Health and social care delivery research最新文献

{"title":"Systematic review of integrated mental and physical health services for children and young people with eating and functional symptoms.","authors":"Efthalia Massou, Josefine Magnusson, Naomi J Fulop, Saheli Gandhi, Angus Ig Ramsay, Isobel Heyman, Sara O'Curry, Sophie Bennett, Tamsin Ford, Stephen Morris","doi":"10.3310/ELPT1245","DOIUrl":"https://doi.org/10.3310/ELPT1245","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that by recognising the psychosocial component of illness as equally important to the biological components, care becomes more holistic, and patients can benefit. Providing this type of care requires collaboration among health professionals, rather than working in isolation, to achieve better outcomes. However, there is a lack of evidence about the implementation of integrated health care. This review focuses on children and young people experiencing eating disorders (i.e. disorders related to feeding and eating) or functional symptom disorders (i.e. medically unexplained symptoms).</p><p><strong>Aims: </strong>The present review is part of a larger study that will inform the development of a new children's hospital in England. Both eating disorders and functional symptom disorders are conditions that may be particularly likely to benefit from an integrated approach to health care, and this review aims to investigate what service models have been used to integrate care, what factors influence their implementation, and what effects these integrated models have on access to and outcomes from care.</p><p><strong>Method: </strong>We conducted a systematic review of studies based on children and young people with eating disorders or functional symptom disorders, investigating the effectiveness of integrated mental and physical health services versus any other type of services provided in these populations. We searched MEDLINE, EMBASE and PsycInfo® (American Psychological Association, Washington, DC, USA) electronic bibliographic databases in July 2024 without restriction on the date of publication or country of interest. We reviewed only studies written in English.</p><p><strong>Results: </strong>We identified 2668 citations which resulted in 1939 papers eligible for title screening. Only one single-site Australian evaluation of an integrated care model from over 20 years ago was included in our review. The study reported significantly higher number of total admissions and total bed-days utilised in the integrated approach. However, the burden of care shifted from psychiatric wards to medical wards and as a result, the cost per admission and the cost per inpatient decreased.</p><p><strong>Limitations: </strong>The lack of conceptual consistency about the definition of integrated care may have driven false screening and loss of some evidence. The same limitation applies in terms of the definition of functional symptom disorders.</p><p><strong>Conclusions: </strong>The review identified a gap in the evidence base relating to integrated secondary service provision for children and adolescents with eating disorders or functional symptom disorders in comparison with generic services. No similar studies were identified for children and young people with functional symptom disorders. Our findings align with previous evidence and show that despite the existence of studies describing aspects of integrated care,","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-24"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961096","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":"Peer support for adult social care in prisons in England and Wales: a mixed-methods rapid evaluation.","authors":"Holly Walton, Efthalia Massou, Chris Sherlaw-Johnson, Donna Gipson, Lucy Wainwright, Paula Harriott, Pei Li Ng, Stephen Riley, Stephen Morris, Naomi J Fulop","doi":"10.3310/MWFD6890","DOIUrl":"https://doi.org/10.3310/MWFD6890","url":null,"abstract":"<p><strong>Background: </strong>More adults in prison need social care support. In some prisons, prisoners ('buddies') are trained to provide social care support for non-personal care tasks to other prisoners. These services are not mandated but have been proposed as a solution to support social care provision in prisons. Previous research explored delivery of peer support initiatives in prisons, but there has been little research evaluating the effectiveness, implementation and experience of social care peer support. There is a need to establish how best to measure the impact and cost of peer support schemes for social care in prisons in England and Wales.</p><p><strong>Objective: </strong>To evaluate peer support schemes for adult social care in prisons in England and Wales (including implementation, experiences, risks and benefits, outcomes and costs, available data, and how to measure impact and cost).</p><p><strong>Methods: </strong>A rapid mixed-methods study, including a rapid systematic scoping review (<i>n</i> = 70 papers), a documentary analysis of 102 His Majesty's Inspectorate of Prisons reports, and a multisite study of implementation and experience. The multisite study included 1 workshop with national and local stakeholders (<i>n</i> = 13) and 71 interviews with national and local leads (<i>n</i> = 7), prison leads from 18 prisons (<i>n</i> = 20), staff (<i>n</i> = 7), peers (<i>n</i> = 18) and recipients (<i>n</i> = 19) from 5 prisons. Qualitative analysis took place in two phases: (1) rapid analysis (using rapid assessment procedure sheets) and (2) in-depth thematic analysis. We analysed availability of data to measure impact and cost of services.</p><p><strong>Results: </strong>'Buddies' are frequently used in prisons in England and Wales, filling an important gap in social care provision. Implementation varies, due to service, prison, staff and prisoner factors. Prison service instruction guidelines for peer-supported social care are not consistently being implemented. This study identified areas for improvement, for example the need for formal training for buddies and staff, and the need for clear standardised employment procedures. Buddy schemes are valued by staff, buddies and recipients. Some barriers were identified, for example, lack of peer and staff training and supervision, and prison regime. Peer-supported social care may have wide-reaching benefits, yet there are several risks for recipients and buddies that must be mitigated, including the potential for exploitation of the role by staff, buddies and recipients. It is currently not possible to evaluate impact and cost due to limited data. We have developed an evaluation guide which outlines operational, cost and outcome data that needs to be collected to enable regular monitoring and/or evaluation in future.</p><p><strong>Limitations: </strong>There is a lack of data collected on impact and cost, so we were unable to measure effectiveness and cost in this study. Inst","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 1","pages":"1-140"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082827","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":"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}