Health and social care delivery research最新文献

{"title":"The implementation of Safety Management Systems in healthcare: a systematic review and international comparison.","authors":"Zhivko Zhelev, Sian de Bell, Alison Bethel, Maria Clarke, Rob Anderson, Jo Thompson Coon","doi":"10.3310/QPLF8546","DOIUrl":"https://doi.org/10.3310/QPLF8546","url":null,"abstract":"<p><strong>Background: </strong>In health care, errors could have serious consequences for patients and staff. High-risk industries, such as aviation, have improved safety by taking a systems approach, known as safety management systems. Safety management systems are generally considered to have four key components: leadership commitment and safety policy; safety risk management; safety assurance; and safety culture. Safety management systems need to be context-specific to be effective. Evidence on the use of safety management systems in health care is therefore needed to inform policy decisions.</p><p><strong>Objectives: </strong>To investigate the application of safety management systems to patient safety in terms of effectiveness, implementation and experience.</p><p><strong>Methods: </strong>We conducted a systematic review of research and other evidence from high-income countries that have publicly funded healthcare systems with universal coverage and key evidence available in English. We included Australia, Canada, Ireland, New Zealand and the Netherlands. We searched the websites of, and contacted experts from, patient safety organisations in each country, and searched MEDLINE (December 2023) and EMBASE (via Ovid), Cumulative Index to Nursing and Allied Health Literature (EBSCO) and Web of Science (February 2024). We included policy documents, research and other evidence relating to the effectiveness, implementation or experience of the safety approach in each country. We summarised and mapped included evidence onto an initial framework based on analysis of safety management systems in high-risk industries. We shared drafts with experts in each country for comment. No standardised quality appraisal was conducted but those studies evaluating impact were critically examined for risk of bias.</p><p><strong>Results: </strong>Fifty-three publications were included, from Australia (5), Canada (7), Ireland (8), New Zealand (9) and the Netherlands (24). The Netherlands was the only country with a patient safety programme explicitly based on a safety management system approach. The programme was associated with improvement in some aspects of patient safety in hospitals but there was significant variation in its implementation and outcomes. The main components of a safety management system were also identified to some extent in the patient safety approaches of the other four countries, along with evidence of influence from high-risk industries and 'safety science' more widely.</p><p><strong>Limitations: </strong>Although we followed best practice for conducting systematic reviews, some limitations should be acknowledged. We did not conduct formal quality appraisal, but the risk of bias in studies evaluating impact was examined. We also tried to mitigate the risk of partial understanding (from the use of policy documents) by talking to experts from each country.</p><p><strong>Conclusions: </strong>Only the Dutch patient safety programme was explicitl","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 7","pages":"1-70"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589205","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 addressing factors affecting carers' mental health during end-of-life caregiving: synopsis of meta synthesis of literature and stakeholder collaboration.","authors":"Gunn Grande, Christine Rowland, Tracey Shield, Kerin Bayliss, Jackie Flynn, Danielle Harris, Alison Wearden, Morag Farquhar, Maria Panagioti, Alexander Hodkinson, Margaret Booth, David Cotterill, Lesley Goodburn, Cedric Knipe, Penny Bee","doi":"10.3310/RTHW8493","DOIUrl":"https://doi.org/10.3310/RTHW8493","url":null,"abstract":"<p><strong>Background: </strong>Family carers provide crucial support to patients nearing end of life. This can affect carers' own mental health negatively. It is important to understand what factors may affect carers' mental health and convey this information to stakeholders who can effect change. We conducted reviews of the qualitative, observational and intervention carer literature and worked with carer advisors and other stakeholders to make findings useful and accessible.</p><p><strong>Aim of the synopsis: </strong>To provide a synopsis of (1) project methods, (2) findings and implications from the evidence syntheses, (3) outcomes of our carer Review Advisory Panel collaboration and (4) feedback from wider stakeholder consultation.</p><p><strong>Method: </strong>Searches of MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Social Sciences Citation Index, EMBASE, Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effects 1 January 2009-24 November 2019. Studies included adult family carers for adult patients at the end of life cared for at home, considering any factor related to carer mental health. Collaboration with the Review Advisory Panel over nine meetings helped map review findings into a framework, shape their presentation and create Review Advisory Panel recommendations. Four workshops, two discussion groups and a survey with stakeholders (carers/patients, practitioners and policy-makers/commissioners) informed output formats and suggested actions.</p><p><strong>Results: </strong>Thirty-one qualitative, 60 observational, 12 intervention and 3 mixed-methods studies were identified. Factors associated with carer mental health were: (1) patient condition, mainly psychological symptoms and quality of life; (2) impact of caring responsibilities, mainly life changes, workload and carer burden; (3) relationships, particularly carer-patient; (4) finances, whether sufficient; (5) internal processes, particularly self-efficacy; (6) support, particularly adequacy and quality; and (7) contextual factors, mainly age and gender. The Review Advisory Panel comprised five carers and a carer chair. They created recommendations for supporting carers based on syntheses findings, including: awareness raising for carers and practitioners; a road map to help carers navigate caregiving; bespoke carer support through carer assessment; assessment of patient's actual rather than 'managed' needs; co-ordinated care through a single contact point; addressing basic practical needs. Other key recommendations included holistic, co-ordinated patient care and cover of basic carer financial needs. Thirty-six stakeholders participated in workshops and discussion groups and 43 in the survey, to review synthesis findings and Review Advisory Panel recommendations. Stakeholders generally valued the qualitative evidence and recommendations over the quantitative evidence, although all outputs resonated with them.","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-27"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470139","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":"Intersecting factors of disadvantage and discrimination and their effect on daily life during the coronavirus pandemic: the CICADA-ME mixed-methods study.","authors":"Carol Rivas, Amanda P Moore, Alison Thomson, Kusha Anand, Zainab Zuzer Lal, Alison Fang-Wei Wu, Ozan Aksoy","doi":"10.3310/KYTF4381","DOIUrl":"https://doi.org/10.3310/KYTF4381","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic exacerbated pre-existing societal inequities. Our study addresses the dearth of studies on how intersecting factors of disadvantage and discrimination affected pandemic daily life for disabled people from minoritised ethnic groups, aiming to improve their experiences and social, health and well-being outcomes.</p><p><strong>Objectives: </strong>Through an intersectionality lens, to: explore and compare, by location and time, survey and qualitative data on changing needs for social, health and well-being outcomes relate coping strategies/solutions to these explore formal and informal network issues/affordances gain insights from synthesising our data contextualise and explore transferability of findings co-create outputs with stakeholders.</p><p><strong>Design: </strong>Mixed-methods, asset-based, underpinned by embodiment disability models and intersectionality, integrating three strands: (secondary): analysis of existing cohort/panel data, literature review (primary: quantitative): new survey (<i>n</i> = 4326), three times over 18 months (primary: qualitative): semistructured interviews (<i>n</i> = 271), interviewee co-create workshops (<i>n</i> = 104) 5 and 10 months later, mixed stakeholder co-design workshops (<i>n</i> = 30) for rapid-impact solutions to issues, key informant interviews (<i>n</i> = 4).</p><p><strong>Setting: </strong>United Kingdom and Republic of Ireland.</p><p><strong>Participants: </strong>Strand 2: community-dwelling migrants, White British comparators, with/without disability. Strand 3: focus on Arab, South Asian, African, Central/East European, or White British heritage with/without disability.</p><p><strong>Results: </strong>We found strong adherence to pandemic restrictions (where accommodation, economic situations and disability allowed) due to COVID-19 vulnerabilities. High vaccine hesitancy (despite eventual uptake) resulted from side-effect concerns and (mis)trust in the government. Many relied on food banks, local organisations, communities and informal networks. Pandemic-related income loss was common, particularly affecting undocumented migrants. Participants reported a crisis in mental health care, non-holistic social and housing care, and inaccessible, poor-quality and discriminatory remote health/social care. They preferred private care (which they could not easily afford), community or self-help online support. Lower socioeconomic status, mental health and mobility issues reduced well-being. Individual and community assets and coping strategies mitigated some issues, adapted over different pandemic phases, and focused on empowerment, self-reflection, self-care and social connectivity. Technology needs cut across these.</p><p><strong>Limitations: </strong>We could not explore area-level social distancing and infection rates. Data collection was largely online, possibly excluding some older, digitally deprived or more disabled participants. Participants en","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 2","pages":"1-185"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416656","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 paramedics working in general practice: a mixed-methods realist evaluation.","authors":"Matthew Booker, Sarah Voss, Nicky Harris, William Hollingworth, Nouf Jeynes, Hazel Taylor, Kirsty Garfield, Helen Baxter, Jonathan Benger, Andy Gibson, Trudy Goodenough, Justin Jagosh, Kim Kirby, Cathy Liddiard, Alyesha Proctor, Sarah Purdy, Behnaz Schofield, Hannah Stott, Grace Scrimgeour, Nicola Walsh","doi":"10.3310/GTJJ3104","DOIUrl":"10.3310/GTJJ3104","url":null,"abstract":"<p><strong>Background: </strong>General practice services are under pressure due increased demand. Alongside substantial national recruitment challenges, there exists a shortage of general practitioners to meet current need. Resultingly, allied healthcare professionals, including paramedics, are being utilised in general practice.</p><p><strong>Aim: </strong>To determine the models of paramedics in general practice settings; the mechanisms that underpin effective paramedics in general practice; and the impact of paramedics in general practice on safety, costs and clinical and patient-reported outcomes and experience.</p><p><strong>Design: </strong>A mixed-methods realist evaluation comprised a rapid realist review followed by an evaluation of paramedics in general practice in general practice case study sites. Patient and public involvement and input was integral, ensuring validity from a patient and carer perspective.</p><p><strong>Setting: </strong>General practices in England.</p><p><strong>Participants: </strong>A total of 34 general practices participated as case study sites, of which 25 were 'paramedics in general practice' sites. Data from qualitative realist interviews (<i>n</i> = 69), quantitative questionnaires (<i>n</i> = 489) and electronic records (<i>n</i> = 22,509 consultations) were collected.</p><p><strong>Interventions: </strong>Paramedics in general practice models were classified according to: (1) level of integration of the paramedic to the general practice team; and (2) complexity of patients seen by paramedics.</p><p><strong>Main outcome measures: </strong>Qualitative interviews investigated initial programme theories with staff and patient participants. Patient participant questionnaires utilised validated measures: the Patient-Reported Experiences and Outcomes of Safety in Primary Care (safety); EuroQol-5 Dimensions, five-level version (health-related quality of life); Primary Care Outcomes Questionnaire; the Modular Resource Use Measure (health and care resource utilisation). Electronic health records provided data on primary care use.</p><p><strong>Review methods: </strong>A rapid realist review of the published and grey literature, supplemented with direct enquiry with system leaders and key stakeholders.</p><p><strong>Results: </strong>The rapid realist review highlighted significant variation in paramedics' roles in general practice. Qualitative interviews identified domains related to access, safety, workforce reconfiguration, infrastructure, patient experience, and outcomes. Lower Patient-Reported Experiences and Outcomes of Safety in Primary Care practice activation scores were found at paramedics in general practice sites (perceived less engaged in promoting safety), in particular those with medium and low levels of paramedics in general practice integration and complexity. There was a small statistically significant difference in the Primary Care Outcomes Questionnaire 'Confidence in Health Plan' by paramedics i","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 6","pages":"1-137"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532121","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":"Optimisation of the deployment of automated external defibrillators in public places in England.","authors":"Terry P Brown, Lazaros Andronis, Asmaa El-Banna, Benjamin Kh Leung, Theodoros Arvanitis, Charles Deakin, Aloysius N Siriwardena, John Long, Gareth Clegg, Steven Brooks, Timothy Cy Chan, Steve Irving, Louise Walker, Craig Mortimer, Sandra Igbodo, Gavin D Perkins","doi":"10.3310/HTBT7685","DOIUrl":"https://doi.org/10.3310/HTBT7685","url":null,"abstract":"<p><strong>Background: </strong>Ambulance services treat over 32,000 patients sustaining an out-of-hospital cardiac arrest annually, receiving over 90,000 calls. The definitive treatment for out-of-hospital cardiac arrest is defibrillation. Prompt treatment with an automated external defibrillator can improve survival significantly. However, their location in the community limits opportunity for their use. There is a requirement to identify the optimal location for an automated external defibrillator to improve out-of-hospital cardiac arrest coverage, to improve the chances of survival.</p><p><strong>Methods: </strong>This was a secondary analysis of data collected by the Out-of-Hospital Cardiac Arrest Outcomes registry on historical out-of-hospital cardiac arrests, data held on the location of automated external defibrillators registered with ambulance services, and locations of points of interest. Walking distance was calculated between out-of-hospital cardiac arrests, registered automated external defibrillators and points of interest designated as potential sites for an automated external defibrillator. An out-of-hospital cardiac arrest was deemed to be covered if it occurred within 500 m of a registered automated external defibrillator or points of interest. For the optimisation analysis, mathematical models focused on the maximal covering location problem were adapted. A de novo decision-analytic model was developed for the cost-effectiveness analysis and used as a vehicle for assessing the costs and benefits (in terms of quality-adjusted life-years) of deployment strategies. A meeting of stakeholders was held to discuss and review the results of the study.</p><p><strong>Results: </strong>Historical out-of-hospital cardiac arrests occurred in more deprived areas and automated external defibrillators were placed in more affluent areas. The median out-of-hospital cardiac arrest - automated external defibrillator distance was 638 m and 38.9% of out-of-hospital cardiac arrests occurred within 500 m of an automated external defibrillator. If an automated external defibrillator was placed in all points of interests, the proportion of out-of-hospital cardiac arrests covered varied greatly. The greatest coverage was achieved with cash machines. Coverage loss, assuming an automated external defibrillator was not available outside working hours, varied between points of interest and was greatest for schools. Dividing the country up into 1 km<sup>2</sup> grids and placing an automated external defibrillator in the centre increased coverage significantly to 78.8%. The optimisation model showed that if automated external defibrillators were placed in each points-of-interest location out-of-hospital cardiac arrest coverage levels would improve above the current situation significantly, but it would not reach that of optimisation-based placement (based on grids). The coverage efficiency provided by the optimised grid points was unmatched by any points of ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 5","pages":"1-179"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538247","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":"Improving the experience of health services for trans and gender-diverse young people and their families: an exploratory qualitative study.","authors":"Melissa Stepney, Samantha Martin, Magdalena Mikulak, Sara Ryan, Jay Stewart, Richard Ma, Adam Barnett","doi":"10.3310/XCYT6530","DOIUrl":"https://doi.org/10.3310/XCYT6530","url":null,"abstract":"<p><strong>Background: </strong>In the United Kingdom, trans young people find themselves at the centre of political storms and debate regarding their access to health care and treatment. This research was carried out against a backdrop of increasing evidence of repeated failings in health care for trans people. Compounding this, trans young people face lengthy waiting lists when seeking specialist gender services and problems with the referral process. In order to cope and thrive, online resources and spaces have become increasingly important for trans young people. Finding good-quality resources and information can be difficult for young people and families.</p><p><strong>Objectives: </strong>Our aim was to improve the care and support of gender-diverse youth, and their families, through identifying improvements to National Health Service care and services. Within this overall aim, our objectives were to gain a better understanding of the experiences of trans youth, family members and health professionals; and to develop and evaluate sections of the Healthtalk website on young people and parent/carer experiences.</p><p><strong>Methods: </strong>The primary method of data collection was qualitative in-depth interviews conducted between 2019 and 2021. In total, 91 interviews were conducted with 50 young people (42 aged 13-24 years and 10 aged 25-35 years), 19 family members (parents/carers) and 20 health professionals working with trans patients. We evaluated the resources with young people and families who have experience of being on the waiting list for specialist gender services.</p><p><strong>Results: </strong>From interviews with health professionals, we identified four key domains that prevent trans and gender-diverse young people receiving good-quality care. These were structural, educational, cultural and social, and technical barriers. Parents/carers' healthcare experiences were marked by multiple challenges. These occurred at all stages of the pathway and range from getting a referral to specialist gender services, lack of support during waiting times through to sometimes unclear and lengthy assessment processes, which many experience as gatekeeping of gender-affirming care. The majority of the young people in our sample felt the current healthcare system does not cater for the diversity of trans identities and needs. A linear, one-dimensional, conception of gender identity informs services. This is restrictive and does not reflect the plurality and fluidity of experiences. Young people we spoke with generally perceived National Health Service services as built around a culture of pathologisation, gatekeeping and trans hostility, resulting in a general level of mistrust. The research supported the development of two sections of the Healthtalk website concerning young people and parent/carer experiences.</p><p><strong>Conclusions: </strong>We make five recommendations: (1) better and empowered decision-making for trans young people; (2) ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 4","pages":"1-130"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470204","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":"Cancer in English prisons: a mixed-methods study of diagnosis, treatment, care costs and patient and staff experiences.","authors":"Elizabeth A Davies, Margreet Lüchtenborg, Rachael Maree Hunter, Renske Visser, Jennie Huynh, Ross Pow, Emma Plugge, Rachel M Taylor, Jo Armes","doi":"10.3310/HYRT9622","DOIUrl":"https://doi.org/10.3310/HYRT9622","url":null,"abstract":"<p><strong>Background: </strong>The increasing size of the ageing English prison population means that non-communicable diseases such as cancer are being more commonly diagnosed in this setting. Little research has so far considered the incidence of cancer in the English prison population, the treatment patients receive when they are diagnosed in a prison setting, their care costs and outcomes or their experiences of care compared with those of people diagnosed in the general population. This is the first mixed-methods study that has been designed to investigate these issues in order to inform recommendations for cancer practice, policy and research in English prisons.</p><p><strong>Methods: </strong>We compared cancer diagnoses made in prison between 1998 and 2017 with those made in the general population using a cohort comparison. We then used a cohort comparison approach to patients' treatment, survival, care experiences and costs of care between 2012 and 2017. We also conducted qualitative interviews with 24 patients diagnosed or treated in prison, and 6 custodial staff, 16 prison health professionals and 9 cancer professionals. Findings were presented to senior prison and cancer stakeholders at a Policy Lab event to agree priority recommendations.</p><p><strong>Results: </strong>By 2017 cancer incidence in prison had increased from lower levels than in the general population to similar levels. Men in prison developed similar cancers to men outside, while women in prison were more likely than women outside to be diagnosed with preinvasive cervical cancer. In the comparative cohort study patients diagnosed in prison were less likely to undergo curative treatment, particularly surgery, and had a small but significantly increased risk of death. They also had fewer but slightly longer emergency hospital admissions, lower outpatient costs and fewer planned inpatient stays. While secondary care costs were lower for patients in prison, when security escorts costs were added, emergency care and total costs were higher. Control and choice, communication, and care and custody emerged as key issues from the qualitative interviews. People in prison followed a similar diagnostic pathway to those in the general population but experienced barriers arising from lower health literacy, a complex process for booking general practitioner appointments, communication issues between prison staff, surgical, radiotherapy and oncology clinicians and a lack of involvement of their family and friends in their care. These issues were reflected in patient experience survey results routinely collected as part of the annual National Cancer Patient Experience Survey. The four priorities developed and agreed at the Policy Lab event were giving clinical teams a better understanding of the prison system, co-ordinating and promoting national cancer screening programmes, developing 'health champions' in prison and raising health literacy and awareness of cancer symptoms among peo","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 3","pages":"1-51"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470140","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":"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}