Abstract
Background: While mental health is a core part of primary care, there are few validated quality measures and little relevant internationally published research. Consensus panel methods are a useful means of developing quality measures where evidence is sparse and/or opinions are diverse. However, little is known about the dynamics of consensus techniques and the factors that influence the judgements and ratings of panels and individual panellists.
Objectives: (1) To describe differences in panel ratings on the quality of primary mental health care services by patient, carer, professional and managerial panels within a Delphi procedure; and (2) to explore why different panels and panellists rate quality indicators of primary mental health care differently.
Design: Two round postal Delphi technique and exploratory semi-structured interviews.
Participants: 115 panellists across 11 panels. Eleven panellists were subsequently interviewed.
Results: 87 of 334 indicators (26%) were rated face valid by all 11 panels. There was little disagreement within panel ratings but significant differences between panels. The GP panel rated the least number of indicators valid (n = 138, 41%) and carers the most (n = 304, 91%). The way in which panellists interpreted and conceptualised the indicators and their definition of quality of mental health care affected the way in which participants made their ratings.
Conclusions: Stakeholders in primary mental health care have diverse views of quality of care and these differences translate into how they rate quality indicators. Exploratory interviews suggest that ratings are influenced by past experience, expectations, definitions of quality of care, and perceived power relationships between stakeholders.
Full Text
The Full Text of this article is available as a PDF (125.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- 'You're depressed'; 'no I'm not': GPs' and patients' different models of depression. UMDS MSc in General Practice Teaching Group. Br J Gen Pract. 1999 Feb;49(439):123–124. [PMC free article] [PubMed] [Google Scholar]
- Attree M. Patients' and relatives' experiences and perspectives of 'Good' and 'Not so Good' quality care. J Adv Nurs. 2001 Feb;33(4):456–466. doi: 10.1046/j.1365-2648.2001.01689.x. [DOI] [PubMed] [Google Scholar]
- Attree M. Towards a conceptual model of 'quality care'. Int J Nurs Stud. 1996 Feb;33(1):13–28. doi: 10.1016/0020-7489(95)00049-6. [DOI] [PubMed] [Google Scholar]
- Bensing J. Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine. Patient Educ Couns. 2000 Jan;39(1):17–25. doi: 10.1016/s0738-3991(99)00087-7. [DOI] [PubMed] [Google Scholar]
- Bower P., Sibbald B. Systematic review of the effect of on-site mental health professionals on the clinical behaviour of general practitioners. BMJ. 2000 Mar 4;320(7235):614–617. doi: 10.1136/bmj.320.7235.614. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Brook R. H., Chassin M. R., Fink A., Solomon D. H., Kosecoff J., Park R. E. A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care. 1986;2(1):53–63. doi: 10.1017/s0266462300002774. [DOI] [PubMed] [Google Scholar]
- Campbell S. M., Braspenning J., Hutchinson A., Marshall M. Research methods used in developing and applying quality indicators in primary care. Qual Saf Health Care. 2002 Dec;11(4):358–364. doi: 10.1136/qhc.11.4.358. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Campbell S. M., Cantrill J. A. Consensus methods in prescribing research. J Clin Pharm Ther. 2001 Feb;26(1):5–14. doi: 10.1046/j.1365-2710.2001.00331.x. [DOI] [PubMed] [Google Scholar]
- Campbell S. M., Hann M., Roland M. O., Quayle J. A., Shekelle P. G. The effect of panel membership and feedback on ratings in a two-round Delphi survey: results of a randomized controlled trial. Med Care. 1999 Sep;37(9):964–968. doi: 10.1097/00005650-199909000-00012. [DOI] [PubMed] [Google Scholar]
- Coulter I., Adams A., Shekelle P. Impact of varying panel membership on ratings of appropriateness in consensus panels: a comparison of a multi- and single disciplinary panel. Health Serv Res. 1995 Oct;30(4):577–591. [PMC free article] [PubMed] [Google Scholar]
- Hasson F., Keeney S., McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000 Oct;32(4):1008–1015. [PubMed] [Google Scholar]
- Holloway Frank. Outcome measurement in mental health--welcome to the revolution. Br J Psychiatry. 2002 Jul;181:1–2. doi: 10.1192/bjp.181.1.1. [DOI] [PubMed] [Google Scholar]
- Mallinson Sara. Listening to respondents: a qualitative assessment of the Short-Form 36 Health Status Questionnaire. Soc Sci Med. 2002 Jan;54(1):11–21. doi: 10.1016/s0277-9536(01)00003-x. [DOI] [PubMed] [Google Scholar]
- Seddon M. E., Marshall M. N., Campbell S. M., Roland M. O. Systematic review of studies of quality of clinical care in general practice in the UK, Australia and New Zealand. Qual Health Care. 2001 Sep;10(3):152–158. doi: 10.1136/qhc.0100152... [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shekelle P. G., Kahan J. P., Bernstein S. J., Leape L. L., Kamberg C. J., Park R. E. The reproducibility of a method to identify the overuse and underuse of medical procedures. N Engl J Med. 1998 Jun 25;338(26):1888–1895. doi: 10.1056/NEJM199806253382607. [DOI] [PubMed] [Google Scholar]
- Shield T., Campbell S., Rogers A., Worrall A., Chew-Graham C., Gask L. Quality indicators for primary care mental health services. Qual Saf Health Care. 2003 Apr;12(2):100–106. doi: 10.1136/qhc.12.2.100. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wensing M., Jung H. P., Mainz J., Olesen F., Grol R. A systematic review of the literature on patient priorities for general practice care. Part 1: Description of the research domain. Soc Sci Med. 1998 Nov;47(10):1573–1588. doi: 10.1016/s0277-9536(98)00222-6. [DOI] [PubMed] [Google Scholar]