BackgroundClinical practice guidelines (CPGs) aim to improve patient care, but their use remains variable. We explored attitudes that influence CPG use amongst newly qualified doctors.MethodsA self-completed, anonymous questionnaire was sent to all Foundation Doctors in England and Wales between December 2012 and May 2013. We included questions designed to measure the 11 domains of the validated Theoretical Domains Framework (TDF). We correlated these responses to questions assessing current and future intention to use CPGs.ResultsA total of 13,138 doctors were invited of which 1698 (13 %) responded. 1,035 (62.5 %) reported regular CPG use with 575 (34.4 %) applying CPGs 2–3 times per week. A significant minority of 606 (36.6 %) declared an inability to critically appraise evidence.Despite efforts to design a questionnaire that captured the domains of the TDF, the domain scales created had low internal reliability. Using previously published studies and input from an expert statistical group, an alternative model was sought using exploratory factor analysis. Five alternative domains were identified. These were judged to represent: “confidence”, “familiarity”, “commitment and duty”, “time” and “perceived benefits”.Using regression analyses, the first three were noted as consistent predictors of both current and future intentions to use CPGs in decreasing strength order.ConclusionsIn this large survey of newly qualified doctors, “confidence”, “familiarity” and “commitment and duty” were identified as domains that influence use of CPGs in frontline practice. Additionally, a significant minority were not confident in critically appraising evidence.Our findings suggest a number of approaches that may be taken to improve junior doctors’ commitment to CPGs through processes that increase their confidence and familiarity in using CPGs.Despite limitations of a self-reported survey and potential non-response bias, these findings are from a large representative sample and a review of existing implementation strategies may be warranted based on these findings.

Rehabilitation services for people with mental illnesses have been extensively researched. However, services with similar aims and specifications for patients with intellectual disabilities (IDs) have had little focus. This study describes the characteristics and outcomes of 21 patients admitted to a specialist ID rehabilitation service over an 8-year time frame. Rather that solely accepting 'step-down' referrals, some patients were referred from community settings. During the study, 20 patients were discharged, 80% to lower levels of service restriction, while 14.3% to higher levels. The study suggested that rehabilitation services have an important role within the wider service model for people with ID. Within the service studied, patients were referred from both higher and lower levels of restriction, suggesting the rehabilitation service 'bridged the gap' between inpatient and community settings, supporting the aim of caring for patients in the least restrictive setting for their needs.

Self-harm in young people is a common presentation to mental health services. There is little literature, however, on how professionals view their role and the role of others within the assessment of these young people, and the relative accountability. This study explored Child and Adolescent Mental Health Services (CAMHS) professionals' views of these roles utilising a qualitative framework. The interviews of 18 CAMHS professionals from different disciplines were analysed using a thematic approach. Findings showed participants to be clear regarding the remit of their own role and the purpose of the assessment process, but were less confident in the abilities of those outside their service. They commented on the ongoing problems of stigma in this area and the difficulties with multi-agency working. Findings suggested possible ways to ameliorate these problems; however, the current economic climate may not be conducive to this.

Aims and method There is a drive to increase the number of psychiatry foundation placements to ensure that training keeps up with the changing health and social care landscape. This qualitative study aimed to explore, by interview, the experiences of 17 doctors who have completed a foundation placement in psychiatry.Results The study highlights the benefits of foundation psychiatry placements and some of their positive and negative aspects.Clinical implications Those developing foundation placements will need to ensure they are of high quality.