Health and social care delivery research最新文献

{"title":"Evaluation of the NHS England Low-Calorie Diet implementation pilot: a coproduced mixed-method study.","authors":"Louisa J Ells, Tamara Brown, Jamie Matu, Ken Clare, Simon Rowlands, Maria Maynard, Karina Kinsella, Kevin Drew, Jordan R Marwood, Pooja Dhir, Tamla S Evans, Maria Bryant, Wendy Burton, Duncan Radley, Jim McKenna, Catherine Homer, Adam Martin, Davide Tebaldi, Tayamika Zabula, Stuart W Flint, Chris Keyworth, Mick Marston, Tanefa Apekey, Janet E Cade, Chirag Bakhai","doi":"10.3310/MPRT2139","DOIUrl":"https://doi.org/10.3310/MPRT2139","url":null,"abstract":"<p><strong>Background: </strong>National Health Service England piloted a low-calorie diet programme, delivered through total diet replacement and behaviour change support via 1 : 1, group or digital delivery, to improve type 2 diabetes in adults with excess weight.</p><p><strong>Aim: </strong>To coproduce a qualitative and economic evaluation of the National Health Service low-calorie diet pilot, integrated with National Health Service data to provide an enhanced understanding of the long-term cost-effectiveness, implementation, equity and transferability across broad and diverse populations.</p><p><strong>Research questions: </strong>What are the theoretical principles, behaviour change components, content and mode of delivery of the programme, and is it delivered with fidelity to National Health Service specifications? What are the service provider, user and National Health Service staff experiences of the programme? Do sociodemographics influence programme access, uptake, compliance and success? What aspects of the service work and what do not work, for whom, in what context and why? Can the programme be improved to enhance patient experience and address inequities? What are the programme delivery costs, and policy implications for wide-spread adoption?</p><p><strong>Methods: </strong>A mixed-methods study underpinned by a realist-informed approach was delivered across five work packages, involving: semistructured interviews with service users (<i>n</i> = 67), National Health Service staff (<i>n</i> = 55), service providers (<i>n</i> = 9); 13 service provider focus groups; and service user surveys (<i>n</i> = 719). Findings were triangulated with clinical data from the National Health Service England's first cohort analysis (<i>n</i> = 7540).</p><p><strong>Results: </strong>Fifty-five per cent of service users who started total diet replacement completed the programme and lost an average of 10.3 kg; 32% of those with data available to measure remission achieved it. Examination of programme mobilisation identified barriers around referral equality and the impact of COVID-19, while effective cross-stakeholder working and communication were key facilitators. Service delivery and fidelity assessments identified a drift in implementation fidelity, alongside variation in the behaviour change content across providers. Perceived barriers to programme uptake and engagement aligned across service providers and users, resulting in key learning on: the importance of person-centred care, service user support needs, improvements to total diet replacement and the social and cultural impact of the programme. Early National Health Service quantitative analyses suggest some socioeconomic variation in programme uptake, completion and outcomes. Insights from the evaluation and National Health Service data were combined to develop the programme theory and underpinning context, mechanisms and outcomes. These were used to develop a list of recommendations to improv","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 29","pages":"1-63"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769532","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":"Implementation of link workers in primary care: Synopsis of findings from a realist evaluation.","authors":"Stephanie Tierney, Geoff Wong, Debra Westlake, Amadea Turk, Steven Markham, Jordan Gorenberg, Joanne Reeve, Caroline Mitchell, Kerryn Husk, Sabi Redwood, Tony Meacock, Catherine Pope, Beccy Baird, Kamal Mahtani","doi":"10.3310/KHGT9993","DOIUrl":"https://doi.org/10.3310/KHGT9993","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Social prescribing link workers formed part of the Additional Roles Reimbursement Scheme introduced into primary care in England from 2019. Link workers assist patients experiencing issues affecting their health and well-being that are 'non-medical' (e.g. lack of social connections, financial difficulties and housing problems). They give patients space to consider these non-medical issues and, when relevant, connect them to support, often within the voluntary-community-social-enterprise sector. We conducted an earlier realist review on the link worker role in primary care. We then carried out a realist evaluation, described in this report, to address the question: When implementing link workers in primary care to sustain outcomes - what works, for whom, why and in what circumstances?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To develop evidence-based recommendations to optimise the implementation of link workers in primary care and to enable patients to receive the best support possible.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A realist evaluation, involving two work packages.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Data were collected around seven link workers in different parts of England.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;For work package 1, researchers spent 3 weeks with each link worker - going to meetings with them, watching them interact with patients, with healthcare professionals and with voluntary-community-social-enterprise staff. During this time, researchers had a daily debrief with the link worker, inviting them to reflect on their working day, and they collected relevant documents (e.g. job descriptions and information on social prescribing given to patients). They also conducted interviews with 93 primary care/voluntary-community-social-enterprise staff and 61 patients. As part of this work package, data on patient contact with a general practitioner before and after being referred to a link worker were collected. Work package 2 consisted of follow-up interviews (9-12 months later) with patients; 41 were reinterviewed. In addition, link workers were reinterviewed. A realist logic of analysis was used to test (confirm, refute or refine) the programme theory we developed from our realist review. Analysis explored connections between contexts, mechanisms and outcomes to explain how, why and in what circumstances the implementation of link workers might be beneficial (or not) to patients and/or healthcare delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We produced three papers from the research - one on link workers 'holding' patients, one on the role of discretion in their job, and another exploring patient-focused data and readiness to engage in social prescribing. Data from these papers were considered in relation to Normalisation Process Theory - a framework for conceptualising the implementation of new interventions into practice (e.g. link workers into primary care). By doing so, we identified infrastructural factors required to help l","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 27","pages":"1-30"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consequences, costs and cost-effectiveness of workforce configurations in English acute hospitals.","authors":"Peter Griffiths, Christina Saville, Jane Ball, David Culliford, Jeremy Jones, Francesca Lambert, Paul Meredith, Bruna Rubbo, Lesley Turner, Chiara Dall'Ora","doi":"10.3310/ZBAR9152","DOIUrl":"10.3310/ZBAR9152","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The National Health Service faces significant challenges in recruiting and retaining registered nurses. Recruiting unregistered staff is often adopted as a solution to the registered nurse shortage, but recent research found lower registered nurse staffing levels increase hospital mortality with no evidence that higher levels of assistant staff reduced risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To estimate the consequences, costs and cost-effectiveness of variation in the size and composition of the staff on acute hospital wards in England. To determine if results are likely to be sensitive to staff groups such as doctors and therapists, who are not on ward rosters, associations between staffing and outcomes for multiple staff groups, including medical, are explored at hospital level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A national cross-sectional panel study and a patient-level longitudinal observational study using routine data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;All English acute hospital Trusts and a subsample of four Trusts for the patient-level study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Naturally occurring variation in the size and composition of the workforce.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Patients experiencing a hospital admission with an overnight stay and nursing staff providing care on inpatient wards.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Death, patient and staff experience, length of stay, re-admission, adverse events, incidents (Datix), staff sickness, costs and quality-adjusted life-years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Publicly available records of hospital activity, staffing and outcomes (cross-sectional study) and hospital administrative systems (longitudinal study).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the cross-sectional study, lower staffing levels from doctors and allied health professionals were associated with increased risk of death. Higher nurse staffing levels were associated with better patient experience and staff well-being. In the longitudinal study, for adult inpatients, exposure to days with lower-than-expected registered nurses or nursing assistant staff was associated with increased hazard of death (adjusted hazard ratio 1.08/1.07, 95% confidence interval 1.07 to 1.09/1.06 to 1.08) and longer hospital stays. Low registered nurse staffing was also associated with increased hazard of re-admission (adjusted hazard ratio 1.01, 95% confidence interval 1.01 to 1.02). Eliminating low staffing cost £2778 per quality-adjusted life-years gained. Avoidance of registered nurse understaffing gave more benefits and was more cost-effective for highly acute patients. Although high bank or agency staffing was associated with increased hazard of death, avoiding low staffing using temporary staff still reduced mortality but was more costly and less effective than using permanent staff. If costs of avoided hospital stays are included, avoiding low staffing generates a net cost saving. Exploration of thr","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 25","pages":"1-107"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding patient pathways to Mother and Baby Units: a longitudinal retrospective service evaluation in the UK.","authors":"Nikolina Jovanović, Žan Lep, Giles Berrisford, Aysegul Dirik, Julia Barber, Bukola Kelani, Olivia Protti","doi":"10.3310/GDVS2427","DOIUrl":"10.3310/GDVS2427","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Mother and Baby Units are specialised psychiatric facilities for women during and after pregnancy. In the United Kingdom, efforts have been made to expand the Mother and Baby Unit availability and establish care guidelines. However, the accessibility of these services for ethnic minority women remains relatively unexplored despite well-documented disparities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To explore patient pathways to Mother and Baby Units in three UK localities, with a focus on variations in pathways between services and among ethnic groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a three-site, longitudinal retrospective service evaluation conducted in Birmingham, London and Nottingham during a 12-month period (1 January-31 December 2019). Electronic records were accessed to extract data on the type of admission, the referral process and the type of pathway (simple or complex). The simple pathway entailed contact with one clinician/service prior to admission to the Mother and Baby Unit, while the complex pathway involved interactions with two or more clinicians/services before Mother and Baby Unit admission. Data were collected using the adapted World Health Organization Encounter form and were analysed using uni- and multivariable analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Electronic records from 198 patients were analysed, with participants distributed proportionally across three sites: Birmingham (&lt;i&gt;n&lt;/i&gt; = 70, 35.4%), London (&lt;i&gt;n&lt;/i&gt; = 62, 31.3%) and Nottingham (&lt;i&gt;n&lt;/i&gt; = 66, 33.3%). All Mother and Baby Units were nationally commissioned and received referrals from across England. Most patients were in the post partum period, admitted for the first time through emergency, informal and complex pathways. The average length of admission was 6 weeks. Significant differences in admission characteristics were observed between services. Patients of Asian ethnicity had more emergency admissions compared to those of Black and White ethnicities. Ethnicity was the only significant factor associated with the simple/complex care pathway. After controlling for pathway-level and patient-level factors, Black patients were 6.24 times less likely to experience a complex care pathway than White patients. No evidence was found that patients from the Black ethnic background are detained more often than White patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The heterogeneity among categorised ethnic groups, data extracted solely from electronic records without validation through patients' personal accounts of their care pathways, unanalysed declined referrals and the utilisation of pre-COVID-19 pandemic data. The ethnic composition of the study sample matched that of the UK maternity population in the Nottingham subsample, but Black and Asian populations were over-represented in the Birmingham and London subsamples.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The study provides valuable insights into patient journeys to Mother and Baby Units","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A digital intervention to improve mental health and interpersonal resilience for young people who have experienced online sexual abuse: the i-Minds non-randomised feasibility clinical trial and nested qualitative study.","authors":"Sandra Bucci, Filippo Varese, Ethel Quayle, Kim Cartwright, Amanda Larkin, Cindy Chan, Prathiba Chitsabesan, Victoria Green, William Hewins, Matthew Machin, Alice Newton, Erica Niebauer, John Norrie, Gillian Radford, Cathy Richards, Marina Sandys, Victoria Selby, Sara Shafi, Jennifer Ward, Pauline Whelan, Matthias Schwannauer","doi":"10.3310/THAL8732","DOIUrl":"https://doi.org/10.3310/THAL8732","url":null,"abstract":"<p><strong>Background: </strong>No evidence-based support for young people who have experienced technology-assisted sexual abuse exists. The project's aims were to develop a digital intervention that improves mentalisation (the ability to understand the minds of oneself and others that underlies behaviour) to reduce the risk for revictimisation and future harm and improve young people's resilience.</p><p><strong>Objectives: </strong>To co-design a mentalisation-based digital intervention; determine its feasibility, acceptability, safety and usability; and determine how to best integrate this into practice.</p><p><strong>Methods: </strong>A mixed-methods, non-randomised study in young people aged 12-18 years exposed to technology-assisted sexual abuse across two United Kingdom sites. We adapted an existing mentalisation-based therapy manual and co-designed a digital health intervention (app) using participatory methods. Recommendations from our pre-trial qualitative work with healthcare professionals supporting young people with technology-assisted sexual abuse and lived experience consultation informed app development and trial procedures. The primary outcome was the feasibility and acceptability of delivering the digital intervention measured against relevant fields of the Consolidated Standards of Reporting Trials statement for feasibility studies. Intervention safety was reported against an adverse events procedure. Usability was guided by the framework for analysing and measuring usage and engagement data in digital interventions. Acceptability was examined using qualitative methods. The planned sample size of the feasibility clinical trial was 60 young people.</p><p><strong>Results: </strong>Between May 2022 and March 2023, 147 young people were screened for eligibility for the feasibility clinical trial; 72 referrals were made and 43 young people were allocated to receive the intervention. We found that it was possible to recruit and retain participants to this trial. Quantitative and qualitative data showed that the i-Minds app was safe, acceptable and associated with promising signals of efficacy on valuable outcomes post treatment, including technology-assisted-sexual-abuse-related post-traumatic symptoms, resilience, internalising symptoms and reflective functioning. Most participants accessed or completed app modules. User feedback indicated that participants had a positive experience using the app, positively increasing their knowledge/understanding of their own mental health and their motivation to address their mental health difficulties. Practitioners identified the barriers to implementing i-Minds into routine practice as not being involved in its design at the outset, possible impact on workload and whether digital health interventions might replace routine care. Facilitators included the distinct nature and specificity of the i-Minds app for the target group and its ability to support young people on service waiting lists.</p><p","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 28","pages":"1-27"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community and hospital-based healthcare professionals perceptions of digital advance care planning for palliative and end-of-life care: a latent class analysis.","authors":"Jacqueline Birtwistle, Gabriella Williamson, Samuel D Relton, Andy Bradshaw, Katherine E Sleeman, Maureen Twiddy, Pablo Millares-Martin, Suzanne Richards, Matthew J Allsop","doi":"10.3310/XCGE3294","DOIUrl":"https://doi.org/10.3310/XCGE3294","url":null,"abstract":"<p><strong>Introduction: </strong>Numerous digital approaches are being explored internationally to support the elicitation, documentation and sharing of advance care planning information. In England, Electronic Palliative Care Coordination Systems have been developed for this purpose, often as a template stored as part of an electronic clinical record system. Despite Electronic Palliative Care Coordination Systems being central to the end-of-life care policy, there has been a lack of exploration of the perspectives of healthcare professionals who use Electronic Palliative Care Coordination Systems and are critical to their implementation.</p><p><strong>Objective: </strong>This study addresses this gap aiming to examine community and hospital-based healthcare professionals' perceptions of Electronic Palliative Care Coordination Systems on advance care planning and the delivery of palliative care.</p><p><strong>Design and methods: </strong>A cross-sectional online survey.</p><p><strong>Setting and participants: </strong>The target sample comprised health professionals from the main professional groups supporting patients with chronic progressive illnesses in West Yorkshire and London. The survey included items adapted from the Normalisation MeAsure Development questionnaire implementation measure. Survey responses were analysed using descriptive statistics and latent class analysis. Free-text responses relating to alternative approaches to advance care planning documentation were analysed using a directed content analysis approach.</p><p><strong>Results: </strong>Five hundred and sixty-nine health professionals responded to the survey from West Yorkshire (<i>n</i> = 189; 33.2%) and London (<i>n</i> = 380; 66.8%). The largest proportion of respondents came from general practice teams (<i>n</i> = 254; 44.6%). There were prominent differences in responses, with respondents in London more likely to report being familiar with Electronic Palliative Care Coordination Systems. However, West Yorkshire respondents rated Electronic Palliative Care Coordination Systems more highly in terms of being a legitimate part of their role. Across professional groups, respondents from both hospice and care home teams were more likely to view Electronic Palliative Care Coordination Systems as being worthwhile. Commonly reported barriers to the use of Electronic Palliative Care Coordination Systems included not having access to electronic devices, lack of training and lack of knowledge relating to advance care plans.</p><p><strong>Limitations: </strong>There was a dominance of responses from participants based on primary care practices, which may reflect general practitioners being largely responsible for initiating an Electronic Palliative Care Coordination Systems record in one region of the survey (West Yorkshire). This survey is reliant on self-reported responses to items and may have also included respondents more engaged with or interested in Electronic Palliative ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"After the disruptive innovation: How remote and digital services were embedded, blended and abandoned in UK general practice - longitudinal study.","authors":"Trisha Greenhalgh, Aileen Clarke, Richard Byng, Francesca Dakin, Stuart Faulkner, Nina Hemmings, Gemma Hughes, Laiba Husain, Asli Kalin, Emma Ladds, Ellen MacIver, Lucy Moore, Sarah O'Rourke, Rebecca Payne, Rebecca Rosen, Sarah Rybczynska-Bunt, Sara E Shaw, Tiffany C Veinot, Sietse Wieringa, Joseph Wherton","doi":"10.3310/KRWS4334","DOIUrl":"10.3310/KRWS4334","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;United Kingdom general practices transitioned rapidly to remote-by-default services in 2020 and subsequently considered whether and how to continue these practices. Their diverse responses provided a unique opportunity to study the longer-term embedding, adaptation and abandonment of digital innovations. Research questions: What was the range of responses to the expansion of remote and digital triage and consultations among United Kingdom general practices in the period following the acute phase of the coronavirus disease discovered in 2019 (COVID-19) pandemic? What can we learn from this example about the long-term impacts of crisis-driven sociotechnical change in healthcare settings?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We collected longitudinal data from 12 general practices from 2021 to 2023, comprising 500 hours of ethnographic observation, 163 interviews in participating practices and linked organisations (132 staff, 31 patients), 39 stakeholder interviews and 4 multi-stakeholder workshops (210 participants), with additional patient and public involvement input. Data were de-identified, uploaded to NVivo (QSR International, Warrington, UK) and synthesised into case studies, drawing on theories of organisational innovation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;General practices' longitudinal progress varied, from a near-total return to traditional in-person services to extensive continuing use of novel digital technologies and pathways. Their efforts to find the right balance were shaped and constrained by numerous contextual factors. Large size, slack resources, high absorptive capacity, strong leadership and good intrapractice relationships favoured innovation. Readiness for remote and digital modalities varied depending on local tension for change, practice values and patient characteristics. Technologies' uptake and use were influenced by their material properties and functionality. Embedding and sustaining technologies required ongoing work to adapt and refine tasks and processes and adjust (or, where appropriate, selectively abandon) technologies. Adoption and embedding of technologies were affected by various staff and patient factors. When technologies fitted poorly with tasks and routines or when embedding efforts were unsuccessful, inefficiencies and 'techno-stress' resulted, with compromises to patient access and quality of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Sampling frame was limited to United Kingdom and patient interviews were relatively sparse.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;There is wide variation in digital maturity among United Kingdom general practices. Low use of remote and digital technologies and processes may be warranted and reflect local strategic choices, but it may also indicate lack of awareness and a reactive rather than strategic approach to digital innovation. We offer an updated typology of digital maturity in general practice with suggestions for tailored support.&lt;/p&gt;&lt;p&gt;&lt;stron","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-37"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How lived experiences of illness trajectories, burdens of treatment, and social inequalities shape service user and caregiver participation in health and social care: a theory-informed qualitative evidence synthesis.","authors":"Carl R May, Katja C Gravenhorst, Alyson Hillis, Mick Arber, Carolyn A Chew-Graham, Katie I Gallacher, Frances S Mair, Ellen Nolte, Alison Richardson","doi":"10.3310/HGTQ8159","DOIUrl":"https://doi.org/10.3310/HGTQ8159","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The workload service users and caregivers take on, and their capacity to do this work, when they engage with and participate in different kinds of care is important. It is reflected in policy and practice interventions that identify service users and caregivers as part of a team that consists of informal networks beyond provider organisations and the professionals within them in health and social care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims and objectives: &lt;/strong&gt;To synthesise qualitative studies of the lived experience of the work of service user and caregiver engagement in three kinds of conditions: long-term conditions associated with significant disability (Parkinson's disease, schizophrenia); serious relapsing-remitting disease (inflammatory bowel disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early-onset dementia).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Theory-informed qualitative evidence synthesis of primary qualitative studies, qualitative systematic reviews and meta-syntheses. Papers analysed using qualitative attribution analysis, and Event-State Modelling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Cumulative Index to Nursing and Allied Health Literature, EMBASE, MEDLINE, PsycInfo, Scopus and Social Care Online were searched from January 2010 to April 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria for selecting studies: &lt;/strong&gt;Qualitative primary studies, systematic reviews and meta-syntheses where the participants were service users, or caregivers, aged ≥ 18, with one of six index conditions, and which described their lived experiences of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Qualitative evidence synthesis to model core components of service user and caregiver work, and to identify common factors across index conditions, disease trajectories and service contexts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Searches identified 34,787 records. Following deduplication, 13,234 records were assessed for relevance, and after first-stage screening, 7782 records were excluded at this stage, leaving 5452 for further screening, and 279 of these met inclusion criteria and were included in the evidence synthesis. These showed that patients' and caregivers' lived experiences of illness trajectories were shaped by mechanisms of enabling agency (personal capacity, social capital, affective contributions of others), and their degree of existential threat, competence in managing processes of care, and caregiver responses to new responsibilities. Their degree of structural disadvantage was framed in terms of loss of income, employment and housing, and by the presence of stigma, rather than by intersectional position and socioeconomic status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This evidence synthesis maps intervention points to support service users and caregivers, and the trajectories of work that frame their effective participation in their care. We identify potential targets for interventions that could support their outward-facin","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 24","pages":"1-120"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to and outcomes of unspecified kidney donation in the UK: BOUnD, a mixed-methods study.","authors":"Nizam Mamode, Sam Norton, Paul McCrone, Joe Chilcot, Heather Draper, Peter Gogalniceanu, Mira Zuchowski, Lisa Burnapp, Jan Shorrock, Kiran Gupta, Hannah Maple","doi":"10.3310/RTEW9328","DOIUrl":"https://doi.org/10.3310/RTEW9328","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Unspecified living kidney donation, where an individual donates a kidney to a stranger, is practised in very few countries. Since the Human Tissue Act 2006, the practice has been increasingly prevalent in the United Kingdom. However, evidence exists of uncertainty from healthcare professionals as to whether this is appropriate or manageable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The Barriers and Outcomes in Unspecified Donation study is a mixed-methods study designed to determine the answers to three research questions: Is there variation in transplant professionals' practice and attitudes, which is preventing some unspecified donations? Are psychosocial and physical outcomes after unspecified donation equivalent to those after specified donation? What is the economic benefit from unspecified donation?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;For RQ1, a qualitative study of healthcare professionals using focus groups and interviews was performed. Additionally, a quantitative, questionnaire-based study, including healthcare professionals from all United Kingdom transplant centres, was carried out. For RQ2, a qualitative study of unspecified kidney donors, including those who did not donate, was performed. A prospective, questionnaire study of both specified kidney donors and unspecified kidney donors across the United Kingdom was completed, and linked to data recorded by National Health Service Blood and Transplant. For RQ3, data on utilisation and quality of life were collected pre- and postoperatively using health economic and quality-of-life questionnaires to allow calculation of costs and comparisons between unspecified kidney donors and specified kidney donors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifty-nine interviews were conducted with healthcare professionals at six United Kingdom centres. There was broad support for unspecified donation, but key themes included the need for further training and information, consistency in approach across the United Kingdom, and uncertainty about age limits and psychological assessments. Managing donor expectations was a major concern. One hundred and fifty-three healthcare professionals, from all 23 United Kingdom transplant units, were recruited into the questionnaire study. The themes above were confirmed, and the need for more resource, particularly training and staffing, were emphasised.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rq2: &lt;/strong&gt;Eight hundred and thirty-seven participants including (59.3%) specified kidney donors and (40.7%) unspecified kidney donors were recruited to the prospective questionnaire study, of whom 373 went on to donate. We found no difference in psychosocial or physical outcomes, withdrawal rates [hazard ratio: unspecified kidney donors vs. specified kidney donors 1.12 (95% confidence interval 0.75 to 1.67)] or regret, although unspecified kidney donors experienced fewer positive perceptions [specified kidney donors 319 (86.2%) vs. unspecified kidney donors 247 (79.9%); &lt;i&gt;p&lt;/i&gt; = 0.03","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 20","pages":"1-43"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing referrals to Child and Adolescent Mental Health Services: the EN-CAMHS mixed-methods study.","authors":"Kathryn M Abel, Pauline Whelan, Lesley-Anne Carter, Heidi Tranter, Charlotte Stockton-Powdrell, Kerry Gutridge, Lamiece Hassan, Rachel Elvins, Julian Edbrooke-Childs","doi":"10.3310/GYDW4507","DOIUrl":"10.3310/GYDW4507","url":null,"abstract":"<p><strong>Background: </strong>National Health Service Child and Adolescent Mental Health Services are specialist teams that assess and treat children and young people with mental health problems. Overall, 497,502 children were referred to National Health Service Child and Adolescent Mental Health Services between 2020 and 2021, and almost one-quarter of these referrals were not successful. Unsuccessful referrals are often distressing for children and families who are turned away usually after a long waiting period and without necessarily being redirected to alternative services. The process is also costly to services because time is wasted reviewing documents about children who should have been referred for alternative help and may prevent young people who need specialist help receiving it in a timely way. The overarching aim of this study was to understand what the problems are with Child and Adolescent Mental Health Services referrals and identify solutions that could improve referral success. A key objective was to talk widely with young people and families, people working in Child and Adolescent Mental Health Services and mental health professionals so that we could understand fully what the problems were and how we might develop their solutions. We gathered individual pseudonymised patient data from nine Child and Adolescent Mental Health Services, and referral data from four National Health Service Trusts to look at what data are available and how complete it is. We report wide variation in the numbers of referrals between and within Trusts and in the proportions not being successful for treatment. Data on factors such as age and gender of children and young people referred into Child and Adolescent Mental Health Services and who made the referral are routinely collected, but ethnicity of the children and young people's reason for referral are not as well collected across all Trusts. We also conducted focus groups with over 100 individuals with differing perspectives on the Child and Adolescent Mental Health Services referral process (children and young people, parents and carers, key referrers, and Child and Adolescent Mental Health Services professionals) and asked about current difficulties within the referral process, as well as potential solutions to these.</p><p><strong>Conclusions: </strong>Problems identified included: confusion about what Child and Adolescent Mental Health Services is for, that is what it does and does not provide; and lack of support provided during the referral process. Possible solutions included: streamlining the referral pathways through digital technologies with accompanying standardisation of referral forms for National Health Service Child and Adolescent Mental Health Services; and early ongoing communication throughout the referral 'journey' for the referrer/family.</p><p><strong>Future work: </strong>Should consider the standardisation of and improvement to the Child and Adolescent Mental Health Service","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 21","pages":"1-59"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}