General practitioners' experience and benefits from patient evaluations

<p>Abstract</p> <p>Background</p> <p>It has now for many years been recognised that patient evaluations should be undertaken as an integral part of the complex task of improving the quality of general practice care. Yet little is known about the general practitioners' (GPs') benefit from patient evaluations. Aim 1 was to study the impact on the GPs of a patient evaluation and subsequent feedback of results presented at a plenary session comprising a study guide for the results and group discussions. Aim 2 was to study possible facilitators and barriers to the implementations of the results raised by the patient evaluation process.</p> <p>Methods</p> <p>A patient evaluation survey of 597 voluntarily participating GPs was performed by means of the EUROPEP questionnaire. Evaluation results were fed back to the GPs as written reports at a single feedback meeting with group discussions of the results. Between 3 and 17 months after the feedback, the 597 GPs received a questionnaire with items addressing their experience with and perceived benefit from the evaluations.</p> <p>Results</p> <p>79.4% of the GPs responded. 33% of the responding GPs reported that the patient evaluation had raised their attention to the patient perspective on the quality of general practice care. Job satisfaction had improved among 26%, and 21% had developed a more positive attitude to patient evaluations. 77% of the GPs reported having learnt from the evaluation. 54% had made changes to improve practice, 82% would recommend a patient evaluation to a colleague and 75% would do another patient evaluation if invited. 14% of the GPs had become less positive towards patient evaluations, and job satisfaction had decreased among 3%.</p> <p>Conclusions</p> <p>We found a significant impact on the GPs regarding satisfaction with the process and attitude towards patient evaluations, GPs' attention to the patients' perspective on care quality and their job satisfaction. Being benchmarked against the average seemed to raise barriers to the concept of patient evaluations and difficulties interpreting the results may have formed a barrier to their implementation which was partly overcome by adding qualitative data to the quantitative results. The GPs' significant willingness to share and discuss the results with others may have served as a facilitator.</p

Improving self-regulation in adolescents: current evidence for the role of mindfulness-based cognitive therapy

Carisa Perry-Parrish,1 Nikeea Copeland-Linder,2 Lindsey Webb,2 Ashley Shields,1 Erica MS Sibinga2 1Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Pediatric Medical Psychology Program, 2Department of Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA Abstract: Mindfulness-based cognitive therapy (MBCT) was introduced in 1995 to address the problem of recurrent depression. MBCT is based on the notion that meditation helps individuals effectively deploy and regulate attention to effectively manage and treat a range of psychological symptoms, including emotional responses to stress, anxiety, and depression. Several studies demonstrate that mindfulness approaches can effectively reduce negative emotional reactions that result from and/or exacerbate psychiatric difficulties and exposure to stressors among children, adolescents, and their parents. Mindfulness may be particularly relevant for youth with maladaptive cognitive processes such as rumination. Clinical experience regarding the utility of mindfulness-based approaches, including MBCT, is being increasingly supported by empirical studies to optimize the effective treatment of youth with a range of challenging symptoms. This paper provides a description of MBCT, including mindfulness practices, theoretical mechanisms of action, and targeted review of studies in adolescents. Keywords: youth, mindfulness-based cognitive therapy, adolescent

A Pilot Randomized Controlled Trial of a Mindfulness Program for Filipino Children

Objectives This study examines the feasibility and acceptability of a local adaptation of a mindfulness-based cognitive therapy (MBCT) program for Filipino school children, called Kamalayan, that was facilitated by trained public school teachers. It also presents preliminary evidence of program effects on the children’s depressive and anxiety symptoms and difficulties in emotion regulation. Methods We utilized a randomized controlled design with an active control condition. Filipino elementary and high school students aged 9 to 16 years old from low-resource schools were randomly assigned to the Kamalayan (n = 87) or the active control Handicrafts condition (n = 99). Changes in outcomes from baseline, immediate post-intervention, and 2-month follow-up were assessed using multilevel modeling. Results Participation in the Kamalayan program did not affect depression, anxiety, or emotion regulation. Impulse control difficulties increased for the Handicrafts group across post-intervention and follow-up but remained stable for Kamalayan participants. Depressive symptoms decreased over time for the Handicrafts group but remained stable for the Kamalayan condition. Implementation issues qualify the absence of program effects, such as the impracticability of delivering after-school sessions in the public school context, program content that may be discordant with cognitive-developmental and cultural considerations, and the inadequacy of the personal mindfulness practice of the paraprofessional facilitators. Conclusions The findings reaffirm the importance of using active control groups and considering the capacities of facilitators in evaluating the effects of mindfulness-based interventions. Testing mindfulness-based interventions in low-resource, non-Western school settings require deeper contextual adaptation and facilitator preparation