a range of child healthcare providers.SettingNational Health Service commissioned/delivered healthcare services in two regional settings in the UK: North of Scotland (NOS) and North East and North Cumbria (NENC) in England.ParticipantsPurposive sample of 39 child healthcare professionals including paediatricians, community/specialist nurses, allied health professionals and mental health professionals, from across the two regions (22 in NOS, 17 in NENC).MethodsSemistructured qualitative interviews conducted via telephone between June and October 2020, fully transcribed and analysed in NVivo V.11 using thematic analysis.ResultsExtensive changes across a range of paediatric services were rapidly implemented to support the pandemic response and ongoing healthcare delivery. New ways of working emerged, principally to control the spread of the virus. Keeping users and their families out of hospital was an urgent driver for change. The changes had considerable impact on the health and well-being of staff with many experiencing radical changes to their working conditions and roles. However, there were some positive changes noted: some practitioners felt empowered and listened to by decision makers; some of the usual bureaucratic barriers to change were lifted; staff saw improved collaboration and joint working across the system; and some new ways of working were seen to be more efficient. Interviewees perceived the implications for children and their families to be profound, particularly with regard to self-care, relationships with practitioners and timely access to services.ConclusionsDespite the challenges experienced by staff, the pandemic provided an opportunity for positive, lasting change. It is vital to capitalise on this opportunity to benefit patient outcomes and to ‘build back’ services in a more sustainable way.
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Thayer, N., S. White, and M. Frisher. "Investigating the relationship between community pharmacy and GP Emergency Hormonal Contraception (EHC) provision: a linear regression analysis." International Journal of Pharmacy Practice 30, Supplement_1 (April 1, 2022): i36—i37. http://dx.doi.org/10.1093/ijpp/riac019.051.
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Abstract Introduction Emergency Hormonal Contraception (EHC) is contracted by Local Authorities to be provided free-of-charge from 46% of community pharmacies in England. (1) There is no difference in EHC consultation outcomes between community pharmacy and GP surgeries. A study in a rural area demonstrated that introduction of a community pharmacy EHC service can reduce GP EHC prescribing rates by approximately 41%, without influencing Family Planning Clinics or Accident and Emergency departments. (2) However, it is not known whether this relationship is universally present, and this relationship has not previously been quantified. Aim To describe the relationship between rates of GP EHC prescribing and commissioned community pharmacy EHC provision. Methods Freedom of Information (FOI) requests were submitted to all Local Authorities in England for numbers of EHC provisions through commissioned services between March 2019 and April 2020. The data were matched to Clinical Commissioning Group (CCG) GP prescribing data, obtained from openprescribing.net. Using population estimates from the Office of National Statistics, rates of supply per 10,000 female population (aged 12-55) were determined. The data indicated small numbers of outliers, which can distort linear regression; boxplots allowed the removal of data points outside 1.5 times the Inter Quartile Range from the 1st or 3rd quarter. Using SPSS v24, linear regressions were calculated between GP prescribing rates and community pharmacy EHC provision rates. This was repeated for community pharmacy EHC provision rates and the proportion of commissioned pharmacies. Results There were 147 Local Authority commissioners identified across England, 113 (76.9%) responded to the FOI request. Of these, 5 did not commission EHC services from community pharmacy. Local Authority and CCG boundaries were compared, 86 areas were identified as ‘co-terminus’ (i.e., greater than 95% overlap). These 86 areas included 82,822 GP prescriptions and 207,731 community pharmacy provisions. The data reflected an estimated female population aged 12-55 of 9,380,153 (Local Authority mean 109,072, SD 83,899), 60% of the total English female (12-55) population. Removing outliers left 92.5% of the data for analysis. The mean GP prescribing rate was 79.3/10,000 (SD 26.3) and the mean community pharmacy provision rate was 200.2/10,000 (SD 154.9). Linear regression indicated a negative correlation between GP prescribing rates and community pharmacy provision rates (R2=0.21) and a positive correlation between community pharmacy provision rates and the proportion of commissioned pharmacies (R2=0.21). Conclusion This study shows that increasing the community pharmacy provision rate by 100/10,000 decreases the GP prescribing rate by 8/10,000. Increasing the proportion of commissioned pharmacies to 100%, through a national service may change GP prescribing rates. This regression analysis predicts this would decrease the GP EHC prescribing rate by 15% to 66.3/10,000. Whilst this data is not fully representative of commissioning in England, this single commissioning change could move 20,706 GP consultations to community pharmacy annually across England. Comparisons with Wales and Scotland (who have national services) suggest this impact could potentially even be doubled. The strength of this study is it’s use of routine data facilitating replication, however local commissioning arrangements mean the conclusions are not necessarily applicable beyond England. References (1) Mackridge AJ, Gray NJ, Krska J. A cross-sectional study using freedom of information requests to evaluate variation in local authority commissioning of community pharmacy public health services in England. BMJ Open. 2017;7(7):e015511 (2) Lloyd K, Gale E. Provision of emergency hormonal contraception through community pharmacies in a rural area. J Fam Plann Reprod Health Care. 2005;31(4):297-300.
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Skivington, Kathryn, Mathew Smith, Nai Rui Chng, Mhairi Mackenzie, Sally Wyke, and Stewart W. Mercer. "Delivering a primary care-based social prescribing initiative: a qualitative study of the benefits and challenges." British Journal of General Practice 68, no. 672 (May 21, 2018): e487-e494. http://dx.doi.org/10.3399/bjgp18x696617.
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BackgroundSocial prescribing is a collaborative approach to improve inter-sectoral working between primary health care and community organisations. The Links Worker Programme (LWP) is a social prescribing initiative in areas of high deprivation in Glasgow, Scotland, that is designed to mitigate the negative impacts of the social determinants of health.AimTo investigate issues relevant to implementing a social prescribing programme to improve inter-sectoral working to achieve public health goals.Design and settingQualitative interview study with community organisation representatives and community links practitioners (CLPs) in LWP areas.MethodAudiorecordings of semi-structured interviews with 30 community organisation representatives and six CLPs were transcribed verbatim and analysed thematically.ResultsParticipants identified some benefits of collaborative working, particularly the CLPs’ ability to act as a case manager for patients, and their position in GP practices, which operated as a bridge between organisations. However, benefits were seen to flow from new relationships between individuals in community organisations and CLPs, rather than more generally with the practice as a whole. Challenges to the LWP were related to capacity and funding for community organisations in the context of austerity. The capacity of CLPs was also an issue given that their role involved time-consuming, intensive case management.ConclusionAlthough the LWP appears to be a fruitful approach to collaborative case management, integration initiatives such as social prescribing cannot be seen as ‘magic bullets’. In the context of economic austerity, such approaches may not achieve their potential unless funding is available for community organisations to continue to provide services and make and maintain their links with primary care.
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McKechnie, A. A. "Creating Community Mental Health Services in Scotland. Volume I: The Issues. Pp 132. £5.00. Volume II: Community Services in Practice. Pp 134. £5.00. Edited by Nancy Drucker. 1987. Obtainable from Scottish Association for Mental Health, 40 Shandwick Place, Edinburgh EH2 4RT." Bulletin of the Royal College of Psychiatrists 12, no. 4 (April 1988): 157–58. http://dx.doi.org/10.1192/pb.12.4.157-a.
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Sii, Samantha, Ahmad Nasser, Cheng Yi Loo, Catherine Croghan, Alan Rotchford, and Pankaj Kumar Agarwal. "The impact of SIGN glaucoma guidelines on false-positive referrals from community optometrists in Central Scotland." British Journal of Ophthalmology 103, no. 3 (May 18, 2018): 369–73. http://dx.doi.org/10.1136/bjophthalmol-2017-311429.
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BackgroundSince the introduction of National Institute for Health and Care Excellence glaucoma guidelines 2009, the number of referrals from community optometrists to hospital eye services has increased across the UK, resulting in increase in first visit discharge rates (FVDRs).AimTo assess the impact of Scottish Intercollegiate Guidelines Network (SIGN) 144 on quality of referrals from community optometrists.MethodologyA retrospective study of patient records who attended as new adult glaucoma referrals to clinics in Princess Alexandra Eye Pavilion, Edinburgh, and in Greater Glasgow and Clyde, was carried out across October–November 2014 (group 1) and September–October 2016 (group 2), before and after the introduction of SIGN 144. The primary outcome of this study is FVDRs. A secondary outcome is the extent of compliance to referral recommendations by SIGN guidelines.ResultsThree hundred and twelve and 325 patients were included in groups 1 and 2, respectively. There was a significant decline in FVDRs between these two periods from 29.2% to 19.2%. (p=0.004) (OR 0.58 (95%CI 0.40 to 0.84)). Post-SIGN guidelines, 87% of referrals were compliant to SIGN referral criteria while 13% remained non-compliant. The main reasons for non-compliance were no repeatable visual field defects (42.0%) and referrals due to high intraocular pressure were either not repeated or not interpreted in the context of age and central corneal thickness (36.8%).ConclusionPatients referred after the introduction of SIGN guidelines were 33.5% less likely to be discharged at the first visit. Although compliance to most recommendations in SIGN guidelines has improved, there is still a need to improve adherence to referral criteria
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Gjorgjev, Dragan, Mirjana Dimovska, George Morris, John Howie, Mirjana Borota Popovska, and Marija Topuzovska Latkovikj. "How Good Is our Place—Implementation of the Place Standard Tool in North Macedonia." International Journal of Environmental Research and Public Health 17, no. 1 (December 27, 2019): 194. http://dx.doi.org/10.3390/ijerph17010194.
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This study describes the implementation, in North Macedonia, of a “tool”, initially devised in Scotland, to generate community and stakeholder discussion about the places in which they live and notably a place’s capacity to generate health wellbeing and greater equity among citizens. In this study, the “place standard tool” (PST) is viewed from the perspective of creating places which can deliver a triple win of health and wellbeing, equity, and environmental sustainability. Skopje, North Macedonia’s capital, inevitably differs economically, culturally, and politically from Scotland, thus providing an opportunity to augment existing knowledge on adaptability of the tool in shaping agendas for policy and action. Тhe PST was tested through seminars with selected focus groups and an online questionnaire. Over 350 respondents were included. Information on priorities enabled the distillation of suggestions for improvement and was shared with the Mayor and municipal administration. Skopje citizens valued an approach which solicited their views in a meaningful way. Specific concerns were expressed relating to heavy traffic and related air and noise pollution, and care and maintenance of places and care services. Responses varied by geographic location. Application of the PST increased knowledge and confidence levels among citizens and enthusiasm for active involvement in decision making. Effective implementation relies heavily on: good governance and top-level support; excellent organization and good timing; careful training of interviewers and focus group moderators; and on prior knowledge of the participants/respondents.
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GORDON, John E., Vanessa BRAZIER, Jim D. HANSOM, and Alan WERRITTY. "Advances in Quaternary studies and geomorphology in Scotland: implications for geoconservation." Earth and Environmental Science Transactions of the Royal Society of Edinburgh 110, no. 1-2 (March 2019): 257–78. http://dx.doi.org/10.1017/s1755691019000069.
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ABSTRACTQuaternary deposits and landforms are an integral component of Scotland's geodiversity and natural heritage with intrinsic, scientific, educational, cultural, aesthetic and ecological values. Their conservation is founded on the assessment and safeguard of key protected areas principally for their scientific values. The evaluation of site networks for Quaternary deposits and landforms (including glacial, fluvial, coastal, mass movement, karst and cave features) has evolved since the late 1940s, culminating in the Great Britain Geological Conservation Review (GCR) site assessments undertaken principally between 1977 and the early 1990s. Significant scientific progress since then has arisen, for example, from re-investigation of existing sites and discoveries of new sites, developments in geochronology and the formulation and application of new concepts and models. Both the GCR site lists and the supporting site documentation now require updating in the light of this progress. Today there is greater emphasis on the wider, non-scientific values of geoconservation including, for example, on ecosystem services, links with biodiversity and cultural heritage, geotourism and the benefits for human health and wellbeing through improved understanding of dynamic landscapes, climate change and natural hazards. Involvement of wider public support beyond the geoscience community and fostering better integration of geoheritage within the developing nature conservation agenda, including a land systems approach, protected area planning and management, natural capital and connecting people and nature, will help further to protect our Quaternary geoheritage.