Can more appropriate support and services be provided for people who attend the emergency department frequently? National Health Service staff views

BACKGROUND: Interventions designed to help Emergency Department (ED) staff manage frequent attenders are labour-intensive and only benefit a small sample of frequent attenders. We aimed to use the in-depth knowledge of health professionals with experience of working with ED frequent attenders to understand the challenges of managing this group of patients and their opinions on providing more appropriate support. METHODS: Semi-structured interviews were conducted with medical and nursing ED staff, mental health liaison nurses and general practitioners (GPs). Interviews covered the following: definitions and experiences of treating frequent attenders and thoughts on alternative service provision. Vignettes of frequent attenders were used to elicit discussions on these topics. Thematic analysis of transcribed interviews was undertaken. RESULTS: Twelve health professionals were interviewed. Three groups of frequent attenders were identified: people with long-term physical conditions, mental health problems and health-related anxiety. Underlying reasons for attendance differed between the groups, highlighting the need for targeted interventions. Suggested interventions included improving self-management of long-term physical conditions; creating a 'go-to' place away from the ED for patients experiencing a mental health crisis; increasing the provision of mental health liaison services; and for patients with health-related anxiety, the role of the GP in the patients' care pathway was emphasised, as were the benefits of providing additional training for ED staff to help identify and support this group. CONCLUSION: Interventions to address frequent attendance should focus on redirection to and liaison with more appropriate services, located on the hospital site or in the community, tailored to each identified patient group

Emergency department clinical leads’ experiences of implementing primary care services where GPs work in or alongside emergency departments in the UK: a qualitative study

Background To manage increasing demand for emergency and unscheduled care NHS England policy has promoted services in which patients presenting to Emergency Departments (EDs) with non-urgent problems are directed to general practitioners (GPs) and other primary care clinicians working within or alongside emergency departments. However, the ways that hospitals have implemented primary care services in EDs are varied. The aim of this study was to describe ED clinical leads’ experiences of implementing and delivering ‘primary care services’ and ‘emergency medicine services’ where GPs were integrated into the ED team. Methods We conducted interviews with ED clinical leads in England (n = 19) and Wales (n = 2). We used framework analysis to analyse interview transcripts and explore differences across ‘primary care services’, ‘emergency medicine services’ and emergency departments without primary care services. Results In EDs with separate primary care services, success was reported when having a distinct workforce of primary care clinicians, who improved waiting times and flow by seeing primary care-type patients in a timely way, using fewer investigations, and enabling ED doctors to focus on more acutely unwell patients. Some challenges were: trying to align their service with the policy guidance, inconsistent demand for primary care, accessible community primary care services, difficulties in recruiting GPs, lack of funding, difficulties in agreeing governance protocols and establishing effective streaming pathways. Where GPs were integrated into an ED workforce success was reported as managing the demand for both emergency and primary care and reducing admissions. Conclusions Introducing a policy advocating a preferred model of service to address primary care demand was not useful for all emergency departments. To support successful and sustainable primary care services in or alongside EDs, policy makers and commissioners should consider varied ways that GPs can be employed to manage variation in local demand and also local contextual factors such as the ability to recruit and retain GPs, sustainable funding, clear governance frameworks, training, support and guidance for all staff. Whether or not streaming to a separate primary care service is useful also depended on the level of primary care demand

Estratégias de aprendizagem e fatores motivacionais relacionados Learning strategies and related motivational factors

O estudo sobre aprendizagem autorregulada de uma perspectiva sociocognitiva tem integrado fatores cognitivos, metacognitivos, afetivos e motivacionais. Um dos constructos mais investigados nesta área é o de estratégias de aprendizagem, pois seu uso pelos estudantes é considerado um importante indicativo do nível de autorregulação. Nota-se que embora muitos alunos conheçam um repertório de estratégias, nem sempre relatam utilizá-las com frequência. Assume-se, portanto, que esta atividade requer esforço e é marcadamente afetada pela motivação do aluno. Dessa forma, tem-se como finalidade neste artigo, discutir a relação entre estratégias de aprendizagem e algumas variáveis motivacionais que têm sido sistematicamente relacionadas a este constructo: autoeficácia, metas de realização e valor da tarefa.<br>The study about self-regulated learning from a socio-cognitive perspective has integrated cognitive, metacognitive, affective and motivational aspects. Learning strategy has been one of the most investigated constructs in this area, because its use by students is considered a relevant indicative of the self-regulation level. It has been noted that although many students know different strategies, they do not relate to use them frequently. Therefore, it is assumed that this activity requires effort and is markedly affected by students' motivation. For that reason, this article aims to discuss the relation between learning strategies and some motivational variables that have been systematically related to this construct: self-efficacy, achievement goals and task-value