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Access to healthcareolder people to receive preventative care and for appointment keeping. Pre-recordedmessages and computer-generated reminder messages were significantly effective inincreasing visits to healthcare services, and after-hours telephone access was alsoassociated with higher service user satisfaction.KINNERSLEY2008 assessed the effectiveness of information giving prior to aconsultation on various outcomes that related to both access and uptake of treatment.The results of the meta-analyses indicated that information giving prior to consultationsignificantly increased question asking (effect size 0.27; 95% CI, 0.19 to 0.36)and individuals’ satisfaction (effect size 0.09; 95% CI, 0.03 to 0.16). No significanteffects on the anxiety of the individual either before or after consultations wereobserved.Systematic reviews assessing vulnerable groupsCHAPMAN2004 5 and PIGNONE2005 investigated the effectiveness of variousadaptations to existing services and interventions (for example, telephone consultations,walk-in centres, NHS Direct, CD-ROMs and interactive videodisks) forimproving clinical outcomes and access to general healthcare for vulnerable groups(see study information in Table 9 for a list of models/methods evaluated). In a qualitativereview of recent innovations in UK-based services, CHAPMAN2004 reportedthat personal medical services, which allow primary healthcare teams to target servicesfor specific population groups and enhance services in under-developed areas,have been found to improve the quality of mental healthcare, the care of older peopleand care in deprived areas. This evidence is based on the findings of pilot studies ofpersonal medical services across the UK. GP-led telephone consultations were alsofound to be effective in increasing the availability and use of primary care services.However, this method cannot help improve access to healthcare for people who do nothave a telephone or language difficulties and hence may not be appropriate for certainvulnerable groups. CHAPMAN2004 reported that walk-in centres were effective inincreasing access to healthcare for a minority of the general population. However, thiswas not the case for BME groups and other vulnerable groups, rather for whitemiddle-class individuals and young and middle-aged men who are not considered avulnerable group with limited access to healthcare. Furthermore, NHS Direct wasalso found to have good onward referral rates, but again does not address inequalitiesor improve access for vulnerable groups and is underused by older people.PIGNONE2005 investigated interventions to address factors that aim to promoteaccess through the use of healthcare information for people with poor literacy withthe intention of improving understanding of health, health behaviours and use ofhealthcare services. In one study, the use of a combined intervention comprising ashort video, a coaching tool, a verbal recommendation and a brochure improved utilisationof a healthcare service. This review found no other studies that investigatedinterventions to improve access to healthcare services for people with poor literacyfrom BME groups or other vulnerable groups.5 This review also identified other service delivery methods with outcomes not relevant to this chapter(see paper for more details).75
Access to healthcare4.4 SERVICE DEVELOPMENTS AND INTERVENTIONSSPECIFICALLY DESIGNED TO PROMOTE ACCESS4.4.1 IntroductionThe alternative approach to improving access to healthcare for target groups is tospecifically develop novel methods of engaging individuals and delivering therapy.4.4.2 Clinical review protocolThe review aimed to perform a narrative synthesis of the evidence relating to services,and the development of services that are focused on community outreach and engagement,with the aim of improving access to healthcare for hard-to-reach groups (forexample, BME groups and older people). The review protocol including the reviewquestion, information about databases searched and the eligibility criteria used in thissection of the guideline can be found in Table 10. A search for systematic reviewspublished since 1995 was conducted. The GDG decided that systematic reviewsconducted before 1995 would not be useful in evaluating access to healthcare, thereforethese were excluded. Furthermore, due to the large volume of literature retrievedfrom the search, the GDG decided to evaluate papers from the last 7 years alone. TheGDG conducted an additional search for RCTs published between 2004 and 2010with the aim of identifying studies that may not have been captured by the includedsystematic reviews (searching for RCTs published in the last 6 years would identifythe studies included in the majority of systematic reviews). Further information aboutthe rationale for the method employed here can be found in Chapter 3 and the searchstrategy can be found in Appendix 6. The evidence was grouped according to thesubquestions reflecting the content of the reviews. The three groups were individual-/practitioner-level interventions, system-level interventions and treatment-level interventionsthat aim to increase access or facilitate uptake of treatment.Individual-/practitioner-level interventions aim to change the behaviour of the healthcareprofessional or individual. System-level interventions refer to policies, organisationaland structural factors or communication methods. Treatment-level interventionsrefer to the provision of new or adapted treatments that aim to increase access.4.4.3 Studies considered 7The literature search for systematic reviews and RCTs yielded 7,534 papers 6 . Ofthese, six systematic reviews (ANDERSON2003 [Anderson et al., 2003];6 The search strategy involved a general search covering all review questions addressed in this chapter.7 Here and elsewhere in the guideline, each study considered for review is referred to by a study ID in capitalletters (primary author and date of study publication, except where a study is in press or has beensubmitted for publication, then a date is not used).76
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Commonmental healthdisordersTHE NIC
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© The British Psychological Societ
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Contents6 FURTHER ASSESSMENT OF RIS
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Guideline development group members
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Preface1 PREFACEThis guideline has
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Prefacecollaborative manner using t
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PrefaceThe experience of people wit
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Common mental health disorders2.2 T
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Summary of recommendations8.1.1.6 S
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Summary of recommendationsFigure 12
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Summary of recommendations●Genera
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Summary of recommendations8.4 STEPS
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Summary of recommendationsDiscuss w
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Summary of recommendationsinclude p
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Appendices9 APPENDICESAppendix 1: S
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Appendix 1of a depressive disorder
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Appendix 1b) Assessment of anxiety
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Appendix 2APPENDIX 2:DECLARATIONS O
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Appendix 2Mr Mike BessantEmployment
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Appendix 2Personal non-pecuniary in
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Appendix 2Actions takenMr Rupert Su
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Appendix 2Personal family interestN
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Appendix 3APPENDIX 3:STAKEHOLDERS A
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Appendix 4ClinicalpopulationPeople
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Appendix 4Case identificationNo. Pr
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Appendix 5APPENDIX 5:REVIEW PROTOCO
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Appendix 7APPENDIX 7:METHODOLOGY CH
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Appendix 9APPENDIX 9:METHODOLOGY CH
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Appendix 92.10 Are all important pa
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Appendix 9case also excludes costs
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Appendix 9For consistency, the EQ-5
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Appendix 9Answer ‘yes’ if the a
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Appendix 9Answer ‘yes’ if the e
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Appendix 9Answer ‘yes’ if appro
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Appendix 10APPENDIX 10: EVIDENCE TA
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Appendix 11APPENDIX 11:HIGH PRIORIT
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Appendix 11discussion of options bu
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Appendix 13APPENDIX 13:GENERALIZED
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ReferencesAndlin-Sobocki, P., Jöns
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ReferencesBower, P., Gilbody, S., R
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ReferencesCooper, S., Smiley, E., M
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ReferencesEhlers A., Gene-Cos N. &
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ReferencesGiles, D. E., Jarrett, R.
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ReferencesHorowitz, M. J., Wilner,
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ReferencesKnapp, M. & Ilson, S. (20
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ReferencesMarks, J., Goldberg, D. P
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ReferencesNCCMH (forthcoming) Self-
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ReferencesOzer, E. J., Best, S. R.,
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ReferencesSartorius, N. (2002) Eine
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ReferencesTiemens, B. G., Ormel, J.
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ReferencesWilkinson, M. J. B. & Bar
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Glossarybeliefs and interpretations
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Glossaryto learn to become more awa
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Abbreviations12 ABBREVIATIONSADDADS
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AbbreviationsOASISOCDONSORPHQ (-A,
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