A Evaluation on Stress Management

VALUATION is an attractive concept. Practices want to be assured that professional and administrative time is being used to good effect. Family health services authorities, particularly since the introduction of cash limiting, want to be able to allocate resources to interventions that are effective, and continuing support is likely to rest on evidence of value. Bids for new initiatives in general practice will be approved only if evidence of some evaluation is built into proposals. This is particularly important in the development of new services such as stress management, which have to date been offered by only a small minority of practices. Evaluation includes a wide range of activities of varying complexity, ranging from simple audits to research studies with sophisticated outcome measures. Evaluation has been defined as "the formal determination of the effectiveness, efficiency and acceptability of a planned intervention in achieving stated objectives" (Holland, 1983). Either the structure, process or outcome of an intervention may be evaluated (Donabedian, 1980). Structure refers to the physical setting of an intervention, and to the resources, both human and financial, committed to it. Process is a measure of the activity of the programme in comparison with stated objectives. Aspects of process that can be measured include coverage rates of a target population, throughput including waiting time, and the extent to which protocols are followed in managing individual cases. Most audit initiatives, whether managerially or medically led, rely on the collection of such process data. Ultimately the benefit of a programme can be assessed only by measuring how far it achieves its stated objectives for outcome. Outcome studies require a research design to control for such factors as the natural history of a condition and the effects of factors not related to the intervention. Ultimate outcomes, such as incidence of heart disease following a preventive programme, rely on large-scale studies including several years of follow-up. Shorter term outcomes may be used as proxy measures, for example the level of control in hypertension as a measure related to ultimate morbidity from stroke.