Health and social care delivery research最新文献

{"title":"Understanding patient pathways to Mother and Baby Units: a longitudinal retrospective service evaluation in the UK.","authors":"Nikolina Jovanović, Žan Lep, Giles Berrisford, Aysegul Dirik, Julia Barber, Bukola Kelani, Olivia Protti","doi":"10.3310/GDVS2427","DOIUrl":"https://doi.org/10.3310/GDVS2427","url":null,"abstract":"<p><strong>Background: </strong>Mother and Baby Units are specialised psychiatric facilities for women during and after pregnancy. In the United Kingdom, efforts have been made to expand the Mother and Baby Unit availability and establish care guidelines. However, the accessibility of these services for ethnic minority women remains relatively unexplored despite well-documented disparities.</p><p><strong>Aims: </strong>To explore patient pathways to Mother and Baby Units in three UK localities, with a focus on variations in pathways between services and among ethnic groups.</p><p><strong>Methods: </strong>This is a three-site, longitudinal retrospective service evaluation conducted in Birmingham, London and Nottingham during a 12-month period (1 January-31 December 2019). Electronic records were accessed to extract data on the type of admission, the referral process and the type of pathway (simple or complex). The simple pathway entailed contact with one clinician/service prior to admission to the Mother and Baby Unit, while the complex pathway involved interactions with two or more clinicians/services before Mother and Baby Unit admission. Data were collected using the adapted World Health Organization Encounter form and were analysed using uni- and multivariable analyses.</p><p><strong>Results: </strong>Electronic records from 198 patients were analysed, with participants distributed proportionally across three sites: Birmingham (<i>n</i> = 70, 35.4%), London (<i>n</i> = 62, 31.3%) and Nottingham (<i>n</i> = 66, 33.3%). All Mother and Baby Units were nationally commissioned and received referrals from across England. Most patients were in the post partum period, admitted for the first time through emergency, informal and complex pathways. The average length of admission was 6 weeks. Significant differences in admission characteristics were observed between services. Patients of Asian ethnicity had more emergency admissions compared to those of Black and White ethnicities. Ethnicity was the only significant factor associated with the simple/complex care pathway. After controlling for pathway-level and patient-level factors, Black patients were 6.24 times less likely to experience a complex care pathway than White patients. No evidence was found that patients from the Black ethnic background are detained more often than White patients.</p><p><strong>Limitations: </strong>The heterogeneity among categorised ethnic groups, data extracted solely from electronic records without validation through patients' personal accounts of their care pathways, unanalysed declined referrals and the utilisation of pre-COVID-19 pandemic data. The ethnic composition of the study sample matched that of the UK maternity population in the Nottingham subsample, but Black and Asian populations were over-represented in the Birmingham and London subsamples.</p><p><strong>Conclusion: </strong>The study provides valuable insights into patient journeys to Mother and Baby Units","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669253","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}

{"title":"Consequences, costs and cost-effectiveness of workforce configurations in English acute hospitals.","authors":"Peter Griffiths, Christina Saville, Jane Ball, David Culliford, Jeremy Jones, Francesca Lambert, Paul Meredith, Bruna Rubbo, Lesley Turner, Chiara Dall'Ora","doi":"10.3310/ZBAR9152","DOIUrl":"10.3310/ZBAR9152","url":null,"abstract":"<p><strong>Background: </strong>The National Health Service faces significant challenges in recruiting and retaining registered nurses. Recruiting unregistered staff is often adopted as a solution to the registered nurse shortage, but recent research found lower registered nurse staffing levels increase hospital mortality with no evidence that higher levels of assistant staff reduced risk.</p><p><strong>Objectives: </strong>To estimate the consequences, costs and cost-effectiveness of variation in the size and composition of the staff on acute hospital wards in England. To determine if results are likely to be sensitive to staff groups such as doctors and therapists, who are not on ward rosters, associations between staffing and outcomes for multiple staff groups, including medical, are explored at hospital level.</p><p><strong>Design: </strong>A national cross-sectional panel study and a patient-level longitudinal observational study using routine data.</p><p><strong>Setting: </strong>All English acute hospital Trusts and a subsample of four Trusts for the patient-level study.</p><p><strong>Interventions: </strong>Naturally occurring variation in the size and composition of the workforce.</p><p><strong>Participants: </strong>Patients experiencing a hospital admission with an overnight stay and nursing staff providing care on inpatient wards.</p><p><strong>Outcomes: </strong>Death, patient and staff experience, length of stay, re-admission, adverse events, incidents (Datix), staff sickness, costs and quality-adjusted life-years.</p><p><strong>Data sources: </strong>Publicly available records of hospital activity, staffing and outcomes (cross-sectional study) and hospital administrative systems (longitudinal study).</p><p><strong>Results: </strong>In the cross-sectional study, lower staffing levels from doctors and allied health professionals were associated with increased risk of death. Higher nurse staffing levels were associated with better patient experience and staff well-being. In the longitudinal study, for adult inpatients, exposure to days with lower-than-expected registered nurses or nursing assistant staff was associated with increased hazard of death (adjusted hazard ratio 1.08/1.07, 95% confidence interval 1.07 to 1.09/1.06 to 1.08) and longer hospital stays. Low registered nurse staffing was also associated with increased hazard of re-admission (adjusted hazard ratio 1.01, 95% confidence interval 1.01 to 1.02). Eliminating low staffing cost £2778 per quality-adjusted life-years gained. Avoidance of registered nurse understaffing gave more benefits and was more cost-effective for highly acute patients. Although high bank or agency staffing was associated with increased hazard of death, avoiding low staffing using temporary staff still reduced mortality but was more costly and less effective than using permanent staff. If costs of avoided hospital stays are included, avoiding low staffing generates a net cost saving. Exploration of thr","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 25","pages":"1-107"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577550","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}

{"title":"Community and hospital-based healthcare professionals perceptions of digital advance care planning for palliative and end-of-life care: a latent class analysis.","authors":"Jacqueline Birtwistle, Gabriella Williamson, Samuel D Relton, Andy Bradshaw, Katherine E Sleeman, Maureen Twiddy, Pablo Millares-Martin, Suzanne Richards, Matthew J Allsop","doi":"10.3310/XCGE3294","DOIUrl":"https://doi.org/10.3310/XCGE3294","url":null,"abstract":"<p><strong>Introduction: </strong>Numerous digital approaches are being explored internationally to support the elicitation, documentation and sharing of advance care planning information. In England, Electronic Palliative Care Coordination Systems have been developed for this purpose, often as a template stored as part of an electronic clinical record system. Despite Electronic Palliative Care Coordination Systems being central to the end-of-life care policy, there has been a lack of exploration of the perspectives of healthcare professionals who use Electronic Palliative Care Coordination Systems and are critical to their implementation.</p><p><strong>Objective: </strong>This study addresses this gap aiming to examine community and hospital-based healthcare professionals' perceptions of Electronic Palliative Care Coordination Systems on advance care planning and the delivery of palliative care.</p><p><strong>Design and methods: </strong>A cross-sectional online survey.</p><p><strong>Setting and participants: </strong>The target sample comprised health professionals from the main professional groups supporting patients with chronic progressive illnesses in West Yorkshire and London. The survey included items adapted from the Normalisation MeAsure Development questionnaire implementation measure. Survey responses were analysed using descriptive statistics and latent class analysis. Free-text responses relating to alternative approaches to advance care planning documentation were analysed using a directed content analysis approach.</p><p><strong>Results: </strong>Five hundred and sixty-nine health professionals responded to the survey from West Yorkshire (<i>n</i> = 189; 33.2%) and London (<i>n</i> = 380; 66.8%). The largest proportion of respondents came from general practice teams (<i>n</i> = 254; 44.6%). There were prominent differences in responses, with respondents in London more likely to report being familiar with Electronic Palliative Care Coordination Systems. However, West Yorkshire respondents rated Electronic Palliative Care Coordination Systems more highly in terms of being a legitimate part of their role. Across professional groups, respondents from both hospice and care home teams were more likely to view Electronic Palliative Care Coordination Systems as being worthwhile. Commonly reported barriers to the use of Electronic Palliative Care Coordination Systems included not having access to electronic devices, lack of training and lack of knowledge relating to advance care plans.</p><p><strong>Limitations: </strong>There was a dominance of responses from participants based on primary care practices, which may reflect general practitioners being largely responsible for initiating an Electronic Palliative Care Coordination Systems record in one region of the survey (West Yorkshire). This survey is reliant on self-reported responses to items and may have also included respondents more engaged with or interested in Electronic Palliative ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532549","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}

{"title":"After the disruptive innovation: How remote and digital services were embedded, blended and abandoned in UK general practice - longitudinal study.","authors":"Trisha Greenhalgh, Aileen Clarke, Richard Byng, Francesca Dakin, Stuart Faulkner, Nina Hemmings, Gemma Hughes, Laiba Husain, Asli Kalin, Emma Ladds, Ellen MacIver, Lucy Moore, Sarah O'Rourke, Rebecca Payne, Rebecca Rosen, Sarah Rybczynska-Bunt, Sara E Shaw, Tiffany C Veinot, Sietse Wieringa, Joseph Wherton","doi":"10.3310/KRWS4334","DOIUrl":"https://doi.org/10.3310/KRWS4334","url":null,"abstract":"<p><strong>Background: </strong>United Kingdom general practices transitioned rapidly to remote-by-default services in 2020 and subsequently considered whether and how to continue these practices. Their diverse responses provided a unique opportunity to study the longer-term embedding, adaptation and abandonment of digital innovations. Research questions: What was the range of responses to the expansion of remote and digital triage and consultations among United Kingdom general practices in the period following the acute phase of the coronavirus disease discovered in 2019 (COVID-19) pandemic? What can we learn from this example about the long-term impacts of crisis-driven sociotechnical change in healthcare settings?</p><p><strong>Methods: </strong>We collected longitudinal data from 12 general practices from 2021 to 2023, comprising 500 hours of ethnographic observation, 163 interviews in participating practices and linked organisations (132 staff, 31 patients), 39 stakeholder interviews and 4 multi-stakeholder workshops (210 participants), with additional patient and public involvement input. Data were de-identified, uploaded to NVivo (QSR International, Warrington, UK) and synthesised into case studies, drawing on theories of organisational innovation.</p><p><strong>Results: </strong>General practices' longitudinal progress varied, from a near-total return to traditional in-person services to extensive continuing use of novel digital technologies and pathways. Their efforts to find the right balance were shaped and constrained by numerous contextual factors. Large size, slack resources, high absorptive capacity, strong leadership and good intrapractice relationships favoured innovation. Readiness for remote and digital modalities varied depending on local tension for change, practice values and patient characteristics. Technologies' uptake and use were influenced by their material properties and functionality. Embedding and sustaining technologies required ongoing work to adapt and refine tasks and processes and adjust (or, where appropriate, selectively abandon) technologies. Adoption and embedding of technologies were affected by various staff and patient factors. When technologies fitted poorly with tasks and routines or when embedding efforts were unsuccessful, inefficiencies and 'techno-stress' resulted, with compromises to patient access and quality of care.</p><p><strong>Limitations: </strong>Sampling frame was limited to United Kingdom and patient interviews were relatively sparse.</p><p><strong>Conclusion: </strong>There is wide variation in digital maturity among United Kingdom general practices. Low use of remote and digital technologies and processes may be warranted and reflect local strategic choices, but it may also indicate lack of awareness and a reactive rather than strategic approach to digital innovation. We offer an updated typology of digital maturity in general practice with suggestions for tailored support.</p><p><stron","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-37"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295601","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}

{"title":"How lived experiences of illness trajectories, burdens of treatment, and social inequalities shape service user and caregiver participation in health and social care: a theory-informed qualitative evidence synthesis.","authors":"Carl R May, Katja C Gravenhorst, Alyson Hillis, Mick Arber, Carolyn A Chew-Graham, Katie I Gallacher, Frances S Mair, Ellen Nolte, Alison Richardson","doi":"10.3310/HGTQ8159","DOIUrl":"https://doi.org/10.3310/HGTQ8159","url":null,"abstract":"<p><strong>Background: </strong>The workload service users and caregivers take on, and their capacity to do this work, when they engage with and participate in different kinds of care is important. It is reflected in policy and practice interventions that identify service users and caregivers as part of a team that consists of informal networks beyond provider organisations and the professionals within them in health and social care.</p><p><strong>Aims and objectives: </strong>To synthesise qualitative studies of the lived experience of the work of service user and caregiver engagement in three kinds of conditions: long-term conditions associated with significant disability (Parkinson's disease, schizophrenia); serious relapsing-remitting disease (inflammatory bowel disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early-onset dementia).</p><p><strong>Design: </strong>Theory-informed qualitative evidence synthesis of primary qualitative studies, qualitative systematic reviews and meta-syntheses. Papers analysed using qualitative attribution analysis, and Event-State Modelling.</p><p><strong>Data sources: </strong>Cumulative Index to Nursing and Allied Health Literature, EMBASE, MEDLINE, PsycInfo, Scopus and Social Care Online were searched from January 2010 to April 2021.</p><p><strong>Eligibility criteria for selecting studies: </strong>Qualitative primary studies, systematic reviews and meta-syntheses where the participants were service users, or caregivers, aged ≥ 18, with one of six index conditions, and which described their lived experiences of care.</p><p><strong>Methods: </strong>Qualitative evidence synthesis to model core components of service user and caregiver work, and to identify common factors across index conditions, disease trajectories and service contexts.</p><p><strong>Results: </strong>Searches identified 34,787 records. Following deduplication, 13,234 records were assessed for relevance, and after first-stage screening, 7782 records were excluded at this stage, leaving 5452 for further screening, and 279 of these met inclusion criteria and were included in the evidence synthesis. These showed that patients' and caregivers' lived experiences of illness trajectories were shaped by mechanisms of enabling agency (personal capacity, social capital, affective contributions of others), and their degree of existential threat, competence in managing processes of care, and caregiver responses to new responsibilities. Their degree of structural disadvantage was framed in terms of loss of income, employment and housing, and by the presence of stigma, rather than by intersectional position and socioeconomic status.</p><p><strong>Conclusions: </strong>This evidence synthesis maps intervention points to support service users and caregivers, and the trajectories of work that frame their effective participation in their care. We identify potential targets for interventions that could support their outward-facin","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 24","pages":"1-120"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478441","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}

{"title":"Barriers to and outcomes of unspecified kidney donation in the UK: BOUnD, a mixed-methods study.","authors":"Nizam Mamode, Sam Norton, Paul McCrone, Joe Chilcot, Heather Draper, Peter Gogalniceanu, Mira Zuchowski, Lisa Burnapp, Jan Shorrock, Kiran Gupta, Hannah Maple","doi":"10.3310/RTEW9328","DOIUrl":"https://doi.org/10.3310/RTEW9328","url":null,"abstract":"<p><strong>Background: </strong>Unspecified living kidney donation, where an individual donates a kidney to a stranger, is practised in very few countries. Since the Human Tissue Act 2006, the practice has been increasingly prevalent in the United Kingdom. However, evidence exists of uncertainty from healthcare professionals as to whether this is appropriate or manageable.</p><p><strong>Objectives: </strong>The Barriers and Outcomes in Unspecified Donation study is a mixed-methods study designed to determine the answers to three research questions: Is there variation in transplant professionals' practice and attitudes, which is preventing some unspecified donations? Are psychosocial and physical outcomes after unspecified donation equivalent to those after specified donation? What is the economic benefit from unspecified donation?</p><p><strong>Design: </strong>For RQ1, a qualitative study of healthcare professionals using focus groups and interviews was performed. Additionally, a quantitative, questionnaire-based study, including healthcare professionals from all United Kingdom transplant centres, was carried out. For RQ2, a qualitative study of unspecified kidney donors, including those who did not donate, was performed. A prospective, questionnaire study of both specified kidney donors and unspecified kidney donors across the United Kingdom was completed, and linked to data recorded by National Health Service Blood and Transplant. For RQ3, data on utilisation and quality of life were collected pre- and postoperatively using health economic and quality-of-life questionnaires to allow calculation of costs and comparisons between unspecified kidney donors and specified kidney donors.</p><p><strong>Results: </strong>Fifty-nine interviews were conducted with healthcare professionals at six United Kingdom centres. There was broad support for unspecified donation, but key themes included the need for further training and information, consistency in approach across the United Kingdom, and uncertainty about age limits and psychological assessments. Managing donor expectations was a major concern. One hundred and fifty-three healthcare professionals, from all 23 United Kingdom transplant units, were recruited into the questionnaire study. The themes above were confirmed, and the need for more resource, particularly training and staffing, were emphasised.</p><p><strong>Rq2: </strong>Eight hundred and thirty-seven participants including (59.3%) specified kidney donors and (40.7%) unspecified kidney donors were recruited to the prospective questionnaire study, of whom 373 went on to donate. We found no difference in psychosocial or physical outcomes, withdrawal rates [hazard ratio: unspecified kidney donors vs. specified kidney donors 1.12 (95% confidence interval 0.75 to 1.67)] or regret, although unspecified kidney donors experienced fewer positive perceptions [specified kidney donors 319 (86.2%) vs. unspecified kidney donors 247 (79.9%); <i>p</i> = 0.03","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 20","pages":"1-43"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304303","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}

{"title":"Enhancing referrals to Child and Adolescent Mental Health Services: the EN-CAMHS mixed-methods study.","authors":"Kathryn M Abel, Pauline Whelan, Lesley-Anne Carter, Heidi Tranter, Charlotte Stockton-Powdrell, Kerry Gutridge, Lamiece Hassan, Rachel Elvins, Julian Edbrooke-Childs","doi":"10.3310/GYDW4507","DOIUrl":"10.3310/GYDW4507","url":null,"abstract":"<p><strong>Background: </strong>National Health Service Child and Adolescent Mental Health Services are specialist teams that assess and treat children and young people with mental health problems. Overall, 497,502 children were referred to National Health Service Child and Adolescent Mental Health Services between 2020 and 2021, and almost one-quarter of these referrals were not successful. Unsuccessful referrals are often distressing for children and families who are turned away usually after a long waiting period and without necessarily being redirected to alternative services. The process is also costly to services because time is wasted reviewing documents about children who should have been referred for alternative help and may prevent young people who need specialist help receiving it in a timely way. The overarching aim of this study was to understand what the problems are with Child and Adolescent Mental Health Services referrals and identify solutions that could improve referral success. A key objective was to talk widely with young people and families, people working in Child and Adolescent Mental Health Services and mental health professionals so that we could understand fully what the problems were and how we might develop their solutions. We gathered individual pseudonymised patient data from nine Child and Adolescent Mental Health Services, and referral data from four National Health Service Trusts to look at what data are available and how complete it is. We report wide variation in the numbers of referrals between and within Trusts and in the proportions not being successful for treatment. Data on factors such as age and gender of children and young people referred into Child and Adolescent Mental Health Services and who made the referral are routinely collected, but ethnicity of the children and young people's reason for referral are not as well collected across all Trusts. We also conducted focus groups with over 100 individuals with differing perspectives on the Child and Adolescent Mental Health Services referral process (children and young people, parents and carers, key referrers, and Child and Adolescent Mental Health Services professionals) and asked about current difficulties within the referral process, as well as potential solutions to these.</p><p><strong>Conclusions: </strong>Problems identified included: confusion about what Child and Adolescent Mental Health Services is for, that is what it does and does not provide; and lack of support provided during the referral process. Possible solutions included: streamlining the referral pathways through digital technologies with accompanying standardisation of referral forms for National Health Service Child and Adolescent Mental Health Services; and early ongoing communication throughout the referral 'journey' for the referrer/family.</p><p><strong>Future work: </strong>Should consider the standardisation of and improvement to the Child and Adolescent Mental Health Service","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 21","pages":"1-59"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304304","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}

{"title":"Implementing routine assessment of perinatal anxiety: case studies.","authors":"Andrea Sinesi, Georgina Constantinou, Cassandra Yuill, Rose Meades, Helen Cheyne, Margaret Maxwell, Catherine Best, Susan Ayers, Judy Shakespeare, Fiona Alderdice, Julie Jomeen, Grace Howard","doi":"10.3310/WWMD9982","DOIUrl":"https://doi.org/10.3310/WWMD9982","url":null,"abstract":"<p><strong>Background: </strong>During pregnancy and the first postnatal year, a substantial proportion of women experience perinatal anxiety, which is associated with increased risk of adverse birth, maternal and child development outcomes. Identification of perinatal anxiety is recommended in various countries, but there is a lack of consensus on the most effective, acceptable and feasible measure to use. The Methods of Assessing Perinatal Anxiety study previously found the Stirling Antenatal Anxiety Scale to be diagnostically accurate and acceptable to women.</p><p><strong>Objectives: </strong>This study aimed to determine the acceptability and feasibility of implementing new assessment of perinatal anxiety in healthcare services.</p><p><strong>Design and methods: </strong>Implementation case studies of perinatal anxiety assessment using the Stirling Antenatal Anxiety Scale in three National Health Service sites in the United Kingdom. Semistructured interviews and focus groups were conducted before and after implementation with healthcare professionals working in maternity, primary care and psychological services that had contact with perinatal women. Preimplementation data collection was used to develop an implementation and training strategy for each site. Interviews and focus groups were conducted with the same participants post implementation. Data were analysed using framework analysis and a combined inductive-deductive approach.</p><p><strong>Setting and participants: </strong>Two National Health Service trusts in England and one National Health Service health board in Scotland. Participants were healthcare professionals, including midwives, health visitors, clinical psychologists and mental health nurses, who used the scale during the implementation period. Other stakeholders such as service managers and team leads were also interviewed. Sites were selected to represent different types of service and pathways of care. The sample comprised 37 participants at preimplementation and 27 at the postimplementation stage.</p><p><strong>Intervention: </strong>Implementation of new assessment of perinatal anxiety in National Health Service services.</p><p><strong>Results: </strong>At the English sites, one focus group and two interviews were conducted at site E1, and five interviews at site E2. At the Scottish site, two focus groups and six interviews were conducted. Evaluation findings were categorised into 5 themes (experience of change in practice, barriers/facilitators to implementation, acceptability, feasibility, improvements to implementation strategy) with 16 subthemes. The experience of introducing a new assessment tool in clinical practice was generally seen as positive, with the scale enabling more focused conversations with women about their symptoms and different types of anxiety. Potential barriers to conducting assessments included women not having English as first language and stigma towards anxiety in some cultures. The scale ove","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145351","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}

{"title":"Emergency Medical Services Streaming Enabled Evaluation In Trauma: The SEE-IT Feasibility RCT.","authors":"Cath Taylor, Lucie Ollis, Richard Lyon, Julia Williams, Simon S Skene, Kate Bennett, Scott Munro, Craig Mortimer, Matthew Glover, Janet Holah, Jill Maben, Carin Magnusson, Rachael Cooke, Heather Gage, Mark Cropley","doi":"10.3310/EUFS2314","DOIUrl":"10.3310/EUFS2314","url":null,"abstract":"<p><strong>Background: </strong>The use of bystander video livestreaming from scene in emergency medical services is becoming increasingly common to inform decisions about the resources and support required. Possible benefits include clinical and financial gains, but evidence is sparse. We aimed to investigate the feasibility of conducting a definitive randomised controlled trial of its use in major trauma incidents.</p><p><strong>Objectives: </strong>To obtain data required to design a subsequent randomised controlled trial. To test trial processes. To embed a process evaluation.</p><p><strong>Design: </strong>A feasibility randomised controlled trial with embedded process and economic evaluations where working shifts (<i>n</i> = 62) in 6 trial weeks were randomised 1 : 1 to video livestreaming or standard care only; and two observational substudies: (1) assessment of acceptability in a diverse inner-city emergency medical service that routinely uses video livestreaming; and (2) assessment of staff well-being in an emergency medical service that does not use livestreaming (for comparison to the trial site). Qualitative data collection included observations (286 hours) and interviews with staff (<i>n</i> = 25) and bystander callers (<i>n</i> = 2).</p><p><strong>Setting: </strong>A pre-hospital emergency medical service in South-East England, with follow-up in associated major trauma centres and trauma units; substudies in (1) London and (2) East of England emergency medical services.</p><p><strong>Participants: </strong>(1) Patients involved in trauma incidents (<i>n</i> = 269); (2) bystander callers (<i>n</i> = 11); and (3) ambulance service staff (<i>n</i> = 67).</p><p><strong>Intervention: </strong>Video livestreaming using GoodSAM's Instant-On-Scene.</p><p><strong>Main outcome measures: </strong>Progression to a definitive randomised controlled trial based on four pre-defined criteria and consideration of qualitative data: (1) ≥ 70% bystanders with smartphones agreeing and able to activate livestreaming; (2) ≥ 50% requests to activate livestreaming resulting in footage being viewed; (3) helicopter emergency medical services stand-down rate reducing by ≥ 10% due to livestreaming; and (4) no evidence of psychological harm to bystanders or staff caused by livestreaming.</p><p><strong>Results: </strong>Sixty-two shifts were randomised, contributing 240 eligible incidents (132 control; 108 intervention). In a further three shifts, we randomised by individual call, which contributed four eligible incidents (two control; two intervention), thereby totalling 244 incidents involving 269 patients. Video livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to access medical records to assess appropriateness of dispatch) and bystander recruitment (to measure potential harm) were both low (58/269, 22% of patients, 4/244, 2% of bystanders). Two progression criteria were met: (1) 86% of bystanders with smartphones agree","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-38"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188716","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}

{"title":"Opportunities and practices supporting responsive health care for forced migrants: lessons from transnational practice and a mixed-methods systematic review.","authors":"Amy Robinson, Protus Musotsi, Ziaur Rahman A Khan, Laura Nellums, Bayan Faiq, Kofi Broadhurst, Gisela Renolds, Michael Pritchard, Andrew Smith","doi":"10.3310/MRWK3419","DOIUrl":"https://doi.org/10.3310/MRWK3419","url":null,"abstract":"<p><strong>Background: </strong>For those displaced across borders, significant adversity before, during and after displacement journeys, including attitudes and structures in countries of transit and arrival, contributes to considerable risk of poor physical and mental health, and poor and exclusionary experiences of health care.</p><p><strong>Objectives: </strong>We aimed to understand the opportunities and practices that can support better healthcare responses for forced migrants.</p><p><strong>Design: </strong>We integrated (1) local stakeholder perspectives, from workshops and dialogue; (2) evidence and knowledge from a mixed-methods systematic review; and (3) learning from five case examples from current international practice.</p><p><strong>Review methods and data sources: </strong>We ran database searches (American Psychological Association PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, National Institute for Health and Care Research Journals Library) in February 2022, searched relevant agency websites and conducted backward and forward citation searches, extracted data, assessed methodological quality and integrated qualitative and quantitative findings.</p><p><strong>Case examples: </strong>We studied three services in the UK, one in Belgium and one in Australia, conducting semistructured interviews with providers, collaborators and service users, and making site visits and observations if possible.</p><p><strong>Results: </strong>The review identified 108 studies. We identified six domains of impact: (1) benefit from and creation of community, including linkages with formal (health) services; (2) the formation of networks of care that included traditional and non-traditional providers; (3) proactive engagement, including conducting care in familiar spaces; (4) considered communication; (5) informed providers and enhanced attitudes; and (6) a right to knowledge (respecting the need of new arrivals for information, knowledge and confidence in local systems). The case examples drew attention to the benefits of a willingness to innovate and work outside existing structures, 'micro-flexibility' in interactions with patients, and the creation of safe spaces to encourage trust in providers. Other positive behaviours included engaging in intercultural exchange, facilitating the connection of people with their cultural sphere (e.g. nationality, language) and a reflexive attitude to the individual and their broader circumstances. Social and political structures can diminish these efforts.</p><p><strong>Limitations: </strong>Review: wide heterogeneity in study characteristics presented challenges in drawing clear associations from the data. Case examples: we engaged only a small numbers of service users and only with service users from some services.</p><p><strong>Conclusions: </strong>We found that environments that enable good health and enable people to l","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 13","pages":"1-182"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049064","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}