Long-Term Mental Health Outcomes of Military Service

Bergman, Beverly P; Mackay, Daniel; Smith, Daniel J.; Pell, Jill P.

doi:10.4088/jcp.15m09837

Cited by 27 publications

(18 citation statements)

References 17 publications

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“…Research studies that previously would have been impossible because of the effort required to collect data have now become possible by reusing data originally collected for the purposes of providing direct health care. Examples include investigations into the prescribing of anxiolytics and hypnotics in over 300,000 children and young people in Wales [ 1 ], the mental health of 57,000 veterans compared with173,000 nonveterans in Scotland [ 2 ], and the impact of a smoke-free legislation on stroke [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Investigating the Extent to Which Patients Should Control Access to Patient Records for Research: A Deliberative Process Using Citizens’ Juries

Tully

Bozentko²,

Clément

et al. 2018

J Med Internet Res

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BackgroundThe secondary use of health data for research raises complex questions of privacy and governance. Such questions are ill-suited to opinion polling where citizens must choose quickly between multiple-choice answers based on little information.ObjectiveThe aim of this project was to extend knowledge about what control informed citizens would seek over the use of health records for research after participating in a deliberative process using citizens’ juries.MethodsTwo 3-day citizens’ juries, of 17 citizens each, were convened to reflect UK national demographics from 355 eligible applicants. Each jury addressed the mission “To what extent should patients control access to patient records for secondary use?” Jurors heard from and questioned 5 expert witnesses (chosen either to inform the jury, or to argue for and against the secondary use of data), interspersed with structured opportunities to deliberate among themselves, including discussion and role-play. Jurors voted on a series of questions associated with the jury mission, giving their rationale. Individual views were polled using questionnaires at the beginning and at end of the process.ResultsAt the end of the process, 33 out of 34 jurors voted in support of the secondary use of data for research, with 24 wanting individuals to be able to opt out, 6 favoring opt in, and 3 voting that all records should be available without any consent process. When considering who should get access to data, both juries had very similar rationales. Both thought that public benefit was a key justification for access. Jury 1 was more strongly supportive of sharing patient records for public benefit, whereas jury 2 was more cautious and sought to give patients more control. Many jurors changed their opinion about who should get access to health records: 17 people became more willing to support wider information sharing of health data for public benefit, whereas 2 moved toward more patient control over patient records.ConclusionsThe findings highlight that, when informed of both risks and opportunities associated with data sharing, citizens believe an individual’s right to privacy should not prevent research that can benefit the general public. The juries also concluded that patients should be notified of any such scheme and have the right to opt out if they so choose. Many jurors changed their minds about this complex policy question when they became more informed. Many, but not all, jurors became less skeptical about health data sharing, as they became better informed of its benefits and risks.

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Section: Introductionmentioning

confidence: 99%

Investigating the Extent to Which Patients Should Control Access to Patient Records for Research: A Deliberative Process Using Citizens’ Juries

Tully

Bozentko²,

Clément

et al. 2018

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…We recommend trying to improve the accuracy and efficiency of identifying veterans from EHR databases, such as CRIS, where possible. For example, as is already the case in NHS Scotland [27], the implementation of a military marker across the UK, perhaps one that could be verified with the Ministry of Defence's records, would be extremely helpful. This would clearly indicate which patients had previously served in the AF, eliminating the reliance on self-reported veteran status and speeding up the manual identification process as a result.…”

Section: Discussionmentioning

confidence: 99%

Identifying Veterans Using Electronic Health Records in the United Kingdom: A Feasibility Study

et al. 2019

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There is a lack of quantitative evidence concerning UK (United Kingdom) Armed Forces (AF) veterans who access secondary mental health care services—specialist care often delivered in high intensity therapeutic clinics or hospitals—for their mental health difficulties. The current study aimed to investigate the utility and feasibility of identifying veterans accessing secondary mental health care services using National Health Service (NHS) electronic health records (EHRs) in the UK. Veterans were manually identified using the Clinical Record Interactive Search (CRIS) system—a database holding secondary mental health care EHRs for an NHS Trust in the UK. We systematically and manually searched CRIS for veterans, by applying a military-related key word search strategy to the free-text clinical notes completed by clinicians. Relevant data on veterans’ socio-demographic characteristics, mental disorder diagnoses and treatment pathways through care were extracted for analysis. This study showed that it is feasible, although time consuming, to identify veterans through CRIS. Using the military-related key word search strategy identified 1600 potential veteran records. Following manual review, 693 (43.3%) of these records were verified as “probable” veterans and used for analysis. They had a median age of 74 years (interquartile range (IQR): 53–86); the majority were male (90.8%) and lived alone (38.0%). The most common mental diagnoses overall were depressive disorders (22.9%), followed by alcohol use disorders (10.5%). Differences in care pathways were observed between pre and post national service (NS) era veterans. This feasibility study represents a first step in showing that it is possible to identify veterans through free-text clinical notes. It is also the first to compare veterans from pre and post NS era.

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“…Similarly, several studies have acknowledged the importance of sharing EHR data for research purposes. In the last decade, the United Kingdom has witnessed a surge in the secondary use of health care data to derive population-based insights, namely, concerning mental health status [22] and prescription patterns [23]. In the United States, pilot studies have already started predicting readmissions and estimating the risk of complications in newborns [21].…”

Section: Discussionmentioning

confidence: 99%

Health Care Professionals’ Perspectives on the Secondary Use of Health Records to Improve Quality and Safety of Care in England: Qualitative Study

Neves¹,

Poovendran²,

Freise³

et al. 2019

J Med Internet Res

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BackgroundHealth care professionals (HCPs) are often patients’ first point of contact in what concerns the communication of the purposes, benefits, and risks of sharing electronic health records (EHRs) for nondirect care purposes. Their engagement is fundamental to ensure patients’ buy-in and a successful implementation of health care data sharing schemes. However, their views on this subject are seldom evaluated.ObjectiveThis study aimed to explore HCPs’ perspectives on the secondary uses of health care data in England. Specifically, we aimed to assess their knowledge on its purposes and the main concerns about data sharing processes.MethodsA total of 30 interviews were conducted between March 27, 2017, and April 7, 2017, using a Web-based interview platform and following a topic guide with open-ended questions. The participants represented a variety of geographic locations across England (London, West Midlands, East of England, North East England, and Yorkshire and the Humber), covering both primary and secondary care services. The transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using the framework analysis method to identify emerging themes.ResultsHCPs were knowledgeable about the possible secondary uses of data and highlighted its importance for patient profiling and tailored care, research, quality assurance, public health, and service delivery planning purposes. Main concerns toward data sharing included data accuracy, patients’ willingness to share their records, challenges on obtaining free and informed consent, data security, lack of adequacy or understanding of current policies, and potential patient exposure and exploitation.ConclusionsThese results suggest a high level of HCPs’ understanding about the purposes of data sharing for secondary purposes; however, some concerns still remain. A better understanding of HCPs’ knowledge and concerns could inform national communication policies and improve tailoring to maximize efficiency and improve patients’ buy-in.

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Long-Term Mental Health Outcomes of Military Service

Cited by 27 publications

References 17 publications

Investigating the Extent to Which Patients Should Control Access to Patient Records for Research: A Deliberative Process Using Citizens’ Juries

Investigating the Extent to Which Patients Should Control Access to Patient Records for Research: A Deliberative Process Using Citizens’ Juries

Identifying Veterans Using Electronic Health Records in the United Kingdom: A Feasibility Study

Health Care Professionals’ Perspectives on the Secondary Use of Health Records to Improve Quality and Safety of Care in England: Qualitative Study

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