books on prescription evaluation & panel discussion

Programme

• Welcome

• WellSouth - history and evaluation

• Perspective of a Public Librarian

• Perspective of an Academic Librarian

• Perspective of a Psychologist

• Discussion

• Close around 7.30

Katie Jahnke & Sophie CartyHealth Promotion & Projects Co-ordinators

WellSouth

What is the Books on Prescription Scheme?

o A community health initiative whereby GPs, mental health professionals and other health professionals can offer their patients recommended self-help books for mild to moderate mental health problems

o A book prescription is issued by a doctor or other health professional and the book can then be borrowed from the local library

o The book is selected from a list recommended and reviewed as amongst the best in the field

o It can be used as an adjunct to medication and as an alternative in many cases

o It can also be useful as an interim intervention while the patient is waiting for psychotherapy

The Concept

o The Books on Prescription scheme is a UK model proven very effective way of helping people with common mental health problems, such as depression, anxiety and phobias.

o The scheme was first set up in Cardiff, in 2003, based on the work of psychologist Dr Neil Frude. It makes use of ‘bibliotherapy’ – self-help therapy in book form

“an alternative way of making psychotherapy available to people with

mild to moderate mental health problems”

o Now running in Primary Care Trusts and libraries all over the UK

o Implemented in Central Otago in 2011 and progressively rolled out in Otago & Southland.

Does bibliotherapy work? Evidence:

o Clinical evidence shows that books can be as effective as other forms of therapy and with the advantage of having no potential side effects associated with drugs, and often achieve good results more quickly.

o There is a body of evidence indicating the effectiveness of bibliotherapy in treating many different kinds of psychological problems including depression, anxiety and eating disorders.

o 80% of psychotherapists and 90% of CBT therapists regularly recommend books to clients as a supplement to therapy.

o Research shows that reading improves mental well-being, and reduces stress levels by 67%

o Research suggests that patients benefit from knowing more about their problems, and learning psychological tactics to deal with them.

Why start a BOP scheme?

o 46.6% of the population will meet the criteria for a mental disorder during their lives

o 39.5% have already had experience of mental disorder

o 20.7% of the population will have experienced a mental health disorder within the past 12 months

o There is significant unmet need for people with mental disorders. Over a 12 month period only 39%

of people with a mental disorder had visited health services.

o Books On Prescription can compliment our existing services and may cut waiting lists and lead to a

reduction in the amount of drugs prescribed

o It works alongside the “Beating The Blues” e-programme

WellSouth

o 285,852 enrolled patients in 86 practices

o 40% enrolled pop. live outside the main cities important to have a rural focus

o Reduced access to mental health services in rural areas

Implementation Evaluation

Data Collection

o Email and letter sent to prescribers asking for the return of ‘prescription forms’

o BoP book issuing data and library membership data requested from libraries

o Survey monkey to librarians and prescribers

o Interviews with prescribers

o Consumer feedback book marks collected from prescribers and libraries

o Extra comments and information collected and stored

Implementation Evaluation

Limitations

o High staff turnover in health and social service sector

o Limited feedback and data from consumers/patients

o Response bias

Implementation Evaluation

Resultso The concept behind the programme was very well received by prescribers and consumers

o Consumers who did provide feedback found the books easy to read and helpful

o BoP books issued 2,104 times across the Southern Region. There were 3,135,195 total library book issues between 2012-2013.

o A small number of prescribers actually made use of the programme, those who did felt that it was a good idea and a valuable resource for the public

o Primary barriers to programme use:

o Privacy and stigma issueso Forgetting about the programmeo Not being familiar with the bookso Not suitable for the client (difficulty level and/or clients motivation level)

Implementation Evaluation

Potential Solutions and Improvements• Stop using the hand written “prescription forms”.

• Redevelop and simplify promotional material.

• Increase the frequency of promotion, especially to prescribers as there is often a high turnover of staff. Make a promotion plan to ensure regular promotions occur.

• Promote the BoP programme directly to the general public – expand to include other health issues.

• Increase visibility of BoP books in the libraries.

• Increase the proportion of basic/short books versus difficult/long books.

• Add resources using other media (websites, smartphone applications, movie recommendations, podcasts, one-page hand-outs, and/or short video clips), and include as much as possible on the website.

Implementation Evaluation

Potential Solutions and Improvements

• Expand on the book review criteria: get reviewer to state their professional background and experience, what sections they think are helpful, which sections they think are unhelpful, and to what type of person/client they would recommend the book.

• Increase the transparency of the review process – allow the general public and prescribers to view what has been said about each book to increase trust in programme.

• Work with the libraries and local council to reduce barriers to book issues as much as possible.

• Enlist IT support to work with libraries (regionally) to ensure more consistent book issuing reporting data, and help with book collection management.

• Re-think how to assess outcome measures from prescribers and consumers.

• Incorporate BoP into the IT system/s available to general practice.

Philip van ZijlLibrarian

Waitaki District Libraries

Statistics

•Most popular = John Kirwin 85+

•Average issue rate = 7

•Range of issues = 1-15+

Richard GermanDivisional Librarian, Health Sciences

University of Otago

Books on Prescription in universities

Otago is one of a few university libraries in the world that have adopted Books on Prescription

•University College Dublin

• Brunel University London

• Loughborough University

Why is the University involved?

Three reasons:

•UO senior medical students go on placements in GP practices throughout Otago and Southland

•Opportunity to support teaching and learning in the UO School of Medicine

•Opportunity to contribute a resource to improve staff and student well-being at UO

Teaching & learning

•Approval of teaching staff

•Ordered books

• Created a guide

• Promotion

Well-being

• Support the well-being of staff and students

• Student Health

•Disability Information & Support

• Employee Assistance Programme (EAP)

Guide

•About the programme

• Evidence base

• Books arranged by subject

•Multimedia resources

www.otago.libguides.com/bop

Jodie BlackRegistered PsychologistStudent Health Services

Benefits for Student Health

• Part of a stepped care approach to mental health

•Options for those on a waitlist or returning home over breaks

• Provide options directly accessible by students

•Utilizing library infrastructure

Top five: loaned books

11 loans 7 loans 6 loans 6 loans 5 loans

Top five: most loan days

375 days

381 days 375 days 346 days 280 days 253 days

Challenges to consider

• Staff familiarisation with the scheme and books

• Client attitudes towards electronic and bibliotherapyself help are more positive than the clinicians

• Some staff already use electronic resources, including websites and apps

Any questions?