Janice Rattray, Jordan Miller, Beth Pollard, Louise McCallum, Alastair Hull, Pam Ramsay, Lisa Salisbury, Teresa Scott, Stephen Cole, Diane Dixon
<p><strong>Objective: </strong>To use the job demands-resources model of occupational stress to quantify and explain the impact of working in critical care during the COVID-19 pandemic on nurses and their employing organisation.</p><p><strong>Design: </strong>Two-phase mixed methods: a cross-sectional survey (January 2021-March 2022), with comparator baseline data from April to October 2018 (critical care nurses only), and semistructured interviews.</p><p><strong>Participants: </strong>Critical care nurses (<i>n</i> = 461) and nurses redeployed to critical care (<i>n</i> = 200) who worked in the United Kingdom National Health Service (primarily Scotland) between January 2021 and March 2022. The 2018 survey was completed by 557 critical care nurses (Scotland only). Survey response rate in Scotland was 32% but could not be determined outside Scotland. Forty-four nurses were interviewed (critical care = 28, redeployed = 16).</p><p><strong>Methods: </strong>A survey measured job demands, job resources, health impairment, work engagement and organisational outcomes. Data were compared to 2018 data. Regression analyses identified predictors of health impairment, work engagement and organisational outcomes. Semistructured interviews were conducted remotely, audio-recorded and transcribed. Data were analysed deductively using framework analysis.</p><p><strong>Findings: </strong>Three-quarters of nurses reached threshold for psychological distress, approximately 50% reached threshold for burnout emotional exhaustion and a third clinically concerning post-traumatic stress symptoms. Compared to 2018, critical care nurses were at elevated risk of probable psychological distress, odds ratio 6.03 (95% CI 4.75 to 7.95); burnout emotional exhaustion, odds ratio 4.02 (3.07 to 5.26); burnout depersonalisation, odds ratio 3.18 (1.99 to 5.07); burnout accomplishment, odds ratio 1.53 (1.18 to 1.97). There were no differences between critical care and redeployed nurses on health impairment outcomes, suggesting elevated risk would apply to redeployed nurses. Job demands increased and resources decreased during the pandemic. Higher job demands predicted greater psychological distress. Job resources reduced the negative impact of job demands on psychological distress, but this moderating effect was not observed at higher levels of demand. All organisational outcomes worsened. Lack of resources predicted worse organisational outcomes. In interviews, staff described the pace and amount, complexity, physical and emotional effort of their work as the most difficult job demands. The sustained high-demand environment impacted physical and psychological well-being, with most interviewees experiencing emotional and physical exhaustion, burnout, and symptoms of post-traumatic stress disorder. Camaraderie and support from colleagues and supervisors were core job resources. The combination of sustained demands and their impact on staff well-being incurred negative organisational co
{"title":"A model of occupational stress to assess impact of COVID-19 on critical care and redeployed nurses: a mixed-methods study.","authors":"Janice Rattray, Jordan Miller, Beth Pollard, Louise McCallum, Alastair Hull, Pam Ramsay, Lisa Salisbury, Teresa Scott, Stephen Cole, Diane Dixon","doi":"10.3310/PWRT8714","DOIUrl":"https://doi.org/10.3310/PWRT8714","url":null,"abstract":"<p><strong>Objective: </strong>To use the job demands-resources model of occupational stress to quantify and explain the impact of working in critical care during the COVID-19 pandemic on nurses and their employing organisation.</p><p><strong>Design: </strong>Two-phase mixed methods: a cross-sectional survey (January 2021-March 2022), with comparator baseline data from April to October 2018 (critical care nurses only), and semistructured interviews.</p><p><strong>Participants: </strong>Critical care nurses (<i>n</i> = 461) and nurses redeployed to critical care (<i>n</i> = 200) who worked in the United Kingdom National Health Service (primarily Scotland) between January 2021 and March 2022. The 2018 survey was completed by 557 critical care nurses (Scotland only). Survey response rate in Scotland was 32% but could not be determined outside Scotland. Forty-four nurses were interviewed (critical care = 28, redeployed = 16).</p><p><strong>Methods: </strong>A survey measured job demands, job resources, health impairment, work engagement and organisational outcomes. Data were compared to 2018 data. Regression analyses identified predictors of health impairment, work engagement and organisational outcomes. Semistructured interviews were conducted remotely, audio-recorded and transcribed. Data were analysed deductively using framework analysis.</p><p><strong>Findings: </strong>Three-quarters of nurses reached threshold for psychological distress, approximately 50% reached threshold for burnout emotional exhaustion and a third clinically concerning post-traumatic stress symptoms. Compared to 2018, critical care nurses were at elevated risk of probable psychological distress, odds ratio 6.03 (95% CI 4.75 to 7.95); burnout emotional exhaustion, odds ratio 4.02 (3.07 to 5.26); burnout depersonalisation, odds ratio 3.18 (1.99 to 5.07); burnout accomplishment, odds ratio 1.53 (1.18 to 1.97). There were no differences between critical care and redeployed nurses on health impairment outcomes, suggesting elevated risk would apply to redeployed nurses. Job demands increased and resources decreased during the pandemic. Higher job demands predicted greater psychological distress. Job resources reduced the negative impact of job demands on psychological distress, but this moderating effect was not observed at higher levels of demand. All organisational outcomes worsened. Lack of resources predicted worse organisational outcomes. In interviews, staff described the pace and amount, complexity, physical and emotional effort of their work as the most difficult job demands. The sustained high-demand environment impacted physical and psychological well-being, with most interviewees experiencing emotional and physical exhaustion, burnout, and symptoms of post-traumatic stress disorder. Camaraderie and support from colleagues and supervisors were core job resources. The combination of sustained demands and their impact on staff well-being incurred negative organisational co","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-32"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Minority ethnic patients are less likely to access timely and effective palliative and end-of-life care and, as a consequence, more likely to experience poorer symptom management and receive more intensive treatments at the end of life. Research activity has the potential to address the aforementioned barriers to improve access. However, there is a need to develop capacity and capability, particularly within underserved communities, to provide an infrastructure that can drive research activity informed by the community to benefit the community.</p><p><strong>Objective: </strong>To build and develop a robust, inclusive and representative research partnership to facilitate improved research activity committed to addressing inequity in access to palliative and end-of-life care among ethnically diverse communities.</p><p><strong>Design: </strong>An inclusive and representative KEEch research Partnership NETwork was established, comprised over 80 partner organisations that represent the local diverse and multifaith communities. Interviews (<i>n</i> = 11) with service providers and face-to-face roundtable workshops with community stakeholders, service providers, informal carers and faith leaders were conducted to understand needs, challenges and research priorities.</p><p><strong>Setting: </strong>Bedfordshire, Hertfordshire and Milton Keynes, United Kingdom.</p><p><strong>Results: </strong>Developing KEEch research Partnership NETwork required a flexible and agile approach to engage effectively with institutionalised and non-institutionalised stakeholders. Sharing a joint purpose of learning, managing partners' expectations and providing transparency and accountability within the network were all essential in building trust and equity within the research partnership. The overarching findings revealed a range of sociocultural and structural barriers that negatively impact access and experience among minority ethnic groups. Discussions centred on the disconnect between informal care and support within the community, which many ethnic minority communities rely upon, and 'institutional' medical services. KEEch research Partnership NETwork uncovered that while service providers and communities acknowledge they need to engage with each other more, they remain uncertain of the best way to achieve this. There was also consensus that services need to deliver more effective, culturally competent, person-centric care that promotes compassion and gives weight to non-medical needs to better meet the needs of the diverse population. These findings and priorities have informed the submission of a co-produced research funding proposal. Beyond that, KEEch research Partnership NETwork has also provided a platform for further unplanned spin-off research projects and collaboration, including the implementation of an innovative 'community connector' role to facilitate better integration of community and voluntary services in palliative and
{"title":"Exploratory study from an end-of-life research partnership network to improve access for ethnically diverse communities in one region.","authors":"Erica J Cook, Elaine Tolliday, Nasreen Ali, Mehrunisha Suleman, Emma Wilkinson, Gurch Randhawa","doi":"10.3310/MWHY5612","DOIUrl":"https://doi.org/10.3310/MWHY5612","url":null,"abstract":"<p><strong>Background: </strong>Minority ethnic patients are less likely to access timely and effective palliative and end-of-life care and, as a consequence, more likely to experience poorer symptom management and receive more intensive treatments at the end of life. Research activity has the potential to address the aforementioned barriers to improve access. However, there is a need to develop capacity and capability, particularly within underserved communities, to provide an infrastructure that can drive research activity informed by the community to benefit the community.</p><p><strong>Objective: </strong>To build and develop a robust, inclusive and representative research partnership to facilitate improved research activity committed to addressing inequity in access to palliative and end-of-life care among ethnically diverse communities.</p><p><strong>Design: </strong>An inclusive and representative KEEch research Partnership NETwork was established, comprised over 80 partner organisations that represent the local diverse and multifaith communities. Interviews (<i>n</i> = 11) with service providers and face-to-face roundtable workshops with community stakeholders, service providers, informal carers and faith leaders were conducted to understand needs, challenges and research priorities.</p><p><strong>Setting: </strong>Bedfordshire, Hertfordshire and Milton Keynes, United Kingdom.</p><p><strong>Results: </strong>Developing KEEch research Partnership NETwork required a flexible and agile approach to engage effectively with institutionalised and non-institutionalised stakeholders. Sharing a joint purpose of learning, managing partners' expectations and providing transparency and accountability within the network were all essential in building trust and equity within the research partnership. The overarching findings revealed a range of sociocultural and structural barriers that negatively impact access and experience among minority ethnic groups. Discussions centred on the disconnect between informal care and support within the community, which many ethnic minority communities rely upon, and 'institutional' medical services. KEEch research Partnership NETwork uncovered that while service providers and communities acknowledge they need to engage with each other more, they remain uncertain of the best way to achieve this. There was also consensus that services need to deliver more effective, culturally competent, person-centric care that promotes compassion and gives weight to non-medical needs to better meet the needs of the diverse population. These findings and priorities have informed the submission of a co-produced research funding proposal. Beyond that, KEEch research Partnership NETwork has also provided a platform for further unplanned spin-off research projects and collaboration, including the implementation of an innovative 'community connector' role to facilitate better integration of community and voluntary services in palliative and ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-23"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth McDermott, Rachael Eastham, Elizabeth Hughes, Emily Pattison, Katherine Johnson, Stephanie Davis, Steven Pryjmachuk, Ceu Mateus, Olu Jenzen, Felix McNulty
<p><strong>Background: </strong>Lesbian, gay, bisexual, trans, queer/questioning, plus young people have a higher risk of poor mental health in comparison to cisgendered heterosexual young people, and they underutilise mental health services and support. In addition, there is a paucity of research conducted in United Kingdom examining mental health early intervention provision for lesbian, gay, bisexual, trans, queer/questioning, plus young people.</p><p><strong>Objectives: </strong>To produce a model of what works for early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people and increase understanding of lesbian, gay, bisexual, trans, queer/questioning, plus young people's access to, navigation of, and engagement with mental health support.</p><p><strong>Method: </strong>This was a multi-methods theory-led case study evaluation with three distinct stages: (1) a meta-narrative review of existing literature to develop a theoretical framework to explain effective mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people; (2) an online and offline service mapping exercise to locate current mental health early intervention support for lesbian, gay, bisexual, trans, queer/questioning, plus young people in the United Kingdom in order to produce a service typology; and (3) a theory-led case study evaluation of 12 case study sites selected from the service typology produced in stage 2, to establish the components of appropriate quality, early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people.</p><p><strong>Results: </strong>Stage 1 produced an interdisciplinary theoretical framework indicating that early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus youth must prioritise addressing normative environments that marginalise youth, lesbian, gay, bisexual, trans, queer/questioning, plus identities and mental health problems. Stage 2 mapping found 111 services, the majority in urban settings in England. There was an absence of mainstream National Health Service support that specifically addressed the needs of lesbian, gay, bisexual, trans, queer/questioning, plus young people. The majority of lesbian, gay, bisexual, trans, queer/questioning, plus youth mental health support was provided by voluntary/community organisations. Stage 3 case study evaluation found that an <i>intersectional, youth-rights</i> approach is the most appropriate way to deliver early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Youth rights should underpin mental health support to address the multiple marginalisation, isolation and stigmatisation that lesbian, gay, bisexual, trans, queer/questioning, plus young people may experience and to enable them to make informed independent decisions about their own bodies and lives, and for the
{"title":"Early mental health intervention and supported self-care for LGBTQ+ young people in the UK: a mixed-methods study.","authors":"Elizabeth McDermott, Rachael Eastham, Elizabeth Hughes, Emily Pattison, Katherine Johnson, Stephanie Davis, Steven Pryjmachuk, Ceu Mateus, Olu Jenzen, Felix McNulty","doi":"10.3310/KYWA6382","DOIUrl":"https://doi.org/10.3310/KYWA6382","url":null,"abstract":"<p><strong>Background: </strong>Lesbian, gay, bisexual, trans, queer/questioning, plus young people have a higher risk of poor mental health in comparison to cisgendered heterosexual young people, and they underutilise mental health services and support. In addition, there is a paucity of research conducted in United Kingdom examining mental health early intervention provision for lesbian, gay, bisexual, trans, queer/questioning, plus young people.</p><p><strong>Objectives: </strong>To produce a model of what works for early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people and increase understanding of lesbian, gay, bisexual, trans, queer/questioning, plus young people's access to, navigation of, and engagement with mental health support.</p><p><strong>Method: </strong>This was a multi-methods theory-led case study evaluation with three distinct stages: (1) a meta-narrative review of existing literature to develop a theoretical framework to explain effective mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people; (2) an online and offline service mapping exercise to locate current mental health early intervention support for lesbian, gay, bisexual, trans, queer/questioning, plus young people in the United Kingdom in order to produce a service typology; and (3) a theory-led case study evaluation of 12 case study sites selected from the service typology produced in stage 2, to establish the components of appropriate quality, early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people.</p><p><strong>Results: </strong>Stage 1 produced an interdisciplinary theoretical framework indicating that early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus youth must prioritise addressing normative environments that marginalise youth, lesbian, gay, bisexual, trans, queer/questioning, plus identities and mental health problems. Stage 2 mapping found 111 services, the majority in urban settings in England. There was an absence of mainstream National Health Service support that specifically addressed the needs of lesbian, gay, bisexual, trans, queer/questioning, plus young people. The majority of lesbian, gay, bisexual, trans, queer/questioning, plus youth mental health support was provided by voluntary/community organisations. Stage 3 case study evaluation found that an <i>intersectional, youth-rights</i> approach is the most appropriate way to deliver early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Youth rights should underpin mental health support to address the multiple marginalisation, isolation and stigmatisation that lesbian, gay, bisexual, trans, queer/questioning, plus young people may experience and to enable them to make informed independent decisions about their own bodies and lives, and for the","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 47","pages":"1-102"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicola E Walsh, Alice Berry, Serena Halls, Rachel Thomas, Hannah Stott, Cathy Liddiard, Zoe Anchors, Fiona Cramp, Margaret E Cupples, Peter Williams, Heather Gage, Dan Jackson, Paula Kersten, Dave Foster, Justin Jagosh
<p><strong>Background: </strong>First-contact physiotherapists assess and diagnose patients with musculoskeletal disorders, determining the best course of management without prior general practitioner consultation.</p><p><strong>Objectives: </strong>The primary aim was to determine the clinical and cost-effectiveness of first-contact physiotherapists compared with general practitioner-led models of care.</p><p><strong>Design: </strong>Mixed-method realist evaluation of effectiveness and costs, comprising three main phases: A United Kingdom-wide survey of first contact physiotherapists. Rapid realist review of first contact physiotherapists to determine programme theories. A mixed-method case study evaluation of 46 general practices across the United Kingdom, grouped as three service delivery models: General practitioner: general practitioner-led models of care (no first contact physiotherapists). First-contact physiotherapists standard provision: standard first-contact physiotherapist-led model of care. First-contact physiotherapists with additional qualifications: first-contact physiotherapists with additional qualifications to enable them to inject and/or prescribe.</p><p><strong>Setting: </strong>United Kingdom general practice.</p><p><strong>Participants: </strong>A total of 46 sites participated in the case study evaluation and 426 patients were recruited; 80 staff and patients were interviewed.</p><p><strong>Main outcome measures: </strong>Short Form 36 physical outcome component score and costs of treatment.</p><p><strong>Results: </strong>No statistically significant difference in the primary outcome Short Form 36 physical component score measure at 6-month primary end point between general practitioner-led, first-contact physiotherapist standard provision and first-contact physiotherapist with additional qualifications models of care. A greater number of patients who had first-contact physiotherapist standard provision (72.4%) and first-contact physiotherapist with additional qualifications (66.4%) showed an improvement at 3 months compared with general practitioner-led care (54.7%). No statistically significant differences were found between the study arms in other secondary outcome measures, including the EuroQol-5 Dimensions, five-level version. Some 6.3% of participants were lost to follow-up at 3 months; a further 1.9% were lost to follow-up after 3 months and before 6 months. Service-use analysis data were available for 348 participants (81.7%) at 6 months. Inspecting the entire 6 months of the study, a statistically significant difference in total cost was seen between the three service models, irrespective of whether inpatient costs were included or excluded from the calculation. In both instances, the general practitioner service model was found to be significantly costlier, with a median total cost of £105.50 versus £41.00 for first-contact physiotherapist standard provision and £44.00 for first-contact physiotherapists with ad
{"title":"Clinical and cost-effectiveness of first contact physiotherapy for musculoskeletal disorders in primary care: the FRONTIER, mixed method realist evaluation.","authors":"Nicola E Walsh, Alice Berry, Serena Halls, Rachel Thomas, Hannah Stott, Cathy Liddiard, Zoe Anchors, Fiona Cramp, Margaret E Cupples, Peter Williams, Heather Gage, Dan Jackson, Paula Kersten, Dave Foster, Justin Jagosh","doi":"10.3310/RTKY7521","DOIUrl":"https://doi.org/10.3310/RTKY7521","url":null,"abstract":"<p><strong>Background: </strong>First-contact physiotherapists assess and diagnose patients with musculoskeletal disorders, determining the best course of management without prior general practitioner consultation.</p><p><strong>Objectives: </strong>The primary aim was to determine the clinical and cost-effectiveness of first-contact physiotherapists compared with general practitioner-led models of care.</p><p><strong>Design: </strong>Mixed-method realist evaluation of effectiveness and costs, comprising three main phases: A United Kingdom-wide survey of first contact physiotherapists. Rapid realist review of first contact physiotherapists to determine programme theories. A mixed-method case study evaluation of 46 general practices across the United Kingdom, grouped as three service delivery models: General practitioner: general practitioner-led models of care (no first contact physiotherapists). First-contact physiotherapists standard provision: standard first-contact physiotherapist-led model of care. First-contact physiotherapists with additional qualifications: first-contact physiotherapists with additional qualifications to enable them to inject and/or prescribe.</p><p><strong>Setting: </strong>United Kingdom general practice.</p><p><strong>Participants: </strong>A total of 46 sites participated in the case study evaluation and 426 patients were recruited; 80 staff and patients were interviewed.</p><p><strong>Main outcome measures: </strong>Short Form 36 physical outcome component score and costs of treatment.</p><p><strong>Results: </strong>No statistically significant difference in the primary outcome Short Form 36 physical component score measure at 6-month primary end point between general practitioner-led, first-contact physiotherapist standard provision and first-contact physiotherapist with additional qualifications models of care. A greater number of patients who had first-contact physiotherapist standard provision (72.4%) and first-contact physiotherapist with additional qualifications (66.4%) showed an improvement at 3 months compared with general practitioner-led care (54.7%). No statistically significant differences were found between the study arms in other secondary outcome measures, including the EuroQol-5 Dimensions, five-level version. Some 6.3% of participants were lost to follow-up at 3 months; a further 1.9% were lost to follow-up after 3 months and before 6 months. Service-use analysis data were available for 348 participants (81.7%) at 6 months. Inspecting the entire 6 months of the study, a statistically significant difference in total cost was seen between the three service models, irrespective of whether inpatient costs were included or excluded from the calculation. In both instances, the general practitioner service model was found to be significantly costlier, with a median total cost of £105.50 versus £41.00 for first-contact physiotherapist standard provision and £44.00 for first-contact physiotherapists with ad","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 49","pages":"1-187"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jon Wilson, Viktoria Cestaro, Eirini Charami-Roupa, Timothy Clarke, Aoife Dunne, Brioney Gee, Sharon Jarrett, Thando Katangwe-Chigamba, Andrew Laphan, Susie McIvor, Richard Meiser-Stedman, Jamie Murdoch, Thomas Rhodes, Carys Seeley, Lee Shepstone, David Turner, Paul Wilkinson
<p><strong>Background: </strong>As milder cases of adolescent depression do not meet treatment thresholds for specialist mental health services, young people often receive support from non-qualified professionals in third-sector/voluntary agencies. Early psychological interventions to meet growing demand with limited resources are crucial.</p><p><strong>Objectives: </strong>The study aimed to explore the effectiveness and cost effectiveness of interpersonal counselling for adolescents by (1) assessing the feasibility and acceptability of trial procedures; (2) exploring the delivery of, and differences between, interpersonal counselling for adolescents and treatment as usual; (3) evaluating the extent of contamination of the control arm and if it should be mitigated against in a future trial; and (4) investigating whether the interval estimate of benefit of interpersonal counselling for adolescents over treatment as usual in depression post treatment includes a clinically significant effect.</p><p><strong>Design: </strong>This was a feasibility randomised controlled trial. Non-qualified professionals from non-specialist mental health services received interpersonal counselling for adolescent training. Participants were randomised to receive either interpersonal counselling for adolescents plus treatment as usual or treatment as usual only. Assessments occurred at baseline and were followed up at weeks 5, 10 and 23. A health economics component was included to inform the design of the economic evaluation in a future study. A process evaluation examined implementation of the intervention across settings, acceptability and contamination. Interviews, observations and focus groups were analysed using thematic analysis. Session recordings were analysed using conversation analysis.</p><p><strong>Setting: </strong>The trial was conducted in 13 non-speicialist mental health services across Norfolk and Suffolk.</p><p><strong>Participants: </strong>Help-seeking adolescents aged 12-18 years with mild depression as the primary difficulty were eligible to participate. Comorbid presentations were not an exclusion criterion. Of a target of 60, 16 participants were randomised, and 2 participants withdrew following study suspensions related to COVID-19. Of the remaining 14 participants, 7 received an intervention, with 3 receiving interpersonal counselling for adolescents and 4 receiving treatment as usual. The rest either disengaged, withdrew or were signposted.</p><p><strong>Interventions: </strong>Participants were randomised to receive either interpersonal counselling for adolescents plus treatment as usual or treatment as usual only.</p><p><strong>Main outcome measures: </strong>The primary outcome was the Revised Children's Anxiety and Depression Scale, although the proposed study was not designed to assess efficacy. The primary output of the feasibility trial was to design a subsequent full-scale trial.</p><p><strong>Results: </strong>Feasibility outcomes di
背景：由于青少年抑郁症的病情较轻，达不到专科心理健康服务的治疗门槛，因此青少年通常会接受第三部门/志愿机构的非专业人员提供的支持。在资源有限的情况下，及早采取心理干预措施以满足日益增长的需求至关重要：本研究旨在通过以下方法探讨青少年人际交往辅导的有效性和成本效益：（1）评估试验程序的可行性和可接受性；（2）探讨青少年人际交往辅导与常规治疗之间的差异；（3）评估对照组的污染程度，以及是否应在今后的试验中减少污染；（4）调查青少年人际交往辅导对治疗后抑郁症的益处的区间估计是否比常规治疗具有临床意义：这是一项可行性随机对照试验。来自非专业心理健康服务机构的非资深专业人员接受了青少年人际咨询培训。参与者被随机分配到接受青少年人际咨询加常规治疗或仅接受常规治疗。在基线时进行评估，并在第5周、第10周和第23周进行随访。研究还包括健康经济学部分，以便为未来研究中的经济学评估设计提供参考。过程评估检查了干预在不同环境下的实施情况、可接受性和污染情况。采用主题分析法对访谈、观察和焦点小组进行分析。采用对话分析法对会议记录进行分析：试验在诺福克郡和萨福克郡的 13 家非司法心理健康服务机构进行：寻求帮助的 12-18 岁青少年，以轻度抑郁为主要问题者均可参加。合并症不作为排除标准。在60名目标参与者中，16名参与者被随机分配，2名参与者因COVID-19研究中止而退出。在剩余的 14 名参与者中，7 人接受了干预，其中 3 人接受了青少年人际咨询，4 人接受了常规治疗。其余的人要么脱离了研究，要么退出了研究，要么被推荐接受干预：干预措施：参与者被随机分配接受青少年人际交往辅导加常规治疗或仅接受常规治疗：主要结果是修订的儿童焦虑和抑郁量表，尽管拟议的研究并非旨在评估疗效。可行性试验的主要成果是设计后续的全面试验：结果：可行性结果未达到预估的进展标准。尽管努力增加转介人数，但招募率仍未达到 80%。青少年人际咨询 10 周的出席率低于 70% 的进展标准估计值，影响了干预的可行性。参与者的保留率很高，85.7%的参与者在23周后进行了随访。健康经济测量似乎表现良好，并已完成。通过四份参与者录音分析了青少年人际咨询的实施和理论忠实性。结果表明，青少年人际咨询的原则得到了遵守，100%的忠实度令人满意，对照组中没有污染迹象。由于研究力量不足，两种干预措施的临床效果不显著：COVID-19影响了随机对照试验的可行性。服务机构不得不改变标准做法，从而扰乱了试验程序。在非专科服务机构实施随机对照试验也面临挑战：研究结果表明，在非专科服务机构开展青少年人际交往咨询随机对照试验并不可行，但数据收集和结果测量是合适的。COVID-19的挑战、研究机构对研究程序的不熟悉以及研究团队对不同早期干预服务机构的运作方式的不熟悉都带来了挑战。人员严重短缺、流动性大、培训不统一等问题也是可以考虑的因素。这项研究表明，在这种服务环境中开展随机对照试验存在困难。在今后尝试进行此类试验之前，还需要进一步开展工作，提高试验的可行性：本试验的注册号为 ISRCTN82180413：该奖项由国家健康与护理研究所（NIHR）的健康与社会护理服务研究项目（NIHR奖项编号：17/112/16）资助，全文发表于《健康与社会护理服务研究》（Health and Social Care Delivery Research）第12卷第48期。
{"title":"Interpersonal counselling for adolescent depression delivered by youth mental health workers without core professional training: the ICALM feasibility RCT.","authors":"Jon Wilson, Viktoria Cestaro, Eirini Charami-Roupa, Timothy Clarke, Aoife Dunne, Brioney Gee, Sharon Jarrett, Thando Katangwe-Chigamba, Andrew Laphan, Susie McIvor, Richard Meiser-Stedman, Jamie Murdoch, Thomas Rhodes, Carys Seeley, Lee Shepstone, David Turner, Paul Wilkinson","doi":"10.3310/GTRV6410","DOIUrl":"10.3310/GTRV6410","url":null,"abstract":"<p><strong>Background: </strong>As milder cases of adolescent depression do not meet treatment thresholds for specialist mental health services, young people often receive support from non-qualified professionals in third-sector/voluntary agencies. Early psychological interventions to meet growing demand with limited resources are crucial.</p><p><strong>Objectives: </strong>The study aimed to explore the effectiveness and cost effectiveness of interpersonal counselling for adolescents by (1) assessing the feasibility and acceptability of trial procedures; (2) exploring the delivery of, and differences between, interpersonal counselling for adolescents and treatment as usual; (3) evaluating the extent of contamination of the control arm and if it should be mitigated against in a future trial; and (4) investigating whether the interval estimate of benefit of interpersonal counselling for adolescents over treatment as usual in depression post treatment includes a clinically significant effect.</p><p><strong>Design: </strong>This was a feasibility randomised controlled trial. Non-qualified professionals from non-specialist mental health services received interpersonal counselling for adolescent training. Participants were randomised to receive either interpersonal counselling for adolescents plus treatment as usual or treatment as usual only. Assessments occurred at baseline and were followed up at weeks 5, 10 and 23. A health economics component was included to inform the design of the economic evaluation in a future study. A process evaluation examined implementation of the intervention across settings, acceptability and contamination. Interviews, observations and focus groups were analysed using thematic analysis. Session recordings were analysed using conversation analysis.</p><p><strong>Setting: </strong>The trial was conducted in 13 non-speicialist mental health services across Norfolk and Suffolk.</p><p><strong>Participants: </strong>Help-seeking adolescents aged 12-18 years with mild depression as the primary difficulty were eligible to participate. Comorbid presentations were not an exclusion criterion. Of a target of 60, 16 participants were randomised, and 2 participants withdrew following study suspensions related to COVID-19. Of the remaining 14 participants, 7 received an intervention, with 3 receiving interpersonal counselling for adolescents and 4 receiving treatment as usual. The rest either disengaged, withdrew or were signposted.</p><p><strong>Interventions: </strong>Participants were randomised to receive either interpersonal counselling for adolescents plus treatment as usual or treatment as usual only.</p><p><strong>Main outcome measures: </strong>The primary outcome was the Revised Children's Anxiety and Depression Scale, although the proposed study was not designed to assess efficacy. The primary output of the feasibility trial was to design a subsequent full-scale trial.</p><p><strong>Results: </strong>Feasibility outcomes di","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 48","pages":"1-121"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joanne M Fitzpatrick, Anne Marie Rafferty, Shereen Hussein, Richard Adams, Lindsay Rees, Sally Brearley, Sarah Sims, Amit Desai, Ruth Harris
<p><strong>Background: </strong>Older people living in care homes are at high risk of poor health outcomes and mortality if they contract coronavirus disease 2019. Protective measures include social distancing and isolation, although implementation is challenging.</p><p><strong>Objectives: </strong>To explore the real-life experiences of social distancing and isolation in care homes for older people, and to develop a toolkit of guidance and resources.</p><p><strong>Design: </strong>A mixed-methods, phased design.</p><p><strong>Setting: </strong>Six care homes in England caring for older adults.</p><p><strong>Participants: </strong>Care home staff (<i>n</i> = 31), residents (<i>n</i> = 17), family members (<i>n</i> = 17), senior health and care leaders (<i>n</i> = 13).</p><p><strong>Methods: </strong>A rapid review to assess the social distancing and isolation measures used by care homes to control the transmission of coronavirus disease 2019 and other infectious diseases (phase 1), in-depth case studies of six care homes, involving remote individual interviews with staff, residents and families, collection of policies, protocols and routinely collected care home data, remote focus groups with senior health and care leaders (phase 2) and stakeholder workshops to co-design the toolkit (phase 3). Interview and focus group data and care home documents were analysed using thematic analysis and care home data using descriptive statistics.</p><p><strong>Results: </strong>The rapid review of 103 records demonstrated limited empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. The case studies found that social distancing and isolation measures presented moral dilemmas for staff and often were difficult, and sometimes impossible to implement. Social distancing and isolation measures made care homes feel like an institution and denied residents, staff and families of physical touch and other forms of non-verbal communication. This was particularly important for residents with cognitive impairment. Care homes developed new visiting modalities to work around social distancing measures. Residents and families valued the work of care homes to keep residents safe and support remote communication. Social distancing, isolation and related restrictions negatively impacted on residents' physical, psychological, social and cognitive well-being. There were feelings of powerlessness for families whose loved ones had moved into the care home during the pandemic. It was challenging for care homes to capture frequent updates in policy and guidance. Senior health and care leaders shared that the care home sector felt isolated from the National Health Service, communication from government was described as chaotic, and trauma was inflicted on care home staff, residents, families and friends. These multiple data sources have informed the co-design of a toolkit to care for residents, families, friend
背景：住在护理院的老年人如果感染冠状病毒疾病，2019 年的健康状况很差，死亡风险很高。保护措施包括社会疏远和隔离，但实施起来具有挑战性：探索老年人护理院中社会疏远和隔离的实际经验，并开发一套指导和资源工具包：设计：混合方法，分阶段设计：地点：英格兰六家老年人护理院：护理院员工（n = 31）、居民（n = 17）、家庭成员（n = 17）、高级健康和护理领导（n = 13）：方法：进行快速审查，评估护理院为控制 2019 年冠状病毒疾病和其他传染病的传播而采取的社会疏远和隔离措施（第 1 阶段）；对六家护理院进行深入案例研究，包括与员工、居民和家属进行远程个别访谈；收集政策、协议和护理院常规收集的数据；与高级卫生和护理领导进行远程焦点小组讨论（第 2 阶段）；以及利益相关者研讨会，共同设计工具包（第 3 阶段）。访谈和焦点小组数据以及护理院文件采用主题分析法进行分析，护理院数据采用描述性统计法进行分析：对 103 份记录的快速审查表明，围绕护理院中的社会疏远和隔离措施的经验证据和政策文件十分有限。案例研究发现，社会疏远和隔离措施给工作人员带来了道德难题，通常很难实施，有时甚至无法实施。社会疏远和隔离措施让护理院感觉像一个机构，并剥夺了居民、员工和家人的身体接触和其他形式的非语言交流。这对有认知障碍的住客尤为重要。护理院开发了新的探访模式，以绕开社会隔离措施。住客和家属对护理院为保障住客安全和支持远程交流所做的工作给予了高度评价。社会隔离、孤立和相关限制对住客的生理、心理、社交和认知健康产生了负面影响。对于那些在大流行期间将亲人迁入护理院的家庭来说，他们感到无能为力。对于护理院来说，掌握政策和指南的频繁更新具有挑战性。高级卫生和护理领导者都认为，护理院部门感到与国家卫生服务部门隔离，政府的沟通被描述为混乱，护理院员工、居民、家人和朋友都受到了创伤。这些多重数据来源为共同设计一个工具包提供了信息，该工具包旨在关爱居民、家人、朋友和护理院员工：局限性：综述只包括以英语发表的论文。六家护理院的护理质量委员会评级为 "良好 "或 "优秀"。参与研究的居民和家属缺乏种族多样性：护理院针对社会疏远和隔离问题实施了创新方法，并取得了不同程度的成功。学习遗产有助于在多个层面重建信任，并为住客、家人、朋友和员工提供创伤知情护理。未来的工作可包括对工具包进行评估，为护理之家部门开发创伤知情护理方法的研究，以及共同设计和评估一项干预措施，使有不同需求的居民能够过渡到在护理之家的良好生活：该奖项由国家健康与护理研究所（NIHR）的健康与社会护理服务研究计划（NIHR奖项编号：NIHR132541）资助，全文发表于《健康与社会护理服务研究》（Health and Social Care Delivery Research）第12卷第45期。更多奖项信息请参阅 NIHR Funding and Awards 网站。
{"title":"Challenges and guidance for implementing social distancing for COVID-19 in care homes: a mixed methods rapid review.","authors":"Joanne M Fitzpatrick, Anne Marie Rafferty, Shereen Hussein, Richard Adams, Lindsay Rees, Sally Brearley, Sarah Sims, Amit Desai, Ruth Harris","doi":"10.3310/YNTW4569","DOIUrl":"https://doi.org/10.3310/YNTW4569","url":null,"abstract":"<p><strong>Background: </strong>Older people living in care homes are at high risk of poor health outcomes and mortality if they contract coronavirus disease 2019. Protective measures include social distancing and isolation, although implementation is challenging.</p><p><strong>Objectives: </strong>To explore the real-life experiences of social distancing and isolation in care homes for older people, and to develop a toolkit of guidance and resources.</p><p><strong>Design: </strong>A mixed-methods, phased design.</p><p><strong>Setting: </strong>Six care homes in England caring for older adults.</p><p><strong>Participants: </strong>Care home staff (<i>n</i> = 31), residents (<i>n</i> = 17), family members (<i>n</i> = 17), senior health and care leaders (<i>n</i> = 13).</p><p><strong>Methods: </strong>A rapid review to assess the social distancing and isolation measures used by care homes to control the transmission of coronavirus disease 2019 and other infectious diseases (phase 1), in-depth case studies of six care homes, involving remote individual interviews with staff, residents and families, collection of policies, protocols and routinely collected care home data, remote focus groups with senior health and care leaders (phase 2) and stakeholder workshops to co-design the toolkit (phase 3). Interview and focus group data and care home documents were analysed using thematic analysis and care home data using descriptive statistics.</p><p><strong>Results: </strong>The rapid review of 103 records demonstrated limited empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. The case studies found that social distancing and isolation measures presented moral dilemmas for staff and often were difficult, and sometimes impossible to implement. Social distancing and isolation measures made care homes feel like an institution and denied residents, staff and families of physical touch and other forms of non-verbal communication. This was particularly important for residents with cognitive impairment. Care homes developed new visiting modalities to work around social distancing measures. Residents and families valued the work of care homes to keep residents safe and support remote communication. Social distancing, isolation and related restrictions negatively impacted on residents' physical, psychological, social and cognitive well-being. There were feelings of powerlessness for families whose loved ones had moved into the care home during the pandemic. It was challenging for care homes to capture frequent updates in policy and guidance. Senior health and care leaders shared that the care home sector felt isolated from the National Health Service, communication from government was described as chaotic, and trauma was inflicted on care home staff, residents, families and friends. These multiple data sources have informed the co-design of a toolkit to care for residents, families, friend","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 45","pages":"1-164"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sue Bellass, Krysia Canvin, Tracey Farragher, Kate McLintock, Nat Wright, Pip Hearty, Nicola Seanor, Marie Cunningham, Robbie Foy, Laura Sheard
<p><strong>Background: </strong>People in prison are generally in poorer health than their peers in the community, often living with chronic illness and multimorbidity. Healthcare research in prisons has largely focused on specific problems, such as substance use; less attention has been paid to conditions routinely managed in primary care, such as diabetes or hypertension. It is important to understand how primary care in prisons is currently delivered in the United Kingdom and how it can be improved, in order to reduce health inequalities.</p><p><strong>Objective: </strong>To understand the quality of primary care in prison, including gaps and variations in care, in order to recommend how quality of prison health care can be improved.</p><p><strong>Design: </strong>A mixed-methods study with six interlinked work packages.</p><p><strong>Setting: </strong>Predominantly the North of England.</p><p><strong>Methods: </strong>Between August 2019 and June 2022, we undertook the following work packages: (1) International scoping review of prison healthcare quality indicators. (2) Stakeholder consensus process to identify United Kingdom focused prison healthcare quality indicators. (3) Qualitative interview study with 21 people who had been in prison and 22 prison healthcare staff. (4) Quantitative analysis of anonymised, routinely collected data derived from prison healthcare records (~ 25,000 records across 13 prisons). (5) Stakeholder deliberation process to identify interventions to improve prison health care. (6a) Secondary analysis of the qualitative data set, focusing on mental health and (6b) analysis of the quantitative data set, focusing on health care of three mental health subgroups.</p><p><strong>Findings: </strong>Our scoping review found predominantly only papers from the United States of America and of variable rigour with the main finding being that performance measurement is very challenging in the prison healthcare setting. In collaboration with stakeholders, we prioritised, refined and applied a suite of 30 quality indicators across several healthcare domains. We found considerable scope for improvement in several indicators and wide variations in indicator achievement that could not be attributed to differences in prison population characteristics. Examples of indicators with scope for improvement included: diabetes care, medicines reconciliation and epilepsy review and control. Longer length of stay in prison was generally associated with higher achievement than shorter stays. Indicator achievement was generally low compared to that of community general practice. We found some encouraging trends and relatively good performance for a minority of indicators. Our qualitative interviews found that quality of health care is related to factors that exist at several levels but is heavily influenced by organisational factors, such as understaffing, leading to a reactive and sometimes crisis-led service. Our stakeholder deliberations sugges
背景：与社区中的同龄人相比，狱中人员的健康状况普遍较差，通常患有慢性疾病和多种疾病。监狱中的医疗保健研究主要集中在特定问题上，如药物使用；而对糖尿病或高血压等常规初级医疗管理的疾病关注较少。了解英国目前是如何在监狱中提供初级医疗服务的，以及如何改进这种服务以减少健康不平等现象，这一点非常重要：目的：了解监狱初级保健的质量，包括保健方面的差距和差异，以便就如何提高监狱保健质量提出建议：设计：混合方法研究，包括六个相互关联的工作包：主要在英格兰北部：2019年8月至2022年6月期间，我们开展了以下工作包：（1）对监狱医疗质量指标进行国际范围审查。(2）利益相关者达成共识，确定以英国为重点的监狱医疗质量指标。(3) 对 21 名曾经入狱者和 22 名监狱医护人员进行定性访谈研究。(4) 对从监狱医疗记录（13 所监狱的约 25,000 份记录）中收集的匿名常规数据进行定量分析。(5) 利益相关者商议过程，确定改善监狱医疗保健的干预措施。(6a) 对定性数据集进行二次分析，重点关注心理健康；(6b) 对定量数据集进行分析，重点关注三个心理健康亚群体的医疗保健：我们的范围审查主要发现了来自美国的论文，其严谨性参差不齐，主要发现是绩效衡量在监狱医疗环境中非常具有挑战性。在与利益相关者的合作下，我们确定了 30 项质量指标的优先次序，并对其进行了改进和应用，这些指标涉及多个医疗保健领域。我们发现有几项指标还有很大的改进空间，而且指标完成情况差异很大，这不能归因于监狱人口特征的差异。有改进余地的指标包括：糖尿病护理、药品协调以及癫痫审查和控制。一般来说，监狱服刑时间越长，绩效越高。与社区全科医生相比，指标完成情况普遍较低。我们发现了一些令人鼓舞的趋势，少数指标的绩效相对较好。我们的定性访谈发现，医疗质量与多个层面的因素有关，但受到组织因素的严重影响，如人手不足，导致服务被动反应，有时甚至是危机导向。我们的利益相关者讨论提出了改进的机会，最好是利用数据来评估和推动改进。我们的心理健康工作包发现，编码的精神疾病与指标完成情况的关系不一，而访谈显示，许多人认为精神痛苦是监禁的一个不可避免的方面：我们对指标完成情况的分析受到现有数据质量和覆盖范围的限制。大多数研究结果都局限于英格兰，因此国际适用性可能有所不同：监狱中初级医疗质量的显著差异可能归因于当地提供医疗服务的组织和条件。常规收集的数据可为变革提供可靠的驱动力：本研究已在 researchregistry.com 注册（编号：5098）：本奖项由国家健康与护理研究所（NIHR）的健康与社会护理服务研究计划（NIHR奖项编号：17/05/26）资助，全文发表于《健康与社会护理服务研究》（Health and Social Care Delivery Research）第12卷第46期。更多奖项信息，请参阅 NIHR Funding and Awards 网站。
{"title":"Understanding and improving the quality of primary care for people in prison: a mixed-methods study.","authors":"Sue Bellass, Krysia Canvin, Tracey Farragher, Kate McLintock, Nat Wright, Pip Hearty, Nicola Seanor, Marie Cunningham, Robbie Foy, Laura Sheard","doi":"10.3310/GRFV4068","DOIUrl":"https://doi.org/10.3310/GRFV4068","url":null,"abstract":"<p><strong>Background: </strong>People in prison are generally in poorer health than their peers in the community, often living with chronic illness and multimorbidity. Healthcare research in prisons has largely focused on specific problems, such as substance use; less attention has been paid to conditions routinely managed in primary care, such as diabetes or hypertension. It is important to understand how primary care in prisons is currently delivered in the United Kingdom and how it can be improved, in order to reduce health inequalities.</p><p><strong>Objective: </strong>To understand the quality of primary care in prison, including gaps and variations in care, in order to recommend how quality of prison health care can be improved.</p><p><strong>Design: </strong>A mixed-methods study with six interlinked work packages.</p><p><strong>Setting: </strong>Predominantly the North of England.</p><p><strong>Methods: </strong>Between August 2019 and June 2022, we undertook the following work packages: (1) International scoping review of prison healthcare quality indicators. (2) Stakeholder consensus process to identify United Kingdom focused prison healthcare quality indicators. (3) Qualitative interview study with 21 people who had been in prison and 22 prison healthcare staff. (4) Quantitative analysis of anonymised, routinely collected data derived from prison healthcare records (~ 25,000 records across 13 prisons). (5) Stakeholder deliberation process to identify interventions to improve prison health care. (6a) Secondary analysis of the qualitative data set, focusing on mental health and (6b) analysis of the quantitative data set, focusing on health care of three mental health subgroups.</p><p><strong>Findings: </strong>Our scoping review found predominantly only papers from the United States of America and of variable rigour with the main finding being that performance measurement is very challenging in the prison healthcare setting. In collaboration with stakeholders, we prioritised, refined and applied a suite of 30 quality indicators across several healthcare domains. We found considerable scope for improvement in several indicators and wide variations in indicator achievement that could not be attributed to differences in prison population characteristics. Examples of indicators with scope for improvement included: diabetes care, medicines reconciliation and epilepsy review and control. Longer length of stay in prison was generally associated with higher achievement than shorter stays. Indicator achievement was generally low compared to that of community general practice. We found some encouraging trends and relatively good performance for a minority of indicators. Our qualitative interviews found that quality of health care is related to factors that exist at several levels but is heavily influenced by organisational factors, such as understaffing, leading to a reactive and sometimes crisis-led service. Our stakeholder deliberations sugges","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 46","pages":"1-329"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikolina Jovanović, Žan Lep, Jelena Janković, Aysegul Dirik, Anna Rees, Maev Conneely
<p><strong>Background: </strong>During pregnancy and the postpartum period, women's mental health can deteriorate quickly. Timely and easy access to services is critically important; however, little is known about the pathways women take to access services. Previous research has shown that women from ethnic minority groups in the United Kingdom experience more access issues compared to the White British women.</p><p><strong>Aim: </strong>To describe pathways taken to specialist community perinatal mental health services and explore how they vary across services and ethnic groups.</p><p><strong>Methods: </strong>This is a two-site, longitudinal retrospective service evaluation conducted in Birmingham and London during 6 months (1 July-31 December 2019). Electronic records of 228 women were accessed and data were extracted on help-seeking behaviour, referral process and the type of pathway (i.e. simple or complex). Data were collected using the adapted World Health Organization encounter form and analysed using uni- and multivariable analyses.</p><p><strong>Results: </strong>The median time from the start of perinatal mental illness to contact with perinatal mental health services was 20 weeks. The majority of patients accessed perinatal mental health services through primary care (69%) and their pathway was simple, that is they saw one service before perinatal mental health services (63%). The simple pathway was used as a proxy for accessible services. In Birmingham, compared to London, more referrals came from secondary care, more women were experiencing current deterioration in mental health, and more women followed a complex pathway. Despite differences between ethnic groups regarding type of pathway and duration of patient journey, there was no evidence of difference when models controlled for confounders such as clinical presentation, general characteristics and location. The service's location was the strongest predictor of the type of pathway and duration of patient journey.</p><p><strong>Limitations: </strong>The heterogeneity among categorised ethnic groups; data extracted from available electronic records and not validated with patient's own accounts of their pathways to care; unanalysed declined referrals; the study was conducted before the COVID-19 pandemic and pathways may be different in the post-COVID-19 period.</p><p><strong>Conclusion: </strong>The study provides important insights into how patients find their way to community perinatal mental health services. It shows that there is a great degree of variability in the time taken to get into these services, and the pathway taken. This variation does not come from different needs of patients or different clinical presentations but rather from service-level factors.</p><p><strong>Future work: </strong>The studied community perinatal mental health services in the United Kingdom operate with a significant degree of variability in the types and characteristics of patient pathways. Futu
{"title":"Pathways to specialist community perinatal mental health services: a two-site longitudinal retrospective service evaluation.","authors":"Nikolina Jovanović, Žan Lep, Jelena Janković, Aysegul Dirik, Anna Rees, Maev Conneely","doi":"10.3310/YTRK6337","DOIUrl":"https://doi.org/10.3310/YTRK6337","url":null,"abstract":"<p><strong>Background: </strong>During pregnancy and the postpartum period, women's mental health can deteriorate quickly. Timely and easy access to services is critically important; however, little is known about the pathways women take to access services. Previous research has shown that women from ethnic minority groups in the United Kingdom experience more access issues compared to the White British women.</p><p><strong>Aim: </strong>To describe pathways taken to specialist community perinatal mental health services and explore how they vary across services and ethnic groups.</p><p><strong>Methods: </strong>This is a two-site, longitudinal retrospective service evaluation conducted in Birmingham and London during 6 months (1 July-31 December 2019). Electronic records of 228 women were accessed and data were extracted on help-seeking behaviour, referral process and the type of pathway (i.e. simple or complex). Data were collected using the adapted World Health Organization encounter form and analysed using uni- and multivariable analyses.</p><p><strong>Results: </strong>The median time from the start of perinatal mental illness to contact with perinatal mental health services was 20 weeks. The majority of patients accessed perinatal mental health services through primary care (69%) and their pathway was simple, that is they saw one service before perinatal mental health services (63%). The simple pathway was used as a proxy for accessible services. In Birmingham, compared to London, more referrals came from secondary care, more women were experiencing current deterioration in mental health, and more women followed a complex pathway. Despite differences between ethnic groups regarding type of pathway and duration of patient journey, there was no evidence of difference when models controlled for confounders such as clinical presentation, general characteristics and location. The service's location was the strongest predictor of the type of pathway and duration of patient journey.</p><p><strong>Limitations: </strong>The heterogeneity among categorised ethnic groups; data extracted from available electronic records and not validated with patient's own accounts of their pathways to care; unanalysed declined referrals; the study was conducted before the COVID-19 pandemic and pathways may be different in the post-COVID-19 period.</p><p><strong>Conclusion: </strong>The study provides important insights into how patients find their way to community perinatal mental health services. It shows that there is a great degree of variability in the time taken to get into these services, and the pathway taken. This variation does not come from different needs of patients or different clinical presentations but rather from service-level factors.</p><p><strong>Future work: </strong>The studied community perinatal mental health services in the United Kingdom operate with a significant degree of variability in the types and characteristics of patient pathways. Futu","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fadi Baghdadi, Bridie Angela Evans, Ann John, Adam Lloyd, Ronan A Lyons, Gargi Naha, Alison Porter, Aloysius Niroshan Siriwardena, Helen Snooks, Alan Watkins, Julia Williams, Ashra Khanom
Introduction: Research has found differences in processes and outcomes of care between people in ethnic minorities and White British populations in some clinical conditions, although findings have been mixed. The Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries study is investigating differences in presentation, experience and health outcomes between people from ethnic minorities and White British people who seek emergency health care for injury.
Objective: Our aim was to consult with stakeholders to define measurable outcomes available in routine ambulance and emergency department data; to assess the appropriateness of existing outcome measures for ethnic minorities and White British people; and to identify any gaps.
Method: Clinicians, public contributors, researchers, people from the third sector, public health, healthcare inclusion were invited to join an online workshop to discuss routine outcomes.
Results: Twenty participants attended the stakeholder consultation, with only one being a public contributor, a limitation. Eleven were from a minority ethnic background and seven were female. The integrated list of outcomes included 25 items, combining routine outcomes from the Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries protocol and literature (n = 17) with additional outcomes (n = 8). Notably, the initial list lacked provisions for safeguarding referrals and cases of treatment refusal, which were new additions. Safety concerns arose due to the lack of safeguarding referrals, treatment refusal and self-discharge. Factors such as pre-existing health conditions, injury location and experiences of discrimination were identified as possible influences on care quality and waiting times for ethnic minority patients.
Conclusion: Although the number of stakeholders taking part in our consultation was low, their participation identified outcomes not found in routine data, supporting the adoption of a mixed-methods approach to answer our research questions. A future consultation could look to include more public members and wider range of clinicians including those who work in safeguarding and rehabilitation services.
Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132744.
{"title":"Routine outcomes to investigate differences between ethnic minorities and White British people presenting to emergency services for injury: the stakeholder consultation.","authors":"Fadi Baghdadi, Bridie Angela Evans, Ann John, Adam Lloyd, Ronan A Lyons, Gargi Naha, Alison Porter, Aloysius Niroshan Siriwardena, Helen Snooks, Alan Watkins, Julia Williams, Ashra Khanom","doi":"10.3310/KTNH6788","DOIUrl":"https://doi.org/10.3310/KTNH6788","url":null,"abstract":"<p><strong>Introduction: </strong>Research has found differences in processes and outcomes of care between people in ethnic minorities and White British populations in some clinical conditions, although findings have been mixed. The Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries study is investigating differences in presentation, experience and health outcomes between people from ethnic minorities and White British people who seek emergency health care for injury.</p><p><strong>Objective: </strong>Our aim was to consult with stakeholders to define measurable outcomes available in routine ambulance and emergency department data; to assess the appropriateness of existing outcome measures for ethnic minorities and White British people; and to identify any gaps.</p><p><strong>Method: </strong>Clinicians, public contributors, researchers, people from the third sector, public health, healthcare inclusion were invited to join an online workshop to discuss routine outcomes.</p><p><strong>Results: </strong>Twenty participants attended the stakeholder consultation, with only one being a public contributor, a limitation. Eleven were from a minority ethnic background and seven were female. The integrated list of outcomes included 25 items, combining routine outcomes from the Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries protocol and literature (<i>n</i> = 17) with additional outcomes (<i>n</i> = 8). Notably, the initial list lacked provisions for safeguarding referrals and cases of treatment refusal, which were new additions. Safety concerns arose due to the lack of safeguarding referrals, treatment refusal and self-discharge. Factors such as pre-existing health conditions, injury location and experiences of discrimination were identified as possible influences on care quality and waiting times for ethnic minority patients.</p><p><strong>Conclusion: </strong>Although the number of stakeholders taking part in our consultation was low, their participation identified outcomes not found in routine data, supporting the adoption of a mixed-methods approach to answer our research questions. A future consultation could look to include more public members and wider range of clinicians including those who work in safeguarding and rehabilitation services.</p><p><strong>Funding: </strong>This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132744.</p>","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Objective: </strong>Computerised clinical decision support systems (CDSS) are an increasingly important part of nurse and allied health professional (AHP) roles in delivering healthcare. The impact of these technologies on these health professionals' performance and patient outcomes has not been systematically reviewed. We aimed to conduct a systematic review to investigate this.</p><p><strong>Materials and methods: </strong>The following bibliographic databases and grey literature sources were searched by an experienced Information Professional for published and unpublished research from inception to February 2021 without language restrictions: MEDLINE (Ovid), Embase Classic+Embase (Ovid), PsycINFO (Ovid), HMIC (Ovid), AMED (Allied and Complementary Medicine) (Ovid), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (Wiley), Cochrane Database of Systematic Reviews (Wiley), Social Sciences Citation Index Expanded (Clarivate), ProQuest Dissertations & Theses Abstracts & Index, ProQuest ASSIA (Applied Social Science Index and Abstract), Clinical Trials.gov, WHO International Clinical Trials Registry (ICTRP), Health Services Research Projects in Progress (HSRProj), OpenClinical(www.OpenClinical.org), OpenGrey (www.opengrey.eu), Health.IT.gov, Agency for Healthcare Research and Quality (www.ahrq.gov). Any comparative research studies comparing CDSS with usual care were eligible for inclusion.</p><p><strong>Results: </strong>A total of 36 106 non-duplicate records were identified. Of 35 included studies: 28 were randomised trials, three controlled-before-and-after studies, three interrupted-time-series and one non-randomised trial. There were ~1318 health professionals and ~67 595 patient participants in the studies. Most studies focused on nurse decision-makers (71%) or paramedics (5.7%). CDSS as a standalone Personal Computer/LAPTOP-technology was a feature of 88.7% of the studies; only 8.6% of the studies involved 'smart' mobile/handheld-technology.</p><p><strong>Discussion: </strong>CDSS impacted 38% of the outcome measures used positively. Care processes were better in 47% of the measures adopted; examples included, nurses' adherence to hand disinfection guidance, insulin dosing, on-time blood sampling and documenting care. Patient care outcomes in 40.7% of indicators were better; examples included, lower numbers of falls and pressure ulcers, better glycaemic control, screening of malnutrition and obesity and triaging appropriateness.</p><p><strong>Conclusion: </strong>CDSS may have a positive impact on selected aspects of nurses' and AHPs' performance and care outcomes. However, comparative research is generally low quality, with a wide range of heterogeneous outcomes. After more than 13 years of synthesised research into CDSS in healthcare professions other than medicine, the need for better quality evaluative research remains as pressing.</p><p><strong>Funding: </strong>This publication was funded by the Health and Soci
目的：计算机化临床决策支持系统（CDSS）在护士和专职医疗人员（AHP）的医疗保健工作中扮演着越来越重要的角色。这些技术对这些医疗专业人员的工作表现和患者治疗效果的影响尚未得到系统的研究。我们的目标是对这一问题进行系统性研究：由一名经验丰富的信息专业人员对以下书目数据库和灰色文献资料进行了检索，以了解从开始到 2021 年 2 月期间已发表和未发表的研究，且无语言限制：MEDLINE (Ovid), Embase Classic+Embase (Ovid), PsycINFO (Ovid), HMIC (Ovid), AMED (Allied and Complementary Medicine) (Ovid), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (Wiley)、Cochrane Database of Systematic Reviews（Wiley）、Social Sciences Citation Index Expanded（Clarivate）、ProQuest Dissertations & Theses Abstracts & Index、ProQuest ASSIA（Applied Social Science Index and Abstract）、Clinical Trials.gov、WHO 国际临床试验注册中心 (ICTRP)、Health Services Research Projects in Progress (HSRProj)、OpenClinical(www.OpenClinical.org)、OpenGrey (www.opengrey.eu)、Health.IT.gov、Agency for Healthcare Research and Quality (www.ahrq.gov)。任何比较 CDSS 与常规护理的对比研究均可纳入：结果：共发现 36 106 条非重复记录。在纳入的 35 项研究中，28 项为随机试验，3 项为前后对照研究，3 项为间断时间序列研究，1 项为非随机试验。共有约 1318 名医疗专业人员和约 67595 名患者参与了这些研究。大多数研究侧重于护士决策者（71%）或护理人员（5.7%）。88.7%的研究将 CDSS 作为独立的个人电脑/笔记本电脑技术；只有 8.6%的研究涉及 "智能 "移动/手持技术：讨论：CDSS 对 38% 的结果测量产生了积极影响。47%的措施改善了护理流程，例如护士遵守手部消毒指导、胰岛素剂量、按时采血和护理记录。在 40.7% 的指标中，患者护理结果有所改善；例如，跌倒和压疮数量减少、血糖控制更好、营养不良和肥胖筛查以及分流的适当性：CDSS 可能会对护士和辅助医务人员某些方面的工作表现和护理效果产生积极影响。然而，比较研究的质量普遍不高，结果也各不相同。在对医学以外的其他医疗保健专业的 CDSS 进行了超过 13 年的综合研究后，对更高质量的评估研究的需求仍然十分迫切：本刊物由健康与社会医疗服务研究计划（Health and Social Care Delivery Research Programme）资助，是 NIHR127926 奖项的一部分。本文报告了该研究奖项的一个组成部分：计算机化临床决策支持系统（CDSS）对护理和专职医疗人员绩效及患者预后的影响：系统回顾和用户背景分析。有关该研究的更多信息，请查看奖项网页 [https://fundingawards.nihr.ac.uk/award/NIHR127926]。Doi: https://doi.org/10.1136/bmjopen-2021-053886.
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