Health and social care delivery research最新文献

{"title":"The spiritual needs and care of children and young people with life-threatening or life-shortening conditions, and parents (SPARK): a mixed-method investigation.","authors":"Bryony Beresford, Natalie Richardson, Suzanne Mukherjee, Rebecca Nye, Jan Aldridge, Karl Atkin, Mark Clayton, Faith Gibson, Julia Hackett, Richard Hain, Mohammed Arshad, Paul Nash, Bob Phillips","doi":"10.3310/ZMLF1648","DOIUrl":"https://doi.org/10.3310/ZMLF1648","url":null,"abstract":"<p><strong>Background: </strong>The human experience comprises four interconnected dimensions: physical, psychological, social and spiritual. Our spirituality is evidenced in the need to make sense of and find meaning, to feel our lives have purpose, to feel we matter and to feel connected to ourselves, others, the natural world and the sacred or divine. Having a life-shortening or life-threatening condition threatens spiritual well-being and causes spiritual suffering. While health care aspires to be holistic, the evidence on meeting spiritual needs and spiritual care in healthcare settings is limited, particularly for neonatal and paediatric populations.</p><p><strong>Objective(s): </strong>To generate evidence to support evidence-informed approaches for the spiritual care of children/young people and their parents, including the role of chaplaincy.</p><p><strong>Design and research participants: </strong>A mixed-method, multicomponent design was used with the quantitative and qualitative data collected. There were four work packages. Work package 1: survey of chaplaincy services in the National Health Service acute trusts in England (<i>n</i> = 98/136). Work package 2: focus groups with National Health Service chaplains across 13 acute trusts (<i>n</i> = 77). Work package 3: interviews with young people (12-25 years) (<i>n</i> = 19) and parents (<i>n</i> = 62). Work package 4: focus groups with National Health Service clinical staff and allied health professionals based in services caring for children with life-threatening or life-shortening conditions (<i>n</i> = 48).</p><p><strong>Results: </strong>Multiple threats to children's/young people's and parents' spiritual well-being were identified. These included struggling to make sense and find meaning in their situation; existing belief systems (or personal philosophies) found wanting, existential worries and concerns; a sense of disconnectedness from others and 'normal life'; and a lack of pleasure and joy, moral distress and feelings of insignificance and invisibility. Almost all described hiding their spiritual distress from themselves and others. At the same time, parents and young people also spoke of wishing for people on whom they could unburden themselves: either at critical moments, or to 'journey' with them. For some, chaplains had provided this care and support. Many, including those identifying themselves as not religious, described drawing comfort from religious rituals and practices (e.g. prayer and blessings). For some, a religious faith protected against spiritual distress. For others, it was regarded as irrelevant or unhelpful. All work packages revealed barriers to children's/young people's and parents' spiritual needs being met. Healthcare staff's accounts revealed a lack of understanding and an uncomfortableness with raising and exploring religious needs and spiritual distress and, for some, a mistrust of chaplaincy services. Survey findings indicated that chaplaincy servic","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 16","pages":"1-119"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210662","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":"Co-designing and testing the learn together guidance to support patient and family involvement in patient safety investigations: a mixed-methods study.","authors":"Jane O'Hara, Lauren Ramsey, Siobhan McHugh, Joseph Langley, Justin Waring, Ruth Simms-Ellis, Gemma Louch, Jenni Murray, Carl Macrae, John Baker, Rebecca Lawton, Daisy Halligan, Olivia Rogerson, Penny Phillips, Debra Hazeldine, Sarah Seddon, Joanne Hughes, Rebecca Partridge, Katherine Ludwin, Laura Sheard","doi":"10.3310/KJHT3375","DOIUrl":"https://doi.org/10.3310/KJHT3375","url":null,"abstract":"<p><strong>Background: </strong>There are multiple reasons for involving patients and families in incident investigations. Fiscally, costs due to clinical negligence claims approximate £4 billion annually. Logically, patients and families provide important information about patient safety incidents. Morally, involving harmed patients and families helps address their concerns. However, little United Kingdom-based evidence was available to support systematic involvement.</p><p><strong>Objective: </strong>To co-design processes and resources to guide the involvement of patients and families in incident investigations at a national and local level, and to test these processes to understand their impact upon experience, learning and likelihood of litigation.</p><p><strong>Design and methods: </strong>A mixed-methods programme of research was undertaken. Stage 1 comprised a scoping review of evidence for the experience of patients/families in incident investigations, and a documentary analysis of 43 National Health Service Trust incident investigation policies. Stage 2A extended this with 41 qualitative interviews with patients/families, healthcare staff and investigators. Stage 2B synthesised previous data to develop common principles and programme theory. Stage 3 involved a 6-month co-design phase with a 'co-design community' of > 50 stakeholders. In stages 4 and 5, co-designed guidance was evaluated in a 15-month ethnography, within four National Health Service Trusts and the national independent investigatory body. Twenty-nine investigations were followed in real time, including 127 interviews and 45 hours of observation. Four final co-design workshops supported iterations to the final guidance and website. A substudy explored meaningful involvement in, and learning from, investigations following suicide via interviews and a qualitative survey involving 32 people (healthcare staff, policy-makers and managers; people bereaved by suicide).</p><p><strong>Findings: </strong>Stage 1 found stakeholders valued involvement, but it was not well supported by local policy, even though it likely reduces litigation. Stage 2A found a need for navigational support, and support for other needs. In stage 2B, 10 common principles and a programme theory were developed, emphasising the aim of reducing compounded harm, alongside promoting organisational learning. In stage 3, four draft guidance booklets and a training session were developed. Stage 4 found these to be feasible, with stakeholders positive about involvement, and generally agreed that it aided organisational learning. The guidance supported systematisation of involvement and encouraged relational working, but wider organisational challenges were highlighted. The substudy found that suicide was regarded as somewhat different to other safety events. Meaningful involvement was complicated by a range of factors and should be decoupled from postvention support.</p><p><strong>Limitations: </strong>Undertaking re","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 18","pages":"1-125"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Implement Digital Clinical Consultations in UK Maternity Care: the ARM@DA Realist Review.","authors":"Catrin Evans, Georgia Clancy, Kerry Evans, Andrew Booth, Benash Nazmeen, Candice Sunney, Mark Clowes, Nia Wyn Jones, Stephen Timmons, Helen Spiby","doi":"10.3310/WQFV7425","DOIUrl":"10.3310/WQFV7425","url":null,"abstract":"<p><strong>Background: </strong>Digital transformation is a key component within the National Health Service Maternity Transformation Programme. The COVID-19 pandemic led to an acceleration of digital innovation, in particular, the use of digital clinical consultations (telephone/video consultations). The ways in which digital clinical consultations can be optimised and utilised alongside the traditional maternity care pathway remains unclear, however, with particular concerns about the potential for digital care to exacerbate inequalities.</p><p><strong>Objective: </strong>To explore how digital clinical consultations can be implemented in a clinically safe, appropriate and acceptable way within UK maternity services? For whom? In what settings? And for what purposes?</p><p><strong>Design: </strong>A realist synthesis combining an evidence review of diverse sources (2010 to the present) from Organisation for Economic Co-operation and Development countries with insights from key stakeholder groups (healthcare professionals, service users and community organisations).</p><p><strong>Data sources: </strong>There were three main sources: (1) published primary and secondary research; (2) grey literature (such as policy documents and maternity safety reports); and (3) stakeholder insights.</p><p><strong>Methods: </strong>A realist synthesis adopts a theory-driven approach which seeks to understand how a complex programme works, for whom and under what circumstances. The review had three iterative phases: (1) refining the review focus and developing initial programme theories; (2) retrieval of evidence for data extraction and analysis (using on a realist logic to identify key contexts, mechanisms and outcomes); and (3) testing and refining the programme theories.</p><p><strong>Results: </strong>The final synthesis included 93 evidence sources (reviews, reports and 77 primary studies), with priority given to UK-focused studies. Study samples included a focus on healthcare professionals (<i>n</i> = 17), women (<i>n</i> = 45, of which 14 focused on vulnerable groups) or both (<i>n</i> = 15). Clinical and safety-related outcomes were reported in 12 studies. Fifteen programme theories were developed. A conceptual framework was produced that illustrates the inter-relationship between key contexts in maternity care through which different interactions activate mechanisms to produce outcomes of interest. The findings suggest that digital clinical consultations can be acceptable and appropriate if implementation includes personalisation and informed choice for women, as well as support and autonomy for staff. The relationship and connection between women and their healthcare professional are proposed as key mechanisms that support safety and engagement in care.</p><p><strong>Limitations: </strong>Some of the evidence lacked details regarding specific settings, interventions or sample characteristics. This limits the extent to which findings can be applied to mic","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-77"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145350","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":"Approaches used to prevent and reduce the use of restrictive practices on adults with learning disabilities: a realist review.","authors":"Joy Duxbury, Alina Haines-Delmont, John Baker, Peter Baker, Gary Bourlet, Elaine Craig, James Ridley, Rachel Whyte, Beth Morrison, Michaela Thomson, Anthony Tsang, Tella Lantta","doi":"10.3310/PGAS1755","DOIUrl":"https://doi.org/10.3310/PGAS1755","url":null,"abstract":"<p><strong>Background: </strong>There is some evidence to support approaches to reduce restrictive practices in settings for people with a learning disability who may also have a diagnosis of autism or mental health problems. However, there is a significant knowledge gap in how and why such approaches work and in what contexts.</p><p><strong>Aim: </strong>This study aimed to understand how, why, for whom, and under what circumstances approaches used by healthcare staff to prevent and reduce the use of restrictive practices on adults with learning disability or autism work (or do not work).</p><p><strong>Design: </strong>The review followed a realist approach. This approach was chosen to understand the mechanisms by which approaches to prevent and reduce the use of restrictive practices work. The review adhered to current Realist and Meta Narrative Evidence Syntheses: Evolving Standards quality and publication standards.</p><p><strong>Data sources: </strong>Applied Social Sciences Index and Abstracts (ProQuest), Cumulative Index to Nursing and Allied Health Literature (EBSCO), MEDLINE (Ovid), PsycInfo (Ovid), EMBASE (Ovid) and Web of Science Core Collection and stakeholder consultations.</p><p><strong>Review methods: </strong>Four main steps were followed: (1) locating existing theories, (2) searching for evidence, (3) extracting and organising data and (4) synthesising the evidence and drawing conclusions. In Steps 1 and 4, the views of stakeholders (academics, key experts, practitioners, people with lived experiences, carers) supplemented systematic searches in electronic databases, supporting the interpretation of results and making recommendations.</p><p><strong>Results: </strong>A total of 53 articles were included, after screening 14,383 articles. In line with realist methods, eight context-mechanism-outcome configurations and an overarching programme theory were used to explain the why and how of preventing and reducing the use of restrictive practices for people with a learning disability. Restrictive practices commonly occur when people with a learning disability, who display behaviour that can harm or who experience communication difficulties, are detained in environments that are unsuitable for their needs, including mental health hospitals. Furthermore, they happen when staff are inadequately trained, lack person-centred values, struggle to regulate their emotions and display limited communication skills. Restrictive practices happen where there is a lack of adequate staffing, a negative organisational culture, and where they are accepted as the 'norm'. Drawing on these findings, we set out recommendations to include positive risk-taking, greater involvement for families and carers, and targeted training for staff. Organisations need to recognise overuse of restrictive practices and using coproduction and leadership within the organisation to implement change.</p><p><strong>Limitations: </strong>Many of the papers reviewed were not dir","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 14","pages":"1-64"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047482","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":"Formulating outputs from a mixed-methods study of access to general practice: a series of collaborative stakeholder workshops.","authors":"Helen Atherton, Toto Gronlund, Abi Eccles, Carol Bryce, Angela Martin, Catherine Pope","doi":"10.3310/WBWD8844","DOIUrl":"https://doi.org/10.3310/WBWD8844","url":null,"abstract":"<p><strong>Background: </strong>Access to general practice is a concern for policy-makers, politicians, service providers and the public. We conducted a study to examine what happens in the long term to general practices that have introduced innovations designed to improve access to appointments. Recognising the importance of ensuring research findings are transferable to those using them, we used collaborative workshops to aid the development of our study outputs.</p><p><strong>Methods: </strong>We held three sequential interactive workshops. These covered (1) early findings of the study, (2) what evidence-based resources attendees use and (3) what resources they would like to see produced. We sought to include 6-12 people from staff from practices participating in the wider research study, from primary care networks, from partnership boards of integrated care systems, clinical commissioners, professional bodies, National Health Service bodies and independent think tanks. The first two workshops were online, the final was in-person. Workshops were facilitated by the research team, including the patient and public involvement lead. A research team member took detailed notes.</p><p><strong>Results: </strong>Workshop 1 had 12 attendees; workshop 2 had 9 attendees, of which 7 were also at the previous workshop; workshop 3 had 7 attendees, of whom 6 had attended a previous workshop. From these workshops, we gained insights that helped us to validate our interpretation of the study data. We observed the competing interests and needs of different groups, who have different perspectives on the value of research evidence. Outputs that are brief, written in lay terms and widely publicised appear to be of especial value.</p><p><strong>Limitations: </strong>The range of stakeholders included was less varied than intended; this was in part due to the commitment involved in attending, and this may limit the inclusivity of the findings.</p><p><strong>Future work: </strong>This approach could be used in future studies to ensure that stakeholder interests are included in study dissemination plans.</p><p><strong>Funding: </strong>This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133620.</p>","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997159","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":"The impact of redeployment during COVID-19 on nurse well-being, performance and retention: a mixed-methods study (REDEPLOY).","authors":"Hannah Hartley, Alice Dunning, Jenni Murray, Ruth Simms-Ellis, Kerrie Unsworth, Angela Grange, Michael Dunn, Jayne Marran, Olivia Joseph, Pam Essler, Uduak Archibong, Judith Johnson, Rebecca Lawton","doi":"10.3310/EWPE7103","DOIUrl":"10.3310/EWPE7103","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Mass redeployment of nurses was critical to the National Health Service response to COVID-19. There remains little understanding of how redeployment was enacted during the pandemic and its impact on nurse managers' and nurses' mental health and well-being, job performance and retention. This study aimed to understand how nurse redeployment was managed prior to and during COVID-19; explore how nurses made sense of redeployment; and the impact on their mental health and well-being, job performance and retention intentions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A mixed methods approach utilising semistructured interviews, focus groups and surveys with nurse managers and nurses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Three National Health Service acute hospital trusts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Thirty-eight nurse managers and human resources advisors participated in interviews and focus groups. Sixty-three nurses who were redeployed or worked with redeployed nurses participated in interviews and surveys over three time points between March 2021 and February 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Interviews asked nurse managers about redeployment decisions and nurses about their redeployment experiences. Interview data were analysed using thematic and pen portrait analyses. The survey measured well-being, performance and intentions to leave. Multilevel modelling was conducted to explore relationships between variables over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seven themes were identified that illustrate the redeployment process, decisions made, and the impact on nurse managers and nurses. Nurse managers redeployed nurses in response to directives focused on numbers of staff and allowable staff:patient ratios, whereas their decisions were more often person focused. This raised logistical and emotional challenges for nurse managers and a disconnect in the levels of the chain of command regarding the needs of nurses. Most reported feeling like they were treated as a commodity, with redeployment having profound impacts on their mental health, well-being, job performance and retention. The longitudinal pen portrait analysis revealed three 'journeys' that represented how nurses made sense of their redeployment, underpinned by two themes: nurse identity and organisational identification. Journeys ranged from those who retained their professional identity and organisational identification (journey one) through to those who experienced a demolition of dual identities (journey three). While most staff in all journeys reported burnout, psychological distress, anxiety, depression and intention to leave their jobs, this was more frequent and severe for those experiencing journey three. These findings, together with stakeholder input, informed the development of 11 recommendations for policy and practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Nurses from minority ethnic backgrounds are under-represented in the sample ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-50"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789512","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":"Multiple Symptoms Study 3 - An extended-role general practitioner clinic for patients with persistent physical symptoms: a Randomised Controlled Trial.","authors":"Christopher Burton, Cara Mooney, Laura Sutton, David White, Jeremy Dawson, Kate Fryer, Monica Greco, Michelle Horspool, Aileen Neilson, Gillian Rowlands, Tom Sanders, Ruth Thomas, Steve Thomas, Cindy Cooper, Jonathan Woodward, Emily Turton, Waquas Waheed, Pavi Kumar, Katie Ridsdale, Ellen Mallender, Vincent Deary","doi":"10.3310/KWGX2382","DOIUrl":"10.3310/KWGX2382","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;People with multiple and persistent physical symptoms have impaired quality of life and poor experiences of health care. We aimed to evaluate the effectiveness of a community-based Symptoms Clinic intervention in people with multiple and persistent physical symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial design: &lt;/strong&gt;Pragmatic multicentre individually randomised parallel group clinical trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participants: Recruitment was between December 2018 and December 2021 in four areas of the UK. Eligibility was based on electronic health records, healthcare use and multiple physical symptoms (PHQ-15 between 10 and 20) which were not due to other medical conditions. Intervention delivery changed from face to face to online in 2020 in response to the pandemic. Interventions: Participants were randomised to receive the Symptoms Clinic plus usual care (intervention) or usual care alone (control). The Symptoms Clinic is a short-term extended medical consultation-based intervention delivered over approximately 8 weeks. Objective: To test the clinical and cost-effectiveness of an extended-role general practitioner 'Symptoms Clinic' for people with persistent physical symptoms. Outcome: The primary outcome measure was the PHQ-15 at 52 weeks post randomisation. Randomisation: Participants were randomised 1 : 1 using a centralised web-based system, stratified by study centre with random permuted blocks of varying sizes. Masking: It was not possible to mask participants to their allocation. Outcome assessors who handled patient-reported questionnaires were masked to allocation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Numbers randomised: 354 participants were randomised into the trial: 176 to the usual care group and 178 to the intervention group. Numbers analysed: 132 participants in the usual care group and 144 participants in the intervention group were included in the analysis representing 77.8% retention. Outcome: Mean (SD) PHQ-15 at baseline was 14.9 (3.0) in the control group and 15.0 (2.9) in the intervention group. At 52 weeks it was 14.1 (3.7) in the control group and 12.2 (4.5) in the intervention group. The between-group difference, adjusted for age, sex, baseline PHQ-15 and clinician effect was -1.82 (95% CI -2.67 to -0.97; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) favouring the intervention. Harms: There were no significant between-group differences in the proportions of patients experiencing non-serious (-0.03, 95% CI -0.11 to 0.05) or serious (0.02, 95% CI -0.02 to 0.07) adverse events. All serious adverse events were deemed unrelated to trial interventions. Economic evaluation: Cost-effectiveness analysis indicated an incremental cost-effectiveness ratio of £15,751/QALY. Process evaluation: The intervention was delivered with high fidelity and was acceptable to patients. The intervention appeared to act through the hypothesised mechanism of explanation as a bridge from uncertainty about the cause to actions to manage symptoms. Limita","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-24"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789511","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 neonatal services for very preterm births between 27⁺⁰ and 31⁺⁶ weeks gestation in England: the OPTI-PREM mixed-methods study.","authors":"Thillagavathie Pillay, Oliver Rivero-Arias, Natalie Armstrong, Sarah E Seaton, Miaoqing Yang, Victor L Banda, Kelvin Dawson, Abdul Qt Ismail, Vasiliki Bountziouka, Caroline Cupit, Alexis Paton, Bradley N Manktelow, Elizabeth S Draper, Neena Modi, Helen E Campbell, Elaine M Boyle","doi":"10.3310/JYWC6538","DOIUrl":"https://doi.org/10.3310/JYWC6538","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To investigate, for preterm babies born between 27&lt;sup&gt;+0&lt;/sup&gt; and 31&lt;sup&gt;+6&lt;/sup&gt; weeks gestation in England, optimal place of birth and early care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Mixed methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;National Health Service neonatal care, England.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;To investigate whether birth and early care in neonatal intensive care units (tertiary units) compared to local neonatal units (non-tertiary units) influenced gestation-specific survival and other major outcomes, we analysed data from the National Neonatal Research Database, for 29,842 babies born between 27&lt;sup&gt;+0&lt;/sup&gt; and 31&lt;sup&gt;+6&lt;/sup&gt; weeks gestation and discharged from neonatal care between 1 January 2014 and 31 December 2018. We utilised an instrumental variable (maternal excess travel time between local neonatal units and neonatal intensive care units) to control for unmeasured differences. Sensitivity analyses excluded postnatal transfers within 72 hours of birth and multiple births. Outcome measures were death in neonatal care, infant mortality, necrotising enterocolitis, retinopathy of prematurity, severe brain injury, bronchopulmonary dysplasia, and receipt of breast milk at discharge. We also analysed outcomes by volume of neonatal intensive care activity. We undertook a health economic analysis using a cost-effectiveness evaluation from a National Health Service perspective and using additional lives saved as a measure of benefit, explored differences in quality of care in high compared with low-performing units and performed ethnographic qualitative research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The safe gestational age cut-off for babies to be born between 27&lt;sup&gt;+0&lt;/sup&gt; and 31&lt;sup&gt;+6&lt;/sup&gt; weeks and early care at either location was 28 weeks. We found no effect on mortality in neonatal care (mean difference -0.001; 99% confidence interval -0.011 to 0.010; &lt;i&gt;p&lt;/i&gt; = 0.842) or in infancy (mean difference -0.002; 99% confidence interval -0.014 to 0.009; &lt;i&gt;p&lt;/i&gt; = 0.579) (&lt;i&gt;n&lt;/i&gt; = 18,847), including after sensitivity analyses. A significantly greater proportion of babies in local neonatal units had severe brain injury (mean difference -0.011; 99% confidence interval -0.022 to -0.001; &lt;i&gt;p&lt;/i&gt; = 0.007) with the highest mean difference in babies born at 27 weeks (-0.040). Those transferred in the first 72 hours were more likely to have severe brain injury. For 27 weeks gestation, birth in centres with neonatal intensive care units reduced the risk of severe brain injury by 4.2% from 11.9% to 7.7%. The number needed to treat was 25 (99% confidence interval 10 to 59) indicating that 25 babies at 27 weeks would have to be delivered in a neonatal intensive care unit to prevent one severe brain injury. For babies born at 27 weeks gestation, birth in a high-volume unit (&gt; 1600 intensive care days/year) reduced the risk of severe brain injury from 0.242 to 0.028 [99% confidence interval 0.035 to 0.542; &lt;i&gt;p&lt;/i&gt; = ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 12","pages":"1-126"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061112","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":"Organising general practice for care homes: a multi-method study.","authors":"Barbara Hanratty, Rachel Stocker, David Sinclair, Katie Brittain, Karen Spilsbury, Daniel Stow, Louise Robinson, Fiona E Matthews","doi":"10.3310/YNDV6358","DOIUrl":"https://doi.org/10.3310/YNDV6358","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;General practice provides first-line National Health Service care for around 400,000 care home residents. Good primary care can enhance residents' health and well-being and optimise use of hospital services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to explore the relationships between organisation of general practice and the perspectives and experiences of residents, general practice and care home staff, outcomes and costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Survey of general practices (2018), qualitative study (2019), analysis of primary care data (2019-21).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Policy context: &lt;/strong&gt;National Health Service England Vanguard funded innovation in services for care homes in five areas (2015-8); Enhanced Health in Care Homes introduces standardised care home healthcare processes in England (2020-4).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;England: national survey; qualitative work in three areas (two Vanguards); analysis of national primary care data across early implementation of Enhanced Health in Care Homes and the COVID-19 pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;One hundred and fifty general practice survey respondents; 101 interviewees (general practitioners, practice managers, receptionists, care home managers, nurses, senior carers, residents, relatives, commissioners) in three areas; 103,732 care home residents ≥ 75 years, registered with participating practices in Clinical Research Datalink Aurum 2019-21.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Qualitative analysis identified three themes concerned with general practitioner services to care homes: relational processes, communication and organisation. Continuity of care, sensitivity to the skills of care home staff and routines of the home, along with a willingness to dedicate time to patients, are all crucial. Different structures (e.g. scheduled visits) provide opportunities to develop effective, efficient care, but flounder without established, trusting relationships. The way in which new initiatives are implemented is crucial to acceptance and ultimate success: telemedicine was an example that generated efficiencies for the National Health Service, but could be a burden to care homes, resented by staff and perceived as a barrier to overcome. One hundred and fifty practices responded to our survey, a majority staffed by ≤ 5 general practitioners. Larger practices were more likely to have a nominated general practitioner for care homes and make weekly scheduled visits. Analysis of primary care data found that in practices with a higher number of care home residents, patients had more contacts with primary care and fewer urgent referrals. Between 2019 and 2021, total contacts and estimated costs increased, and urgent referrals and polypharmacy fell.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Sparse evidence of systematic change in Vanguard areas limited our conclusions about specific initiatives. Implementation of national policy during the COVID-19 pande","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 11","pages":"1-68"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049359","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":"Exploring voluntary sector specialist services for victim-survivors of sexual violence in England: the PROSPER co-production study.","authors":"Caroline Bradbury-Jones, Sarah Damery, Kirsten Fruin, Clare Gunby, Jenny Harlock, Lucy Hebberts, Louise Isham, Anne-Marie Jones, Fay Maxted, Amelia Mighty, Priti Parmar, Laura Patterson, Jason Schaub, Fee Scott, Harriet Smailes, Debs Smith, Julie Taylor","doi":"10.3310/WWKT3077","DOIUrl":"https://doi.org/10.3310/WWKT3077","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is increasing recognition in England that voluntary sector specialist sexual violence services are essential in providing crisis and longer-term support to victim-survivors. However, there is limited empirical evidence about the scope, range and effectiveness of voluntary sector specialist provision and commissioning, or what victim-survivors want from services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Explore victim-survivors' experiences of accessing and using voluntary sector specialist services. Analyse the range, scope and funding of voluntary sector specialist services and how demand is managed. Explore the usefulness of different approaches to service delivery and different therapy models. Explore how different principles underlying service provision influence service delivery. Investigate referral patterns and pathways, and how voluntary sector specialist services fit with each other and link to the wider network of services for victim-survivors. Explore how arrangements for commissioning and funding services for victim-survivors across health, local authorities and criminal justice have evolved. Develop a taxonomy of the voluntary sector specialist services/service models being commissioned and provided. Make recommendations for the commissioning and provision of voluntary sector specialist services at practice and policy levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Interviews with key stakeholders, focus groups with victim-survivors; a national survey of key stakeholders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This multimethod study comprised five sequential work packages: work package 1: exploratory interviews with commissioners and providers and focus groups with victim-survivors; work package 2: national survey of service providers and commissioners; work package 3: in-depth case studies in four areas of England; work package 4: co-research with victim-survivors; work package 5: data integration. Co-production was built into the study from its inception through robust patient and public involvement and engagement activities. These included a co-applicant who is a survivor of sexual violence, plus the appointment of five expert-by-experience co-researchers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We captured the combined findings conceptually and diagrammatically into a new model comprising six themes: the complex and precarious funding landscape; the challenge of competition for funding and contracts; the importance and success of partnership working with organisations; the pressured environments within which voluntary sector specialist services work; different roles, scope and eligibility of voluntary and statutory services within an area; and the ways services are organised and delivered, underpinned by services' values and philosophies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The COVID-19 pandemic meant that we were unable to use the proposed methods of data collection for the qualitative components. Mitigation was th","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 10","pages":"1-104"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014836","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}