Health and social care delivery research最新文献

{"title":"Accessibility and acceptability of perinatal mental health services for women from ethnic minority groups: a synopsis of the PAAM study.","authors":"Nikolina Jovanović, Maev Conneely, Sarah Bicknell, Jelena Janković","doi":"10.3310/TDAS1298","DOIUrl":"https://doi.org/10.3310/TDAS1298","url":null,"abstract":"<p><strong>Background: </strong>Ethnic minority women face worse maternity outcomes and increased risk of perinatal mental health issues, yet research on the accessibility and acceptability of perinatal mental health services for these groups is limited.</p><p><strong>Objectives: </strong>(1) To explore access to and utilisation of mental health services during the perinatal period among ethnic minority women; (2) to explore care pathways to community and inpatient perinatal mental health services; (3) to explore the attitudes, experiences and service improvement suggestions of ethnic minority women with perinatal mental health problems, as well as those of their partners, family members and healthcare professionals and (4) to produce recommendations for improving clinical practice.</p><p><strong>Methods: </strong>Mixed-methods study was conducted during 2018-23, encompassing four studies aligned with specific aims: (1) a population-based study of 615,092 women who gave birth in National Health Services hospitals in England, using data from the National Commissioning Data Repository; (2) a retrospective evaluation of patients accessing community perinatal mental health services in Birmingham and London (<i>n</i> = 228) and inpatient services in Birmingham, London and Nottingham (<i>n</i> = 198) using an adapted World Health Organization care pathways questionnaire; (3) a qualitative study with four cohorts across England: service users (<i>n</i> = 37), non-users or those who disengaged (<i>n</i> = 23), partners/family (<i>n</i> = 15) and healthcare professionals (<i>n</i> = 24); (4) findings informed recommendations for practice improvements, coproduced with individuals with lived experience of perinatal mental illness and of being in a minoritised ethnic group. Data were analysed using quantitative and qualitative approaches.</p><p><strong>Results: </strong>Access issues to mental health services were evident for Black African, Asian and White other women compared to White British women. Variability in patient journeys to community perinatal mental health services seem to stem from service-level factors rather than patient needs. Asian patients had more emergency admissions to Mother and Baby Units, while Black patients were less likely to experience multiple services before Mother and Baby Unit admission. Barriers to access included limited service awareness, fear of child removal, stigma, remote clinical appointments and unresponsive services. Despite these challenges, many women found services helpful. Family members noted gaps in family-focused care. Recommendations for improvement include raising awareness, monitoring access for different ethnic groups and addressing concerns about child removal, with a focus on consistent care, family involvement and cultural sensitivity.</p><p><strong>Conclusion: </strong>These findings shed light on health inequalities in perinatal mental health care for ethnic minority women. The results can be utilised","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 36","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277004","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":"Strategies to manage emergency ambulance telephone callers with sustained high needs: the STRETCHED mixed-methods evaluation with linked data.","authors":"Alan Watkins, Rabeea'h Aslam, Alex Dearden, Timothy Driscoll, Adrian Edwards, Bethan Edwards, Bridie Angela Evans, Angela Farr, Theresa Foster, Rachael Fothergill, Penny Gripper, Imogen M Gunson, Ann John, Ashrafunnesa Khanom, Tessa Noakes, Robin Petterson, Alison Porter, Nigel Rees, Andy Rosser, Jason Scott, Bernadette Sewell, Anna Tee, Helen Snooks","doi":"10.3310/PWGF6008","DOIUrl":"https://doi.org/10.3310/PWGF6008","url":null,"abstract":"<p><strong>Background: </strong>Emergency ambulance services aim to respond to patients calling with urgent healthcare needs, prioritising the sickest. A small minority make high use of the service, which raises clinical and operational concerns. Multidisciplinary 'case management' approaches combining emergency, primary and social care have been introduced in some areas but evidence about effectiveness is lacking.</p><p><strong>Aim: </strong>To evaluate effectiveness, safety and costs of case management for people frequently calling emergency ambulance services.</p><p><strong>Design: </strong>A mixed-methods 'natural experiment', evaluating anonymised linked routine outcomes for intervention ('case management') and control ('usual care') patient cohorts within participating ambulance services, and qualitative data. Cohorts met criteria for 'Frequent Callers' designation; we assessed effects of case management within 6 months on processes, outcomes, safety and costs. The primary outcome combined indicators on mortality, emergency hospital admission, emergency department attendance and emergency ambulance call. Focus groups and interviews elicited views of service providers on acceptability, successes and challenges of case management; interviews with service users examined their experiences.</p><p><strong>Setting: </strong>Four United Kingdom ambulance services each with one intervention and one control area.</p><p><strong>Participants: </strong>Natural experiment: adults meeting criteria for 'frequent caller' classification by ambulance services during 2018. Service providers: service commissioners; emergency and non-acute health and social care providers. Service users: adults with experience of calling emergency ambulance services frequently.</p><p><strong>Interventions: </strong>Usual care comprised within-service management, typically involving: patient and general practitioner letters; call centre flags invoking care plans; escalation to other services, including police. Intervention care comprised usual care with optional 'case management' referral to cross-service multidisciplinary team to review and plan care for selected patients.</p><p><strong>Results: </strong>We found no differences in intervention (<i>n</i> = 550) and control (<i>n</i> = 633) patients in the primary outcome (adjusted odds ratio: 1.159; 95% confidence interval: 0.595 to 2.255) or its components. Nearly all patients recorded at least one outcome (95.6% intervention; 94.9% control). Mortality was high (10.5% intervention; 14.1% control). Less than 25% of calls resulted in conveyance (24.3% intervention; 22.3% control). The most common reasons for calling were 'fall' (6.5%), 'sick person' (5.2%) and acute coronary syndrome (4.7%). Case management models varied highly in provision, resourcing, leadership and implementation costs. We found no differences in costs per patient of healthcare resource utilisation (adjusted difference: £243.57; 95% confidence interval: -£1972.","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 37","pages":"1-76"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277024","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":"'Come and work here!' Qualitative research exploring community-led initiatives to improve healthcare recruitment and retention in remote and rural areas.","authors":"Louise Locock, Andrew S Maclaren, Zoë Skea, Lorraine Angell, Jennifer Cleland, Topher Dawson, Alan Denison, Christina Dobson, Rosemary Hollick, Peter Murchie, Diane Skåtun, Verity Watson","doi":"10.3310/DJGR6622","DOIUrl":"10.3310/DJGR6622","url":null,"abstract":"<p><strong>Background: </strong>Recruitment and retention of healthcare staff in rural and remote areas is a significant problem for the National Health Service. Some communities have experimented with initiatives to support recruitment and retention, but these actions are often ad hoc and undocumented.</p><p><strong>Objectives: </strong>To explore the experiences of remote and rural community members and organisations of trying to attract healthcare staff and their families. To map local context and describe initiatives they have undertaken to improve recruitment. To understand how community initiatives have been received by those staff and families who have been attracted to work and live in a rural area as a result. To assess which initiatives seem to have been more or less successful and why. To provide resources for other communities and the National Health Service based on this learning.</p><p><strong>Design and setting: </strong>Qualitative case studies, three in Scotland and two in England. A case description of each site was developed, and interviews were analysed thematically. Documentary framework analysis of published job adverts for remote and rural healthcare posts.</p><p><strong>Participants: </strong>Case studies: 22 individuals, including community members, healthcare practitioners and family members, took part in interviews and focus groups. Job adverts: 270 from <i>British Medical Journal</i>, and National Health Service Scotland websites for general practitioner and general National Health Service vacancies.</p><p><strong>Results: </strong>Case studies: communities engaged in a range of activities, such as making promotional videos, social media campaigns, help finding accommodation and informal social integration efforts. They drew on multiple local 'assets' to encourage healthcare staff to move to the area, including showcasing beautiful local landscapes; outdoor activities; a safe, cohesive community for children; and high quality of life. Often a small number of people drove these efforts. While this worked well in some communities, the burden of responsibility could be unsustainable, and not all communities have people with the necessary skills and time. There was less focus on retention than recruitment. Where this worked well, it relied on informal networks of key individuals who created social links for incoming families. Communities struggle with the absence of some key assets, including housing; schools; employment opportunities for family members; cultural activities. Job adverts: different emphases on job details, place and wider area. Only 18/49 advertisers (of 189 approached) reported positive outcome in terms of appointments. We suggest greater use of photographs and place descriptions in future advertisements.</p><p><strong>Limitations: </strong>This is a small exploratory study. Sampling was constrained by the small number of eligible communities and people involved. Planned ethnographic fieldwork was impacted","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 34","pages":"1-70"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067236","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":"Post-pandemic planning for maternity care for local, regional, and national maternity systems across the four nations: a mixed-methods study.","authors":"Hiten D Mistry, Sergio A Silverio, Emma Duncan, Abigail Easter, Peter von Dadelszen, Laura A Magee","doi":"10.3310/HHTE6611","DOIUrl":"10.3310/HHTE6611","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, significant reconfigurations were made to maternity care, to deliver this essential service while minimising the risk of infection for pregnant/post partum women and their infants, initially considered to be more vulnerable.</p><p><strong>Design: </strong>This mixed-methods study had three work packages. Work package 1 used quantitative methods to analyse pregnancy outcomes over time, considering service reconfiguration and inequalities, using routinely collected maternity and offspring data from three diverse South London trusts. Work package 2 involved in-depth interviews with a diverse sample of pregnant/post partum women, partners, healthcare professionals and policy-makers, and used thematic framework analysis. Systematic reviews were undertaken of women's experiences of receiving maternity care during the pandemic, and healthcare professionals' experiences of providing that care. Questionnaires (October-December 2021 and August-September 2022) were administered nationally via the King's College London COVID Symptom Study Biobank, to evaluate vaccine uptake among women who were planning pregnancy, pregnant or post partum. Work package 3 engaged stakeholders within maternity systems through regional Listening Events and a national Policy Lab.</p><p><strong>Results: </strong>Among women of reproductive age (8 December 2020-15 February 2021), older age, white ethnicity and a lack of social deprivation were associated with higher vaccine uptake, although ethnicity exerted the strongest effect (Office for National Statistics data). Across pre-pandemic, pandemic with and pandemic without lockdowns, pregnancy outcomes, over time, largely followed pre-pandemic trends (record linkage, South London). However, virtual antenatal care in the second and third trimesters was associated with an excess of adverse pregnancy outcomes (and increased costs).</p><p><strong>Work package 2: </strong>Our systematic reviews of experiences of receiving (by women) or delivering (by healthcare professionals) maternity care during the pandemic identified the need for personalised care adapted to service users and communities, including those who are marginalised, and including provision of information; and co-design and coproduction of services with service users and staff, to reflect their collective lived experiences. This has the potential to improve workplace well-being for maternity care staff and facilitate inclusive and equitable care for service users. Interviews about COVID-19 vaccination in pregnancy identified a legacy of mistrust, lack of information, and confusing guidance that contributed to vaccine hesitancy for pregnant women during the pandemic. In our national survey, women of reproductive age (including pregnant/post partum women) reported being promptly vaccinated, but with angst and despite having received misinformation and discouragement from some healthcare professionals.</p><p><strong>","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 35","pages":"1-25"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056541","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":"Remote and digital services in UK general practice 2021-2023: the Remote by Default 2 longitudinal qualitative study synopsis.","authors":"Trisha Greenhalgh, Anica Alvarez Nishio, Aileen Clarke, Richard Byng, Francesca Dakin, Stuart Faulkner, Isabel Hanson, Nina Hemmings, Gemma Hughes, Laiba Husain, Asli Kalin, Emma Ladds, Ellen MacIver, Lucy Moore, Sarah O'Rourke, Rebecca Payne, Tabitha Pring, Rebecca Rosen, Sarah Rybczynska-Bunt, Sara E Shaw, Nadia Swann, Sietse Wieringa, Joseph Wherton","doi":"10.3310/QQTT4411","DOIUrl":"https://doi.org/10.3310/QQTT4411","url":null,"abstract":"<p><strong>Background: </strong>Remote services (in which the patient and staff member are not physically colocated) and digital services (in which a patient encounter is digitally mediated in some way) were introduced extensively when the COVID-19 pandemic began in 2020. We undertook a longitudinal qualitative study of the introduction, embedding, evolution and abandonment of remote and digital innovations in United Kingdom general practice. This synoptic paper summarises study design, methods, key findings, outputs and impacts to date.</p><p><strong>Overview of the study and key findings: </strong>From September 2021 to December 2023, we collected > 500 hours of ethnographic observation from a diverse sample of 12 general practices. Other data sources included over 200 interviews (with practice staff, patients and wider stakeholders), 4 multi-stakeholder workshops (184 participants), grey literature (e.g. Care Quality Commission reports) and safety incident reports. Patient involvement included digitally excluded individuals from disadvantaged backgrounds (e.g. homeless, complex needs). Data were de-identified, uploaded to NVivo (QSR International, Warrington, UK), coded thematically and analysed using various theoretical lenses. Despite an adverse context for general practice including austerity, workforce shortages, rising demand, rising workload and procurement challenges, all 12 participating practices adjusted to some extent to a 'new normal' of hybrid (combined traditional and remote/digital) provision following the external shock of the pandemic. By late 2023, practices showed wide variation in digital maturity from a 'trailblazer' practice which used digital technologies extensively and creatively to 'strategically traditional' practices offering mainly in-person services to deprived and vulnerable populations. We explained practices' varied fortunes using diffusion of innovations theory, highlighting the extensive work needed to embed and routinise technologies and processes. Digitally enabled patients often, but not always, found remote and digital services convenient and navigable, but vulnerable groups experienced exclusion. We explored these inequities through the lenses of digital candidacy, fractured reflexivity and intersectionality. For staff, remote and digital tasks and processes were often complex, labour-intensive, stressful and dependent on positive interpersonal relations - findings that resonated with theories of technostress, suffering and relational co-ordination. Our initial plan for workshop-based co-design of access pathways with patients was unsuccessful due to dynamic complexities; shifting to a more bespoke and agile design process generated helpful resources for patients and staff.</p><p><strong>Discussion: </strong>This study has confirmed previous findings from sociotechnical research showing that new technologies are never 'plug and play' and that appropriate solutions vary with context. Much variation in dig","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 31","pages":"1-49"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008643","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":"Team-based motivational engagement intervention in young people with first-episode psychosis: the EYE-2 cluster RCT with economic and process evaluation.","authors":"Kathryn Greenwood, Christopher Iain Jones, Nahel Yaziji, Andy Healey, Carl May, Stephen Bremner, Richard Hooper, Shanaya Rathod, Peter Phiri, Richard de Visser, Tanya Mackay, Gergely Bartl, Iga Abramowicz, Jenny Gu, Rebecca Webb, Sunil Nandha, Belinda Lennox, Louise Johns, Paul French, Jo Hodgekins, Heather Law, James Plaistow, Rose Thompson, David Fowler, Philippa Garety, Anastacia O'Donnell, Michelle Painter, Rebecca Jarvis, Stuart Clark, Emmanuelle Peters","doi":"10.3310/WDWG4102","DOIUrl":"10.3310/WDWG4102","url":null,"abstract":"<p><strong>Background: </strong>Early Intervention in Psychosis services improves outcomes for young people with psychosis, but 25% disengage in the first 12 months with costs to their mental health.</p><p><strong>Objectives: </strong>To refine a toolkit and training and evaluate effectiveness, implementation, and cost-effectiveness of the Early Youth Engagement-2 intervention to reduce disengagement.</p><p><strong>Design: </strong>Cluster randomised controlled trial with economic and process evaluation.</p><p><strong>Randomisation: </strong>Randomisation at team level stratified by site.</p><p><strong>Masking: </strong>Research assistants, outcome assessors and statisticians were masked to treatment allocation for the primary disengagement and cost-effectiveness outcomes. Participants and teams administering the interventions were unmasked.</p><p><strong>Setting: </strong>Twenty Early Intervention in Psychosis teams in five sites across England.</p><p><strong>Participants: </strong>A total of 1027 young people (14-35 years) with first-episode psychosis (F20-29, 31; ICD-10); 20-282 Early Intervention in Psychosis staff.</p><p><strong>Intervention: </strong>Team-based motivational engagement (Early Youth Engagement-2) intervention, delivered by Early Intervention in Psychosis clinicians alongside standardised Early Intervention in Psychosis, supported by the implementation toolkit (training, website and booklet series).</p><p><strong>Comparison: </strong>Standardised Early Intervention in Psychosis, including National Institute for Health and Care Excellence guidelines approved interventions.</p><p><strong>Main outcome measures: </strong>Primary outcome - time to disengagement over 26 months (days from date of allocation to care co-ordinator to date of last contact following refusal to engage with service, or lack of response to contact for consecutive 3-month period). Secondary outcomes - mental health, recovery, quality of life, service use, at 6 and 12 months. Economic outcomes - National Health Service mental healthcare costs, wider societal care costs, clinical and social outcomes over 12 months; cost-effectiveness. Process evaluation outcomes - fidelity to the Early Youth Engagement-2 model, implementation process scores, therapeutic alliance, qualitative outcomes.</p><p><strong>Results: </strong>Disengagement was 16% across both arms. The multivariable Cox regression on 1005 participants estimated an adjusted hazard ratio for Early Youth Engagement-2 + standardised Early Intervention in Psychosis (<i>n</i> = 652) versus standardised Early Intervention in Psychosis service alone (<i>n</i> = 375) of 1.07 (95% confidence interval 0.76 to 1.49; <i>p</i> = 0.713). There were no observed differences between arms for any secondary outcomes. The health economic evaluation indicated lower mean mental healthcare costs of -£788 (95% CI -£3571 to £1994) and marginally improved mental health states for intervention participants. Early Youth Engagement-2","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 33","pages":"1-221"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067253","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":"Identifying acceptable and effective methods of assessing perinatal anxiety: the MAP study.","authors":"Susan Ayers, Rose Meades, Andrea Sinesi, Helen Cheyne, Margaret Maxwell, Catherine Best, Julie Jomeen, James Walker, Judy Shakespeare, Fiona Alderdice","doi":"10.3310/RRHD1124","DOIUrl":"https://doi.org/10.3310/RRHD1124","url":null,"abstract":"<p><strong>Background: </strong>Anxiety is a common mental illness that can occur during and after pregnancy, which is associated with an increased risk of adverse outcomes for women and their infants. Despite this, there is no consensus on the best method of assessing anxiety.</p><p><strong>Objectives: </strong>The methods of assessing perinatal anxiety (MAP) study aimed to identify the most acceptable, effective and feasible method for assessing anxiety in pregnancy and after birth.</p><p><strong>Design and methods: </strong>The MAP study had four work packages: a qualitative and cognitive interview study (work package 1); a prospective longitudinal cohort study of women during pregnancy (early, mid- and late pregnancy) and post partum, with nested diagnostic interviews (work package 2) and implementation case studies (work package 3). Secondary analysis of cohort data was commissioned as an add-on project to examine the impact of socioeconomic deprivation on perinatal anxiety (work package 4). The MAP study evaluated four assessment measures based on clinical criteria and research evidence: the General Anxiety Disorder Questionnaire, 2-item, or 7-item version scale, Whooley questions, Stirling Antenatal Anxiety Scale and Clinical Outcomes in Routine Evaluation - 10 item version scale.</p><p><strong>Setting and participants: </strong>Qualitative and cognitive interviews (work package 1) were conducted with 41 pregnant and postpartum women, recruited through patient and public involvement representative organisations and social media. The MAP cohort (work package 2) included 2243 women recruited through 12 National Health Service Trusts in England and 5 National Health Service Boards in Scotland. Diagnostic interviews were conducted with a consecutive subsample of 403 participants. Implementation case studies (work package 3) were conducted with two National Health Service sites in England and one in Scotland.</p><p><strong>Results: </strong>Routine assessment of perinatal anxiety was acceptable to women and was viewed positively, although this was qualified by the extent to which the process was informed and personalised. Results from cognitive interviews found that all measures were acceptable and easy to use. Diagnostic accuracy was greatest for the Stirling Antenatal Anxiety Scale and Clinical Outcomes in Routine Evaluation - 10 item version. Increased anxiety on all measures was associated with greater difficulties with daily living, poorer quality of life and participants wanting treatment. Early pregnancy (i.e. the first trimester) was the optimal time for identifying participants with anxiety disorders who wanted treatment. Two measures met criteria for implementation: the Stirling Antenatal Anxiety Scale and the Clinical Outcomes in Routine Evaluation - 10 item version. The Stirling Antenatal Anxiety Scale was preferred by stakeholders (41 women and 55 health professionals), so it was implemented. Acceptability to health professionals (","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 32","pages":"1-44"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071328","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":"Meeting the needs of women in the perinatal period, who use or are in treatment for using drugs: A mixed-methods systematic review.","authors":"Emma Smith, Shirley Lewis, Lynne Gilmour, Louise Honeybul, Helen Cheyne, Narendra Aladangady, Brigid Featherstone, Margaret Maxwell, Joanne Neale, Mariana Gonzalez Utrilla, Polly Radcliffe","doi":"10.3310/GJPR0321","DOIUrl":"https://doi.org/10.3310/GJPR0321","url":null,"abstract":"<p><strong>Background: </strong>Women who use and/or are in treatment for using drugs during the perinatal period have complex health and social care needs. Substance use in the perinatal period is multifaceted, with many confounding factors that may impact the long-term health and well-being of both mothers and children. Evidence is needed to identify which psychosocial interventions are effective for women who use and/or are in treatment for drug use during the perinatal period.</p><p><strong>Objective(s): </strong>(1) Describe the range of psychosocial interventions available for women who use and/or are in treatment for drugs in the perinatal period; (2) to document evidence on the effectiveness of interventions and (3) identify interventions that women feel most meet their needs.</p><p><strong>Design: </strong>A mixed-methods systematic review was conducted following a predetermined protocol and the Joanna Briggs Institute guidance for mixed-methods systematic reviews, adopting a segregated approach.</p><p><strong>Review methods: </strong>Eight databases were searched for articles meeting the inclusion criteria on 7 April 2022, and updated searches were run on 5 February 2024. The search was limited to include peer-reviewed articles published after 1990 and available in English. In total, 15,655 articles were identified. Following screening by four reviewers by title and abstract and then full text, 197 articles were included in the review. A data extraction template was used to extract study characteristics and results. Quality was assessed using the mixed-methods Quality Appraisal Tool. Cohen's <i>d</i> was used to measure the effect size for quantitative data to understand if an intervention had a small (> 0.2), medium (> 0.5) or large effect (> 0.8). Effectiveness was measured through three outcomes: (1) improvements and engagement with and retention in substance use treatment services for women in the prenatal and postnatal period; (2) reductions in substance use by women in the perinatal period and (3) improvements in engagement with and retention in prenatal care. For qualitative data, articles were grouped by the intervention type and the authors' analytical themes and conclusions were thematically synthesised.</p><p><strong>Results: </strong>The 197 included studies described 217 separate interventions. Most interventions (85.3%) were community-based, delivered in more than one way (49.3%), and delivered in single settings (50.6%), although some were colocated alongside other services (22.1%). No conclusive evidence for effectiveness was established for any type of intervention, although most interventions that improved retention in substance use services included practical support. The qualitative synthesis supported these findings and additionally suggested that women appreciated being able to access multiple services in one place: non-judgemental, trauma-informed services and peer-support models.</p><p><strong>Limitations: </stro","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-25"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985393","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":"Optimising the delivery and impacts of interventions to improve hospital doctors' workplace wellbeing in the NHS: The Care Under Pressure 3 realist evaluation study.","authors":"Daniele Carrieri, Alison Pearson, Anna Melvin, Charlotte Bramwell, Jason Hancock, Chrysanthi Papoutsi, Mark Pearson, Geoff Wong, Karen Mattick","doi":"10.3310/PASQ1155","DOIUrl":"https://doi.org/10.3310/PASQ1155","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The key role of medical workforce well-being in the delivery of excellent and equitable care is recognised internationally. However, doctors are known to experience significant mental ill health and erosion of their well-being due to challenging demands and pressurised work environments. Existing workplace support strategies often have limited effect and do not consider the multiple factors contributing to poor well-being in doctors (e.g. individual, organisational and social), nor whether interventions have been implemented effectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To work with, and learn from, diverse hospital settings to understand how to optimise strategies to improve doctors' workplace well-being and reduce negative impacts on the workforce and patient care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and method: &lt;/strong&gt;Three inter-related sequential phases of research activity: Phase 1: a typology of interventions and mapping tool to improve hospital doctors' workplace well-being based on iterative cycles of analysis of published and in-practice interventions and informed by relevant theories and frameworks and engagement with stakeholders. Phase 2: realist evaluation consistent with Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality standards of existing strategies to improve hospital doctors' workplace well-being in eight purposively selected acute National Health Service trusts in England based on 124 interviews with doctors, well-being intervention implementers/practitioners and leaders. Phase 3: codeveloped implementation guidance for all National Health Service trusts to optimise their strategies to improve hospital doctors' workplace well-being - drawing on phases 1 and 2, and engagement with stakeholders in three online national workshops.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Phase 1: although many sources did not clarify their underlying assumptions about causal pathways or the theoretical basis of interventions, we were able to develop a typology and mapping tool which can be used to conceptualise interventions by type (e.g. whether they are designed to be largely preventative or 'curative'). Phase 2: key findings from our realist interviews were that: (1) solutions needed to align with problems to support doctor's well-being and avoid harm to doctors; (2) involving doctors in creating solutions was important to address their well-being problems; (3) doctors often do not know what well-being support is available and (4) there were physical and psychological barriers to accessing well-being support. Phase 3: our 'Workplace well-being MythBuster's guide' provides constructive evidence-based implementation guidance, while authentically representing the predominantly negative experiences reported in phase 2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Although we sampled for diversity, the eight trusts we worked with may not be representative of all trusts in England.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Misaligned ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 30","pages":"1-35"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985381","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":"Centralisation of specialised healthcare services: a scoping review of definitions, types, and impact on outcomes.","authors":"Angus Ig Ramsay, Sonila M Tomini, Saheli Gandhi, Naomi J Fulop, Stephen Morris","doi":"10.3310/REMD6648","DOIUrl":"https://doi.org/10.3310/REMD6648","url":null,"abstract":"<p><strong>Background: </strong>Centralising specialised healthcare services into high-volume centres is proposed to improve patient outcomes and efficiency. Most reviews focus on relatively few conditions and a limited range of outcomes.</p><p><strong>Objectives: </strong>To review the evidence on centralisation of a range of specialised acute services, to analyse (1) how centralisations are defined; (2) how centralisations are organised and delivered; and (3) the relationship between centralisation and several key outcomes.</p><p><strong>Design: </strong>Scoping review, conducted in November 2020.</p><p><strong>Setting: </strong>Specialised acute healthcare services.</p><p><strong>Intervention: </strong>Centralisation of services into a reduced number of high-volume units.</p><p><strong>Findings: </strong>We included 93 papers covering specialised emergency and elective acute healthcare services, published to November 2020. Definitions of centralisation commonly lacked detail, but, where available, covered centralisation's form, objectives, mechanisms and drivers. We proposed a typology of four forms of centralisation, reflecting the number and functions of specialist units (centralisation of whole pathway, centralisation of pathway components, hierarchy of specialist units, partial centralisation). For most outcomes, the majority of papers suggested a positive impact of centralisation: mortality (33/55 papers), survival (19/25), morbidity (17/27), quality of life (6/7), quality of care (22/30), length of stay (17/26), cost-effectiveness (3/3) and patient experience (3/3). Centralisation was associated with increased patient travel (9/12); 3/5 papers suggested no impact on inequalities.</p><p><strong>Limitations: </strong>This review was conducted in November 2020 and did not include grey literature or studies that did not analyse outcomes, so more recent and further evidence - for example, on types of centralisation model and how centralisation was implemented - may exist. As this was a scoping review, we did not conduct a quality assessment, which may reduce the confidence with which we may view the presented impacts of centralisation.</p><p><strong>Conclusions: </strong>Centralisation is commonly associated with improved care and outcomes. However, research seldom describes centralised services in sufficient detail, rarely compares different service models and tends to focus on a narrow range of outcomes. Therefore, understanding the extent and nature of centralisation's impact - and the mechanisms by which it is achieved - remains elusive. By addressing these gaps, future research may of greater use to all stakeholders with an interest in centralisation.</p><p><strong>Future research: </strong>Should provide clearer descriptions of centralisations, compare different centralisation models and study a wider range of important outcomes, including patient experience and cost-effectiveness.</p><p><strong>Funding: </strong>This article presents i","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-70"},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762971","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}