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dc.contributor.authorByng, Ren
dc.contributor.authorNorman, Ien
dc.contributor.authorRedfern, Sen
dc.contributor.authorJones, Ren
dc.date.accessioned2018-04-12T10:49:08Z
dc.date.issued2008-12-23en
dc.identifier.urihttp://hdl.handle.net/10026.1/11262
dc.description.abstract

BACKGROUND: Complex interventions have components which can vary in different contexts. Using the Realistic Evaluation framework, this study investigates how a complex health services intervention led to developments in shared care for people with long-term mental illness. METHODS: A retrospective qualitative interview study was carried out alongside a randomised controlled trial. The multi-faceted intervention supported by facilitators aimed to develop systems for shared care. The study was set in London. Participants included 46 practitioners and managers from 12 participating primary health care teams and their associated community mental health teams. Interviews focussed on how and why out comes were achieved, and were analysed using a framework incorporating context and intervening mechanisms. RESULTS: Thirty-one interviews were completed to create 12 case studies. The enquiry highlighted the importance of the catalysing, doing and reviewing functions of the facilitation process. Other facets of the intervention were less dominant. The intervention catalysed the allocation of link workers and liaison arrangements in nearly all practices. Case discussions between link workers and GPs improved individual care as well as helping link workers become part of the primary care team; but sustained integration into the team depended both on flexibility and experience of the link worker, and upon selection of relevant patients for the case discussions. The doing function of facilitators included advice and, at times, manpower, to help introduce successful systems for reviewing care, however time spent developing IT systems was rarely productive. The reviewing function of the intervention was weak and sometimes failed to solve problems in the development of liaison or recall. CONCLUSION: Case discussions and improved liaison at times of crisis, rather than for proactive recall, were the key functions of shared care contributing to the success of Mental Health Link. This multifaceted intervention had most impact through catalysing and doing, whereas the reviewing function of the facilitation was weak, and other components were seen as less important. Realistic Evaluation provided a useful theoretical framework for this process evaluation, by allowing a specific focus on context. Although complex interventions might appear 'out of control', due to their varied manifestation in different situations, context sensitive process evaluations can help identify the intervention's key functions.

en
dc.format.extent274 - ?en
dc.languageengen
dc.language.isoengen
dc.subjectDelivery of Health Care, Integrateden
dc.subjectHumansen
dc.subjectInterviews as Topicen
dc.subjectLong-Term Careen
dc.subjectMental Disordersen
dc.subjectOrganizational Case Studiesen
dc.subjectPatient Care Teamen
dc.subjectRetrospective Studiesen
dc.subjectUnited Kingdomen
dc.titleExposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation.en
dc.typeJournal Article
plymouth.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/19105823en
plymouth.volume8en
plymouth.publication-statusPublished onlineen
plymouth.journalBMC Health Serv Resen
dc.identifier.doi10.1186/1472-6963-8-274en
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Medical School
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/Institute of Health and Community
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)/CCT&PS
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
dc.publisher.placeEnglanden
dcterms.dateAccepted2008-12-23en
dc.identifier.eissn1472-6963en
dc.rights.embargoperiodNot knownen
rioxxterms.versionofrecord10.1186/1472-6963-8-274en
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2008-12-23en
rioxxterms.typeJournal Article/Reviewen


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