Graham Tanya, Rose Diana, Murray Joanna, Ashworth Mark, Tylee André
Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK.
Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
BMJ Qual Saf. 2014 Oct;23(10):857-66. doi: 10.1136/bmjqs-2014-002842. Epub 2014 Jun 11.
To develop user-generated quality standards for young people with mental health problems in primary care using a participatory research model.
50 young people aged 16-25 from community settings and primary care participated in focus groups and interviews about their views and experiences of seeking help for mental health problems in primary care, cofacilitated by young service users and repeated to ensure respondent validation. A second group of young people also aged 16-25 who had sought help for any mental health problem from primary care or secondary care within the last 5 years were trained as focus groups cofacilitators (n=12) developed the quality standards from the qualitative data and participated in four nominal groups (n=28).
46 quality standards were developed and ranked by young service users. Agreement was defined as 100% of scores within a two-point region. Group consensus existed for 16 quality standards representing the following aspects of primary care: better advertising and information (three); improved competence through mental health training and skill mix within the practice (two); alternatives to medication (three); improved referral protocol (three); and specific questions and reassurances (five). Alternatives to medication and specific questions and reassurances are aspects of quality which have not been previously reported.
We have demonstrated the feasibility of using participatory research methods in order to develop user-generated quality standards. The development of patient-generated quality standards may offer a more formal method of incorporating the views of service users into quality improvement initiatives. This method can be adapted for generating quality standards applicable to other patient groups.
采用参与式研究模型，为基层医疗中患有心理健康问题的年轻人制定用户生成的质量标准。
50名年龄在16至25岁之间、来自社区环境和基层医疗机构的年轻人参加了焦点小组讨论和访谈，内容涉及他们在基层医疗中寻求心理健康问题帮助的观点和经历，由年轻的服务使用者共同主持，并重复进行以确保受访者验证。第二组同样年龄在16至25岁之间、在过去5年内曾从基层医疗或二级医疗机构寻求过任何心理健康问题帮助的年轻人被培训为焦点小组共同主持人（n = 12），他们根据定性数据制定质量标准，并参加了四个名义小组（n = 28）。
年轻的服务使用者制定并排列了46项质量标准。一致性定义为在两点区域内得分的100%。16项质量标准达成了小组共识，代表了基层医疗的以下方面：更好的宣传和信息（3项）；通过实践中的心理健康培训和技能组合提高能力（2项）；药物替代方案（3项）；改进转诊方案（3项）；以及特定问题和保证（5项）。药物替代方案以及特定问题和保证是以前未报告过的质量方面。
我们已经证明了使用参与式研究方法来制定用户生成的质量标准的可行性。患者生成的质量标准的制定可能提供一种更正式的方法，将服务使用者的观点纳入质量改进计划。这种方法可以适用于生成适用于其他患者群体的质量标准。
